Latest Articles
- Barriers to Accessing Emergency Medical Services in Accra, Ghana: Development of a Survey Instrument and Initial Application in Ghana
Most respondents thought the number of ambulances insufficient and said they would rather use a taxi—perceived to be faster—in a medical emergency. Nevertheless, people generally had favorable attitudes of existing public ambulance services, although few knew of the toll-free emergency number and many thought it appropriate to use ambulances to transport corpses. Targeted public education, along with improved capacity of ambulance agencies to handle increased caseload, could improve use.
- Introduction of Mobile Health Tools to Support Ebola Surveillance and Contact Tracing in Guinea
An informatics system consisting of a mobile health application and business intelligence software was used for collecting and analyzing Ebola contact tracing data. This system offered potential to improve data access and quality to support evidence-based decision making for the Ebola response in Guinea. Implementation challenges included software limitations, technical literacy of users, coordination among partners, government capacity for data utilization, and data privacy concerns.
- Reduced Effectiveness of Contraceptive Implants for Women Taking the Antiretroviral Efavirenz (EFV): Still Good Enough and for How Long?
EFV clearly reduces effectiveness of implants. However, the reduced effectiveness still appears better compared with short-acting methods overall, at least for the initial period of implant use, and may be acceptable to many women. We need better data on effectiveness, especially over the long term and on whether ENG implants (Implanon) might be more effective than LNG implants (Jadelle). Communicating the risk of pregnancy to clients under these circumstances is very challenging. In the longer term, providing an alternative to EFV, such as dolutegravir, might solve this problem.
- The Levonorgestrel Intrauterine System: A Pragmatic View of an Excellent Contraceptive
The levonorgestrel intrauterine system (LNG IUS) has major advantages and could be a “game-changer” in improving contraceptive choice and use. It faces important challenges, however, including: (1) high commodity cost; (2) often-strong provider resistance to IUDs and difficult programmatic requirements; (3) need for demand creation, including assessing if markedly reduced menstrual bleeding is attractive to clients; and (4) the many requirements for introducing any new contraceptive. A good next step would be a well-focused and multifaceted “learning introduction” to assess the LNG IUS’s potential in several low-income countries, with rapid scale-up if results are promising.
- Prevalence and Incidence of Traumatic Experiences Among Orphans in Institutional and Family-Based Settings in 5 Low- and Middle-Income Countries: A Longitudinal Study
Contrary to some conventional wisdom, in this large study that randomly sampled orphans and separated children from 5 countries, prevalence of reported traumatic events was no worse among those institutionalized than among those in family-based care. Reported incidence of physical or sexual abuse was actually higher for those in family-based care. Understanding the specific context, and elements contributing to potential harm and benefits in both family-based and institutional care, are essential to promoting the best interest of the child.
- Estimating Contraceptive Prevalence Using Logistics Data for Short-Acting Methods: Analysis Across 30 Countries
Three models showed strong correlation between public-sector logistics data for injectables, oral contraceptives, and condoms and their prevalence rates, demonstrating that current logistics data can provide useful prevalence estimates when timely survey data are unavailable.
- The Astronomy of Africa’s Health Systems Literature During the MDG Era: Where Are the Systems Clusters?
The volume of literature on health systems in sub-Saharan Africa has been expanding since the 2000 MDG era. Focus has remained generally on categorical health themes rather than systems concepts. Topics such as scaling-up, organizational development, data use for decision making, logistics, and financial planning remain underrepresented. And quite surprisingly, implementation science remains something of a “black hole.” But bibliometric evidence suggests there is a shift in focus that may soon address these gaps.
- Women’s Groups to Improve Maternal and Child Health Outcomes: Different Evidence Paradigms Toward Impact at Scale
The Care Group model, with relatively intensive international NGO implementation at moderate scale, appears successful in a wide variety of settings, as assessed by high-quality evaluation with rich program learning. Another women’s group approach—Participatory Women’s Groups—has also been implemented across various settings but at smaller scale and assessed using rigorous RCT methodology under controlled—but less naturalistic—conditions with generally, although not uniformly, positive results. Neither approach, as implemented to date, is directly applicable to large-scale integration into current public programs. Our challenge is to distill the elements of success across these approaches that empower women with knowledge, motivation, and increased self-efficacy—and to apply them in real-world programs at scale.
- Remote Sensing of Vital Signs: A Wearable, Wireless “Band-Aid” Sensor With Personalized Analytics for Improved Ebola Patient Care and Worker Safety
This wireless sensor technology, currently being field-tested in an Ebola Treatment Unit in Sierra Leone, monitors multiple vital signs continuously and remotely. When connected with enhanced analytics software, it can discern changes in patients’ status much more quickly and intelligently than conventional periodic monitoring, thus saving critical health care worker time and reducing exposure to pathogens.
- Task Sharing Implant Insertion by Community Health Workers: Not Just Can It Work, but How Might It Work Practically and With Impact in the Real World
Demonstrating that a health service, such as providing contraceptive implants, can be safely task shared to less highly trained workers is crucial but is only one step toward effective implementation at scale. Providers need dedicated time, enough clients, supplies, supervision, and other system support, allowing them to maintain their competency, confidence, and productivity.