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Marshall K, Beaden P, Durrani H, Tang K, Mogilevskii R, Bhutta Z. The role of the private sector in noncommunicable disease prevention and management in low- and middle-income countries: a series of systematic reviews and thematic syntheses. Int J Qual Stud Health Well-being 2023; 18:2156099. [PMID: 36591948 PMCID: PMC9815432 DOI: 10.1080/17482631.2022.2156099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Conduct six systematic reviews investigating for-profit private sector roles in NCD prevention and management in low- and middle-income countries (LMICs) through our a priori framework's pillars. METHODS Six systematic reviews and thematic syntheses were performed between March-August 2021, Six databases, websites of relevant organizations, and references lists of included studies were comprehensively searched. Studies published in English from 2000 onwards involving the pillar of interest, for-profit private sector, NCD prevention/management, and LMIC context were included. Results were synthesized using an inductive thematic synthesis approach. RESULTS Ultimately, 25 articles were included in the PPP review, 33 in Governance and Policy, 22 in Healthcare Provision, 15 in Innovation, 14 in Knowledge Educator, and 42 in Investment and Finance. The following themes emerged: PPPs (coordination; financial resources; provision; health promotion; capacity building; innovation; policy); Governance/Policy (lobbying; industry perception; regulation); Healthcare Provision (diagnosis/treatment; infrastructure; availability/accessibility/affordability); Innovation (product innovation; process innovation; marketing innovation; research; innovation dissemination); Knowledge Educator (training; health promotion; industry framework/guideline formation); Investment and Finance (treatment cost; regulation; private insurance; subsidization; direct investment; collaborative financing; innovative financing; research). CONCLUSION These findings will be instrumental for LMICs considering private sector engagement. Potential conflicts of interest must be considered when implementing private sector involvement.
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Affiliation(s)
- Keiko Marshall
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,CONTACT Keiko Marshall University of Toronto
| | - Philippa Beaden
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Hammad Durrani
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Roman Mogilevskii
- Institute of Public Policy and Administration, University of Central Asia, Bishkek, Kyrgyzstan
| | - Zulfiqar Bhutta
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada,Centre for Excellence in Women and Child Health and Institute of Global Health and Development, The Aga Khan University, Karachi, Pakistan,Zulfiqar Bhutta Zulfiqar BhuttaCentre for Global Child Health Hospital, Sick Children 686 Bay Street, 11th Floor, Suite 11.9805 Toronto, ON M5G 0A4 Canada ext. 328532 Aga Khan University
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Sadeghi M, Jamalian M, Mehrabani-Zeinabad K, Turk-Adawi K, Kopec J, AlMahmeed W, Abdul Rahim HF, Farhan HA, Anwar W, Manla Y, Fadhil I, Lui M, Roohafza H, Islam SMS, Sulaiman K, Bazargani N, Saade G, Hassen N, Alandejani A, Abdin A, Bokhari S, Roth GA, Johnson C, Stark B, Sarrafzadegan N, Mokdad AH. The burden of ischemic heart disease and the epidemiologic transition in the Eastern Mediterranean Region: 1990-2019. PLoS One 2023; 18:e0290286. [PMID: 37669274 PMCID: PMC10479892 DOI: 10.1371/journal.pone.0290286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
It has been estimated that in the next decade, IHD prevalence, DALYs and deaths will increase more significantly in EMR than in any other region of the world. This study aims to provide a comprehensive description of the trends in the burden of ischemic heart disease (IHD) across the countries of the Eastern Mediterranean Region (EMR) from 1990 to 2019. Data on IHD prevalence, disability-adjusted life years (DALYs), mortality, DALYs attributable to risk factors, healthcare access and quality index (HAQ), and universal health coverage (UHC) were extracted from the Global Burden of Disease (GBD) database for EMR countries. The data were stratified based on the social demographic index (SDI). Information on cardiac rehabilitation was obtained from publications by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), and additional country-specific data were obtained through advanced search methods. Age standardization was performed using the direct method, applying the estimated age structure of the global population from 2019. Uncertainty intervals were calculated through 1000 iterations, and the 2.5th and 97.5th percentiles were derived from these calculations. The age-standardized prevalence of IHD in the EMR increased from 5.0% to 5.5% between 1990 and 2019, while it decreased at the global level. In the EMR, the age-standardized rates of IHD mortality and DALYs decreased by 11.4% and 15.4%, respectively, during the study period, although both rates remained higher than the global rates. The burden of IHD was found to be higher in males compared to females. Bahrain exhibited the highest decrease in age-standardized prevalence (-3.7%), mortality (-65.0%), and DALYs (-69.1%) rates among the EMR countries. Conversely, Oman experienced the highest increase in prevalence (14.5%), while Pakistan had the greatest increase in mortality (30.0%) and DALYs (32.0%) rates. The top three risk factors contributing to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particulate matter pollution. The trend analysis over the 29-year period (1990-2019) revealed that high fasting plasma glucose (64.0%) and high body mass index (23.4%) exhibited increasing trends as attributed risk factors for IHD DALYs in the EMR. Our findings indicate an increasing trend in the prevalence of IHD and a decrease in mortality and DALYs in the EMR. These results emphasize the need for well-planned prevention and treatment strategies to address the risk factors associated with IHD. It is crucial for the countries in this region to prioritize the development and implementation of programs focused on health promotion, education, prevention, and medical care.
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Affiliation(s)
- Masoumeh Sadeghi
- Cardiovascular Research Institute, Cardiac Rehabilitation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Jamalian
- Cardiovascular Research Institute, Hypertension Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kamran Mehrabani-Zeinabad
- Cardiovascular Research Institute, Pediatric Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karam Turk-Adawi
- Department of Public Health, QU-Health, Qatar University, Doha, Qatar
| | - Jacek Kopec
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Wael AlMahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Hanan F. Abdul Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Hasan Ali Farhan
- Scientific Council of Cardiology, Iraqi Board for Medical Specializations. Baghdad Heart Center, Baghdad, Iraq
| | - Wagida Anwar
- Faculty of Medicine, Community Medicine Department, Ain Shams University, Egypt and Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Yosef Manla
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | | | - Michelle Lui
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Hamidreza Roohafza
- Cardiovascular Research Institute, Interventional Cardiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | | | - George Saade
- Department of Cardiology, Bellevue Medical Center, Beirut, Lebanon
| | - Nejat Hassen
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Amani Alandejani
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Amr Abdin
- Syrian Cardiovascular Association, Damascus, Syria
| | - Saira Bokhari
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Gregory A. Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
- Department of Health Metrics Sciences, University of Washington, Seattle, United States of America
| | - Catherine Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
| | - Benjamin Stark
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
| | - Nizal Sarrafzadegan
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Cardiovascular Research Institute, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America
- Department of Health Metrics Sciences, University of Washington, Seattle, United States of America
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Somani NA, Marshall K, Durrani H, Tang K, Mogilevskii R, Bhutta Z. Evaluation of frameworks demonstrating the role of private sector in non-communicable disease management and control: a systematic review and thematic synthesis. BMJ Open 2023; 13:e061370. [PMID: 36868600 PMCID: PMC9990678 DOI: 10.1136/bmjopen-2022-061370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVES Conduct a systematic review of existing frameworks to understand the for-profit private sector's roles in non-communicable disease (NCD) control and management. Control includes population-level control measures that prevent NCDs and mitigate the magnitude of the NCD pandemic, and management includes treatment and management of NCDs. The for-profit private sector was defined as any private entities that make profit from their activities (ie, pharmaceutical companies, unhealthy commodity industries, distinct from not-for-profit trusts or charitable organisations). DESIGN A systematic review and inductive thematic synthesis was performed. Comprehensive searches of PubMed, EMBASE, Cochrane Library, Web of Science, Business Source Premier and Proquest/ABI Inform were conducted on 15 January 2021. Grey literature searches were conducted on 2 February 2021 using the websites of 24 relevant organisations. Searches were filtered to only include articles published from the year 2000 onwards, in English. Articles that included frameworks, models or theories and the for-profit private sector's role in NCD control and management were included. Two reviewers performed the screening, data extraction and quality assessment. Quality was assessed using the tool developed by Hawker et al for qualitative studies. SETTING The for-profit private sector. RESULTS There were 2148 articles initially identified. Following removal of duplicates, 1383 articles remained, and 174 articles underwent full-text screening. Thirty-one articles were included and used to develop a framework including six themes that outlined the roles that the for-profit private sector plays in NCD management and control. The themes that emerged included healthcare provision, innovation, knowledge educator, investment and financing, public-private partnerships, and governance and policy. CONCLUSION This study provides an updated insight on literature that explores the role of the private sector in controlling and monitoring NCDs. The findings suggest that the private sector could contribute, through various functions, to effectively manage and control NCDs globally.
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Affiliation(s)
- Nadia Amin Somani
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Keiko Marshall
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hammad Durrani
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Roman Mogilevskii
- Institute of Public Policy and Administration, University of Central Asia, Bishkek, Kyrgyzstan
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
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Ngaruiya C, Bernstein R, Leff R, Wallace L, Agrawal P, Selvam A, Hersey D, Hayward A. Systematic review on chronic non-communicable disease in disaster settings. BMC Public Health 2022; 22:1234. [PMID: 35729507 PMCID: PMC9210736 DOI: 10.1186/s12889-022-13399-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment. METHODS A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769). RESULTS Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity. CONCLUSIONS An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.
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Affiliation(s)
- Christine Ngaruiya
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA.
| | - Robyn Bernstein
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Rebecca Leff
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lydia Wallace
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Denise Hersey
- Director, Dana Medical Library, University of Vermont, Burlington, VT, USA
| | - Alison Hayward
- Division of Global Emergency Medicine, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
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Mezzi N, Messaoud O, Mkaouar R, Zitouna N, Romdhane S, Abdessalem G, Charfeddine C, Maazoul F, Ouerteni I, Hamdi Y, Zaouak A, Mrad R, Abdelhak S, Romdhane L. Spectrum of Genetic Diseases in Tunisia: Current Situation and Main Milestones Achieved. Genes (Basel) 2021; 12:1820. [PMID: 34828426 PMCID: PMC8617973 DOI: 10.3390/genes12111820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023] Open
Abstract
Genetic diseases in Tunisia are a real public health problem given their chronicity and the lack of knowledge concerning their prevalence and etiology, and the high rates of consanguinity. Hence, we performed systematic reviews of the literature in order to provide a more recent spectrum of these disorders and to expose the challenges that still exist to tackle these kinds of diseases. A manual textual data mining was conducted using MeSH and PubMed databases. Collected data were classified according to the CIM-10 classification and the transmission mode. The spectrum of these diseases is estimated to be 589 entities. This suggests remarkable progress through the development of biomedical health research activities and building capacities. Sixty percent of the reported disorders are autosomal recessive, which could be explained by the high prevalence of endogamous mating. Congenital malformations (29.54%) are the major disease group, followed by metabolic diseases (22%). Sixty percent of the genetic diseases have a known molecular etiology. We also reported additional cases of comorbidity that seem to be a common phenomenon in our population. We also noticed that epidemiological data are scarce. Newborn and carrier screening was only limited to pilot projects for a few genetic diseases. Collected data are being integrated into a database under construction that will be a valuable decision-making tool. This study provides the current situation of genetic diseases in Tunisia and highlights their particularities. Early detection of the disease is important to initiate critical intervention and to reduce morbidity and mortality.
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Affiliation(s)
- Nessrine Mezzi
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, Tunis 1002, Tunisia
- Department of Biology, Faculty of Sciences of Bizerte, Université Tunis Carthage, Jarzouna 7021, Tunisia
| | - Olfa Messaoud
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Rahma Mkaouar
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Nadia Zitouna
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Safa Romdhane
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Ghaith Abdessalem
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Cherine Charfeddine
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, Tunis 1002, Tunisia
- High Institute of Biotechnology of Sidi Thabet, Biotechpole of Sidi Thabet, University of Manouba, Ariana 2080, Tunisia
| | - Faouzi Maazoul
- Department of Congenital and Hereditary Diseases, Charles Nicolle Hospital, Tunis 1002, Tunisia
| | - Ines Ouerteni
- Department of Congenital and Hereditary Diseases, Charles Nicolle Hospital, Tunis 1002, Tunisia
| | - Yosr Hamdi
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, Tunis 1002, Tunisia
- Laboratory of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Anissa Zaouak
- Department of Dermatology, Research Unit Genodermatosis and Cancer LR12SP03, Habib Thameur Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1002, Tunisia
| | - Ridha Mrad
- Department of Congenital and Hereditary Diseases, Charles Nicolle Hospital, Tunis 1002, Tunisia
| | - Sonia Abdelhak
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Lilia Romdhane
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, Tunis 1002, Tunisia
- Department of Biology, Faculty of Sciences of Bizerte, Université Tunis Carthage, Jarzouna 7021, Tunisia
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Khiari H, Mallekh R, Cherif I, Hsairi M. Burden of non-communicable diseases in Tunisia, 1990-2017: results from the global burden of disease study. Pan Afr Med J 2021; 40:62. [PMID: 34804330 PMCID: PMC8590256 DOI: 10.11604/pamj.2021.40.62.30980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/04/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION non-communicable diseases (NCDs) are the leading cause of mortality and disability worldwide especially in developing countries such as Tunisia. We aimed to describe the national burden of non-communicable diseases in 2017 and to analyze disability-adjusted life year trends from 1990 to 2017 in Tunisia by cause and gender. METHODS we used Joinpoint regression analysis to assess trends of the age standardized disability-adjusted life year rate from 1990 to 2017 and to determine average annual percentage change. RESULTS non-communicable diseases accounted for 87.7% of total disability-adjusted life year in Tunisia in 2017. The five leading causes of this rate in Tunisia in 2017 were cardiovascular diseases, musculoskeletal disorders, neoplasms, mental disorders and neurological disorders. The trend of disability-adjusted life year rate of non-communicable diseases decreased significantly from 23403.2 per 100.000 (95% CI: 20830.2-26285.8) in 1990 to 18454.6 (95% CI: 15611.3-21555.4) in 2017, with a change of -0.9%; p=0.00. The decrease of the age standardized disability-adjusted life year rate concerned mainly cardiovascular diseases and neoplasms secondly. This decrease was more important in female (change=-1.1, p=0.00) in comparison to males (change=-0.7, p=0.00). On the other hand, the increase of the standardized disability-adjusted life year rate was related to musculoskeletal disorders, diabetes, kidney disorders and substance use disorders with a significant annual percentage change of 0.1%, 0.2% and 1.3% (p=0.00) respectively. Conclusion: the implementation of the national strategy is the key solution to mitigate the impact of non-communicable diseases in Tunisia.
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Affiliation(s)
- Houyem Khiari
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Rym Mallekh
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Cherif
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Hsairi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Heidari A, Arab M, Damari B. A policy analysis of the national phenylketonuria screening program in Iran. BMC Health Serv Res 2021; 21:120. [PMID: 33546689 PMCID: PMC7863318 DOI: 10.1186/s12913-021-06116-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Phenylketonuria (PKU) screening is a public health measure taken to diagnose and treat the patients with PKU to prevent severe neurological disorders in them. The present study was aimed at analyzing the policies of the national PKU screening (NaPS) program in Iran. Methods PKU screening program policies were analyzed in compliance with the policy triangle model. Document review and 38 semi-structured interviews were used for data collection. Document review data were analyzed using content analysis, and interview data were analyzed using framework analysis. Results The national PKU screening (NaPS) program was a decision made at the genetics department of Ministry of Health and Medical Education (MOHME) in Iran. Many internal and external stakeholders were involved in it and valid evidence was used to formulate the policies. Despite some opposition and insufficient support, the program was implemented due to the continuous persistence of parents, interested executives, formulated valid content and a top-down approach. The main barriers included rapid substitution of managers, shortage of Phe-free milk, little awareness of patients’ families, social stigma, and inadequate co-operation of some hospital administrators. Conclusions The policy triangle framework contributed to explaining the different components of the PKU screening program. A successful PKU screening program requires more stability of senior managers in MOHME, enough human resources and Phe-free milk, educating patients’ families, and commitment of hospitals administrators. Meanwhile, all the stakeholders need to be involved in the program effectively. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06116-w.
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Affiliation(s)
- Alireza Heidari
- Health Management and Social Development Research Center, Golestan University of Medical Sciences (GOUMS), Golha Alley, Gorgan, Iran.
| | - Mohammad Arab
- Department of Management and Health Economic, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Behzad Damari
- Governance and Health Department, Neuroscience Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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van Crevel R, Critchley JA. The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice. Trop Med Infect Dis 2021; 6:tropicalmed6010008. [PMID: 33435609 PMCID: PMC7838867 DOI: 10.3390/tropicalmed6010008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetes Mellitus increases the risk of developing Tuberculosis (TB) disease by about three times; it also doubles the risk of death during TB treatment and other poor TB treatment outcomes. Diabetes may increase the risk of latent infection with Mycobacterium tuberculosis (LTBI), but the magnitude of this effect is less clear. Whilst this syndemic has received considerable attention, most of the published research has focussed on screening for undiagnosed diabetes in TB patients or observational follow-up of TB treatment outcomes by diabetes status. There are thus substantial research and policy gaps, particularly with regard to prevention of TB disease in people with diabetes and management of patients with TB-diabetes, both during TB treatment and after successful completion of TB treatment, when they likely remain at high risk of TB recurrence, mortality from TB and cardiovascular disease. Potential strategies to prevent development of TB disease might include targeted vaccination programmes, screening for LTBI and preventive therapy among diabetes patients or, perhaps ideally, improved diabetes management and prevention. The cost-effectiveness of each of these, and in particular how each strategy might compare with targeted TB prevention among other population groups at higher risk of developing TB disease, is also unknown. Despite research gaps, clinicians urgently need practical management advice and more research evidence on the choice and dose of different anti-diabetes medication and effective medical therapies to reduce cardiovascular risks (statins, anti-hypertensives and aspirin). Substantial health system strengthening and integration may be needed to prevent these at risk patients being lost to care at the end of TB treatment.
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Affiliation(s)
- Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Correspondence:
| | - Julia A. Critchley
- Population Health Research Institute, St George’s, University of London, London SW17 ORE, UK;
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Haghravan S, Mohammadi-Nasrabadi F, Rafraf M. A critical review of national diabetes prevention and control programs in 12 countries in Middle East. Diabetes Metab Syndr 2021; 15:439-445. [PMID: 33592370 DOI: 10.1016/j.dsx.2021.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diabetes mellitus has been known as one of the most significant systemic diseases with severe consequences and challenges to human health. AIM The primary aim of the current paper was to review the diabetes prevention programs in the Middle East countries, and secondary compare their goals and success rate and conclude possible upcoming strategies. METHODS All reports and documents regarding to diabetes prevention and control programs in the region were collected by searching Web of Science, PubMed, MEDLINE, Google Scholar, Scopus and EMBASE for articles up to 2020. The health policy triangle framework was used to analyze diabetes policies and programs. In the Middle East, a shift from rural to urban life, socioeconomic development, sedentary lifestyles, and high fat and sugary foods consumption led to increasing in obesity and diabetes rate, which have become a real challenge. RESULTS To decrease the burden of diabetes, preventive strategies with proper local socio-cultural context are needed. Evaluation of current policies and identifying stakeholders' views can help to improve the current strategies for the prevalence of diabetes and its complications. CONCLUSIONS It can provide local and global insight to evidence-informed decision-making for future policy reforms to enhance effectiveness of the program.
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Affiliation(s)
- Simin Haghravan
- Students Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Mohammadi-Nasrabadi
- Research Department of Food and Nutrition Policy and Planning, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rafraf
- Nutrition Research Center, Faculty of Nutrition & Food Science, Tabriz University of Medical Sciences, Tabriz, Iran.
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10
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Alikhani M, Vatankhah S, Gorji HA, Ravaghi H. How Cancer Supportive and Palliative Care is Developed: Comparing the Policy-Making Process in Three Countries from Three Continents. Indian J Palliat Care 2020; 26:72-79. [PMID: 32132789 PMCID: PMC7017679 DOI: 10.4103/ijpc.ijpc_55_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Supportive and palliative care worldwide is recognized as one of the six main cancer control bases and plays an important role in managing the complications of cancer. Limited studies have been published in the field of this policy analysis in the world. Aim: This study aimed to analysis the policy-making process of supportive and palliative cancer care in three countries. Methodology: This qualitative study is a part of a comparative study. The data were collected through reviewing scientific and administrative documents, the World Health Organization website and reports, government websites, and other authoritative websites. Searches were done through texts in English and valid databases, in the period between 2000 and 2018. To investigate the policy process, heuristic stages model is implemented consisting of the four stages: agenda setting, policy formulation, policy implementation, and policy evaluation. Results: The findings of the study were categorized based on the conceptual model used in four areas related to the policy process, including agenda setting, policy formulation, policy implementation, and evaluation of cancer palliative care policies. Conclusion: Several factors are involved in how cancer palliative care policy is included in policy-makers' agenda, understanding a necessity, raising public awareness, and acceptance as a result of sensing the physical and nonphysical care outcomes. The stages of development, implementation, and evaluation of palliative care in countries regardless of existing differences are a function of the health system and context of each country.
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Affiliation(s)
- Mahtab Alikhani
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Vatankhah
- Department of Health Services Management, Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Abolghasem Gorji
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Ravaghi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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11
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Oleribe OO, Momoh J, Uzochukwu BSC, Mbofana F, Adebiyi A, Barbera T, Williams R, Taylor-Robinson SD. Identifying Key Challenges Facing Healthcare Systems In Africa And Potential Solutions. Int J Gen Med 2019; 12:395-403. [PMID: 31819592 PMCID: PMC6844097 DOI: 10.2147/ijgm.s223882] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/17/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Healthcare systems in Africa suffer from neglect and underfunding, leading to severe challenges across the six World Health Organization (WHO) pillars of healthcare delivery. We conducted this study to identify the principal challenges in the health sector in Africa and their solutions for evidence-based decisions, policy development and program prioritization. METHODS The study was conducted as part of a recent African Epidemiological Association Meeting in Maputo, Mozambique with participants drawn from 11 African countries, Cuba, Portugal and the United Kingdom. Participants were divided into 10 groups, consisting of 7 to 10 persons each. Brainstorming approaches were used in a structured, modified nominal group process exercise to identify key challenges and strategies to mitigate healthcare service challenges in Africa. Identified challenges and solutions were prioritised by ranking 1-5, with 1 most important and 5 being least important. RESULTS The first three challenges identified were inadequate human resources (34.29%), inadequate budgetary allocation to health (30%) and poor leadership and management (8.45%). The leading solutions suggested included training and capacity building for health workers (29.69%), increase budgetary allocation to health (20.31%) and advocacy for political support and commitment (12.31%). CONCLUSION The underdeveloped healthcare systems in Africa need radical solutions with innovative thought to break the current impasse in service delivery. For example, public-private initiatives should be sought, where multinational companies extracting resources from Africa might be encouraged to plough some of the profits back into healthcare for the communities providing the workforce for their commercial activities. Most problems and their solutions lie within human resources, budget allocation and management. These should be accorded the highest priority for better health outcomes.
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Affiliation(s)
- Obinna O Oleribe
- Excellence and Friends Management Care Centre (EFMC), Abuja, Nigeria
| | - Jenny Momoh
- Department of Epidemiology and Community Medicine, Federal University Lafia, Nasarawa State, Nigeria
| | - Benjamin SC Uzochukwu
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | | | | | - Thomas Barbera
- Liver Unit, Department of Surgery and Cancer, St Mary’s Campus, Imperial College London, LondonW2 1PG, UK
| | | | - Simon D Taylor-Robinson
- Liver Unit, Department of Surgery and Cancer, St Mary’s Campus, Imperial College London, LondonW2 1PG, UK
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12
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Burden of cardiovascular diseases in the Eastern Mediterranean Region, 1990-2015: findings from the Global Burden of Disease 2015 study. Int J Public Health 2018; 63:137-149. [PMID: 28776245 PMCID: PMC5973984 DOI: 10.1007/s00038-017-1012-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/20/2017] [Accepted: 06/28/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To report the burden of cardiovascular diseases (CVD) in the Eastern Mediterranean Region (EMR) during 1990-2015. METHODS We used the 2015 Global Burden of Disease study for estimates of mortality and disability-adjusted life years (DALYs) of different CVD in 22 countries of EMR. RESULTS A total of 1.4 million CVD deaths (95% UI: 1.3-1.5) occurred in 2015 in the EMR, with the highest number of deaths in Pakistan (465,116) and the lowest number of deaths in Qatar (723). The age-standardized DALY rate per 100,000 decreased from 10,080 in 1990 to 8606 in 2015 (14.6% decrease). Afghanistan had the highest age-standardized DALY rate of CVD in both 1990 and 2015. Kuwait and Qatar had the lowest age-standardized DALY rates of CVD in 1990 and 2015, respectively. High blood pressure, high total cholesterol, and high body mass index were the leading risk factors for CVD. CONCLUSIONS The age-standardized DALY rates in the EMR are considerably higher than the global average. These findings call for a comprehensive approach to prevent and control the burden of CVD in the region.
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13
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da Silva Marinho MG, Fontbonne A, Vasconcelos Barbosa JM, de Melo Rodrigues H, Freese de Carvalho E, Vieira de Souza W, Pessoa Cesse EA. The impact of an intervention to improve diabetes management in primary healthcare professionals' practices in Brazil. Prim Care Diabetes 2017; 11:538-545. [PMID: 28663022 DOI: 10.1016/j.pcd.2017.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/30/2017] [Accepted: 06/03/2017] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate the results of a structured intervention in primary healthcare to improve type 2 diabetes management. METHODS The intervention was implemented in 2011-2012 in two cities in the State of Pernambuco, Brazil, and evaluated in 2013 by interviewing healthcare professionals about their practices in all primary care facilities of these two cities (intervention group), and of two paired control cities (control group). Comparisons between the intervention and control groups were made using standard parametric tests. RESULTS The percentage of professionals who measured adherence to treatment, developed educational actions to control high-risk situations or prevent complications, or declared that they "explained" the disease to the patients, was higher in the control group (p<0.05). Multidisciplinary involvement, requests for electrocardiograms and referrals to specialists were also more frequent in the control group (p<0.01). The only differences favoring the intervention group were the higher proportion of nurses (p<0.05) and community health workers (p<0.01) trained for diabetes management and a greater frequency of discussing the cases of diabetic patients at team meetings (p<0.01). CONCLUSIONS These negative results raise questions about the effectiveness of actions aiming to improve diabetes management in primary care, and reinforce the need for careful evaluation of their impact.
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MESH Headings
- Adolescent
- Adult
- Aged
- Brazil/epidemiology
- Cross-Sectional Studies
- Delivery of Health Care, Integrated/standards
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/therapy
- Female
- Health Care Surveys
- Health Knowledge, Attitudes, Practice
- Health Services Research
- Humans
- Male
- Middle Aged
- Patient Care Team/standards
- Patient Education as Topic/standards
- Practice Patterns, Physicians'/standards
- Primary Health Care/standards
- Process Assessment, Health Care/standards
- Professional Practice/standards
- Program Evaluation
- Quality Improvement/standards
- Quality Indicators, Health Care/standards
- Self Care/standards
- Time Factors
- Treatment Outcome
- Urban Health Services/standards
- Young Adult
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Affiliation(s)
| | - Annick Fontbonne
- UMR 204 Nutripass, Institute of Research for Development (IRD), Montpellier University, Montpellier, France.
| | | | | | - Eduardo Freese de Carvalho
- Department of Community Health, Aggeu Magalhães Research Centre, Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil
| | - Wayner Vieira de Souza
- Department of Community Health, Aggeu Magalhães Research Centre, Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil
| | - Eduarda Angela Pessoa Cesse
- Department of Community Health, Aggeu Magalhães Research Centre, Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil
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Roncarolo F, Boivin A, Denis JL, Hébert R, Lehoux P. What do we know about the needs and challenges of health systems? A scoping review of the international literature. BMC Health Serv Res 2017; 17:636. [PMID: 28886736 PMCID: PMC5591541 DOI: 10.1186/s12913-017-2585-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/30/2017] [Indexed: 11/12/2022] Open
Abstract
Background While there is an extensive literature on Health System (HS) strengthening and on the performance of specific HSs, there are few exhaustive syntheses of the challenges HSs are facing worldwide. This paper reports the findings of a scoping review aiming to classify the challenges of HSs investigated in the scientific literature. Specifically, it determines the kind of research conducted on HS challenges, where it was performed, in which health sectors and on which populations. It also identifies the types of challenge described the most and how they varied across countries. Methods We searched 8 databases to identify scientific papers published in English, French and Italian between January 2000 and April 2016 that addressed HS needs and challenges. The challenges reported in the articles were classified using van Olmen et al.’s dynamic HS framework. Countries were classified using the Human Development Index (HDI). Our analyses relied on descriptive statistics and qualitative content analysis. Results 292 articles were included in our scoping review. 33.6% of these articles were empirical studies and 60.1% were specific to countries falling within the very high HDI category, in particular the United States. The most frequently researched sectors were mental health (41%), infectious diseases (12%) and primary care (11%). The most frequently studied target populations included elderly people (23%), people living in remote or poor areas (21%), visible or ethnic minorities (15%), and children and adolescents (15%). The most frequently reported challenges related to human resources (22%), leadership and governance (21%) and health service delivery (24%). While health service delivery challenges were more often examined in countries within the very high HDI category, human resources challenges attracted more attention within the low HDI category. Conclusions This scoping review provides a quantitative description of the available evidence on HS challenges and a qualitative exploration of the dynamic relationships that HS components entertain. While health services research is increasingly concerned about the way HSs can adopt innovations, little is known about the system-level challenges that innovations should address in the first place. Within this perspective, four key lessons are drawn as well as three knowledge gaps. Electronic supplementary material The online version of this article (10.1186/s12913-017-2585-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Federico Roncarolo
- Institute of Public Health Research of Université de Montréal (IRSPUM), Montreal, Canada
| | - Antoine Boivin
- Institute of Public Health Research of Université de Montréal (IRSPUM), Montreal, Canada.,Department of Family Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Research Center of the Université de Montréal Health Center (CRCHUM), Montreal, Canada.,Canada Research Chair in Patient and Public Partnership, Montreal, Canada
| | - Jean-Louis Denis
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, P.O. Box 6128, Branch Centre-ville, Montreal, QC, H3C 3J7, Canada.,Canada Research Chair in Governance and Transformation of Health Organizations and Systems, Montreal, Canada
| | - Rejean Hébert
- Institute of Public Health Research of Université de Montréal (IRSPUM), Montreal, Canada.,Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, P.O. Box 6128, Branch Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Pascale Lehoux
- Institute of Public Health Research of Université de Montréal (IRSPUM), Montreal, Canada. .,Research Center of the Université de Montréal Health Center (CRCHUM), Montreal, Canada. .,Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, P.O. Box 6128, Branch Centre-ville, Montreal, QC, H3C 3J7, Canada. .,Université de Montréal Chair on Responsible Innovation in Health, Montreal, Canada.
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Heidari A, Arab M, Etemad K, Damari B, Kabir MJ. Challenges of Implementation of the National Phenylketonuria Screening Program in Iran: A Qualitative Study. Electron Physician 2016; 8:3048-3056. [PMID: 27957302 PMCID: PMC5133027 DOI: 10.19082/3048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/12/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction Newborn screening (NBS) is a public health measure aimed at identification of early cases, management of afflicted infants, and making efforts to reduce the morbidity and mortality among newborns. All countries may face challenges in implementation of screening programs. The present study aimed to determine the challenges of implementation of the National Phenylketonuria (PKU) Screening Program in Iran. Methods In this qualitative study, 38 health policymakers, managers, and PKU experts in Iran were purposively selected as the respondents in 2015. The semi-structured interview was used for collecting the required data and information. After transcription of interviews, their content was analyzed using framework analysis. Results The results were categorized into five main themes and 22 subthemes. The main themes extracted from data were management challenges, diagnosis challenges, treatment challenges, care challenges, and patients’ family problems. Each category consisted of several subthemes. Conclusion Considering the challenges of implementing this program, some measures such as increased stability of managers in the health system, greater interaction of the Ministry of Health and Medical Education with the heath stakeholders, improving the level of parents’ awareness, the use of efficient information systems, support and legal backing for requiring parents who refuse newborn screening for various reasons, and appropriate insurance coverage seem necessary to be taken.
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Affiliation(s)
- Alireza Heidari
- Ph.D. Candidate of Health Policy, Department of Management and Health Economic, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Arab
- Professor, Health Services Management, Department of Management and Health Economic, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Koorosh Etemad
- Assistant Professor, Department of Epidemiology, Environmental and Occupational Hazards Control Research Center, Faculty of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Damari
- Assistant Professor, Community Medicine, Department of Social Determinant of Health, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Kabir
- Assistant Professor, Health Services Management, Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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