Jennyfer Wolf, Richard Johnston, Matthew C Freeman and Annette Prüss-Ustün
Handwashing with soap after faecal contact is key to preventing disease and death from enteric infectious diseases. Our study, recently published in the IJE, is the first to provide global, regional and country estimates of handwashing with soap after potential contact with human faeces, based on representative data on access to handwashing facilities collected for monitoring of the Sustainable Development Goals (SDGs). Our results show that handwashing with soap after using the toilet or other potential contact with human faeces is poorly practised worldwide and that even the necessary equipment – handwashing facilities with soap and water – are inaccessible to billions of people.
Reducing child mortality remains one of the key objectives of the Sustainable Development Goals. Remarkable progress has been made over the past 25 years, with the global number of deaths of children aged under 5 falling from 13 million in 1990 to six million in 2015. Yet little is known about the relative contributions of specific public health interventions and general improvements in socioeconomic status and educational attainment over the same period.
Tanja AJ Houweling, David Osrin, Kishwar Azad, Dharma S Manandhar, Prasanta Tripathy, Tambosi Phiri, Joanna Morrison and Anthony Costello
In low- and middle-income countries, the odds of surviving the first 28 days of life are grossly unequal between infants born in deprived and better-off families, even among children living in the same community. In our study, recently published in the IJE, we have shown that women’s groups are able to address this problem. Under the guidance of a facilitator, women came together every month to discuss problems during pregnancy, delivery and the newborn period, and then designed and implemented strategies to overcome these problems with the help of the entire community.
Rheumatic Heart Disease (RHD) is caused by a bacterial (streptococcal) throat infection acquired in childhood. Although this type of infection is common and widespread, a small proportion of children so affected go on to develop an inflammatory condition that leads to scarring and narrowing of the heart valves and, in time, heart failure. Early on in the course of the disease the joints may be affected – hence the term “rheumatic”.
Still an important disease At one time Rheumatic Heart Disease was common throughout the UK, Europe and the US; it was the most important cause of heart disease among young adults in Victorian Britain and probably caused the death of Mozart. Although rare now in most developed countries, it remains an important public health problem in many low and middle income countries. The disease is widespread in the Middle East and Asia, and the the poor indigenous populations of some wealthy countries, for example among Australian Aboriginees and New Zealand Maoris. It is particularly prevalent in sub-Saharan Africa, where it is one of the commonest causes of heart disease, typically affecting children or young adults. There it carries a grim prognosis because of the lack of specialised treatment. Continue reading “Smoke exposure in early life and Rheumatic Heart Disease”→
Since the start of the Mexican Drug War in December 2006, over 100,000 people have been murdered and over 20,000 are still missing. The escalation of violence has led to questions regarding the legitimacy and ability of political institutions, including law enforcement, to protect the public. A yet unmeasured cost of the drug war, related to living in an insecure environment, is the increased risk of dying from a heart attack.
From 2010 to 2012 a P4P programme in Afghanistan provided quarterly bonus payments to health-care providers for increases in the use of maternal and child health (MCH) services, adjusted by a quality of care score. Our study, a large-scale cluster randomized trial, demonstrates that the programme did not produce the intended results. There were no observable improvements in any of the five key MCH coverage indicators measuring contraceptive prevalence, skilled birth attendances, vaccinations, and antenatal and postnatal check-ups. No changes were observed in the equity of care. While the programme appeared to increase time spent with patients, resulting in more complete histories and physical examinations, and improved patient counselling, other measures of quality, such as availability of medicines and supplies, did not substantially change. Continue reading “Lessons from the recent trial of a pay-for-performance programme in Afghanistan”→