Essential evidence for guiding health system priorities and policies: anticipating epidemiological transition in Africa

KIMBACKGROUND: Despite indications that infection-related mortality in sub-Saharan Africa may be decreasing and the burden of non-communicable diseases increasing, the overwhelming reality is that health information systems across most of sub-Saharan Africa remain too weak to track epidemiological transition in a meaningful and effective way. PROPOSALS: We propose a minimum dataset as the basis of a functional health information system in countries where health information is lacking. This would involve continuous monitoring of cause-specific mortality through routine civil registration, regular documentation of exposure to leading risk factors, and monitoring effective coverage of key preventive and curative interventions in the health sector. Consideration must be given as to how these minimum data requirements can be effectively integrated within national health information systems, what methods and tools are needed, and ensuring that ethical and political issues are addressed. A more strategic approach to health information systems in sub-Saharan African countries, along these lines, is essential if epidemiological changes are to be tracked effectively for the benefit of local health planners and policy makers. CONCLUSION: African countries have a unique opportunity to capitalize on modern information and communications technology in order to achieve this. Methodological standards need to be established and political momentum fostered so that the African continent's health status can be reliably tracked. This will greatly strengthen the evidence base for health policies and facilitate the effective delivery of services

Detection and mapping of polar stratospheric clouds using limb scattering observations

International audienceSatellite-based measurements of Visible/NIR limb-scattered solar radiation are well suited for the detection and mapping of polar stratospheric clouds (PSCs). This publication describes a method to detect PCSs from limb scattering observations with the Scanning Imaging Absorption spectroMeter for Atmospheric CartograpHY (SCIAMACHY) on the European Space Agency's Envisat spacecraft. The method is based on a color-index approach and requires a priori knowledge of the stratospheric background aerosol loading in order to avoid false PSC identifications by stratospheric background aerosol. The method is applied to a sample data set including the 2003 PSC season in the Southern Hemisphere. The PSCs are correlated with coincident UKMO model temperature data, and with very few exceptions, the detected PSCs occur at temperatures below 195?198 K. Monthly averaged PSC descent rates are about 1.5 km/month for the ?50° S to ?75° S latitude range and assume a maximum between August and September with a value of about 2.5 km/month. The main cause of the PSC descent is the slow descent of the lower stratospheric temperature minimum

Do surveys with paper and electronic devices differ in quality and cost? Experience from the Rufiji Health and demographic surveillance system in Tanzania

Data entry at the point of collection using mobile electronic devices may make data-handling processes more efficient and cost-effective, but there is little literature to document and quantify gains, especially for longitudinal surveillance systems.; To examine the potential of mobile electronic devices compared with paper-based tools in health data collection.; Using data from 961 households from the Rufiji Household and Demographic Survey in Tanzania, the quality and costs of data collected on paper forms and electronic devices were compared. We also documented, using qualitative approaches, field workers, whom we called 'enumerators', and households' members on the use of both methods. Existing administrative records were combined with logistics expenditure measured directly from comparison households to approximate annual costs per 1,000 households surveyed.; Errors were detected in 17% (166) of households for the paper records and 2% (15) for the electronic records (p < 0.001). There were differences in the types of errors (p = 0.03). Of the errors occurring, a higher proportion were due to accuracy in paper surveys (79%, 95% CI: 72%, 86%) compared with electronic surveys (58%, 95% CI: 29%, 87%). Errors in electronic surveys were more likely to be related to completeness (32%, 95% CI 12%, 56%) than in paper surveys (11%, 95% CI: 7%, 17%).The median duration of the interviews ('enumeration'), per household was 9.4 minutes (90% central range 6.4, 12.2) for paper and 8.3 (6.1, 12.0) for electronic surveys (p = 0.001). Surveys using electronic tools, compared with paper-based tools, were less costly by 28% for recurrent and 19% for total costs. Although there were technical problems with electronic devices, there was good acceptance of both methods by enumerators and members of the community.; Our findings support the use of mobile electronic devices for large-scale longitudinal surveys in resource-limited settings

Comparison of NLC particle sizes derived from SCIAMACHY/Envisat observations with ground-based LIDAR measurements at ALOMAR (69° N)

SCIAMACHY, the Scanning Imaging Absorption spectroMeter for Atmospheric CHartographY has provided measurements of limb-scattered solar radiation in the 220 nm to 2380 nm wavelength range since summer of 2002. Measurements in the UV spectral range are well suited for the retrieval of particle sizes of noctilucent clouds (NLCs) and have been used to compile the largest existing satellite data base of NLC particle sizes. This paper presents a comparison of SCIAMACHY NLC size retrievals with the extensive NLC particle size data set based on ground-based LIDAR measurements at the Arctic LIDAR Observatory for Middle Atmosphere Research (ALOMAR, 69° N, 16° E) for the Northern Hemisphere NLC seasons 2003 to 2007. Most of the presented SCIAMACHY NLC particle size retrievals are based on cylindrical particles and a Gaussian particle size distribution with a fixed width of 24 nm. If the differences in spatial as well as vertical resolution between SCIAMACHY and the ALOMAR LIDAR are taken into account, very good agreement is found. The mean particle size derived from SCIAMACHY limb observations for the ALOMAR overpasses in 2003 to 2007 is 56.2 nm with a standard deviation of 12.5 nm, and the LIDAR observations yield a value of 54.2 nm with a standard deviation of 17.4 nm

Error budget analysis of SCIAMACHY limb ozone profile retrievals using the SCIATRAN model

A comprehensive error characterization of SCIAMACHY (Scanning Imaging Absorption Spectrometer for Atmospheric CHartographY) limb ozone profiles has been established based upon SCIATRAN transfer model simulations. The study was carried out in order to evaluate the possible impact of parameter uncertainties, e.g. in albedo, stratospheric aerosol optical extinction, temperature, pressure, pointing, and ozone absorption cross section on the limb ozone retrieval. Together with the a posteriori covariance matrix available from the retrieval, total random and systematic errors are defined for SCIAMACHY ozone profiles. Main error sources are the pointing errors, errors in the knowledge of stratospheric aerosol parameters, and cloud interference. Systematic errors are of the order of 7%, while the random error amounts to 10–15% for most of the stratosphere. These numbers can be used for the interpretation of instrument intercomparison and validation of the SCIAMACHY V 2.5 limb ozone profiles in a rigorous manner

Global investigation of the Mg atom and ion layers using SCIAMACHY/Envisat observations between 70 and 150 km altitude and WACCM-Mg model results

Mg and Mg+ concentration fields in the upper mesosphere/lower thermosphere (UMLT) region are retrieved from SCIAMACHY/Envisat limb measurements of Mg and Mg+ dayglow emissions using a 2-D tomographic retrieval approach. The time series of monthly mean Mg and Mg+ number density and vertical column density in different latitudinal regions are presented. Data from the limb mesosphere–thermosphere mode of SCIAMACHY/Envisat are used, which cover the 50 to 150 km altitude region with a vertical sampling of ≈3.3 km and latitudes up to 82°. The high latitudes are not observed in the winter months, because there is no dayglow emission during polar night. The measurements were performed every 14 days from mid-2008 until April 2012. Mg profiles show a peak at around 90 km altitude with a density between 750 cm−3 and 1500 cm−3. Mg does not show strong seasonal variation at latitudes below 40°. For higher latitudes the density is lower and only in the Northern Hemisphere a seasonal cycle with a summer minimum is observed. The Mg+ peak occurs 5–15 km above the neutral Mg peak altitude. These ions have a significant seasonal cycle with a summer maximum in both hemispheres at mid and high latitudes. The strongest seasonal variations of Mg+ are observed at latitudes between 20 and 40° and the density at the peak altitude ranges from 500 cm−3 to 4000 cm−3. The peak altitude of the ions shows a latitudinal dependence with a maximum at mid latitudes that is up to 10 km higher than the peak altitude at the equator. The SCIAMACHY measurements are compared to other measurements and WACCM model results. The WACCM results show a significant seasonal variability for Mg with a summer minimum, which is more clearly pronounced than for SCIAMACHY, and globally a higher peak density than the SCIAMACHY results. Although the peak density of both is not in agreement, the vertical column density agrees well, because SCIAMACHY and WACCM profiles have different widths. The agreement between SCIAMACHY and WACCM results is much better for Mg+ with both showing the same seasonality and similar peak density. However, there are also minor differences, e.g. WACCM showing a nearly constant altitude of the Mg+ layer's peak density for all latitudes and seasons

Access to Artemisinin-Based Anti-Malarial Treatment and its Related Factors in Rural Tanzania.

Artemisinin-based combination treatment (ACT) has been widely adopted as one of the main malaria control strategies. However, its promise to save thousands of lives in sub-Saharan Africa depends on how effective the use of ACT is within the routine health system. The INESS platform evaluated effective coverage of ACT in several African countries. Timely access within 24 hours to an authorized ACT outlet is one of the determinants of effective coverage and was assessed for artemether-lumefantrine (Alu), in two district health systems in rural Tanzania. From October 2009 to June 2011we conducted continuous rolling household surveys in the Kilombero-Ulanga and the Rufiji Health and Demographic Surveillance Sites (HDSS). Surveys were linked to the routine HDSS update rounds. Members of randomly pre-selected households that had experienced a fever episode in the previous two weeks were eligible for a structured interview. Data on individual treatment seeking, access to treatment, timing, source of treatment and household costs per episode were collected. Data are presented on timely access from a total of 2,112 interviews in relation to demographics, seasonality, and socio economic status. In Kilombero-Ulanga, 41.8% (CI: 36.6-45.1) and in Rufiji 36.8% (33.7-40.1) of fever cases had access to an authorized ACT provider within 24 hours of fever onset. In neither of the HDSS site was age, sex, socio-economic status or seasonality of malaria found to be significantly correlated with timely access. Timely access to authorized ACT providers is below 50% despite interventions intended to improve access such as social marketing and accreditation of private dispensing outlets. To improve prompt diagnosis and treatment, access remains a major bottle neck and new more innovative interventions are needed to raise effective coverage of malaria treatment in Tanzania

How can health systems be strengthened to control and prevent an Ebola outbreak? a narrative review

The emergence and re-emergence of infectious diseases are now more than ever considered threats to public health systems. There have been over 20 outbreaks of Ebola in the past 40 years. Only recently, the World Health Organization has declared a public health emergency of international concern (PHEIC) in West Africa, with a projected estimate of 1.2 million deaths expected in the next 6 months. Ebola virus is a highly virulent pathogen, often fatal in humans and non-human primates. Ebola is now a great priority for global health security and often becomes fatal if left untreated. This study employed a narrative review. Three major databases MEDLINE, EMBASE, and Global Health were searched using both ‘text-words’ and ‘thesaurus terms’. Evidence shows that low- and middle-income countries (LMICs) are not coping well with the current challenges of Ebola, not only because they have poor and fragile systems but also because there are poor infectious disease surveillance and response systems in place. The identification of potential cases is problematic, particularly in the aspects of contact tracing, infection control, and prevention, prior to the diagnosis of the case. This review therefore aims to examine whether LMICs’ health systems would be able to control and manage Ebola in future and identifies two key elements of health systems strengthening that are needed to ensure the robustness of the health system to respond effectively

Tropospheric column amount of ozone retrieved from SCIAMACHY limb–nadir-matching observations

Tropospheric ozone (O₃), has two main sources: transport from the stratosphere and photochemical production in the troposphere. It plays important roles in atmospheric chemistry and climate change. Its amount and destruction are being modified by anthropogenic activity. Global measurements are needed to test our understanding of its sources and sinks. In this paper, we describe the retrieval of tropospheric O₃ columns (TOCs) from the combined limb and nadir observations (hereinafter referred to as limb–nadir-matching (LNM)) of the SCanning Imaging Absorption spectroMeter for Atmospheric CHartographY (SCIAMACHY) instrument, which flew as part of the payload onboard the European Space Agency (ESA) satellite Envisat (2002–2012). The LNM technique used in this study is a residual approach that subtracts stratospheric O₃ columns (SOCs), retrieved from the limb observations, from the total O₃ columns (TOZs), derived from the nadir observations. The technique requires accurate knowledge of the SOCs, TOZs, tropopause height, and their associated errors. The SOCs were determined from the stratospheric O₃ profiles retrieved in the Hartley and Chappuis bands from SCIAMACHY limb scattering measurements. The TOZs were also derived from SCIAMACHY measurements, but in this case from the nadir viewing mode using the Weighting Function Differential Optical Absorption Spectroscopy (WFDOAS) technique in the Huggins band. Comparisons of the TOCs from SCIAMACHY and collocated measurements from ozonesondes in both hemispheres between January 2003 and December 2011 show agreement to within 2–5 DU (1 DU = 2.69 × 10¹⁶ molecules cm⁻²). TOC values from SCIAMACHY have also been compared to the results from the Tropospheric Emission Spectrometer (TES) and from the LNM technique exploiting Ozone Monitoring Instrument (OMI) and Microwave Limb Sounder (MLS) data (hereinafter referred to as OMI/MLS). All compared data sets agree within the given data product error range and exhibit similar seasonal variations, which, however, differ in amplitude. The spatial distributions of tropospheric O₃ in the SCIAMACHY LNM TOC product show characteristic variations related to stratosphere–troposphere exchange (STE) processes, anthropogenic activities and biospheric emissions

The building blocks of community health systems: a systems framework for the design, implementation and evaluation of iCCM programs and community-based interventions

INTRODUCTION: Almost all sub-Saharan African countries have adopted some form of integrated community case management (iCCM) to reduce child mortality, a strategy targeting common childhood diseases in hard-to-reach communities. These programs are complex, maintain diverse implementation typologies and involve many components that can influence the potential success of a program or its ability to effectively perform at scale. While tools and methods exist to support the design and implementation of iCCM and measure its progress, these may not holistically consider some of its key components, which can include program structure, setting context and the interplay between community, human resources, program inputs and health system processes. METHODS: We propose a Global South-driven, systems-based framework that aims to capture these different elements and expand on the fundamental domains of iCCM program implementation. We conducted a content analysis developing a code frame based on iCCM literature, a review of policy documents and discussions with key informants. The framework development was guided by a combination of health systems conceptual frameworks and iCCM indices. RESULTS: The resulting framework yielded 10 thematic domains comprising 106 categories. These are complemented by a catalogue of critical questions that program designers, implementers and evaluators can ask at various stages of program development to stimulate meaningful discussion and explore the potential implications of implementation in decentralised settings. CONCLUSION: The iCCM Systems Framework proposed here aims to complement existing intervention benchmarks and indicators by expanding the scope and depth of the thematic components that comprise it. Its elements can also be adapted for other complex community interventions. While not exhaustive, the framework is intended to highlight the many forces involved in iCCM to help managers better harmonise the organisation and evaluation of their programs and examine their interactions within the larger health system