Prevention of sexually transmitted diseases The Shurugwi sex-workers project

Sex-workers play an important role in the spread of sexually trans:mitted diseases (STDs) and this article tries to show that they can also play an important role in their prevention. Community participation by sex-workers in the prevention of STDs can also decrease the incidence thereof

Attitudes ofwotnen towards traditional midwives - a survey in the Kgalagadi (Kalahari) region

Two hundred and forty-nine women of childbearing age from 20 villages in the Kgalagadi (Kalahari) desert region, who had borne a child, were asked about their attitudes towards institutional and non-institutional deliveries. Two hundred and two (81,6%) women preferred to give birth at home. One hundred and seventeen (46,9%) attended antenatal clinics at health facilities but virtually none of these attended postnatal clinics. Forty-one per cent of the women who prefer to give birth at home do so because at home they receive African 'muti' and an abdominal massage; 22,5% deliver at home because they feel it is safer and more convenient. Most African women and commnunities are reluctant to entrust the sluicing oftheir placenta and other products of conception to strangers such as nurses. Ninety per cent of respondents suggested that traditional midwives and health personnel should work together to improve community maternal health services

Quality end-of-life care: A global perspective

BACKGROUND: Quality end-of-life care has emerged as an important concept in industrialized countries. DISCUSSION: We argue quality end-of-life care should be seen as a global public health and health systems problem. It is a global problem because 85 % of the 56 million deaths worldwide that occur annually are in developing countries. It is a public health problem because of the number of people it affects, directly and indirectly, in terms of the well being of loved ones, and the large-scale, population based nature of some possible interventions. It is a health systems problem because one of its main features is the need for better information on quality end-of-life care. We examine the context of end-of-life care, including the epidemiology of death and cross-cultural considerations. Although there are examples of success, we could not identify systematic data on capacity for delivering quality end-of-life care in developing countries. We also address a possible objection to improving end-of-life care in developing countries; many deaths are preventable and reduction of avoidable deaths should be the focus of attention. CONCLUSIONS: We make three recommendations: (1) reinforce the recasting of quality end-of-life care as a global public health and health systems problem; (2) strengthen capacity to deliver quality end-of-life care; and (3) develop improved strategies to acquire information about the quality of end-of-life care

The role of culture in primary health care

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Evaluating HIV/STD interventions in developing countries: do current indicators do justice to advances in intervention approaches?

HIV continues to spread unabated in many developing countries. Here we consider the interventions that are currently in place and critically discuss the methods that are being used to evaluate them as reported in the published literature. In recent years there has been a move away from highly individual-oriented interventions towards more participatory approaches that emphasise techniques such as community-led peer education and group discussions. However, this move towards more community orientated intervention techniques has not been matched by the development of evaluation methods with which to capture and explain the community and social changes which are often necessary preconditions for health-enhancing behaviour change. Evaluation research continues to rely on quantitative methodologies that fail to elucidate the complex changes that the newer interventions seek to promote within target communities. In addition, these methods of evaluation tend to rely on the use of highly individualistic and quantitative biomedical indicators such as HIV/STD rates, or knowledge, attitude, perception and behaviour (KAPB) survey questionnaires. We argue that such approaches are inadequate for the task of tracking and measuring important determinants of programme success such as psycho-social changes, features of the community-intervention interface and the degree of trust and identification with which members of target communities regard particular interventions. Rigorously conducted qualitative process evaluations taking account of the above factors could make a key contribution to the development of more successful HIV-prevention interventions