MinervaBMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7519.786 (Published 29 September 2005) Cite this as: BMJ 2005;331:786
Why do people attend dentists? The answer, in Burkino Faso at least, is pain. A survey of almost 14 600 people attending 15 dental care facilities in one year found that 54% of them were new patients and 71% were aged 15-44 years. The commonest reason for attendance was caries with pulpal involvement, and 60% of all complaints were associated with pain. Future provision of primary care services, say the authors, should be targeted at providing pain relief at the patient's first point of contact (Bulletin of the World Health Organization 2005;9: 650-5).
When computers die or overheat in Nigeria, they're often dumped behind clinics and schools, where they leak toxic chemicals and metals into the groundwater. These same clinics and schools draw their water not from Western-style mains water services but from local boreholes. Although users generally know to boil the water for drinking, many will be unaware of the dangers from chemical and metal contaminants, warns Fantsuam Foundation, a non-profit organisation in Nigeria committed to safe information technology transfer especially for women and young people (http://www.fantsuam.org/).
Most women in Uganda and Tanzania give birth at home with the help of traditional birth attendants, who seem to know little about mother to child transmission of HIV (Journal of Social Aspects of HIV/AIDS 2005;2: 258-66). A survey of 47 such attendants found that knowledge about prevention was particularly poor: most did not know that breast feeding can transmit the infection, and their advice on infant feeding was incompatible with the WHO recommendations.
Twelve different orchids are currently used as medicine in Malawi. Nine are used for stomach complaints and two for fertility problems. Cyrtorchis arcuata is said to promote friendship, and is also used to treat diabetes and skin conditions, while Tridactyle tricuspis is said to cure madness. Elsewhere in Africa a paste made from the pseudo-bulbs of Ansellia africana and impregnated into an amulet of leaves from the same plant is said to work as a contraceptive, but only in the short term and in unmarried women (QJM 2005;98: 625-31). None has been “proved” to be efficacious in a double blind randomised controlled trial.
African scientists working in a range of public health areas have joined up to form YASNET (Young African Scientists Network in Health Research). They are particularly interested in getting hold of literature on “capacity building” in Africa, especially when it's relevant to health. For more information about the network, or if you have anything to offer, email.
Hand held devices for front line healthcare workers are catching on everywhere, even in Africa. Here, as elsewhere, they're being used to collect data, share information, and obtain reference material. A paper posted on HealthNet (http://www.healthnet.org/) describes how a lack of power can be addressed by the use of solar chargers, but (as with the introduction of all new technologies) change needs to be managed and works best when there's a local champion to get others interested in using the technology.
In South Africa women lose more years of life than men from HIV/AIDS, partly because they tend to be younger when they die from HIV/AIDS, but also because they live longer with non-HIV related diseases than men. Death certificate analysis from one hospital in KwaZulu-Natal revealed that the average age of death from HIV/AIDS is 35 years for women and 40 for men. About 45% of all registered deaths in people after the age of 9 years are from HIV/AIDS, which is higher than previous estimates have indicated (South African Family Practice 2005;47: 51-7).
Visually assessing children at high risk of dying from malnutrition on admission to hospital seems to be just as good a way of doing it as calculating the currently favoured weight-for-height z score, says a study in JAMA (2005;294: 591-7). The researchers, who evaluated use of mid-upper arm circumference measures and “visual severe wasting” to predict probability of death, suggest that these methods are cheaper and more practical than the z score.
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The estimated annual cost of treatment for an African child with type 1 diabetes is $125 (£69, €103). This is roughly 35% of the annual income of families in most sub-Saharan countries. But increasing the supplies of insulin through donations is not sustainable, and a huge report commissioned by the International Insulin Foundation says the root of the problem is not being addressed (http://www.access2insulin.org/). In common with more high profile health issues in Africa, health worker training and retention is just as important, as is educating the patients themselves.
Urgent and rapid increases in staff numbers, skill enhancement, and productivity are critical for developing countries. Health worker migration is a symptom of deeper issues linked to poor career opportunities where resources are limited, and a sign of inadequate planning and underinvestment in richer countries. Developing self sufficiency is important in both cases. Developing systems of substitute health workers may be one option that fulfils both time and cost effectiveness issues, but the purpose of such schemes should not be to create workers who cannot migrate because they do not have the skills required by international standards (see “Responding to the health workforce crisis” on http://www.id21.org/).
Guidance at bmj.com/advice