Spotlight on January's International Health

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Thursday, 19 January 2017

The freely available Editor's Choice for January is an original research paper from Aliyu et al on the sex disparities in outcomes among adults on long-term antiretroviral treatment in northern Nigeria. There are conflicting reports of sex differences in HIV treatment outcomes in Africa. The authors investigated sex disparities in treatment outcomes for adults on first line antiretroviral treatment (ART) in Nigeria. They found that women achieved better long-term immune response to ART at baseline and during treatment, but had similar rates of long-term retention in care to men. Targeted efforts are needed to improve immune outcomes in men in this setting.

Health system strengthening

In this issue of International Health, we have a number of papers looking at different aspects of health system strengthening and the economic burden of disease. We start with a Commentary from Joseph Freer discussing the sustainable development goals and the human resources crisis in Africa. Freer suggests that a paradigm shift is required in the design of health systems that can properly identify, train, allocate and retain health workers.

Continuing with the theme of strengthening health systems, a paper from Weathers et al aims to understand the determinants of the Global Fund to Fight AIDS, Tuberculosis, and Malaria's dedicated channel for health systems strengthening (HSS) funding across countries and to analyse their health system priorities expressed in budgets and performance indicators. They found that health worker densities were not correlated with HSS funding, despite the emphasis on health workforce in budgets and performance indicators. The authors suggest the Global Fund to better engage and collaborate with WHO to develop indicators that represent performance of improving health workforce and health products, the two main areas of spending for the dedicated HSS channel.

Moving on to look at the economic burden of specific diseases, an original reasearch paper from Jan et al looks at the economic impact of ischaemic heart disease (IHD) in Malaysia. Malaysia is an upper-middle income country with a tax-based health financing system and care is relatively affordable, and safety nets are provided for the needy. However, the economic impact of IHD on patients in Malaysia is considerable and the prospect of economic hardship likely to persist over the years due to the long-standing nature of IHD. The findings highlight the need to evaluate the present health financing system in Malaysia and to expand its safety net coverage for vulnerable patients.

A paper from Ukwaja et al studied the economic burden of Buruli ulcer in Nigeria and assessed the costs of Buruli ulcer care to patients from the onset of illness to diagnosis and to the end of treatment. The authors found that direct costs of Buruli ulcer diagnosis and treatment are catastrophic to a substantial proportion of patients and their families.

What else is in January's issue?

The issue also sees original research papers on the prevalence and correlates of self-reported chronic NCDs in Botswana, womens' attitudes towards child marriage and wife beating in Pakistan, device-associated infection rates and bacterial resistance in intensive care units of Venezuela, joint association of screen time and physical activity on self-rated health and life satisfaction in children and adolescents, and estimating the discriminative power of risk models for ordinal disease outcome treatments.

Read the full issue here.

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