Linking disease control programmes in rural Africa: a pro-poor strategy to reach Abuja targets and millennium development goals.
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ABSTRACT:
SUBMITTER: Molyneux DH
PROVIDER: S-EPMC406331 | biostudies-literature | 2004 May
REPOSITORIES: biostudies-literature
Publications
Linking disease control programmes in rural Africa: a pro-poor strategy to reach Abuja targets and millennium development goals.
Molyneux David H DH Nantulya Vinand M VM
BMJ (Clinical research ed.) 20040501 7448
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Project description:Reducing child mortality is a key global health challenge. We examined reasons for greater or lesser success in meeting under-five mortality rate reductions, i.e. Millennium Development Goal #4, between 1990 and 2015 in Sub-Saharan Africa where child mortality remains high. We first examined factors associated with child mortality from all World Health Organization African Region nations during the Millennium Development Goal period. This analysis was followed by case studies of the facilitators and barriers to Millennium Development Goal #4 in four countries - Kenya, Liberia, Zambia, and Zimbabwe. Quantitative indicators, policy documents, and qualitative interviews and focus groups were collected from each country to examine factors within and across countries related to child mortality. We found familiar themes that highlighted the need for both specific services (e.g. primary care access, emergency obstetric and neonatal care) and general management (e.g. strong health governance and leadership, increasing community health workers, quality of care). We also identified methodological opportunities and challenges to assessing progress in child health, which can provide insights to similar efforts during the Sustainable Development Goal period. Specifically, it is important for countries to adapt general international goals and measurements to their national context, considering baseline mortality rates and health information systems, to develop country-specific goals. It will also be critical to develop more rigorous measurement tools and indicators to accurately characterize maternal, neonatal, and child health systems, particularly in the area of governance and leadership. Valuable lessons can be learned from Millennium Development Goal successes and failures, as well as how they are evaluated. As countries seek to lower child mortality further during the Sustainable Development Goal period, it will be necessary to prioritize and support countries in quantitative and qualitative data collection to assess and contextualize progress, identifying areas needing improvement.
| S-EPMC7067162 | biostudies-literature
Project description:BackgroundVery little has been researched about the efficacy, effectiveness, feasibility, sustainability and impact of food-based approaches on the diets and nutritional status of populations at risk of hunger and food insecurity. This study contributes knowledge about the impact of food-based approaches on the diets of populations at risk of hunger and food insecurity in four of the poorest rural communities in South Africa. The study investigated the consumption and production patterns of rural households (278 in summer and 280 in winter) in four sites in the poorest municipalities in South Africa.MethodsA multistage stratified random sampling technique was applied to identify the communities and sample households for the quantitative survey and qualitative assessments. Qualitative and quantitative data were collected between 2013 and 2015 through focus group discussions (FGDs), key informant interviews and the two-round panel survey to cover both the summer and winter seasons at each site.ResultsHome gardening led to a significant positive increase in the consumption of white roots and tubers, dark green leafy vegetables, orange-coloured fruit and other fruit in the 24 h prior to the survey. Participation in a community garden led to significant increases in the consumption of dark green leafy vegetables and other vegetables. School gardening did not demonstrate any statistical relationships with the consumption of foods from the crop-related food groups. Crop production improved dietary diversity. Selling produce and irrigation showed a stronger improvement in dietary diversity. Seasonality affected the availability of fresh fruit and vegetables for home consumption in winter.ConclusionsProducing beyond that solely for home consumption has greater benefits for dietary diversity and a consumption-smoothing effect during the post-harvest period. Politicians and the scientific community should recognise the role that household and small-scale crop production plays in supporting household consumption and the provision of essential micronutrients despite constraints and disincentives. Production and education programmes should focus on strengthening existing good consumption patterns and promoting the consumption of foods that can improve dietary diversity.
| S-EPMC7488396 | biostudies-literature
Project description:BackgroundMeasuring national progress towards the Sustainable Development Goals (SDGs) enables the identification of gaps which need to be filled to end poverty, protect the planet and improve lives. Progress is typically calculated using indicators stemming from published methodologies. South Africa tracks progress towards the SDGs at a national scale, but aggregated data may mask progress, or lack thereof, at local levels.ObjectiveTo assess the progress towards achievement of the SDGs in four low-income, rural villages (Giyani) in South Africa and to relate the findings to national SDG indicators.MethodsUsing data from a cross-sectional environmental health study, the global indicator framework for the SDGs was applied to calculate indicators for Giyani. Local progress towards SDG achievement was compared with national progress, to contextualize and supplement national scale tracking.FindingsVillage scores were mostly in line with country scores for those indices which were computable, given the available data. Low data availability prevented a complete local progress assessment. Higher levels of poverty prevail in the study villages compared to South Africa as a whole (17.7% compared to 7.4%), high unemployment (49.0% compared to 27.3%) and lack of access to information via the Internet (only 4.2% compared to 61.8%) were indicators in the villages identified as falling far short of the South African averages.ConclusionsUnderstanding progress towards the SDGs at a local scale is important when trying to unpack national progress. It shines a light upon issues that are not picked up by national composite assessments yet require most urgent attention. Gaps in data required to measure progress towards targets represents a serious stumbling block, preventing the creation of a true reflection of local and national scale progress.
| S-EPMC7894382 | biostudies-literature
Project description: Not available
| S-EPMC1283260 | biostudies-literature
Project description:ObjectiveThe aim of this study was to determine whether metabolic adaptation, at the level of resting metabolic rate, was associated with time to reach weight loss goals, after adjusting for confounders.MethodsA total of 65 premenopausal women with overweight (BMI: 28.6 ± 1.5 kg/m2 ; age: 36.4 ± 5.9 years; 36 were White, and 29 were Black) followed an 800-kcal/d diet until BMI ≤25 kg/m2 . Body weight and composition were measured at baseline and after weight loss. Dietary adherence was calculated from total energy expenditure, determined by double labeled water, and body composition changes. Metabolic adaptation was defined as a significantly lower measured versus predicted resting metabolic rate (from own regression model). A regression model to predict time to reach weight loss goals was developed including target weight loss, energy deficit, dietary adherence, and metabolic adaptation as predictors.ResultsParticipants lost on average 12.5 ± 3.1 kg (16.1% ± 3.4%) over 155.1 ± 49.2 days. Average dietary adherence was 63.6% ± 31.0%. There was significant metabolic adaptation after weight loss (-46 ± 113 kcal/d, p = 0.002) and this variable was a significant predictor of time to reach weight loss goals (β = -0.1, p = 0.041), even after adjusting for confounders (R2 adjusted = 0.63, p < 0.001).ConclusionIn premenopausal women with overweight, metabolic adaptation after a 16% weight loss increases the length of time necessary to achieve weight loss goals.
| S-EPMC8852805 | biostudies-literature
Project description:During reach planning, fronto-parietal brain areas need to transform sensory information into a motor code. It is debated whether these areas maintain a sensory representation of the visual cue or a motor representation of the upcoming movement goal. Here, we present results from a delayed pro-/anti-reach task which allowed for dissociating the position of the visual cue from the reach goal. In this task, the visual cue was combined with a context rule (pro vs. anti) to infer the movement goal. Different levels of movement goal specification during the delay were obtained by presenting the context rule either before the delay together with the visual cue (specified movement goal) or after the delay (underspecified movement goal). By applying functional magnetic resonance imaging (fMRI) multivoxel pattern analysis (MVPA), we demonstrate movement goal encoding in the left dorsal premotor cortex (PMd) and bilateral superior parietal lobule (SPL) when the reach goal is specified. This suggests that fronto-parietal reach regions (PRRs) maintain a prospective motor code during reach planning. When the reach goal is underspecified, only area PMd but not SPL represents the visual cue position indicating an incomplete state of sensorimotor integration. Moreover, this result suggests a potential role of PMd in movement goal selection.
| S-EPMC5323385 | biostudies-literature
Project description:The parietal reach region (PRR) is known to be involved in the preparation of visually guided arm movements to single targets. We explored whether PRR encodes only the target of the next movement or, alternatively, also a subsequent goal in a double-reach sequence. Two monkeys were trained to memorize the locations of two peripheral cues and to prepare for a memory-guided delayed double-reach sequence. On a GO-signal they had to reach in a predefined order to both remembered target locations without breaking eye fixation. The movement goals were arranged such that either the first or the second target was inside the response field of an isolated neuron. We analyzed the neural activity of single cells in PRR during the late memory period between cue offset and the GO-signal. During this memory period, most PRR cells encoded the first as well as the second goal of the planned reaching sequence. The results indicate that the posterior parietal cortex is involved in the spatial planning of more complex action patterns and represents immediate and subsequent movement goals.
| S-EPMC2744218 | biostudies-other
Project description:In 2000, 189 member states of the United Nations (UN) developed a plan for peace and development, which resulted in eight actionable goals known as the Millennium Development Goals (MDGs). Since their inception, the MDGs have been considered the international standard for measuring development progress and have provided a blueprint for global health policy and programming. However, emphasis upon the achievement of priority benchmarks around the "big three" diseases--namely HIV, tuberculosis (TB), and malaria--has influenced global health entities to disproportionately allocate resources. Meanwhile, several tropical diseases that almost exclusively impact the poorest of the poor continue to be neglected, despite the existence of cost-effective and feasible methods of control or elimination. One such Neglected Tropical Disease (NTD), onchocerciasis, more commonly known as river blindness, is a debilitating and stigmatizing disease primarily affecting individuals living in remote and impoverished areas. Onchocerciasis control is considered to be one of the most successful and cost-effective public health campaigns ever launched. In addition to improving the health and well-being of millions of individuals, these programs also lead to improvements in education, agricultural production, and economic development in affected communities. Perhaps most pertinent to the global health community, though, is the demonstrated effectiveness of facilitating community engagement by allowing communities considerable ownership with regard to drug delivery. This paper reviews the contributions that such concentrated efforts to control and eliminate onchocerciasis make to achieving select MDGs. The authors hope to draw the attention of public policymakers and global health funders to the importance of the struggle against onchocerciasis as a model for community-directed interventions to advance health and development, and to advocate for NTDs inclusion in the post 2015 agenda.
| S-EPMC4440802 | biostudies-other
Project description: Not available
| S-EPMC4464219 | biostudies-literature
Project description:BackgroundThe Centers for Disease Control and Prevention's Million Hearts initiative includes an ambitious ≥80% blood pressure control goal in US adults with hypertension by 2022. We used the validated Blood Pressure Control Model to quantify changes in clinic-based hypertension management processes needed to attain ≥80% blood pressure control.Methods and resultsThe Blood Pressure Control Model simulates patient blood pressures weekly using 3 key modifiable hypertension management processes: office visit frequency, clinician treatment intensification given uncontrolled blood pressure, and continued antihypertensive medication use (medication adherence rate). We compared blood pressure control rates (using the Seventh Joint National Committee on hypertension targets) achieved over 4 years between usual care and the best-observed values for management processes identified from the literature (1-week return visit interval, 20%-44% intensification rate, and 76% adherence rate). We determined the management process values needed to achieve ≥80% blood pressure control in US adults. In adults with uncontrolled blood pressure, usual care achieved 45.6% control (95% uncertainty interval, 39.6%-52.5%) and literature-based best-observed values achieved 79.7% control (95% uncertainty interval, 79.3%-80.1%) over 4 years. Increasing treatment intensification rates to 62% of office visits with an uncontrolled blood pressure resulted in ≥80% blood pressure control, even when the return visit interval and adherence remained at usual care values. Improving to best-observed values for all 3 management processes would achieve 78.1% blood pressure control in the overall US population with hypertension, approaching the ≥80% Million Hearts 2022 goal.ConclusionsAchieving the Million Hearts blood pressure control goal by 2022 will require simultaneously increasing visit frequency, overcoming therapeutic inertia, and improving patient medication adherence. As the relative importance of each of these 3 processes will depend on local characteristics, simulation models like the Blood Pressure Control Model can help local healthcare systems tailor strategies to reach local and national benchmarks.
| S-EPMC6768426 | biostudies-literature