International Health – May 2015

International Health
Volume 7 Issue 3 May 2015
http://inthealth.oxfordjournals.org/content/current

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Noma: neglected, forgotten and a human rights issue
M. Leila Sroura,*, Klaas W. Marckb and Denise Baratti-Mayerc
Author Affiliations
aHealth Frontiers, Bhan Tat Khao, Vientiane, Laos
bDutch Noma Foundation, De Pôlle 24, 9084BT Goutum, The Netherlands
cGESNOMA (Geneva Study Group on Noma), Service of Plastic and Reconstructive Surgery, Geneva University Hospitals, Geneva, Switzerland
Abstract
Noma, an orofacial gangrene and opportunistic infection, affects primarily malnourished children living in extreme poverty. Neglected, forgotten, unknown by most health workers, noma results in death, disfigurement and disability of some of the world’s most vulnerable children. Noma is a biological indicator of multiple human rights violations, including the right to food. International support and national attention in countries with noma are lacking. The end of neglect of noma can lead to the elimination of this horrific childhood disease.

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Patients struggle to access effective health care due to ongoing violence, distance, costs and health service performance in Afghanistan
Niamh Nic Carthaigha, Benoit De Gryseb, Abdul Sattar Esmatic, Barak Nizard, Catherine Van Overloope, Renzo Frickee, Jehan Bseisoa, Corinne Bakere, Tom Decroof and Mit Philipsa,*
Author Affiliations
aMédecins Sans Frontières–Operational Centre Brussels, Advocacy and Analysis Unit, Brussels
bMédecins Sans Frontières–Operational Centre Brussels, Afghanistan Mission, Kabul
cMinistry of Health–Afghanistan, Direction Ahmad Shah Baba District Hospital, Kabul, Afghanistan
dMinistry of Health–Afghanistan, Direction Boost Provincial Hospital, Helmand, Afghanistan
eMédecins Sans Frontières–Operational Centre Brussels, Operational Department, Brussels
fMédecins Sans Frontières–Operational Centre Brussels, Operational Research Unit, Brussels
Abstract
Background
The Afghan population suffers from a long standing armed conflict. We investigated patients’ experiences of their access to and use of the health services.
Methods
Data were collected in four clinics from different provinces. Mixed methods were applied. The questions focused on access obstacles during the current health problem and health seeking behaviour during a previous illness episode of a household member.
Results
To access the health facilities 71.8% (545/759) of patients experienced obstacles. The combination of long distances, high costs and the conflict deprived people of life-saving healthcare. The closest public clinics were underused due to perceptions regarding their lack of availability or quality of staff, services or medicines. For one in five people, a lack of access to health care had resulted in death among family members or close friends within the last year.
Conclusions
Violence continues to affect daily life and access to healthcare in Afghanistan. Moreover, healthcare provision is not adequately geared to meet medical and emergency needs. Impartial healthcare tailored to the context will be vital to increase access to basic and life-saving healthcare.

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Health worker perceptions of integrating mobile phones into community case management of malaria in Saraya, Senegal
Demetri A. Blanasa,*, Youssoupha Ndiayeb, Matthew MacFarlanec, Isaac Mangab, Ammar Siddiquid, Olivia Veleze, Andrew S. Kanterf, Kim Nicholsg and Nils Hennigd
Author Affiliations
aHarlem Residency in Family Medicine, Institute for Family Health, New York, New York, 10029, USA
bHealth District of Saraya, Senegalese Ministry of Health, Saraya, Senegal
cCenter on Child Protection, Jakarta, Indonesia
dMount Sinai Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
eICF International, New York, New York, 10028, USA
fEarth Institute, Columbia University, New York, New York, 10027, USA
gAfrican Services Committee, New York, New York, 10027, USA
Abstract
Background
Although community case management of malaria increases access to life-saving care in isolated settings, it contends with many logistical challenges. Mobile phone health information technology may present an opportunity to address a number of these barriers.
Methods
Using the wireless adaptation of the technology acceptance model, this study assessed availability, ease of use, usefulness, and job relevance of mobile phones by health workers in Saraya, Senegal.
Results
This study conducted seven key informant interviews with government health workers, and three focus groups and 76 surveys with lay health workers. Principal findings included that mobile phones are already widely available and used, and that participants valued using phones to address training, stock management, programme reporting, and transportation challenges.
Conclusions
By documenting widespread use of mobile phones and health worker perceptions of their most useful applications, this paper provides a framework for their integration into the community case management of malaria programme in Saraya, Senegal.