Implementing clinical guidelines in low-income settings: A review of literature

The use of clinical guidelines has been shown to confer benefits for care delivery in high-income settings, but little is known about their implementation in low-income settings. We conducted a systematic literature review on the implementation of World Health Organisation (WHO) clinical guidelines for hospital care in low-income settings. We searched Medline, Global Health and Scopus for articles describing the implementation of clinical guidelines issued by the WHO for hospitals in low-income countries. Each article in the final sample was reviewed independently by two reviewers who harmonised their findings to identify key factors affecting the implementation process, which were grouped into thematic categories through negotiated consensus among project team members. Seventeen studies met the inclusion criteria. Factors affecting the guideline implementation process in low-income countries were (1) degree of support from facility management and Ministry of Health, (2) credibility and acceptability of clinical guidelines from the perspective of health care providers, (3) efforts to adapt clinical guidelines to local circumstances and (4) use of guides and checklists for implementation. These four factors consistently emerged in our review and should be considered when designing future strategies to implement clinical guidelines in low-income countries.     

From the field side of the binoculars: a different view on global public health surveillance

It is generally assumed by the donor community that the targeted funding of global, regional or cross-border surveillance programmes is an efficient way to support resource-poor countries in developing their own national public health surveillance infrastructure, to encourage national authorities to share outbreak intelligence, and ultimately to ensure compliance of World Health Organization (WHO) Member States with the revised (2005) International Health Regulations. At country level, a number of factors and constraints appear to contradict this view. Global or regional surveillance initiatives, including syndromic surveillance and rumour surveillance projects, have been conceived in neglect of fragile health systems, from which they extract scarce human resources. In contradiction with a rightful stance promoting 'integrated surveillance' by WHO, the nurturing of donor-driven, poorly coordinated and redundant surveillance networks generally adds further fragmentation to national health priorities set up by developing countries. In their current categorical format, ignoring the overwhelming deficits in governance and health care capacity, global surveillance strategies seem bound to benefit mainly the most industrially developed nations through the provision of early warning information or scientific data. In lower-income countries, a focus of resources on strengthening the health system first would ultimately be a more efficient way to achieve proper detection and response to outbreaks at national or sub-national level. As documented in several pilot initiatives at sub-national level (India, South Africa, Tuvalu and Cambodia), the empowerment of frontline health workers and communities is a key element for an efficient surveillance system. Such simple measures centred on human resources and community values appear to be more beneficial than massive and conditional monetary inputs.     

高渗氯化钠治疗失血性休克技术推广制约因素初探

[目的]分析高渗氯化钠溶液治疗失血性休克技术的培训和推广效果,初步探讨制约该技术推广的主要因素。[方法]对培训对象在培训前、课堂讲授后和互动强化后分别进行考核,在培训后进行满意度调查,评价培训效果;对培训对象进行小组访谈,调查该技术推广应用情况,评价推广应用效果。[结果]培训对象对该技术知识的知晓率从培训前的46.95%提高到课堂讲授后的82.20%及互动强化后的85.93%;平均成绩从培训前的43.22分提高到课堂讲授后的81.08分及互动强化后的83.85分;培训对象未使用该技术。在访谈过程中,访谈对象普遍反映市场上无相应产品,并且配制高渗氯化钠溶液医院需要具备一定的条件和标准,并且只能在院内流通不能在院外流通。[结论]技术本身的完善性是制约该技术推广应用的关键因素。     

Meeting the Challenge of Influenza Pandemic Preparedness in Developing Countries

Developing countries face unique difficulties preparing for an influenza pandemic. Our current top-down approach will not provide these countries with adequate supplies of vaccines and antiviral agents. Consequently, they will have to use a bottom-up approach based on inexpensive generic agents that either modify the host response to influenza virus or act as antiviral agents. Several of these agents have shown promise, and many are currently produced in developing countries. Investigators must primarily identify agents for managing infection in populations and not simply seek explanations for how they work. They must determine in which countries these agents are produced and define patterns of distribution and costs. Because prepandemic research cannot establish whether these agents will be effective in a pandemic, randomized controlled trials must begin immediately after a new pandemic virus has emerged. Without this research, industrialized and developing countries could face an unprecedented health crisis.     

Defining Sexual Health: A Descriptive Overview

This paper examines the historical events that have contributed to evolving definitions of sexual health. Through a review of the literature, eight definitions of sexual health were identified from the original 1975 World Health Organization (WHO) definition up until the most recent definition in 2002. Each of these definitions is reviewed for the context in which they were developed and the particular contributions they have played in the development of the understanding of sexual health. The more recent definitions have built upon the essential elements provided in the original WHO definition but have added concepts of mental health, responsibility, and sexual rights. Although similarities exist in the definitions, they are not all alike. The importance of defining sexual health in the discussion of promoting sexual health is illustrated. The concept and definition of sexual health will continue to evolve shaped by historical events.     

福建省闽西北农村集资医疗基本资金筹集估计模式与参数探讨

本文通过闽西北农村的各类型集资医疗居民的实际门诊与住院的消费水平抽样调查,对居民的基本医疗费用(包括村医生工资负担A,门诊费用负担B_i,住院费用负担C_j)及医疗补偿规定比例q等参数作出估计,建立集资医疗基本资金筹集预算模式((?)=A+ΣB_i+∑C_i·q)。结果表明,接本模式推算出的基本资金筹集估计值与实际筹集值非常接近(t=1.12,P>0.05)。     

运用信息化技术监控合理用药——广州市“阳光用药”电子监察系统解析

广州市卫生局运用现代信息技术率先开发了"阳光用药"电子监察系统,并在信息化程度较高的广州市第一人民医院和市红十字会医院两所三甲医院试运行,并取得了初步成效。本文主要是从技术的角度与层面来分析"阳光用药"系统是如何得以实现的,包括其系统结构、网络组成、应用体系结构以及总体规划模式等内容。     

世界卫生组织和中国在流感大流行应对准备计划方面的发展及现状

历史上流感的每次大流行都给人类带来灾难,其中以1918年"西班牙流感"大流行最为严重。近100年来,随着对流感病毒了解的不断深入,以及检测技术的长足发展和监测手段的逐步丰富,人类面对流感大流行并非如前般无所适从。为努力延缓和降低其危害,人们希望通过不断完善应对准备工作,以期实现早期预警或尽早发现具备大流行潜能的流感病毒,以及在大流行期间,通过实施应对准备计划中相应的防控措施,延缓高峰出现和控制疫情流行,从而达到降低影响的目的。本文回顾了百年来WHO和中国的流感大流行应对准备工作的策略、重点及其随时间的演变与发展进程,以温故而知新,为今后不断完善流感大流行应对准备工作提供参考。     

沿海农村健康人群乙丙肝病毒感染血清流行病学研究

目的 :为了解沿海农村健康人群乙型和丙型病毒性肝炎感染现状 ,建立有效的防治措施。方法 :应用间接反向血凝法 (RPHA)和酶联免疫吸附试验 (EL ISA)对 10 78名健康人群分别进行了血清乙肝表面抗原 (HBs Ag)和抗 - HCV检测。结果 :共检出 HBs Ag阳性 115人 ,抗 - HCV阳性 6 6人 ,阳性率分别为 10 .6 7% (8.83% - 12 .5 1% )和 6 .12 % (4.6 9% -7.5 5 % ) ,同时检出乙型和丙型肝炎病毒感染 8例 ,检出率为 0 .74%。结论 :本次调查健康人群中 HBV和抗 - HCV感染与国内农村一般人群 HBV和抗 - HCV的感染一致。     

娱乐场所女性服务员预防艾滋病、性病行为干预研究

目的：评价对娱乐场所女服务员实施预防性病、艾滋病行为干预的效果。方法：对贵州省贵阳市桑拿、卡拉OK厅、夜总会等38家娱乐场所的女服务员进行有关性病、艾滋病基本知识的宣传教育。比较受过健康教育干预后的302名调查对象和未受教育的306名调查对象的艾滋病的知晓率,艾滋病、性病的传播途径,预防方法等基本知识。结果：受教育组的回答正确率显著高于未受教育组。受教育组回答使用避孕套能预防艾滋病的正确率为82．4％,未受教育组回答正确率为52．3％。高危性行为时,受教育组避孕套的使用率为88．2％,未受教育组为74．0％。结论：加强健康教育、行为干预对改变危险性行为,预防艾滋病、性病的传播是可行的。