Mobile primary healthcare services and health outcomes of children in rural Namibia.

INTRODUCTION: In rural areas of Namibia where health facilities are far apart, health outcomes are poor among high utilization groups such as pregnant women and children. Among children, orphans and vulnerable children (OVC) are generally more affected than non-OVC. This study assessed the health changes of orphans and other vulnerable and non-vulnerable children visiting a mobile clinic in rural Namibia. METHODS: Over a 6 month period, information on immunization status, diagnosis of anemia, skin and intestinal disorders, nutrition, dental disorders and referrals was collected from the records of a mobile clinic serving farms and surrounding areas in parts of rural Namibia. Data were compared for all children with visits in months 1 or 2 (baseline) and a visit in months 5 or 6 (follow up). Data for a cohort of children seen at both time points (the longitudinal group) were also analyzed. RESULTS: For all children, there was significant reduction in outstanding immunizations (5% to 1% p<0.0001), skin and intestinal parasites (15.5% to 0.2% p<0.0001), and stunting (26.9% to 14.2% p<0.0001) between baseline and follow up. Within the longitudinal group, reductions were observed in the prevalence of anemia (1.9% to 0.5% p<0.0001), incomplete immunizations (6.5% to <1% p<0.0001), and parasitic infections (16.9% to 0.2% p<0.0001) between the two time points. At baseline, orphans were more likely to have incomplete immunizations and parasitic infections. Among orphans, incomplete immunizations declined from 25% to 0 (p<0.001) while parasitic infections decreased from 22.7% to 0 (p<0.001). Among other vulnerable children incomplete immunizations declined from 5% to 1% (p=0.002), as did skin and parasitic infestations (17.2% to 0.3% p<0.001). CONCLUSION: Regular mobile clinic visits improved the health indices of child attendees. The greatest change was among OVC whose disease burden was greater at baseline. Mobile clinics may be an effective intervention in hard-to-reach, resource-limited settings.

Hypertension in sub-Saharan Africa: cross-sectional surveys in four rural and urban communities.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of adult mortality in low-income countries but data on the prevalence of cardiovascular risk factors such as hypertension are scarce, especially in sub-Saharan Africa (SSA). This study aims to assess the prevalence of hypertension and determinants of blood pressure in four SSA populations in rural Nigeria and Kenya, and urban Namibia and Tanzania. METHODS AND FINDINGS: We performed four cross-sectional household surveys in Kwara State, Nigeria; Nandi district, Kenya; Dar es Salaam, Tanzania and Greater Windhoek, Namibia, between 2009-2011. Representative population-based samples were drawn in Nigeria and Namibia. The Kenya and Tanzania study populations consisted of specific target groups. Within a final sample size of 5,500 households, 9,857 non-pregnant adults were eligible for analysis on hypertension. Of those, 7,568 respondents ≥ 18 years were included. The primary outcome measure was the prevalence of hypertension in each of the populations under study. The age-standardized prevalence of hypertension was 19.3% (95%CI:17.3-21.3) in rural Nigeria, 21.4% (19.8-23.0) in rural Kenya, 23.7% (21.3-26.2) in urban Tanzania, and 38.0% (35.9-40.1) in urban Namibia. In individuals with hypertension, the proportion of grade 2 (≥ 160/100 mmHg) or grade 3 hypertension (≥ 180/110 mmHg) ranged from 29.2% (Namibia) to 43.3% (Nigeria). Control of hypertension ranged from 2.6% in Kenya to 17.8% in Namibia. Obesity prevalence (BMI ≥ 30) ranged from 6.1% (Nigeria) to 17.4% (Tanzania) and together with age and gender, BMI independently predicted blood pressure level in all study populations. Diabetes prevalence ranged from 2.1% (Namibia) to 3.7% (Tanzania). CONCLUSION: Hypertension was the most frequently observed risk factor for CVD in both urban and rural communities in SSA and will contribute to the growing burden of CVD in SSA. Low levels of control of hypertension are alarming. Strengthening of health care systems in SSA to contain the emerging epidemic of CVD is urgently needed.

University students and HIV in Namibia: an HIV prevalence survey and a knowledge and attitude survey.

BACKGROUND: With an overall adult HIV prevalence of 15.3%, Namibia is facing one of the largest HIV epidemics in Africa. Young people aged 20 to 34 years constitute one of the groups at highest risk of HIV infection in Namibia. However, little is known about the impact of HIV on this group and its access to healthcare. The purpose of this study was to estimate HIV prevalence, to assess the knowledge of and attitudes towards HIV/AIDS, and to assess access to healthcare among university students in Namibia. METHODS: We assessed HIV/AIDS knowledge and attitudes, HIV prevalence and access to healthcare among students at the Polytechnic of Namibia and the University of Namibia. HIV prevalence was tested through anonymous oral fluid-based tests. RESULTS: Half (n = 2790/5568) of the university students and 45% (n = 2807/6302) of the Polytechnic students participated in the knowledge and attitudes surveys. HIV/AIDS knowledge was reasonable, except for misperceptions about transmission. Awareness of one's own HIV status and risks was low. In all, 55% (n = 3055/5568) of university students and 58% (n = 3680/6302) of Polytechnic students participated in the HIV prevalence survey; 54 (1.8%) university students and 103 (2.8%) Polytechnic students tested HIV positive. Campus clinics were not the major providers of healthcare to the students. CONCLUSIONS: Meaningful strategies addressing the gap between knowledge, attitude and young people's perception of risk of HIV acquisition should be implemented. HIV prevalence among Namibian university students appears relatively low. Voluntary counselling and testing should be stimulated. Efforts should be made to increase access to healthcare through the campus clinics.