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Alie MS, Girma D, Adugna A, Negesse Y. Diabetes mellitus service preparedness and availability: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1427175. [PMID: 39099669 PMCID: PMC11294177 DOI: 10.3389/fendo.2024.1427175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/28/2024] [Indexed: 08/06/2024] Open
Abstract
Background In areas with limited resources, the lack of preparedness and limited availability of diabetes mellitus services in healthcare facilities contribute to high rates of illness and death related to diabetes mellitus. As a result, this study focused on analyzing the combined prevalence of preparedness and availability of diabetic services in countries with limited resources. Methods A comprehensive search was conducted across various databases, such as PubMed/MEDLINE, Web of Science, Google Scholar, and African Journal Online. The search aimed to identify primary research articles that assessed the availability and preparedness of services for individuals with type 2 diabetes mellitus specifically. The articles included in the search spanned from January 2000 to 23 February 2024. To analyze the data, a meta-analysis of proportions was performed using the random-effects model. Additionally, the researchers assessed publication bias by examining a funnel plot and conducting Egger's test. Heterogeneity and sensitivity analyses were also conducted to evaluate the data. The findings of the study regarding the pooled prevalence of diabetes service preparedness and availability, along with their corresponding 95% confidence intervals, were presented using a forest plot. Results A comprehensive analysis was conducted on 16 research articles that focused on service preparedness and 11 articles that examined service availability. The sample sizes for these studies were 3,422 for service preparedness and 1,062 for service availability. The findings showed that the pooled prevalence of diabetes service preparedness was 53.0% (95% CI: 47.0-60.0). Furthermore, in this systematic synthesis, the overall pooled prevalence of service availability for diabetes mellitus was 48% (95% CI: 36.0-67.0), with the highest pooled prevalence observed in Asia, with a pooled prevalence of 58% (95% CI: 38.0-89.0). Conclusion Our study reveals a significant disparity in the preparedness and availability of services for diabetes mellitus, which falls below the minimum threshold set by the WHO. These findings should capture the attention of policymakers and potentially serve as a foundation for reevaluating the current approach to diabetes service preparedness and availability. To enhance the availability and preparedness of diabetes services, a tailored, multifaceted, and action-oriented approach to strengthening the health system is required. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42024554911.
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Affiliation(s)
- Melsew Setegn Alie
- Department of Public Health, School of Public Health, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Desalegn Girma
- Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Amauel Adugna
- Department of Midwifery, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Yilkal Negesse
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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Orji IA, Baldridge AS, Ikechukwu-Orji MU, Banigbe B, Eze NC, Chopra A, Omitiran K, Iyer G, Odoh D, Alex-Okoh M, Reng R, Hirschhorn LR, Huffman MD, Ojji DB. Evaluating diabetes care in primary healthcare centers in Abuja, Nigeria: a cross-sectional formative assessment. BMC PRIMARY CARE 2024; 25:243. [PMID: 38969978 PMCID: PMC11227205 DOI: 10.1186/s12875-024-02487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
INTRODUCTION Noncommunicable diseases (NCDs) are associated with high and rising burden of morbidity and mortality in sub-Saharan Africa, including Nigeria. Diabetes mellitus (DM) is among the leading causes of NCD-related deaths worldwide and is a foremost public health problem in Nigeria. As part of National policy, Nigeria has committed to implement the World Health Organization (WHO) Package of Essential Non-communicable Disease interventions for primary care. Implementing the intervention requires the availability of essential elements, including guidelines, trained staff, health management information systems (HMIS), equipment, and medications, in primary healthcare centers (PHCs). This study assessed the availability of the DM component of the WHO package, and the readiness of the health workers in these PHCs to implement a DM screening, evaluation, and management program to inform future adoption and implementation. METHODS This cross-sectional formative assessment adapted the WHO Service Availability and Readiness Assessment (SARA) tool to survey 30 PHCs selected by multistage sampling for readiness to deliver DM diagnosis and care in Abuja, Nigeria, between August and October 2021. The SARA tool was adapted to focus on DM services and the availability and readiness indicator scores were calculated based on the proportion of PHCs with available DM care services, minimum staff requirement, diagnostic tests, equipment, medications, and national guidelines/protocols for DM care within the defined SARA domain. RESULTS All 30 PHCs reported the availability of at least two full-time staff (median [interquartile range] = 5 [4-9]), which were mostly community health extension workers (median [interquartile range]) = 3 [1-4]. At least one staff member was recently trained in DM care in 11 PHCs (36%). The study also reported high availability of paper-based HMIS (100%), and DM screening services using a glucometer (87%), but low availability of DM job aids (27%), treatment (23%), and national guidelines/protocols (0%). CONCLUSION This formative assessment of PHCs' readiness to implement a DM screening, evaluation, and management program in Abuja demonstrated readiness to integrate DM care into PHCs regarding equipment, paper-based HMIS, and nonphysician health workers' availability. However, strategies are needed to promote DM health workforce training, provide DM management guidelines, and supply essential DM medications.
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Affiliation(s)
- Ikechukwu A Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria.
| | - Abigail S Baldridge
- Department of Medical Social Science, Feinberg School of Medicine, Northwestern University and Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Mercy U Ikechukwu-Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Nelson C Eze
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Aashima Chopra
- Department of Medical Social Science, Feinberg School of Medicine, Northwestern University and Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Kasarachi Omitiran
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Guhan Iyer
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Deborah Odoh
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | | | - Rifkatu Reng
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Gwagwalada, Abuja, Nigeria
| | - Lisa R Hirschhorn
- Department of Medical Social Science, Feinberg School of Medicine, Northwestern University and Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Mark D Huffman
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, MO, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Gwagwalada, Abuja, Nigeria
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Kohler S, Bärnighausen T, Kazonda P, Leyna GH, Lohmann J, Killewo J, Rohr JK, Stieglitz LM, Paul N. Chronic Conditions and Multimorbidity Among Middle-Aged and Elderly Peri-Urban Dwellers in Dar es Salaam, Tanzania. Int J Public Health 2024; 69:1606387. [PMID: 38988502 PMCID: PMC11233465 DOI: 10.3389/ijph.2024.1606387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
Objectives Chronic conditions and multimorbidity affect care needs and prevention opportunities. Methods We studied 2,246 men and women aged ≥40 years within the Dar es Salaam Urban Cohort Study from June 2017 to July 2018. Seventeen chronic conditions were assessed based on self-report, body and blood pressure measurement, blood tests, and screening instruments. Results Hypertension (51.3%), anemia (34.1%), obesity (32.2%), diabetes (31.6%), depressive symptoms (31.5%), low grip strength (21.2%), and ischemic heart disease (11.9%) were widespread. Multimorbidity was common (73.7%). Women had higher odds of obesity, ischemic heart disease, and high cholesterol (adjusted OR: 2.08-4.16) and lower odds of underweight, low grip strength, alcohol problems, and smoking (adjusted OR: 0.04-0.45). Ten years of age were associated with higher odds of low grip strength, cognitive problems, hypertension, kidney disease, chronic cough, diabetes, high cholesterol, ischemic heart disease, and multimorbidity (adjusted OR: 1.21-1.81) and lower odds of HIV infection (adjusted OR: 0.51). Conclusion We found a higher prevalence of multimorbidity than previously estimated for middle-aged and elderly people in sub-Saharan Africa. The chronic conditions underlying multimorbidity differed by sex.
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Affiliation(s)
- Stefan Kohler
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Berlin, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | - Germana H Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julia Lohmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julia K Rohr
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, United States
| | - Laura-Marie Stieglitz
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Nicolas Paul
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
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Ravindranath R, Sarma PS, Sivasankaran S, Thankappan KR, Jeemon P. Voices of care: unveiling patient journeys in primary care for hypertension and diabetes management in Kerala, India. Front Public Health 2024; 12:1375227. [PMID: 38846619 PMCID: PMC11155455 DOI: 10.3389/fpubh.2024.1375227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
Background Diabetes and hypertension are leading public health problems, particularly affecting low- and middle-income countries, with considerable variations in the care continuum between different age, socio-economic, and rural and urban groups. In this qualitative study, examining the factors affecting access to healthcare in Kerala, we aim to explore the healthcare-seeking pathways of people living with diabetes and hypertension. Methods We conducted 20 semi-structured interviews and one focus group discussion (FGD) on a purposive sample of people living with diabetes and hypertension. Participants were recruited at four primary care facilities in Malappuram district of Kerala. Interviews were transcribed and analyzed deductively and inductively using thematic analysis underpinned by Levesque et al.'s framework. Results The patient journey in managing diabetes and hypertension is complex, involving multiple entry and exit points within the healthcare system. Patients did not perceive Primary Health Centres (PHCs) as their initial points of access to healthcare, despite recognizing their value for specific services. Numerous social, cultural, economic, and health system determinants underpinned access to healthcare. These included limited patient knowledge of their condition, self-medication practices, lack of trust/support, high out-of-pocket expenditure, unavailability of medicines, physical distance to health facilities, and attitude of healthcare providers. Conclusion The study underscores the need to improve access to timely diagnosis, treatment, and ongoing care for diabetes and hypertension at the lower level of the healthcare system. Currently, primary healthcare services do not align with the "felt needs" of the community. Practical recommendations to address the social, cultural, economic, and health system determinants include enabling and empowering people with diabetes and hypertension and their families to engage in self-management, improving existing health information systems, ensuring the availability of diagnostics and first-line drug therapy for diabetes and hypertension, and encouraging the use of single-pill combination (SPC) medications to reduce pill burden. Ensuring equitable access to drugs may improve hypertension and diabetes control in most disadvantaged groups. Furthermore, a more comprehensive approach to healthcare policy that recognizes the interconnectedness of non-communicable diseases (NCDs) and their social determinants is essential.
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Affiliation(s)
- Ranjana Ravindranath
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - P. Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | | | | | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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K. Banda C, Banda NPK, Gombachika BT, Nyirenda MJ, Hosseinipour MC, Muula AS. Primary health care preparedness to integrate diabetes care in Blantyre, Malawi: A mixed methods study. PLoS One 2024; 19:e0303030. [PMID: 38771783 PMCID: PMC11108178 DOI: 10.1371/journal.pone.0303030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/15/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND There is limited access to diabetes care services at primary care facilities in Malawi. Assessing the capacity of facilities to provide diabetes care is an initial step to integrating services at primary care. AIM To assess the preparedness for delivering diabetes services at primary care level within the Blantyre District Health Office (DHO) to support the response to NCD epidemic in Malawi. SETTING Blantyre DHO primary care facilities. MATERIALS AND METHODS A mixed methods approach nested in a national needs assessment for NCD response in Malawi was used. Fourteen primary healthcare facilities from Blantyre DHO were assessed. A tool adapted from the WHO rapid assessment questionnaire was used to identify human resource, equipment, supplies, and medication needed for comprehensive diabetes care. Descriptive statistics were done to analyze the quantitative data. Fisher's exact test was used to assess if there was a statistically significant difference between urban and rural facilities. Seventeen health care workers from the selected facilities participated in key informant interviews. Framework analysis method guided the qualitative data analysis. The quantitative and qualitative data were merged and displayed jointly. RESULTS The quantitative assessment showed that none of the facilities assessed had capacity to provide all the interventions recommended by WHO for diabetes care at primary level. Eight (57%) of the facilities had the capacity to diagnose diabetes, monitor glucose, prevent limb amputations and manage hypoglycemia and hyperglycemia. Four themes emerged from the qualitative data: differences in level of preparedness and implementation of diabetes care; disparities in resources between urban and rural facilities; low utilization of diabetes services; and strategy and policy recommendations for improvement of diabetes care. CONCLUSION Inadequate health financing resulted in significant disparities in the available resources between the rural and urban facilities to offer diabetes care services. There is need to develop national policies and guidelines for diabetes care to strengthen the capacity of primary care facilities to facilitate achievement of universal health coverage.
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Affiliation(s)
- Chimwemwe K. Banda
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Public Health Group, Malawi Liverpool Wellcome Program, Blantyre, Malawi
| | | | | | - Moffat J. Nyirenda
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- Uganda MRC/UVRI Research Unit, Entebbe, Uganda
- NCD-BRITE Consortium, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mina C. Hosseinipour
- NCD-BRITE Consortium, Kamuzu University of Health Sciences, Blantyre, Malawi
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill NC, United States of America
- UNC Project Malawi, Lilongwe, Malawi
| | - Adamson S. Muula
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- NCD-BRITE Consortium, Kamuzu University of Health Sciences, Blantyre, Malawi
- Africa Center of Excellence in Public Health and Herbal Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
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Orji IA, Baldridge AS, Ikechukwu-Orji MU, Banigbe B, Eze NC, Chopra A, Omitiran K, Iyer G, Odoh D, Alex-Okoh M, Reng R, Hirschhorn LR, Huffman MD, Ojji DB. Evaluation of Primary Healthcare Centers' Service Availability and Readiness for Implementing Diabetes Care in Abuja, Nigeria: A Cross-Sectional, Formative Assessment. RESEARCH SQUARE 2024:rs.3.rs-3959541. [PMID: 38585872 PMCID: PMC10996784 DOI: 10.21203/rs.3.rs-3959541/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Introduction Noncommunicable diseases (NCDs) are associated with a high and rising burden of morbidity and mortality in sub-Saharan Africa, including Nigeria. Diabetes mellitus (DM) is among the leading causes of NCD-related deaths worldwide and is a foremost public health problem in Nigeria. As part of the National Multi-Sectoral Action Plan for the Prevention and Control of NCDs, Nigeria has committed to implementing the World Health Organization (WHO) Package of Essential NCD control interventions. Implementing the intervention requires the availability of essential elements, including guidelines, trained staff, health management information systems, equipment, and medications, in primary healthcare centers (PHCs). This study assessed the availability of the WHO package components and the readiness of PHCs to implement a DM screening, evaluation, and management program. Methods This cross-sectional formative assessment adapted the WHO Service Availability and Readiness Assessment (SARA) tool to survey 30 PHCs selected by multistage sampling for readiness to deliver DM diagnosis and care in Abuja, Nigeria, between August 2021 and October 2021. The service availability and readiness indicator scores were calculated based on the proportion of PHCs with available DM care services, minimum staff requirement, diagnostic tests, equipment, medications, and national guidelines/protocols for DM care within the defined SARA domain. Results All 30 PHCs reported the availability of at least two full-time staff (median [interquartile range] staff = 5 [4-9]), which were mostly community health extension workers (median [interquartile range]) = 3 [1-4]. At least one staff member was recently trained in DM care in only 11 (36%) of the PHCs. The study also reported high availability (100%) of paper-based health management information systems (HMIS) and DM screening services using a glucometer (87%), but low availability of DM treatment (23%), printed job aids (27%), and national guidelines/protocols (0%). Conclusion This systematic assessment of PHCs' readiness to implement a DM screening, evaluation, and management program in Abuja demonstrated readiness to integrate DM care into PHCs in terms of equipment, paper-based HMIS, and nonphysician health workers' availability. However, strategies are needed to promote DM health workforce training, provide DM management guidelines, and ensure a reliable supply of essential DM medications.
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Affiliation(s)
- Ikechukwu A Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja
| | - Abigail S Baldridge
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine and Robert J Havey Institute for Global Health, Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Nelson C Eze
- Department of Public Health, Federal Ministry of Health, Abuja
| | - Aashima Chopra
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine and Robert J Havey Institute for Global Health, Feinberg School of Medicine, Chicago, Illinois
| | - Kasarachi Omitiran
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja
| | - Guhan Iyer
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri
| | - Deborah Odoh
- Department of Public Health, Federal Ministry of Health, Abuja
| | | | - Rifkatu Reng
- Prof. F. Anuma Diabetes & Endocrine Center, University of Abuja Teaching Hospital, Gwagwalada, Abuja
| | - Lisa R Hirschhorn
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine and Robert J Havey Institute for Global Health, Feinberg School of Medicine, Chicago, Illinois
| | - Mark D Huffman
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja
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Defar A, Zeleke GT, Berhanu D, Lemango ET, Bekele A, Alemu K, Biadgilign S. Health system's availability and readiness of health facilities for chronic non-communicable diseases: Evidence from the Ethiopian national surveys. PLoS One 2024; 19:e0297622. [PMID: 38394315 PMCID: PMC10890768 DOI: 10.1371/journal.pone.0297622] [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: 02/04/2022] [Accepted: 01/09/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) currently cause more deaths than all other causes of deaths. Cardiovascular disease, diabetes, cancer, and chronic respiratory diseases-threaten the health and economies of individuals and populations worldwide. This study aimed to assess the availability and readiness of health facilities for chronic non-communicable diseases (NCDs) and describe the changes of service availability for common NCDs in Ethiopia. Methods We used data from the 2014 Ethiopia Service Provision Assessment Plus (ESPA +) and 2016 and 2018 Service Availability and Readiness Assessment (SARA) surveys, which were cross-sectional health facility-based studies. A total of 873 health facilities in 2014, 547 in 2016, 632 in 2018 were included in the analysis. (ESPA+) and SARA surveys are conducted as a census or a nationally/sub-nationally representative sample of health facilities. Proportion of facilities that offered the service for diabetes, cardiovascular disease, chronic respiratory disease, cancer diseases, mental illness, and chronic renal diseases was calculated to measure health service availability. The health facility service readiness was measured using the mean availably of tracer items that are required to offer the service. Thus, 13 tracer items for diabetes disease, 12 for cardiovascular disease, 11 for chronic respiratory disease and 11 cervical cancer services were used. RESULTS The services available for diagnosis and management did not show improvement between 2014, 2016 and 2018 for diabetes (59%, 22% and 36%); for cardiovascular diseases (73%, 41% and 49%); chronic respiratory diseases (76%, 45% and 53%). Similarly, at the national level, the mean availability of tracer items between 2014, 2016 and 2018 for diabetes (37%, 53% and 48%); cardiovascular diseases (36%, 41% and 42%); chronic respiratory diseases (26%, 27% and 27%); and cancer diseases (6%, 72% and 51%). However, in 2014 survey year, the mean availability of tracer items was 7% each for mental illness and chronic renal diseases, respectively. CONCLUSIONS The majority of the health facilities have low and gradual decrement in the availability to provide NCDs services in Ethiopia. There is a need to increase NCD service availability and readiness at primary hospitals and health centers, and private and rural health facilities where majority of the population need the services.
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Affiliation(s)
- Atkure Defar
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | | | - Della Berhanu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ephrem Tekle Lemango
- Maternal, Child Health and Nutrition Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Abebe Bekele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kassahun Alemu
- College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Sibhatu Biadgilign
- Independent Public Health Analyst and Research Consultant, Addis Ababa, Ethiopia
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Molefe-Baikai OJ, Kebotsamang K, Modisawakgomo P, Tlhakanelo JT, Motlhatlhedi K, Moshomo T, Youssouf NF, Masupe T, Gaolathe T, Tapela N, Lockman S, Mosepele M. Self-reported cardiovascular disease risk factor screening among people living with HIV vs. members of the general population in Botswana: a community-based study. BMC Public Health 2024; 24:198. [PMID: 38229024 PMCID: PMC10792864 DOI: 10.1186/s12889-024-17651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Morbidity and mortality due to cardiovascular diseases (CVDs) are high and increasing in low- and middle-income countries. People living with HIV (PLWH) are more likely to experience CVD than members of the general population. Therefore, we aimed to assess whether PLWH were more likely to have previously been screened for cardiovascular disease risk factors (CVDRFs) than people without HIV. METHODS A population-based, cross-sectional study was conducted among individuals aged 16 to 68 years across 22 communities in Botswana from February to August 2017 as part of a larger community-based cluster randomized HIV treatment-as-prevention trial. Participants were asked if they had been screened for and counselled on cardiovascular disease risk factors (history of hypertension or blood pressure check, blood glucose and cholesterol measurements, weight check and weight control, tobacco smoking and cessation, alcohol use and physical activity) in the preceding 3 years. HIV testing was offered to those with an unknown HIV status. Multiple logistic regression analysis controlling for age and sex was used to assess the relationship between CVDRF screening and HIV status. RESULTS Of the 3981 participants enrolled, 2547 (64%) were female, and 1196 (30%) were PLWH (93% already on antiretroviral therapy [ART]). PLWH were more likely to report previous screening for diabetes (25% vs. 19%, p < 0.001), elevated cholesterol (17% vs. 12%, p < 0.001) and to have had their weight checked (76% vs. 55%, p < 0.001) than HIV-uninfected participants. PLWH were also more likely to have received counselling on salt intake (42% vs. 33%, p < 0.001), smoking cessation (66% vs. 46%, p < 0.001), weight control (38% vs. 29%, p < 0.001), physical activity (46% vs. 34%, p < 0.001) and alcohol consumption (35% vs. 23%, p < 0.001) than their HIV-uninfected counterparts. Overall, PLWH were more likely to have received screening for and/or counselling on CVDRFs (adjusted odds ratio 1.84, 95% CI: 1.46-2.32, p < 0.001). CONCLUSION PLWH were almost two times more likely to have been previously screened for CVDRFs than those without HIV, indicating a need for universal scale-up of integrated management and prevention of CVDs in the HIV-uninfected population.
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Affiliation(s)
- Onkabetse Julia Molefe-Baikai
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana.
| | - Kago Kebotsamang
- Faculty of Social Sciences, Department of Statistics, University of Botswana, Gaborone, Botswana
| | | | - John Thato Tlhakanelo
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Keneilwe Motlhatlhedi
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Thato Moshomo
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
| | - Nabila Farah Youssouf
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- London School of Hygiene and Tropical Medicine, London, UK
| | - Tiny Masupe
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Tendani Gaolathe
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- International Consortium for Health Outcomes Measurement, Boston, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, USA
| | - Mosepele Mosepele
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Princess Marina Hospital, Gaborone, Botswana
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, USA
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Prattipati S, Tarimo TG, Kweka GL, Mlangi JJ, Samuel D, Sakita FM, Tupetz A, Bettger JP, Thielman NM, Temu G, Hertz JT. Patient and provider perspectives on barriers to myocardial infarction care among persons with human immunodeficiency virus in Tanzania: A qualitative study. Int J STD AIDS 2024; 35:18-24. [PMID: 37703080 PMCID: PMC11139408 DOI: 10.1177/09564624231199507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION People with HIV (PLWH) have an increased risk myocardial infarction (MI), and evidence suggests that MI is under-diagnosed in Tanzania. However, little is known about barriers to MI care among PLWH in the region. METHODS In this qualitative study grounded in phenomenology, semi-structured interviews were conducted in northern Tanzania. Purposive sampling was used to recruit a diverse group of providers who care for PLWH and patients with HIV and electrocardiographic evidence of prior MI. Emergent themes were identified via inductive thematic analysis. RESULTS 24 physician and patient participants were interviewed. Most participants explained MI as caused by emotional shock and were unaware of the association between HIV and increased MI risk. Providers described poor provider training regarding MI, high out-of-pocket costs, and lack of diagnostic equipment and medications. Patients reported little engagement with and limited knowledge of cardiovascular care, despite high engagement with HIV care. Most provider and patient participants indicated that they would prefer to integrate cardiovascular care with routine HIV care. CONCLUSIONS PLWH face many barriers to MI care in Tanzania. There is a need for multifaceted interventions to educate providers and patients, improve access to MI diagnosis, and increase engagement with cardiovascular care among this population.
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Affiliation(s)
| | | | | | | | | | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Janet P Bettger
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA, USA
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gloria Temu
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
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10
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Kamp M, Achilonu O, Kisiangani I, Nderitu DM, Mpangase PT, Tadesse GA, Adetunji K, Iddi S, Speakman S, Hazelhurst S, Asiki G, Ramsay M. Multimorbidity in African ancestry populations: a scoping review. BMJ Glob Health 2023; 8:e013509. [PMID: 38084495 PMCID: PMC10711865 DOI: 10.1136/bmjgh-2023-013509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Multimorbidity (MM) is a growing concern linked to poor outcomes and higher healthcare costs. While most MM research targets European ancestry populations, the prevalence and patterns in African ancestry groups remain underexplored. This study aimed to identify and summarise the available literature on MM in populations with African ancestry, on the continent, and in the diaspora. DESIGN A scoping review was conducted in five databases (PubMed, Web of Science, Scopus, Science Direct and JSTOR) in July 2022. Studies were selected based on predefined criteria, with data extraction focusing on methodology and findings. Descriptive statistics summarised the data, and a narrative synthesis highlighted key themes. RESULTS Of the 232 publications on MM in African-ancestry groups from 2010 to June 2022-113 examined continental African populations, 100 the diaspora and 19 both. Findings revealed diverse MM patterns within and beyond continental Africa. Cardiovascular and metabolic diseases are predominant in both groups (80% continental and 70% diaspora). Infectious diseases featured more in continental studies (58% continental and 16% diaspora). Although many papers did not specifically address these features, as in previous studies, older age, being women and having a lower socioeconomic status were associated with a higher prevalence of MM, with important exceptions. Research gaps identified included limited data on African-ancestry individuals, inadequate representation, under-represented disease groups, non-standardised methodologies, the need for innovative data strategies, and insufficient translational research. CONCLUSION The growing global MM prevalence is mirrored in African-ancestry populations. Recognising the unique contexts of African-ancestry populations is essential when addressing the burden of MM. This review emphasises the need for additional research to guide and enhance healthcare approaches for African-ancestry populations, regardless of their geographic location.
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Affiliation(s)
- Michelle Kamp
- Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Okechinyere Achilonu
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Isaac Kisiangani
- African Population and Health Research Center (APHRC), APHRC Campus, Nairobi, Kenya
| | - Daniel Maina Nderitu
- African Population and Health Research Center (APHRC), APHRC Campus, Nairobi, Kenya
| | - Phelelani Thokozani Mpangase
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Kayode Adetunji
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Samuel Iddi
- African Population and Health Research Center (APHRC), APHRC Campus, Nairobi, Kenya
| | | | - Scott Hazelhurst
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Electrical and Information Engineering, Faculty of Engineering and the Built Environment, University of the Witwatersrand, Johannesburg, South Africa
| | - Gershim Asiki
- African Population and Health Research Center (APHRC), APHRC Campus, Nairobi, Kenya
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Michèle Ramsay
- Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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11
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Ndumwa HP, Amani DE, Ngowi JE, Njiro BJ, Munishi C, Mboya EA, Mloka D, Kikula AI, Balandya E, Ruggajo P, Kessy AT, Kitambala E, Kapologwe N, Kengia JT, Kiologwe J, Ubuguyu O, Salum B, Kamuhabwa A, Ramaiya K, Sunguya BF. Mitigating the Rising Burden of Non-Communicable Diseases through Locally Generated Evidence-Lessons from Tanzania. Ann Glob Health 2023; 89:77. [PMID: 38025921 PMCID: PMC10655751 DOI: 10.5334/aogh.4111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background The burden of Non-Communicable Diseases (NCDs) is rapidly increasing globally, and low- and middle-income countries (LMICs) bear the brunt of it. Tanzania is no exception. Addressing the rising burden of NCDs in this context calls for renewed efforts and commitment by various stakeholders. This paper highlights local initiatives and strategies to combat NCDs in Tanzania and provides lessons for countries with similar contexts. Methods We reviewed published and grey literature and conducted policy analysis on NCDs in Tanzania to examine the burden of NCDs and the national response addressing it. The documents included National NCD strategic plans, NCD research agenda, and reports from the World Diabetes Foundation and the World Health Organization. Moreover, a scoping review of ongoing NCD activities and programs in other countries was also conducted to supplement the evidence gathered. Results The rising burden of NCDs as a result of the epidemiological transition in Tanzania called for the launching of a dedicated National NCD Control and Prevention Program. The Ministry of Health collaborates with local, national, and international partners on NCD prevention and curative strategies. This led to the development of important guidelines and policies on NCDs, including strengthening the capacity of health facilities and healthcare workers, increased community engagement and awareness of NCDs, and increased advocacy for more resources in NCD initiatives. Strong governmental commitment has been vital; this is demonstrated by a renewed commitment to the fight through national NCD week and related advocacy activities conducted annually. To ensure multi-stakeholders' engagement and political commitment, all these activities are coordinated at the Prime Minister's office and provide strong lessons for countries with contexts similar to Tanzania. Conclusion Multi-stakeholders' engagement, innovative approaches, and coordinated governmental efforts to address NCDs have shone a light on addressing the burden of NCDs and may be sustainable if aligned with locally available resources. Such initiatives are recommended for adoption by other nations to address the burdens of NCDs.
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Affiliation(s)
- Harrieth P. Ndumwa
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Davis E. Amani
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Jackline E. Ngowi
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Belinda J. Njiro
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Castory Munishi
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Erick A. Mboya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Doreen Mloka
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Amani I. Kikula
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Paschal Ruggajo
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
- Ministry of Health, P O Box 743, Dodoma, Tanzania
| | - Anna T. Kessy
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Emilia Kitambala
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Ntuli Kapologwe
- President’s Office Regional Administration and Local Government, P O Box, 1923 Dodoma, Tanzania
| | - James T. Kengia
- President’s Office Regional Administration and Local Government, P O Box, 1923 Dodoma, Tanzania
| | | | | | - Bakari Salum
- President’s Office Regional Administration and Local Government, P O Box, 1923 Dodoma, Tanzania
| | - Appolinary Kamuhabwa
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Kaushik Ramaiya
- Tanzania Non-Communicable Diseases Alliance, P O Box 65201, Dar es salaam, Tanzania
- Tanzania Diabetes Association, P O Box 65201, Dar es salaam, Tanzania
- Shree Hindu Mandal Hospital, P O Box 581, Dar es salaam, Tanzania
| | - Bruno F. Sunguya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
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12
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Kinyenje E, Ngowi RR, Msigwa YS, Hokororo JC, Yahya TA, German CJ, Mawazo A, Mohamed MA, Nassoro OA, Degeh MM, Bahegwa RP, Marandu LE, Mwaisengela SM, Mwanginde LW, Makala R, Eliakimu ES. Status of countrywide laboratory services quality and capacity in primary healthcare facilities in Tanzania: Findings from Star Rating Assessment. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001489. [PMID: 37851603 PMCID: PMC10584114 DOI: 10.1371/journal.pgph.0001489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
Accurate disease diagnosis relies on a well-organized and reliable laboratory system. This study assesses the quality of laboratory services in Tanzania based on the nationwide Star Rating Assessment (SRA) of Primary Healthcare (PHC) facilities conducted in 2017/18. This cross-sectional study utilized secondary data from all the country's PHC facilities stored in the SRA database. Laboratory service quality was assessed by aggregating scores as percentages of the maximum achievable score across various indicators: dedicated laboratory department/room, adequate equipment, staffing levels, adherence to testing protocols, establishment of turnaround times, internal and external quality controls, and safety and supplies management. Scores equal to or exceeding 80% were deemed compliant. Multiple linear regression was used to determine the influence of facility characteristics (level, ownership, location, staffing) on quality scores, with statistical significance set at p < 0.05. The study included 6,663 PHC facilities (85.9% dispensaries, 11% health centers, 3.2% hospital-level-1), with the majority being public (82.3% vs. 17.7%) and located in rural areas (77.1% vs. 22.9%). On average, facilities scored 30.8% (SD = 35.7), and only 26.6% met staffing requirements. Compliance with quality standards was higher in private (63% vs. 19%, p<0.001) and urban facilities (62% vs. 16%, p<0.001). More than half of the facilities did not meet either of the eight quality indicators. Quality was positively linked to staffing compliance (Beta = 5.770) but negatively impacted by dispensaries (Beta = -6.342), rural locations (Beta = -0.945), and public ownership (Beta = -1.459). A score of 30% falls significantly short of the national target of 80%. Improving laboratory staffing levels at PHC facilities could improve the quality of laboratory services, especially in public facilities that are based in rural areas. There is a need to further strengthen laboratory services in PHC facilities to ensure the quality of laboratory services and clients' satisfaction.
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Affiliation(s)
- Erick Kinyenje
- Health Quality Assurance Unit, Ministry of Health, Dodoma, Tanzania
| | - Ruth R. Ngowi
- Health Quality Assurance Unit, Ministry of Health, Dodoma, Tanzania
| | | | | | | | | | - Akili Mawazo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mohamed A. Mohamed
- Tanzania Field Epidemiology and Laboratory Training Programme (TFELTP), Dar es Salaam, Tanzania
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Omary A. Nassoro
- Health Quality Assurance Unit, Ministry of Health, Dodoma, Tanzania
| | - Mbwana M. Degeh
- Health Quality Assurance Unit, Ministry of Health, Dodoma, Tanzania
| | | | - Laura E. Marandu
- Health Quality Assurance Unit, Ministry of Health, Dodoma, Tanzania
| | | | | | - Robert Makala
- Regional Administrative Secretary’s Office—Regional Health Management Team, Manyara, Tanzania
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13
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Kisigo GA, Peck RN. Integrating HIV, hypertension, and diabetes primary care in Africa. Lancet 2023; 402:1211-1213. [PMID: 37805198 DOI: 10.1016/s0140-6736(23)01884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/04/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Godfrey A Kisigo
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania; Departments of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Robert N Peck
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania; Departments of Internal Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania; Center for Global Health, Departments of Medicine and Pediatrics, Weill Cornell Medicine, New York, NY, USA.
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14
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Kilindimo SS, Abdulkarim A, Simbila AN, Harrison R, Shirima L, Abdallah F, Mukhtar AG, Mfinanga J, Saika J, Kisanga E, Sawe HR. The burden and management strategies of hypertensive crisis in adult patients presenting to emergency departments of district and regional hospitals in Sub-Saharan Africa. Clin Hypertens 2023; 29:27. [PMID: 37777812 PMCID: PMC10544116 DOI: 10.1186/s40885-023-00251-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 09/03/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Hypertensive crisis is among the causes of morbidity and mortality in adult patients with hypertension in Sub-Saharan Africa. We aimed to determine the burden, risk factors and describe the management strategies of hypertensive crisis among adult patients seen at emergency departments of district and regional hospitals in Tanzania. METHODS This was a prospective multicenter longitudinal study which included all 162 district and regional hospitals in Tanzania. It was part of the Tanzania Emergency Care Capacity Survey (TECCS), a large assessment of burden of acute illness and emergency care capacity in Tanzania. Adult patients who presented to emergency departments with blood pressure ≥ 180/110mmHg were enrolled. Demographics, clinical presentation, management, and 24-hours outcomes were recorded using a structured case report form. Descriptive statistics were summarized in frequency and median, while logistic regression was used to evaluate the association between risk factors and presence of hypertensive crisis. RESULTS We screened 2700 patients and enrolled 169 adults, henceforth proportion of adult patients with hypertensive crisis was 63 per 1000. Median age was 62 years (IQR 50-70 years) and predominantly females, 112 (66.3%). Majority 151(89.3%) were self-referred with two-wheel motorcycle being the commonest 46 (27.2%) mode of arrival to the hospital. Hypertensive emergency was found in over half 96 (56.8%) of the patients with hypertensive crisis, with oral medications administered in more than half of them, 71 (74%) as means to control the high blood pressure, and one-third 33 (34.4%) were discharged home. On multivariate analysis increasing age (AOR 4.53, p < 0.001), use of illicit drug (AOR 4.14, p-0.04) and pre-existing hypertension (AOR 8.1, p < 0.001) were independent risk factors for hypertensive crisis occurrence. CONCLUSION Hypertensive crisis among adult patients attending district and regional hospitals is common (63 patients per every 1000 patients). Increasing age, use of illicit drug and pre-existing hypertension are independent associated factors for developing hypertensive crisis.
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Affiliation(s)
- Said S Kilindimo
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania.
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | - Ahmed Abdulkarim
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Alphonce N Simbila
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Raynald Harrison
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Lucy Shirima
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Farida Abdallah
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Aliasghar G Mukhtar
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Juma Mfinanga
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Joseph Saika
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Emanuel Kisanga
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Hendry R Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
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15
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Katende D, Kasamba I, Sekitoleko I, Nakuya K, Kusilika C, Buyinza A, Mubiru MC, Mutungi G, Nyirenda M, Grosskurth H, Baisley K. Medium-to-long term sustainability of a health systems intervention to improve service readiness and quality of non-communicable disease (NCD) patient care and experience at primary care settings in Uganda. BMC Health Serv Res 2023; 23:1022. [PMID: 37737179 PMCID: PMC10514956 DOI: 10.1186/s12913-023-09983-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/29/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND With the double burden of rising chronic non-communicable diseases (NCDs) and persistent infectious diseases facing sub-Saharan Africa, integrated health service delivery strategies among resource-poor countries are needed. Our study explored the post-trial sustainability of a health system intervention to improve NCD care, introduced during a cluster randomised trial between 2013 and 2016 in Uganda, focusing on hypertension (HT) and type-2 diabetes mellitus (DM) services. In 2020, 19 of 38 primary care health facilities (HFs) that constituted the trial's original intervention arm until 2016 and 3 of 6 referral HFs that also received the intervention then, were evaluated on i) their facility performance (FPS) through health worker knowledge, and service availability and readiness (SAR), and ii) the quality-of-patient-care-and-experience (QoCE) received. METHODS Cross-sectional data from the original trial (2016) and our study (2020) were compared. FPS included a clinical knowledge test with 222 health workers: 131 (2016) and 91 (2020) and a five-element SAR assessment of all 22 HFs. QoCE assessment was performed among 420 patients: 88 (2016) and 332 (2020). Using a pair-matched approach, FPS and QoCE summary scores were compared. Linear and random effects Tobit regression models were also analysed. RESULTS The mean aggregate facility performance (FPS) in 2020 was lower than in 2016: 70.2 (95%CI = 66.0-74.5) vs. 74.8 (95%CI = 71.3-78.3) respectively, with no significant difference (p = 0.18). Mean scores declined in 4 of 5 SAR elements. Overall FPS was negatively affected by rural or urban HF location relative to peri-urban HFs (p < 0.01). FPS was not independently predicted but patient club functionality showed weak association (p = 0.09). QoCE declined slightly to 8.7 (95%CI = 8.4-91) in 2020 vs 9.5 (95%CI = 9.1-9.9) in 2016 (p = 0.02) while the proportion of patients receiving adequate quality care also declined slightly to 88.2% from 98.5% respectively, with no statistical difference (p = 0.20). Only the parent district weakly predicted QoCE (p = 0.05). CONCLUSIONS Four years after the end of research-related support, overall facility performance had declined as expected because of the interrupted supplies and a decline in regular supervision. However, both service availability and readiness and quality of HT/DM care were surprisingly well preserved. Sustainability of an NCD intervention in similar settings may remain achievable despite the funding instability following a trial's end but organisational measures to prepare for the post-trial phase should be taken early on in the intervention process.
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Affiliation(s)
- David Katende
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK.
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda.
| | - Ivan Kasamba
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Isaac Sekitoleko
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kevin Nakuya
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Allan Buyinza
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | | | - Moffat Nyirenda
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Heiner Grosskurth
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK
| | - Kathy Baisley
- London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK
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16
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Cissé K, Samadoulougou S, Kaboré J, Somda P, Zongo A, Traoré S, Zabsonre P, Yombi JC, Kouanda S, Kirakoya-Samadoulougou F. Healthcare system's preparedness to provide cardiovascular and diabetes-specific care in the context of geopolitical crises in Burkina Faso: a trend analysis from 2012 to 2018. BMJ Open 2023; 13:e065912. [PMID: 37221029 DOI: 10.1136/bmjopen-2022-065912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the trends of the availability and readiness of the healthcare system to provide cardiometabolic (cardiovascular diseases (CVD) and diabetes) services in Burkina Faso in multiple political and insecurity crises context. DESIGN We performed a secondary analysis of repeated nationwide cross-sectional studies in Burkina Faso. DATA SOURCE Four national health facility survey data (using WHO Service Availability and Readiness Assessment (SARA) tool) conducted between 2012 and 2018 were used. PARTICIPANTS In 2012, 686 health facilities were surveyed, 766 in 2014, 677 in 2016 and 794 in 2018. PRIMARY AND SECONDARY OUTCOME MEASURES The main outcomes were the availability and readiness services indicators defined according to the SARA manual. RESULTS Between 2012 and 2018, the availability of CVD and diabetes services significantly increased (67.3% to 92.7% for CVD and 42.5% to 54.0% for diabetes). However, the mean readiness index of the healthcare system to manage CVD decreased from 26.8% to 24.1% (p for trend <0.001). This trend was observed mainly at the primary healthcare level (from 26.0% to 21.6%, p<0.001). For diabetes, the readiness index increased (from 35.4% to 41.1%, p for trend=0.07) during 2012-2018. However, during the crisis period (2014-2018), both CVD (27.9% to 24.1%, p<0.001) and diabetes (45.8% to 41.1%, p<0.001) service readiness decreased. At the subnational level, the readiness index for CVD significantly decreased in all regions but predominantly in the Sahel region, which is the main insecure region (from 32.2% to 22.6%, p<0.001). CONCLUSION In this first monitoring study, we found a low level and decreased trend of readiness of the healthcare system for delivering cardiometabolic care, particularly during the crisis period and in conflicted regions. Policymakers should pay more attention to the impact of crises on the healthcare system to mitigate the rising burden of cardiometabolic diseases.
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Affiliation(s)
- Kadari Cissé
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Institut de Recherche en Sciences de la santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Sékou Samadoulougou
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute Research Center, Quebec City, Quebec, Canada
- Centre for Research On Planning and Development (CRAD), Laval University, Quebec City, Quebec, Canada
| | - Jean Kaboré
- Institut de Recherche en Sciences de la santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Paulin Somda
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | | | | | - Patrice Zabsonre
- Unité de formation et de recherche en sciences de la santé, Université Joseph Ki-Zerbo Ouagadougou, Ouagadougou, Burkina Faso
| | - Jean Cyr Yombi
- Service de médecine interne et maladies infectieuses, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Seni Kouanda
- Institut de Recherche en Sciences de la santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
- Institut Africain de Sante Publique, Ouagadougou, Burkina Faso
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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17
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Yenit MK, Kolbe-Alexander TL, Gelaye KA, Gezie LD, Tesema GA, Abebe SM, Azale T, Shitu K, Gyawali P. An Evaluation of Community Health Workers' Knowledge, Attitude and Personal Lifestyle Behaviour in Non-Communicable Disease Health Promotion and Their Association with Self-Efficacy and NCD-Risk Perception. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095642. [PMID: 37174162 PMCID: PMC10178727 DOI: 10.3390/ijerph20095642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
Community health workers, also known as health extension workers (HEWs), play an important role in health promotion. This study evaluates HEWs' knowledge, attitude, and self-efficacy for non-communicable diseases (NCD) health promotion. HEWs (n = 203) completed a structured questionnaire on knowledge, attitude, behaviour, self-efficacy and NCD risk perception. Regression analysis was used to determine the association between self-efficacy and NCD risk perception with knowledge (high, medium, low), attitude (favourable/unfavourable) and physical activity (sufficient/insufficient). HEWs with higher self-efficacy were more likely to have high NCD knowledge (AOR: 2.21; 95% CI: 1.21. 4.07), favourable attitude towards NCD health promotion (AOR: 6.27; 95% CI: 3.11. 12.61) and were more physically active (AOR: 2.27; 95% CI: 1.08. 4.74) than those with lower self-efficacy. HEWs with higher NCD susceptibility (AOR: 1.89; 95% CI: 1.04. 3.47) and perceived severity (AOR: 2.69; 95% CI: 1.46, 4.93) had higher odds of NCD knowledge than their counterparts. Moreover, sufficient physical activity was influenced by HEWs' perceived NCD susceptibility and perceived benefits of lifestyle change. Therefore, HEWs need to adopt healthy lifestyle choices to become effective role models for the community. Our findings highlight the need to include a healthy lifestyle when training HEWs, which might increase self-efficacy for NCD health promotion.
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Affiliation(s)
- Melaku Kindie Yenit
- School of Health and Medical Sciences, Centre for Health Research, University of Southern Queensland, Ipswich, QLD 4305, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Tracy L Kolbe-Alexander
- School of Health and Medical Sciences, Centre for Health Research, University of Southern Queensland, Ipswich, QLD 4305, Australia
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Solomon Mekonnen Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Telake Azale
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Kegnie Shitu
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Prajwal Gyawali
- Centre for Health Research, School of Health and Medical Sciences, University of Southern Queensland, Toowoomba, QLD 4350, Australia
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Garrib A, Njim T, Adeyemi O, Moyo F, Halloran N, Luo H, Wang D, Okebe J, Bates K, Santos VS, Ramaiya K, Jaffar S. Retention in care for type 2 diabetes management in Sub-Saharan Africa: A systematic review. Trop Med Int Health 2023; 28:248-261. [PMID: 36749181 PMCID: PMC10947597 DOI: 10.1111/tmi.13859] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Diabetes prevalence has risen rapidly in Sub-Saharan Africa, but rates of retention in diabetes care are poorly understood. We conducted a systematic review and meta-analysis to determine rates of retention in care of persons with type 2 diabetes. METHODS We searched MEDLINE, Global Health and CINAHL online databases for cohort studies and randomised control trials (RCTs) published up to 12 October 2021, that reported retention in or attrition from care for patients with type 2 diabetes in Sub-Saharan Africa. Retention was defined as persons diagnosed with diabetes who were alive and in care or with a known outcome, while attrition was defined as loss from care. RESULTS From 6559 articles identified, after title and abstract screening, 209 articles underwent full text review. Forty six papers met the inclusion criteria, comprising 22,610 participants. Twenty one articles were of RCTs of which 8 trials had 1 year or more of follow-up and 25 articles were of non-randomised studies of which 19 had 12 months or more of follow-up. A total of 11 studies (5 RCTs and 6 non-randomised) were assessed to be of good quality. Sixteen RCTs were done in secondary or tertiary care settings. Their pooled retention rate (95% CI) was 80% (77%, 84%) in the control arm. Four RCTs had been done in primary care settings and their pooled retention rate (95% CI) was 53% (45%, 62%) in the control arm. The setting of one trial was unclear. For non-randomised studies, retention rates (95% CI) were 68% (62%, 75%) among 19 studies done in secondary and tertiary care settings, and 40% (33%, 49%) among the 6 studies done in primary care settings. CONCLUSION Rates of retention in care of people living with diabetes are poor in primary care research settings.
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Affiliation(s)
- Anupam Garrib
- Department of Clinical SciencesLiverpool School of Tropical MedicineLiverpoolUK
| | - Tsi Njim
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Olukemi Adeyemi
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Faith Moyo
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Natalie Halloran
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Huanyuan Luo
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Duolao Wang
- Department of Clinical SciencesLiverpool School of Tropical MedicineLiverpoolUK
| | - Joseph Okebe
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
| | - Katie Bates
- Department of International Public HealthLiverpool School of Tropical MedicineLiverpoolUK
- Department of Medical Statistics, Informatics and Health EconomicsMedical University of InnsbruckInnsbruckAustria
| | - Victor Santana Santos
- Department of MedicineFederal University of SergipeLagartoBrazil
- Health Science Graduate ProgramFederal University of SergipeAracajuBrazil
| | | | - Shabbar Jaffar
- UCL Institute for Global HealthUniversity College LondonLondonUK
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19
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Olds P, Kachimanga C, Talama G, Mailosi B, Ndarama E, Totten J, Musinguzi N, Hangiwa D, Bukhman G, Wroe EB. Non-communicable disease burden among inpatients at a rural district hospital in Malawi. Glob Health Res Policy 2023; 8:4. [PMID: 36810123 PMCID: PMC9945353 DOI: 10.1186/s41256-023-00289-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/09/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) is high in Malawi. However, resources and training for NCD care remain scarce, especially in rural hospitals. Current care for NCDs in the developing world focuses on the WHO's traditional 4 × 4 set. However, we do not know the full burden of NCDs outside of that scope, like neurological disease, psychiatric illness, sickle cell disease, and trauma. The goal of this study was to understand the burden of NCDs among inpatients in a rural district hospital in Malawi. We broadened our definition of NCDs beyond the traditional 4 × 4 set of NCDs, and included neurological disease, psychiatric illness, sickle cell disease, and trauma. METHODS We conducted a retrospective chart review of all inpatients who were admitted to the Neno District Hospital between January 2017 and October 2018. We broke patients down by age, date of admission, type, and number of NCD diagnoses, and HIV status, and constructed multivariate regression models for length of stay and in-hospital mortality. RESULTS Of 2239 total visits, 27.5% were patients with NCDs. Patients with NCDs were older (37.6 vs 19.7 years, p < 0.001) and made up 40.2% of total hospital time. We also found two distinct populations of NCD patients. The first were patients 40 years and older with primary diagnoses of hypertension, heart failure, cancer, and stroke. The second were patients under 40 years old with primary diagnoses of mental health conditions, burns, epilepsy, and asthma. We also found significant trauma burden, accounting for 40% of all NCD visits. In multivariate analysis, carrying a medical NCD diagnosis was associated with longer length of stay (coefficient 5.2, p < 0.001) and a higher risk of in-hospital mortality (OR 1.9, p = 0.03). Burn patients also had significantly longer length of stay (coefficient 11.6, p < 0.001). CONCLUSIONS There is a significant burden of NCDs in a rural hospital in Malawi, including those outside of the traditional 4 × 4 set. We also found high rates of NCDs in the younger population (under 40 years of age). Hospitals must be equipped with adequate resources and training to meet this burden of disease.
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Affiliation(s)
- Peter Olds
- Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | | | | | | | - Enoch Ndarama
- grid.415722.70000 0004 0598 3405Ministry of Health and Population, Lilongwe, Malawi
| | - Jodie Totten
- grid.34477.330000000122986657Department of Emergency Medicine, University of Washington, Seattle, WA USA
| | - Nicholas Musinguzi
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Gene Bukhman
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,Partners in Health, Neno, Malawi ,grid.62560.370000 0004 0378 8294Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XProgram in Global NCDs and Social Change, Deparment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Emily B. Wroe
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,Partners in Health, Neno, Malawi ,grid.62560.370000 0004 0378 8294Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XProgram in Global NCDs and Social Change, Deparment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
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20
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Preparedness of primary health care facilities on implementation of essential non-communicable disease interventions in osun state south-west Nigeria: a rural-urban comparative study. BMC Health Serv Res 2023; 23:154. [PMID: 36788557 PMCID: PMC9930353 DOI: 10.1186/s12913-023-09138-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Global response to the growing burden of non-communicable diseases (NCDs) in developing countries includes the development of WHO Package of Essential Non-communicable Disease Interventions (WHO PEN) for Primary Health Care (PHC). The study assessed the level of preparedness of PHC facilities on implementation of essential NCD interventions in rural and urban Local Government Areas (LGAs) of Osun State, Nigeria. METHODS The study was a comparative cross-sectional survey. Information was collected from heads of 33 rural and 33 urban PHC facilities and through direct observation on the domains of staff training, basic equipment, diagnostics and essential medicines for cardiovascular diseases, diabetes and chronic respiratory diseases (CRDs) using a semi-structured interviewer administered questionnaire. RESULTS Manual sphygmomanometer was found in similar proportions (84.8%) of PHC facilities in rural and urban LGAs. Glucometer was available in 45.5% of the PHC facilities in urban and 33.3% of the PHC facilities in the rural LGAs, the difference was not statistically significant (χ2 = 1.015; p = 0.314). Basic equipment for CRDs were not available in majority of PHC facilities in both locations. Moduretic tablets were the most reported essential NCD medicines, available in 15% of PHC facilities in rural LGAs and none in urban LGAs. The anti-diabetic medicines were not available in any of the PHC facilities in both locations. More than 90% (≥ 30) of the PHC facilities in both locations were not prepared to implement essential interventions for each NCD across domains of staff training and essential medicines. Overall, 97.0% of the PHC facilities in the rural LGAs and all the PHC facilities in urban LGAs were not prepared on implementation of essential interventions for the three NCDs. CONCLUSION The level of preparedness of the PHC facilities on implementation of essential NCD interventions in the rural and urban LGAs of Osun State is very low. Government needs to strengthen the PHC system by providing needed essential medicines, basic diagnostics, equipment, and training of clinical health care workers for implementation of essential NCD interventions in the state.
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21
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Noubiap JJ, Millenaar D, Ojji D, Wafford QE, Ukena C, Böhm M, Sliwa K, Huffman MD, Mahfoud F. Fifty Years of Global Cardiovascular Research in Africa: A Scientometric Analysis, 1971 to 2021. J Am Heart Assoc 2023; 12:e027670. [PMID: 36734342 PMCID: PMC9973645 DOI: 10.1161/jaha.122.027670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background To analyze the quantity and impact of cardiovascular research done in Africa or coauthored by researchers based in Africa, their determinants, and the patterns of research collaboration. Methods and Results We retrieved data from Web of Science and additional sources. We analyzed temporal trends from 1971 to 2021 and geographical distribution, research impact using country-level h-index, international research cooperation, and associations of research quantity and quality using linear regression. The annual volume of cardiovascular research from Africa has increased from 4 publications in 1971 to 3867 in 2020 and currently represents ~3% of the global cardiovascular research output. Authors from South Africa (28.1%) and Egypt (24.1%) accounted for more than half of all publications from African countries, and they had the highest h-index (209 and 111, respectively). Important collaborators outside Africa included the United States, United Kingdom, France, Germany, and Australia. The country's publication count was associated with larger population size (P<0.001), whereas the country's h-index was associated with larger population size (P=0.001) and higher human development index (P=0.023). International collaboration was dominated by the United States, South Africa, United Kingdom, Egypt, and Canada. The level of collaboration between African countries was lower than their collaboration with non-African countries. Conclusions Cardiovascular research output from African authors remains low, despite marked progress over the past 5 decades. These findings highlight the urgent need to improve the quantity and quality of cardiovascular research in Africa through increased investments, training of human resources, improved infrastructures, and expansion of collaborative research networks, particularly within Africa.
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Affiliation(s)
- Jean Jacques Noubiap
- Cameroon Ministry of Public HealthYaoundéCameroon,Centre for Heart Rhythm DisordersThe University of AdelaideAdelaideAustralia
| | - Dominic Millenaar
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care MedicineSaarland University HospitalHomburgGermany
| | - Dike Ojji
- Department of Medicine, Faculty of Clinical SciencesUniversity of Abuja, and University of Abuja Teaching HospitalGwagwaladaNigeria
| | - Q. Eileen Wafford
- Galter Health Sciences Library and Learning Center, Feinberg School of Medicine, Northwestern UniversityChicagoIL
| | - Christian Ukena
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care MedicineSaarland University HospitalHomburgGermany
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care MedicineSaarland University HospitalHomburgGermany,Cape Heart Institute Faculty of Health SciencesUniversity of Cape TownSouth Africa
| | - Karen Sliwa
- Division of Cardiology, Department of Medicine, Faculty of Health SciencesGroote Schuur HospitalCape TownSouth Africa,Cape Heart Institute Faculty of Health SciencesUniversity of Cape TownSouth Africa
| | - Mark D. Huffman
- Department of Medicine and Global Health CenterWashington University in St. LouisSt. LouisMO,The George Institute for Global HealthUniversity of New South WalesSydneyAustralia
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology, Intensive Care MedicineSaarland University HospitalHomburgGermany,Institute for Medical Engineering and Science, Massachusetts Institute of TechnologyCambridgeMA
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22
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Ajisegiri WS, Abimbola S, Tesema AG, Odusanya OO, Peiris D, Joshi R. "We just have to help": Community health workers' informal task-shifting and task-sharing practices for hypertension and diabetes care in Nigeria. Front Public Health 2023; 11:1038062. [PMID: 36778542 PMCID: PMC9909193 DOI: 10.3389/fpubh.2023.1038062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction Nigeria's skilled health professional health workforce density is insufficient to achieve its national targets for non-communicable diseases (NCD) which include 25% reduction in the prevalence of diabetes and hypertension, particularly at the primary health care (PHC) level. This places a great demand on community health workers (CHWs) who constitute the majority of PHC workers. Traditionally, CHWs are mainly involved in infectious diseases programmes, and maternal and child health services. Their involvement with prevention and control of NCDs has been minimal. With government prioritization of PHC for combating the rising NCD burden, strengthening CHWs' skills and competencies for NCD care delivery is crucial. Methods We conducted a mixed methods study to explore the roles and practices of CHWs in the delivery of hypertension and diabetes care at PHC facilities in four states (two each in northern and southern regions) in Nigeria. We reviewed the National Standing Orders that guide CHWs' practices at the PHC facilities and administered a survey to 76 CHWs and conducted 13 focus groups (90 participants), and in-depth individual interviews with 13 CHWs and 7 other local and state government stakeholders. Results Overall, we found that despite capacity constraints, CHWs frequently delivered services beyond the scope of practice stipulated in the National Standing Orders. Such informal task-shifting practices were primarily motivated by a need to serve the community. Discussion While these practices may partially support health system functions and address unmet need, they may also lead to variable care quality and safety. Several factors could mitigate these adverse impacts and strengthen CHW roles in the health system. These include a stronger enabling policy environment to support NCD task-sharing, investment in continuous capacity building for CHWs, improved guidelines that can be implemented at the point of care, and improved coordination processes between PHC and higher-level facilities.
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Affiliation(s)
- Whenayon Simeon Ajisegiri
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Seye Abimbola
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Azeb Gebresilassie Tesema
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Olumuyiwa O. Odusanya
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Nigeria
| | - David Peiris
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Rohina Joshi
- School of Population Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- The George Institute for Global Health, New Delhi, India
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23
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Chamba NG, Byashalira KC, Christensen DL, Ramaiya KL, Kapyolo EP, Shayo PJ, Lillebaek T, Ntinginya NE, Mmbaga BT, Bygbjerg IC, Mpagama SG, Manongi RN. Experiences and perceptions of participants on the pathway towards clinical management of dual tuberculosis and diabetes mellitus in Tanzania. Glob Health Action 2022; 15:2143044. [PMID: 36441076 PMCID: PMC9894537 DOI: 10.1080/16549716.2022.2143044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a common comorbidity among people with tuberculosis (TB). Despite the availability of guidelines on how to integrate dual TB/DM in Tanzania, the practice of integration at various healthcare levels is unclear. OBJECTIVE To explore the participants' experiences and perceptions on the pathway towards clinical management of dual TB/DM. METHOD The research was carried out in Dar es Salaam, Iringa, and Kilimanjaro regions between January and February 2020. A qualitative, in-depth interview approach was used to collect participants' experiences and perspectives on the acquisition of dual TB/DM services at various levels of healthcare facilities. The information gathered were coded and classified thematically. RESULTS The participants' perception of TB services within the healthcare facilities was positive due to the support they received from the healthcare providers. On the other hand, participants reported difficulty receiving management in various health facilities for each condition in terms of access to dual TB/DM care and access to DM medication. This was viewed as a significant challenge for the participants with dual TB/DM. CONCLUSIONS The current disjunction and disruption in healthcare for people with dual TB/DM makes it difficult to access services at various levels of health facilities. For optimal clinical management for people with dual TB/DM, patient-centered strategies and integrated approaches are urgently needed.
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Affiliation(s)
- Nyasatu G. Chamba
- Kilimanjaro Christian Medical University College, Faculty of Medicine, Moshi, United Republic of Tanzania,Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania,CONTACT Nyasatu G. Chamba Department of Internal Medicine, Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania
| | - Kenneth C. Byashalira
- Kilimanjaro Christian Medical University College, Faculty of Medicine, Moshi, United Republic of Tanzania,Kibong’oto Infectious Disease Hospital, Department of Research, Sanya Juu, United Republic of Tanzania
| | - Dirk L. Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kaushik L. Ramaiya
- Department of Internal Medicine, Shree Hindu Mandal Hospital, Dar es Salaam, United Republic of Tanzania
| | - Eliakimu P. Kapyolo
- Department of Clinical research, National Institute for Medical Research, Dodoma Medical Research Centre, Dodoma, United Republic of Tanzania
| | - PendoMartha J. Shayo
- Kibong’oto Infectious Disease Hospital, Department of Research, Sanya Juu, United Republic of Tanzania
| | - Troels Lillebaek
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark,International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Nyanda E. Ntinginya
- National Institute for Medical Research, Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College, Faculty of Medicine, Moshi, United Republic of Tanzania,Kilimanjaro Clinical Research Institute, Directorate of Research and Consultancies, Moshi, United Republic of Tanzania
| | - Ib C. Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stellah G. Mpagama
- Kilimanjaro Christian Medical University College, Faculty of Medicine, Moshi, United Republic of Tanzania,Kibong’oto Infectious Disease Hospital, Department of Research, Sanya Juu, United Republic of Tanzania
| | - Rachel N. Manongi
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
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Bissett M, Gray CM, Abdulla S, Bunn C, Crampin AC, Dillip A, Gill JMR, Kaare HC, Kalima S, Kambalu E, Lwanda J, Makoye HF, Mtema O, Perry M, Strachan Z, Todd H, Mtenga SM. "I see salt everywhere": A qualitative examination of the utility of arts-based participatory workshops to study noncommunicable diseases in Tanzania and Malawi. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000927. [PMID: 36962765 PMCID: PMC10022006 DOI: 10.1371/journal.pgph.0000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/22/2022] [Indexed: 12/28/2022]
Abstract
The burden of noncommunicable diseases (NCDs) including hypertension, diabetes, and cancer, is rising in Sub-Saharan African countries like Tanzania and Malawi. This increase reflects complex interactions between diverse social, environmental, biological, and political factors. To intervene successfully, new approaches are therefore needed to understand how local knowledges and attitudes towards common NCDs influence health behaviours. This study compares the utility of using a novel arts-based participatory method and more traditional focus groups to generate new understandings of local knowledges, attitudes, and behaviours towards NCDs and their risk factors. Single-gender arts-based participatory workshops and focus group discussions were conducted with local communities in Tanzania and Malawi. Thematic analysis compared workshop and focus group transcripts for depth of content and researcher-participant hierarchies. In addition, semiotic analysis examined the contribution of photographs of workshop activities to understanding participants' experiences and beliefs about NCD risk factors. The arts-based participatory workshops produced in-depth, vivid, emotive narratives of participants' beliefs about NCDs and their impact (e.g., "… it spreads all over your body and kills you-snake's poison is similar to diabetes poison"), while the focus groups provided more basic accounts (e.g., "diabetes is a fast killer"). The workshops also empowered participants to navigate activities with autonomy, revealing their almost overwhelmingly negative beliefs about NCDs. However, enabling participants to direct the focus of workshop activities led to challenges, including the perpetuation of stigma (e.g., comparing smells associated with diabetes symptoms with sewage). Semiotic analysis of workshop photographs provided little additional insight beyond that gained from the transcripts. Arts-based participatory workshops are promising as a novel method to inform development of culturally relevant approaches to NCD prevention in Tanzania and Malawi. Future research should incorporate more structured opportunities for participant reflection during the workshops to minimise harm from any emerging stigma.
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Affiliation(s)
- Maria Bissett
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M. Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sharifa Abdulla
- Fine and Performing Arts Department, University of Malawi, Zomba, Malawi
| | - Christopher Bunn
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Amelia C. Crampin
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Angel Dillip
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Jason M. R. Gill
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Heri C. Kaare
- Taasisi ya Sanaa na Utamaduni Bagamoyo (TaSUBa), Bagamoyo, United Republic of Tanzania
| | | | | | - John Lwanda
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Herbert F. Makoye
- Taasisi ya Sanaa na Utamaduni Bagamoyo (TaSUBa), Bagamoyo, United Republic of Tanzania
| | | | - Mia Perry
- School of Education, University of Glasgow, Glasgow, United Kingdom
| | - Zoë Strachan
- School of Critical Studies, University of Glasgow, Glasgow, United Kingdom
| | - Helen Todd
- Art and Global Health Centre Africa, Zomba, Malawi
| | - Sally M. Mtenga
- Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Flood D, Geldsetzer P, Agoudavi K, Aryal KK, Brant LCC, Brian G, Dorobantu M, Farzadfar F, Gheorghe-Fronea O, Gurung MS, Guwatudde D, Houehanou C, Jorgensen JMA, Kondal D, Labadarios D, Marcus ME, Mayige M, Moghimi M, Norov B, Perman G, Quesnel-Crooks S, Rashidi MM, Moghaddam SS, Seiglie JA, Bahendeka SK, Steinbrook E, Theilmann M, Ware LJ, Vollmer S, Atun R, Davies JI, Ali MK, Rohloff P, Manne-Goehler J. Rural-Urban Differences in Diabetes Care and Control in 42 Low- and Middle-Income Countries: A Cross-sectional Study of Nationally Representative Individual-Level Data. Diabetes Care 2022; 45:1961-1970. [PMID: 35771765 PMCID: PMC9472489 DOI: 10.2337/dc21-2342] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/18/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes prevalence is increasing rapidly in rural areas of low- and middle-income countries (LMICs), but there are limited data on the performance of health systems in delivering equitable and effective care to rural populations. We therefore assessed rural-urban differences in diabetes care and control in LMICs. RESEARCH DESIGN AND METHODS We pooled individual-level data from nationally representative health surveys in 42 countries. We used Poisson regression models to estimate age-adjusted differences in the proportion of individuals with diabetes in rural versus urban areas achieving performance measures for the diagnosis, treatment, and control of diabetes and associated cardiovascular risk factors. We examined differences across the pooled sample, by sex, and by country. RESULTS The pooled sample from 42 countries included 840,110 individuals (35,404 with diabetes). Compared with urban populations with diabetes, rural populations had ∼15-30% lower relative risk of achieving performance measures for diabetes diagnosis and treatment. Rural populations with diagnosed diabetes had a 14% (95% CI 5-22%) lower relative risk of glycemic control, 6% (95% CI -5 to 16%) lower relative risk of blood pressure control, and 23% (95% CI 2-39%) lower relative risk of cholesterol control. Rural women with diabetes had lower achievement of performance measures relating to control than urban women, whereas among men, differences were small. CONCLUSIONS Rural populations with diabetes experience substantial inequities in the achievement of diabetes performance measures in LMICs. Programs and policies aiming to strengthen global diabetes care must consider the unique challenges experienced by rural populations.
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Affiliation(s)
- David Flood
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
- Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, CA
- Chan Zuckerberg Biohub, San Francisco, CA
| | | | - Krishna K. Aryal
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Luisa Campos Caldeira Brant
- Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Garry Brian
- The Fred Hollows Foundation New Zealand, Auckland, New Zealand
| | - Maria Dorobantu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Oana Gheorghe-Fronea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- Cardiology Department, Emergency Hospital Bucharest, Bucharest, Romania
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | | | - Dimple Kondal
- Public Health Foundation of India, Gurugram, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Maja E. Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Mana Moghimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bolormaa Norov
- Division of Nutrition, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Gastón Perman
- Department of Public Health, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sarah Quesnel-Crooks
- Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | - Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Silver K. Bahendeka
- Saint Francis Hospital Nsambya, Kampala, Uganda
- Uganda Martyrs University, Kampala, Uganda
| | | | - Michaela Theilmann
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany
| | - Lisa J. Ware
- South African Medical Research Council–Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science and Innovation–National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA
| | - Justine I. Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Parati G, Lackland DT, Campbell NRC, Ojo Owolabi M, Bavuma C, Mamoun Beheiry H, Dzudie A, Ibrahim MM, El Aroussy W, Singh S, Varghese CV, Whelton PK, Zhang XH. How to Improve Awareness, Treatment, and Control of Hypertension in Africa, and How to Reduce Its Consequences: A Call to Action From the World Hypertension League. Hypertension 2022; 79:1949-1961. [PMID: 35638381 DOI: 10.1161/hypertensionaha.121.18884] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertension is the leading preventable risk factor for cardiovascular diseases and disability globally. In low- and middle-income countries hypertension has a major social impact, increasing the disease burden and costs for national health systems. The present call to action aims to stimulate all African countries to adopt several solutions to achieve better hypertension management. The following 3 goals should be achieved in Africa by 2030: (1) 80% of adults with high blood pressure in Africa are diagnosed; (2) 80% of diagnosed hypertensives, that is, 64% of all hypertensives, are treated; and (3) 80% of treated hypertensive patients are controlled. To achieve these aims, we call on individuals and organizations from government, private sector, health care, and civil society in Africa and indeed on all Africans to undertake a few specific high priority actions. The aim is to improve the detection, diagnosis, management, and control of hypertension, now considered to be the leading preventable killer in Africa.
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Affiliation(s)
- Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences; and Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.)
| | - Daniel T Lackland
- Division of Translational Neurosciences and Population Studies, Medical University of South Carolina, Charleston (D.T.L.)
| | - Norman R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada (N.R.C.C.)
| | - Mayowa Ojo Owolabi
- Faculty of Clinical Sciences; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria (M.O.O.)
| | - Charlotte Bavuma
- Kigali University Teaching Hospital, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda (C.B.)
| | - Hind Mamoun Beheiry
- Faculty of Nursing Sciences; Physiology Department, Faculty of Medicine; International University of Africa (IUA), Sudan (H.M.B.)
| | - Anastase Dzudie
- Faculty of Medicine and biomedical sciences, University of Yaounde 1, Cameroon (A.D.)
| | | | | | - Sandhya Singh
- Director; Cluster: Non-Communicable Diseases, National Department of Health, South Africa (S.S.)
| | - Cherian V Varghese
- Department of Noncommunicable Disease, World Health Organization, Geneva, Switzerland (C.V.V.)
| | - Paul K Whelton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana (P.K.W.)
| | - Xin-Hua Zhang
- Beijing Hypertension League Institute, China (X.-H.Z.)
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Kehlenbrink S, Ansbro É, Besançon S, Hassan S, Roberts B, Jobanputra K. Strengthening Diabetes Care in Humanitarian Crises in Low- and Middle-income Settings. J Clin Endocrinol Metab 2022; 107:e3553-e3561. [PMID: 35639997 DOI: 10.1210/clinem/dgac331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Indexed: 11/19/2022]
Abstract
Amid the growing global diabetes epidemic, the scale of forced displacement resulting from armed conflict and humanitarian crises is at record-high levels. More than 80% of the displaced population lives in lower- and middle-income countries, which also host 81% of the global population living with diabetes. Most crises are protracted, often lasting decades, and humanitarian aid organizations are providing long-term primary care to both the local and displaced populations. Humanitarian crises are extremely varied in nature and occur in contexts that are diverse and dynamic. The scope of providing diabetes care varies depending on the phase of the crisis. This paper describes key challenges and possible solutions to improving diabetes care in crisis settings. It focuses on (1) ensuring a reliable supply of life preserving medications and diagnostics, (2) restoring and maintaining access to health care, and (3) adapting service design to the context. These challenges are illustrated through case studies in Ukraine, Mali, the Central African Republic, and Jordan.
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Affiliation(s)
- Sylvia Kehlenbrink
- Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Humanitarian Initiative, Cambridge, MA 02138, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Éimhín Ansbro
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | | | - Saria Hassan
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322,USA
- Emory Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
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29
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Gnugesser E, Chwila C, Brenner S, Deckert A, Dambach P, Steinert JI, Bärnighausen T, Horstick O, Antia K, Louis VR. The economic burden of treating uncomplicated hypertension in Sub-Saharan Africa: a systematic literature review. BMC Public Health 2022; 22:1507. [PMID: 35941626 PMCID: PMC9358363 DOI: 10.1186/s12889-022-13877-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background and Objectives Hypertension is one of the leading cardiovascular risk factors with high numbers of undiagnosed and untreated patients in Sub Saharan Africa (SSA). The health systems and affected people are often overwhelmed by the social and economic burden that comes with the disease. However, the research on the economic burden and consequences of hypertension treatment remains scare in SSA. The objective of our review was to compare different hypertension treatment costs across the continent and identify major cost drivers. Material and Methods Systematic literature searches were conducted in multiple databases (e.g., PubMed, Web of Science, Google Scholar) for peer reviewed articles written in English language with a publication date from inception to Jan. 2022. We included studies assessing direct and indirect costs of hypertension therapy in SSA from a provider or user perspective. The search and a quality assessment were independently executed by two researchers. All results were converted to 2021 US Dollar. Results Of 3999 results identified in the initial search, 33 were selected for data extraction. Costs differed between countries, costing perspectives and cost categories. Only 25% of the SSA countries were mentioned in the studies, with Nigeria dominating the research with a share of 27% of the studies. We identified 15 results each from a user or provider perspective. Medication costs were accountable for the most part of the expenditures with a range from 1.70$ to 97.06$ from a patient perspective and 0.09$ to 193.55$ from a provider perspective per patient per month. Major cost drivers were multidrug treatment, inpatient or hospital care and having a comorbidity like diabetes. Conclusion Hypertension poses a significant economic burden for patients and governments in SSA. Interpreting and comparing the results from different countries and studies is difficult as there are different financing methods and cost items are defined in different ways. However, our results identify medication costs as one of the biggest cost contributors. When fighting the economic burden in SSA, reducing medication costs in form of subsidies or special interventions needs to be considered. Trial registration Registration: PROSPERO, ID CRD42020220957. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13877-4.
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Affiliation(s)
- E Gnugesser
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - C Chwila
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - S Brenner
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - A Deckert
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - P Dambach
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - J I Steinert
- TUM School of Social Sciences and Technology, Technical University of Munich, Munich, Germany
| | - T Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - O Horstick
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - K Antia
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany
| | - V R Louis
- Heidelberg Institute of Global Health, Heidelberg University Medical School, Heidelberg University, Heidelberg, Germany.
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30
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Hennein R, Ggita J, Ssuna B, Shelley D, Akiteng AR, Davis JL, Katamba A, Armstrong-Hough M. Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption. Glob Public Health 2022; 17:1868-1882. [PMID: 34775913 PMCID: PMC10570963 DOI: 10.1080/17441692.2021.2003838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
Many implementation efforts experience interruptions, especially in settings with developing health systems. Approaches for evaluating interruptions are needed to inform re-implementation strategies. We sought to devise an approach for evaluating interruptions by exploring the sustainability of a programme that implemented diabetes mellitus (DM) screening within tuberculosis clinics in Uganda in 2017. In 2019, we conducted nine interviews with clinic staff and observed clinic visits to determine their views and practices on providing integrated care. We mapped themes to a social ecological model with three levels derived from the Consolidated Framework for Implementation Research (CFIR): outer setting (i.e. community), inner setting (i.e. clinic), and individuals (i.e. clinicians). Respondents explained that DM screening ceased due to disruptions in the national supply chain for glucose test strips, which had cascading effects on clinics and clinicians. Lack of screening supplies in clinics limited clinicians' opportunities to perform DM screening, which contributed to diminished self-efficacy. However, culture, compatibility and clinicians' beliefs about DM screening sustained throughout the interruption. We propose an approach for evaluating interruptions using the CFIR and social ecological model; other programmes can adapt this approach to identify cascading effects of interruptions and target them for re-implementation.
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Affiliation(s)
- Rachel Hennein
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States
- Yale School of Medicine, New Haven, Connecticut, United States
| | - Joseph Ggita
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Bashir Ssuna
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Donna Shelley
- Department of Public Health Policy and Management, New York University, New York, New York, United States
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Upper Mulago Hill, Kampala, Uganda
| | - J. Lucian Davis
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, United States
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, United States
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mari Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Social and Behavioral Sciences, New York University, New York, NY
- Department of Epidemiology, New York University, New York, New York, United States
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31
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Kaur P, Borah PK, Gaigaware P, Mohapatra PK, R Das NK, Uike PV, Tobgay KJ, Tushi A, Zorinsangi, Mazumdar G, Marak B, Pizi D, Chakma T, Sugunan AP, Vijayachari P, Bhardwaj RR, Arambam PC, Kutum T, Sharma A, Pal P, Shanmugapriya PC, Manivel P, Kaliyamoorthy N, Chakma J, Mathur P, Dhaliwal RS, Mahanta J, Mehendale SM. Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India. Indian J Med Res 2022; 156:260-268. [PMID: 36629185 PMCID: PMC10057372 DOI: 10.4103/ijmr.ijmr_3248_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background and objectives Non-communicable diseases (NCDs) are highly prevalent in the tribal populations; however, there are limited data regarding health system preparedness to tackle NCDs among these populations. We estimated the availability of human resources, equipment, drugs, services and knowledge of doctors for NCD management in the selected tribal districts in India. Methods A cross-sectional survey was conducted in 12 districts (one from each State) with at least 50 per cent tribal population in Andaman and Nicobar Islands, Himachal Pradesh, Madhya Pradesh, Odisha and eight northeastern States. Primary health centres (PHCs), community health centres (CHCs) and district/sub-district hospitals (DHs) were surveyed and data on screening and treatment services, human resources, equipment, drugs and information systems indicators were collected and analysed. The data were presented as proportions. Results In the present study 177 facilities were surveyed, including 156 PHCs/CHCs and 21 DHs. DHs and the majority (82-96%) of the PHCs/CHCs provided outpatient treatment for diabetes and hypertension. Overall, 97 per cent of PHCs/CHCs had doctors, and 78 per cent had staff nurses. The availability of digital blood pressure monitors ranged from 35 to 43 per cent, and drugs were either not available or inadequate. Among 213 doctors, three-fourths knew the correct criteria for hypertension diagnosis, and a few correctly reported diabetes diagnosis criteria. Interpretation & conclusions The results of this study suggest that the health system of the studied tribal districts was not adequately prepared to manage NCDs. The key challenges included inadequately trained workforce and a lack of equipment and drugs. It is suggested that capacity building and, procurement and distribution of equipment, drugs and information systems to track NCD patients should be the key focus areas of national programmes.
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Affiliation(s)
- Prabhdeep Kaur
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - P K Borah
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Pooja Gaigaware
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - P K Mohapatra
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Nabajit K R Das
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Pankaj V Uike
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Karma Jigme Tobgay
- Department of Health Care, Human Services & Family Welfare, Government of Sikkim, Gangtok, Sikkim, India
| | - Aonungdok Tushi
- Department of Health & Family Welfare, Government of Nagaland, Mokokchung, Nagaland, India
| | - Zorinsangi
- Department of Health & Family Welfare, Government of Mizoram, Aizwal, Mizoram, India
| | | | - Bibha Marak
- Department of Health & Family Welfare, Government of Meghalaya, East Garo Hills, Meghalaya, India
| | - Dirang Pizi
- Department of Health & Family Welfare, Government of Arunachal Pradesh, East Kameng, Arunachal Pradesh, India
| | - Tapas Chakma
- Division of Non-communicable Diseases, ICMR- National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - A P Sugunan
- ICMR-Regional Medical Research Centre, Port Blair, Andaman & Nicobar Islands, India
| | - P Vijayachari
- ICMR-Regional Medical Research Centre, Port Blair, Andaman & Nicobar Islands, India
| | - Rakesh R Bhardwaj
- Department of Health & Family Welfare, Government of Himachal Pradesh, Shimla, Himachal Pradesh, India
| | - Probin C Arambam
- Directorate of Health Services, Government of Manipur, Imphal, Manipur, India
| | - Tridip Kutum
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Anand Sharma
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Piyalee Pal
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - P C Shanmugapriya
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Prathab Manivel
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Neelakandan Kaliyamoorthy
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Joy Chakma
- Indian Council of Medical Research, New Delhi, India
| | - Prashant Mathur
- ICMR-National Centre for Disease Informatics & Research, Bengaluru, Karnataka, India
| | - R S Dhaliwal
- Indian Council of Medical Research, New Delhi, India
| | - J Mahanta
- ICMR-Regional Medical Research Centre, NE Region, Dibrugarh, Assam, India
| | - Sanjay M Mehendale
- Division of Non-communicable Diseases, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
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County Health Leadership Practices and Readiness for Noncommunicable Disease Services in Kenya. Ann Glob Health 2022; 88:58. [PMID: 35936230 PMCID: PMC9306762 DOI: 10.5334/aogh.2673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 06/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Premature mortality from noncommunicable diseases (NCDs) is a contemporary development challenge. Low-income and lower-middle-income countries are disproportionately affected, with the poorest in society considered the most vulnerable. A paucity of literature exists on how leadership practices at the implementation level relate to ensuring readiness for NCD services. Objective: This study investigated any relationship between leadership practices and readiness for NCD services. Methods: This correlational study investigated any relationship between leadership practices at the county level and readiness for NCD services in Kenya using secondary data from a 2013 Service Availability and Readiness Assessment survey. Correlation and multiple linear regression tests were used to determine the strength and direction of any relationship between leadership practices (annual work planning, therapeutic committees, and supportive supervision), and NCD readiness (county readiness score). Findings: The findings indicated a statistically significant relationship between therapeutic committee (p = .002) and supportive supervision practices (p = .023) and NCD readiness. Leadership practices also had a statistically significant predictive relationship with NCD readiness (p = .009). Conclusion: Health leaders should ensure that leadership practices that have a predictive relationship with NCD readiness, such as therapeutic committee activities and supportive supervision visits, are implemented appropriately. Further, county health leaders should pay particular attention to the implementation of these leadership practices at nonpublic and Tiers 2, 3, and 4 health facilities that had lower NCD readiness scores.
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Gupta A, Gitanjali T, Christina S, Janani L, Jamsheer MKM, Akoijam BS. Preparedness of healthcare facilities of manipur in the management of noncommunicable diseases: A cross-sectional study. Indian J Public Health 2022; 66:245-250. [PMID: 36149099 DOI: 10.4103/ijph.ijph_29_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background India is experiencing a rapid health transition with a rising burden of noncommunicable diseases (NCDs), causing significant morbidity and mortality. Cost-effective interventions for comprehensive NCD management can only be designed after assessing the readiness of various health facilities. Objectives This study aimed to assess the preparedness of healthcare facilities of Manipur in the management of NCDs and to assess the knowledge of doctors regarding NCDs. Methods A cross-sectional study was conducted in 21 public healthcare facilities in seven districts of Manipur during October 2021. Readiness of these facilities was assessed through observation and interview of doctors and nurses using a checklist adapted from the WHO Package of Essential NCDs. Knowledge of 153 doctors was also assessed using a self-administered, structured questionnaire. Data were entered in SPSS-26 and expressed using descriptive statistics. Results General readiness index of primary health centers (PHCs), community health centers (CHCs), district hospitals (DHs), and tertiary care centers (TCCs) was 47%, 66.3%, 73.2%, and 70%, respectively. CHCs were ready in the domains of patient care services (80%), human resources (75%), and advocacy (91.7%). DHs and TCCs were ready in terms of patient care services, human resources, record maintenance, referral system, and advocacy. PHCs were not ready in any of the nine domains. Majority of the doctors (88%) had inadequate knowledge regarding NCDs. Conclusion PHCs and CHCs were not adequately prepared, but DHs and TCCs were ready to manage NCDs. More than four-fifth of the doctors had inadequate knowledge. Strengthening PHCs and CHCs and training of healthcare workers are needed for integrated NCD management.
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Affiliation(s)
- Avantika Gupta
- Senior Resident, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Takhellambam Gitanjali
- Post Graduate Trainee, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Soubam Christina
- Senior Resident, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - L Janani
- Senior Resident, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - M K Mohammed Jamsheer
- Post Graduate Trainee, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Brogen Singh Akoijam
- Professor and Head, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
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Edward A, Kagaruki GB, Manase F, Appel LJ, Matsushita K. Effectiveness of instructional videos for enhancing healthcare provider competencies for hypertension management - a pre-post study in primary healthcare settings, Tanzania. BMC Health Serv Res 2022; 22:721. [PMID: 35641952 PMCID: PMC9153873 DOI: 10.1186/s12913-022-08064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/04/2022] [Indexed: 12/03/2022] Open
Abstract
Background Inadequate adherence to hypertension (HT) clinical standards by healthcare providers is one of the major barriers for HT management. We examined the effectiveness of four short instructional training videos on HT management. Methods Eighteen primary health care facilities were randomly selected using systematic sampling from five districts in the Dar es Salaam region, Tanzania. Pre-post provider knowledge assessments were conducted six months after training and provider performance was measured using patient observations on 8-10 consecutive adult patients per facility. A Screening Quality Index (SQI), comprised of ten HT screening standards, was used to measure adherence. Results Pre-post knowledge scores improved significantly, for, time between blood pressure (BP) readings (28.1% to 72.7%, p=0.01), BP threshold for patients with complications (21.2% to 97.0%, p<0.001), and lifestyle/dietary counseling (from 36.4% to 97.0%, p<0.001). SQI was significantly higher following the training for all provider groups; Nurses (3.0±3.5 to 8.4±1.0, p<0.001), Assistant Medical Officers and Medical Officers (3.5±4.1 to 7.6±2.4, p<0.001), and Assistant Clinical Officers and Clinical Officers (5.4±3.8 to 8.4±2.0, p<0.001). After training, significantly higher adherence was evident for key aspects of managing patients with HT: e.g., counseling on medication (62.1% to 92.7%, p=0.002), side effects (41.4% to 56.1%, p=0.009), reducing caloric intake (69.0 % to 95.1%, p=0.003), reducing cooking salt (65.5% to 97.6%, p<0.01), increasing physical activity (55.2% to 92.7% p<0.001), stopping/reducing cigarette smoking (24.1% to 63.4%, p=0.001), and reducing alcohol consumption (24.1% to 68.3%, p<0.001). SQI was significantly associated with number of years of provider experience (more than 2 years), type of primary healthcare facility (public facility), and exposure to the training intervention. Conclusion Training with short instructional videos can improve provider competency and clinical performance for HT management. The strategy has the potential to enhance effective implementation of HT control strategies in primary care clinics in Tanzania and elsewhere.
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Affiliation(s)
- Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205, USA.
| | - Gibson B Kagaruki
- National Institute for Medical Research, Tukuyu Medical Research Centre, Moshi, Tanzania.,Department of Epidemiology & Biostatistics, Institute of Public Health, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Afrique One ASPIRE via Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Moshi, Tanzania
| | - Frank Manase
- Community Center for Preventive Medicine, Dar es Salaam, Tanzania
| | - Lawrence J Appel
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Johns Hopkins School of Medicine, Baltimore, USA.,Johns Hopkins School of Nursing, Baltimore, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Motala AA, Mbanya JC, Ramaiya K, Pirie FJ, Ekoru K. Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities. Nat Rev Endocrinol 2022; 18:219-229. [PMID: 34983969 DOI: 10.1038/s41574-021-00613-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 12/26/2022]
Abstract
Type 2 diabetes mellitus (T2DM), which was once thought to be rare in sub-Saharan Africa (SSA), is now well established in this region. The SSA region is undergoing a rapid but variable epidemiological transition fuelled by the pace of urbanization, with disease burden profiles shifting from communicable diseases to non-communicable diseases (NCDs). Information on the epidemiology of T2DM has increased, but wide variations in study methods, diagnostic biomarkers and criteria hamper analytical comparison, and data from high-quality studies are limited. The prevalence of T2DM is still low in some rural populations but moderate or high rates are reported in many countries/regions, with evidence for an increase in some. In addition, the proportion of undiagnosed T2DM is still high. The prevalence of T2DM is highest in African people living in urban areas, and the gradient between African people living in urban areas and people in the African diaspora is rapidly fading. However, data from longitudinal studies are lacking and there is limited information on chronic complications and the genetics of T2DM. The large unmet needs for T2DM care call for greater investment of resources into health systems to manage NCDs in SSA. Proposed health-system paradigms are being developed in some countries/regions. However, national NCD programmes need to be adequately funded and coordinated to stem the tide of T2DM and its complications.
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Affiliation(s)
- Ayesha A Motala
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa.
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences University of Yaounde 1, Yaounde, Cameroon
| | | | - Fraser J Pirie
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Kenneth Ekoru
- Centre for Research on Genomics and Global Health, National Human Genome Research Institute, National Institute of Health, Bethesda, MD, USA
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Lotfizadeh A, Palafox B, Takallou A, Balabanova D, McKee M, Murphy A. Factors associated with the availability and affordability of essential cardiovascular disease medicines in low- and middle-income countries: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000072. [PMID: 36962256 PMCID: PMC10021589 DOI: 10.1371/journal.pgph.0000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/24/2021] [Indexed: 11/19/2022]
Abstract
Despite their potential to prevent or delay the onset and progression of cardiovascular disease (CVD), medicines for CVD remain unavailable and unaffordable to many in low- and middle-income countries (LMICs). We systematically reviewed the literature to identify factors associated with availability and affordability of CVD medicines in LMICs. A protocol for this study was registered on the PROSPERO register of systematic reviews (CRD42019135393). We searched Medline, EMBASE, Global Health, Cumulative Index to Nursing and Allied Health Literature, EconLit, Social Policy and Practice, and Africa Wide Information for studies analyzing factors associated with the presence of medicines (availability) or the price of these medicines as it relates to ability to pay (affordability) in LMICs. We performed a narrative synthesis of the results using an access to medicines framework that examines influences at different levels of the health system. We did not conduct a meta-analysis because of the differences in analytic approaches and outcome measures in different studies. The search was conducted in accordance with PRISMA guidelines. Of 43 studies meeting inclusion criteria, 41 were cross-sectional. Availability and affordability were defined and measured in different ways. A range of factors such as sociodemographic characteristics, facility tier, presence of medicines on national essential medicine lists, and international subsidy programs were examined. The studies had variable quality and findings were often inconsistent. We find gaps in the literature on factors associated with availability and affordability of CVD medicines, particularly at the health program level. We conclude that there is a need for experimental and quasi-experimental studies that could identify causal factors and effective responses. Such studies would help further our understanding of how complex multifactorial influences impact these outcomes, which could inform policy decisions. Along with this, greater standardization of definitions and measurement approaches of availability and affordability are needed to allow for more effective comparisons.
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Affiliation(s)
- Ali Lotfizadeh
- PASHA, Los Angeles, California, United States of America
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Benjamin Palafox
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Armin Takallou
- School of Medicine, Oregon Health and Science University, Portland, Oregon, United States of America
| | - Dina Balabanova
- Department of Global Health and Development, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Adrianna Murphy
- Department of Health Services Research and Policy, Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Chakraborty S, Rai RK, Biswas AK, Barik A, Gurung P, Praveen D. Health care seeking behaviour and financial protection of patients with hypertension: A cross-sectional study in rural West Bengal, India. PLoS One 2022; 17:e0264314. [PMID: 35213621 PMCID: PMC8880395 DOI: 10.1371/journal.pone.0264314] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Elevated blood pressure or hypertension is responsible for around 10 million annual deaths globally, and people residing in low and middle-income countries are disproportionately affected by it. India is no exception, where low rate of treatment seeking for hypertension coupled with widespread out-of-pocket payments (OOPs) have been a challenge. This study assessed the pattern of health care seeking behaviour and financial protection along with the associated factors among hypertensive individuals in rural West Bengal, India. Method and findings A cross-sectional study was conducted in Birbhum district of the state of West Bengal, India, during 2017–2018, where 300 individuals were recruited randomly from a list of hypertensives in a population cohort. Healthcare seeking for hypertension and related financial protection in terms of–OOPs and expenses relative to monthly per-capita family expenditure, were analysed. Findings indicated that 47% of hypertensives were not on treatment. Among those under treatment, 80% preferred non-public facilities, and 91% of them had wide-spread OOPs. Cost of medication was a major share of expenses followed by transportation cost to access public health care facility. Multivariable logistic regression analysis indicated longer duration of disease (adjusted odds ratio (aOR): 5.68, 95% Confidence Interval (CI) 1.24–25.99) and health care seeking from non-public establishment (aOR: 34.33, CI: 4.82–244.68) were associated with more incident of OOPs. Linear regression with generalized linear model revealed presence of co-morbidities (adjusted coefficient (aCoeff)10.28, CI: 4.96,15.61) and poorer economic groups (aCoeffpoorest 11.27, CI 3.82,18.71; aCoefflower-middle 7.83, CI 0.65,15.00 and aCoeffupper-middle 7.25, CI: 0.80,13.70) had higher relative expenditure. Conclusion This study suggests that individuals with hypertension had poor health care seeking behaviour, preferred non-public health facilities and had suboptimal financial protection. Economically poorer individuals had higher burden of health expenditure for treatment of hypertension, which indicated gaps in equitable health care delivery for the control of hypertension.
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Affiliation(s)
- Sandipta Chakraborty
- Institute of Public Health, Kalyani, West Bengal, India
- Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, West Bengal, India
| | - Rajesh Kumar Rai
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Economics, University of Goettingen, Goettingen, Germany
- Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
- * E-mail:
| | | | - Anamitra Barik
- Society for Health and Demographic Surveillance, Suri, West Bengal, India
- Suri District Hospital, Suri, West Bengal, India
| | | | - Devarsetty Praveen
- Primary Health Care Research, The George Institute for Global Health, Hyderabad, Telangana, India
- Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Stieglitz LM, Bärnighausen T, Leyna GH, Kazonda P, Killewo J, Rohr JK, Kohler S. Patterns of comorbidity and multimorbidity among middle-aged and elderly women in peri-urban Tanzania. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221076254. [PMID: 35586032 PMCID: PMC9106316 DOI: 10.1177/26335565221076254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/04/2021] [Indexed: 12/11/2022]
Abstract
Background Multimorbidity poses an increasing challenge to health care systems in Sub-Saharan Africa. We studied the extent of multimorbidity and patterns of comorbidity among women aged 40 years or older in a peri-urban area of Dar es Salaam, Tanzania. Methods We assessed 15 chronic conditions in 1528 women who participated in a cross-sectional survey that was conducted within the Dar es Salaam Urban Cohort Study (DUCS) from June 2017 to July 2018. Diagnoses of chronic conditions were based on body measurements, weight, blood testing, screening instruments, and self-report. Results The five most prevalent chronic conditions and most common comorbidities were hypertension (49.8%, 95% CI 47.2 to 52.3), obesity (39.9%, 95% CI 37.3 to 42.4), anemia (36.9%, 95% CI 33.3 to 40.5), signs of depression (32.5%, 95% CI 30.2 to 34.9), and diabetes (30.9%, 95% CI 27.6 to 34.2). The estimated prevalence of multimorbidity (2+ chronic conditions) was 73.8% (95% CI 71.2 to 76.3). Women aged 70 years or older were 4.1 (95% CI 1.5 to 10.9) times mores likely to be affected by multimorbidity and had 0.7 (95% CI 0.3 to 1.2) more chronic conditions than women aged 40 to 44 years. Worse childhood health, being widowed, not working, and higher food insecurity in the household were also associated with a higher multimorbidity risk and level. Conclusion A high prevalence of multimorbidity in the general population of middle-aged and elderly women suggests substantial need for multimorbidity care in Tanzania. Comorbidity patterns can guide multimorbidity screening and help identify health care and prevention needs.
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Affiliation(s)
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Germana H. Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julia K. Rohr
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Stefan Kohler
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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Kabir A, Karim MN, Islam RM, Romero L, Billah B. Health system readiness for non-communicable diseases at the primary care level: a systematic review. BMJ Open 2022; 12:e060387. [PMID: 35140165 PMCID: PMC8830230 DOI: 10.1136/bmjopen-2021-060387] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To synthesise evidence on the primary healthcare system's readiness for preventing and managing non-communicable diseases (NCDs). DESIGN Systematic review. DATA SOURCES Ovid MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus were searched from 1 January 1984 to 30 July 2021, with hand-searching references and expert advice. ELIGIBILITY CRITERIA Any English-language health research with evidence of readiness/preparedness of the health system at the primary healthcare level in the context of four major NCDs: diabetes mellitus, cancer, chronic respiratory diseases (CRDs) and cardiovascular diseases (CVDs). DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data and assessed the bias. The full-text selected articles were then assessed using the Mixed Methods Appraisal Tool. Health system readiness was descriptively and thematically synthesised in line with the health system dynamics framework. RESULTS Out of 7843 records, 23 papers were included in this review (15 quantitative, 3 qualitative and 5 mixed-method studies). The findings showed that existing literature predominantly examined health system readiness from the supply-side perspective as embedded in the WHO's health system framework. However, at the primary healthcare level, these components are insufficiently prepared for NCDs. Among NCDs, higher levels of readiness were reported for diabetes mellitus and hypertension in comparison to CRDs (asthma, chronic obstructive pulmonary disease), CVDs and cancer. There has been a dearth of research on the demand-side perspective, which is an essential component of a health system and must be addressed in the future research. CONCLUSION The supply-side components at the primary healthcare level are inadequately ready to address the growing NCD burden. Improving supply-side factors, with a particular focus on CRDs, CVDs and cancer, and improving understanding of the demand-side components of the health system's readiness, may help to prevent and manage NCDs at the primary healthcare level.
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Affiliation(s)
- Ashraful Kabir
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Md Nazmul Karim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rakibul M Islam
- Women's Health Research Program, Monash University, Melbourne, Victoria, Australia
| | - Lorena Romero
- The Ian Potter Library, Ground Floor, AMREP Building, The Alfred, Melbourne, Victoria, Australia
| | - Baki Billah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Chen Y, Alphonce E, Mujuni E, Kisigo GA, Kingery JR, Makubi A, Peck RN, Kalokola F. Atrial fibrillation and mortality in outpatients with heart failure in Tanzania: a prospective cohort study. BMJ Open 2022; 12:e058200. [PMID: 35046009 PMCID: PMC8772409 DOI: 10.1136/bmjopen-2021-058200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE In recent years, the prevalence and mortality of heart failure (HF) and other associated cardiovascular diseases have doubled in sub-Saharan Africa (SSA). Studies in high-income countries indicate that HF with concurrent atrial fibrillation (AF) is linked to increased mortality. Our objective was to determine the incidence and clinical outcomes of AF among patients with HF in SSA. DESIGN A prospective cohort study using data collected between October 2018 and May 2020. SETTING Outpatient clinic at a tertiary hospital in Mwanza, Tanzania. PARTICIPANTS 303 adult participants (aged ≥18 years) with HF as defined by the European Society of Cardiology guidelines (2016) and 100 adults with HF as defined by clinical criteria alone were enrolled into the study. Patients with comorbid medical condition that had prognosis of <3 months (ie, advance solid tumours, advance haematological malignancies) were excluded. METHODS Participants were screened for AF, and their medical history, physical examinations and sociodemographic information were obtained. Multivariable logistic regression models were used to examine factors associated with AF incidence. Cox regression models were used to analyse 3-month mortality and its associated risk factors. RESULTS We enrolled 403 participants with HF (mean age 60±19 years, 234 (58%) female). The AF prevalence was 17%. In multivariable models, factors associated with AF were low income, alcohol consumption and longer duration of HF. At the end of the 3-month follow-up, 120 out of 403 (30%) participants died, including 44% (31/70) of those with AF. Higher heart rate on ECG, more severe New York Heart Association HF class, rural residence and anaemia were significantly correlated with mortality. CONCLUSION AF is common, underdiagnosed and is associated with significant mortality among outpatients with HF in Tanzania (HR 1.749, 95% CI 1.162 to 2.633, p=0.007). Our findings additionally identify tachycardia (>110 bpm, HR 1.879, 95% CI 1.508 to 2.340, p<0.001) as an easily measurable, high-impact physical examination finding for adverse outcomes in patients with HF.
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Affiliation(s)
- Yunchan Chen
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Emmanuel Alphonce
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Eva Mujuni
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Godfrey A Kisigo
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Justin R Kingery
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Abel Makubi
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Dar es Salaam, Tanzania, United Republic of
| | - R N Peck
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
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Untad V, Napirah MR, Pongsapan N. Factors Related to the Utilization of the Integrated Development Posts of Non-Communicable Diseases (POSBINDU PTM) in Bulili Health Centre Area. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.6936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Non-Communicable Diseases (NCD) are a chronic disease that causes many deaths globally, which is under serious attention by putting in NCD as one target of the Sustainable Development Goals of 2030. An effort in overcoming NCD in Indonesia is through the Integrated Development Post of NCDs (POSBINDU-PTM). Based on a preliminary study at the Bulili Health Center (PUSKESMAS Bulili), it was found that there was a lack of utilization of POSBINDU-PTM such as less role of cadres, lack of health counseling, lack of coordination between cadres and health center (PUSKESMAS) officers, lack of commitment from health center as a coaching team, lack of cross-sector collaboration with POSBINDU programs, and the community not being motivated to be cadres.
AIM: This study aimed to determine the factors related to the utilization of POSBINDU-PTM in the working area of the Bulili Health Center, Palu City.
METHOD: It was quantitative research with an analytical survey design using a cross-sectional design. The sample was all people in the South Birobuli and Petobo villages of 100 people. The data collected are the characteristics of respondents, and knowledge, access to POSBINDU-PTM, facilities and infrastructure, health cadres support, health officer support, and family support toward the utilization of POSBINDU-PTM. Data analysis with the Chi-square test with a significance level of p < 0.05.
RESULTS: The results of this study indicated a relationship between knowledge (p = 0.005), access (p = 0.000), facilities and Infrastructure (p = 0.000), health cadre support (p = 0.000), health center officer support (p = 0.000), and family support (p = 0.000) by utilizing POSBINDU-PTM under the work area of the Bulili Health Center, Palu City.
CONCLUSION: The utilization of POSBINDU-PTM is still very low only 22%. All factors in this study (knowledge, Access, Facilities and Infrastructure, Health Cadre Support, Health Center Officer Support, and Family Support) have a significant correlation to Utilizing POSBINDU-PTM.
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Ideal Cardiovascular Health: Distribution, Determinants and Relationship with Health Status among People Living with HIV in Urban Tanzania. Glob Heart 2022; 17:74. [PMID: 36382155 PMCID: PMC9562968 DOI: 10.5334/gh.1157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background Ageing adults living with HIV (ALHIV) have increased risk of cardiovascular diseases as a result of HIV-infection-related chronic immune activation and inflammatory responses. Cardiovascular health index (CVHI) is a valid and relatively simple index for assessing the cardiovascular health (CVH) of the general population. Use of this index among ALHIV in Sub Saharan Africa, a resource-restricted setting where it could be mostly beneficial, remains limited. Understanding of the distribution and associated factors may inform the design of optimal interventions to improve CVH of ALHIV. Objective We aimed to assess the distribution and factors associated with CVHI scores among ALHIV in an urban setting in Tanzania. Methods A cross-sectional study was conducted among ALHIV on antiretroviral therapy at six HIV clinics in Dar-es-Salaam, Tanzania. We summed the score of each of the seven CVHI metric to obtain the overall CVHI score and assessed the distribution of the score by sex. We then categorized the overall score into ideal (5-7), intermediate (3-4) and poor (<3) CVH categories and performed ordinal regression to identify CVHI score associated factors. Results In all, 629 ALHIV [mean age of 43.5(SD ± 11.2) years] were enrolled. Most had ideal levels of blood glucose (96.2%) and smoking status (83.4%) while less than half had ideal BMI (48.1%), blood pressure (BP) (43.9%) and dietary intake (7.8%). Less than half (47.6%) showed ideal CVH, while less than 1% had all seven metrics at ideal level. Older age (0.96(95%CI:0.95-0.97), p-value < 0.001), being retired/unemployed (0.59(95%CI:0.43-0.81), p-value < 0.01), being employed (0.76(95%CI:0.62-0.94), p-value = 0.01) alcohol use (0.41(95%CI:0.21-0.80), p-value = 0.01) and presence of non-communicable disease comorbidities (0.68(95%CI:0.48-0.97), p-value = 0.04) had significant lower odds of ideal CVH. Conclusion Based on our findings, interventions to improve CVH of ALHIV should target BP management, health education on diet for BMI control and reduction in alcohol consumption, particularly among ageing ALHIV with comorbidities.
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Ajisegiri WS, Abimbola S, Tesema AG, Odusanya OO, Peiris D, Joshi R. The organisation of primary health care service delivery for non-communicable diseases in Nigeria: A case-study analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000566. [PMID: 36962373 PMCID: PMC10021956 DOI: 10.1371/journal.pgph.0000566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/29/2022] [Indexed: 11/19/2022]
Abstract
As chronic diseases, non-communicable diseases (NCDs) require sustained person-centred and community-based care. Given its direct link to communities and households, Primary Health Care (PHC) is well positioned to achieve such care. In Nigeria, the national government has prioritized PHC system strengthening as a means of achieving national NCD targets. However, strengthening PHC systems for NCDs require re-organization of PHC service delivery, based on contextual understanding of existing facilitators and barriers to PHC service delivery for NCDs. We conducted a mixed method case study to explore NCD service delivery with 13 PHC facilities serving as the cases of interest. The study was conducted in two northern and two southern states in Nigeria-and included qualitative interviews with 25 participants, 13 focus group discussion among 107 participants and direct observation at the 13 PHCs. We found that interprofessional role conflict among healthcare workers, perverse incentives to sustain the functioning of PHC facilities in the face of government under-investment, and the perception of PHC as an inferior health system were major barriers to improved organisation of NCD management. Conversely, the presence of physicians at PHC facilities and involvement of civil society organizations in aiding community linkage were key enablers. These marked differences in performance and capacity between PHC facilities in northern compared to southern states, with those in the south better organised to deliver NCD services. PHC reforms that are tailored to the socio-political and economic variations across Nigeria are needed to improve capacity to address NCDs.
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Affiliation(s)
| | - Seye Abimbola
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Azeb Gebresilassie Tesema
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Olumuyiwa O Odusanya
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Nigeria
| | - David Peiris
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
| | - Rohina Joshi
- School of Population Health, University of New South Wales (UNSW), Sydney, Australia
- The George Institute for Global Health, New Delhi, India
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Magodoro IM, Olivier S, Gareta D, Koole O, Modise TH, Gunda R, Herbst K, Pillay D, Wong EB, Siedner MJ. Linkage to HIV care and hypertension and diabetes control in rural South Africa: Results from the population-based Vukuzazi Study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001221. [PMID: 36962629 PMCID: PMC10021540 DOI: 10.1371/journal.pgph.0001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/07/2022] [Indexed: 03/26/2023]
Abstract
Non-communicable diseases (NCDs) account for half of all deaths in South Africa, partly reflecting unmet NCDs healthcare needs. Leveraging existing HIV infrastructure is touted as a strategy to alleviate this chronic care gap. We evaluated whether HIV care platforms are associated with improved NCDs care. We conducted a community-based screening of adults in rural KwaZulu-Natal, collecting BP, HbA1c, and health services utilization data. Care cascade indicators for hypertension and diabetes mellitus were defined as: 1) aware, if previously diagnosed, 2) in care, if seeing a provider within last 6 months; 3) treated, if reporting medication use within preceding 2 weeks; and 4) controlled, if BP<140/90mmHg or HbA1c<6.5%. We fit multivariable adjusted logistic regression models to compare successful completion of each step of the care cascade for hypertension and diabetes between people with virally suppressed HIV and HIV-negative comparators. Inverse probability sampling weights were applied to derive population-level estimates. The analytic sample included 4,933 individuals [mean age 58.4 years; 77% female]. Compared to being HIV-negative, having suppressed HIV was associated with lower adjusted prevalence of being aware (-6.0% [95% CI: -11.0, -1.1%]), in care (-5.7% [-10.6, -0.8%]), and in treatment (-4.8% [-9.7, 0.1%]) for diabetes; but higher adjusted prevalence of controlled diabetes (3.2% [0.2-6.2%]). In contrast, having suppressed HIV was associated with higher adjusted prevalence of being aware (7.4% [5.3-9.6%]), in care (8.0% [5.9-10.2%]), in treatment (8.4% [6.1-10.6%]) and controlled (9.0% [6.2-11.8%]), for hypertension. Overall, disease control was achieved for 40.0% (38.6-40.8%) and 6.8% (5.9-7.8%) of individuals with hypertension and diabetes, respectively. Engagement in HIV care in rural KwaZulu-Natal was generally associated with worse diabetes care and improved hypertension care. While further work should explore how success of HIV programs can be translated to NCD care, strengthening of primary healthcare will also be needed to respond to the growing NCDs epidemic.
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Affiliation(s)
- Itai M Magodoro
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Stephen Olivier
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Dickman Gareta
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Olivier Koole
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- London School of Tropical Medicine and Hygiene, London, United Kingdom
| | - Tshwaraganang H Modise
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- Witwatersrand University, Johannesburg, South Africa
| | - Resign Gunda
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Deenan Pillay
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- University College London, London, United Kingdom
| | - Emily B Wong
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mark J Siedner
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
- University of KwaZulu-Natal, Durban, South Africa
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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'It is not fashionable to suffer nowadays': Community motivations to repeatedly participate in outreach HIV testing indicate UHC potential in Tanzania. PLoS One 2021; 16:e0261408. [PMID: 34937061 PMCID: PMC8694479 DOI: 10.1371/journal.pone.0261408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Objective This study examined people’s motivations for (repeatedly) utilizing HIV testing services during community-based testing events in urban and rural Shinyanga, Tanzania and potential implications for Universal Health Coverage (UHC). Methods As part of a broader multidisciplinary study on the implementation of a HIV Test and Treat model in Shinyanga Region, Tanzania, this ethnographic study focused on community-based testing campaigns organised by the implementing partner. Between April 2018 and December 2019, we conducted structured observations (24), short questionnaires (42) and in-depth interviews with HIV-positive (23) and HIV-negative clients (8). Observations focused on motivations for (re-)testing, and the counselling and testing process. Thematic analysis based on inductive and deductive coding was completed using NVivo software. Results Regular HIV testing was encouraged by counsellors. Most participants in testing campaigns were HIV-negative; 51.1% had tested more than once over their lifetimes. Testing campaigns provided an accessible way to learn one’s HIV status. Motivations for repeat testing included: monitoring personal health to achieve (temporary) reassurance, having low levels of trust toward sexual partners, feeling at risk, seeking proof of (ill)-health, and acting responsibly. Repeat testers also associated testing with a desire to start treatment early to preserve a healthy-looking body, should they prove HIV positive. Conclusions Community-based testing campaigns serve three valuable functions related to HIV prevention and treatment: 1) enable community members to check their HIV status regularly as part of a personalized prevention strategy that reinforces responsible behaviour; 2) identify recently sero-converted clients who would not otherwise be targeted; and 3) engage community with general prevention and care messaging and services. This model could be expanded to include routine management of other (chronic) diseases and provide an entry for scaling up UHC.
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Readiness of health facilities and determinants to manage diabetes mellitus: evidence from the nationwide Service Provision Assessment survey of Afghanistan, Bangladesh and Nepal. BMJ Open 2021. [PMCID: PMC8719183 DOI: 10.1136/bmjopen-2021-054031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives Using nationally representative surveys, the study’s aims were to: (1) evaluate healthcare facilities’ readiness to provide diabetes mellitus (DM) services and (2) identify the factors that affect DM service readiness. Data source Data from Service Provision Assessment surveys conducted in three low-resource South Asian (SA) countries: Afghanistan, Bangladesh and Nepal, were used in this study. Design Cross-sectional nationally representative survey Participants A total of 117, 317 and 397 public and private health facilities in Afghanistan, Bangladesh and Nepal, respectively were analysed. Primary outcome A total of 12 items/indicators were used to measure a health facility’s readiness to provide DM services across four domains. Results For DM management, about 39.3%, 58.4% and 58.2% of health facilities in Afghanistan, Bangladesh and Nepal centred around 7–8, 3–6 and 4–6 items. Only 12.8%, 5.0% and 4.8% of healthcare facilities in Afghanistan, Bangladesh and Nepal reported having at least % (9/12) of the necessary items for DM management, and no one reported having all 12 important items for DM management. According to the negative binomial regression models, the factors associated with higher readiness scores vary among the three countries analysed. Regression models also showed that increases in the number of DM care providers and facility types are similar factors linked to increased readiness scores in all three countries. Conclusions In order to increase a health facility’s readiness to offer DM care, country-specific factors must be addressed in addition to common factors found in all three countries. Further research is required to determine the cause of country-level differences in tracer item availability in order to develop targeted and effective country-specific strategies to improve care quality in the SA region.
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Manavalan P, Wanda L, Galson SW, Thielman NM, Mmbaga BT, Watt MH. Hypertension Care for People With HIV in Tanzania: Provider Perspectives and Opportunities for Improvement. J Int Assoc Provid AIDS Care 2021; 20:23259582211052399. [PMID: 34751055 PMCID: PMC8743911 DOI: 10.1177/23259582211052399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
One in three people with HIV (PWH) has hypertension. However, most hypertensive PWH in sub-Saharan Africa are unaware of their hypertension diagnosis and are not on treatment. To better understand barriers to hypertension care faced by PWH, we interviewed 15 medical providers who care for patients with HIV and hypertension in northern Tanzania. The data revealed barriers at the patient, provider, and system level and included: stress, depression, and HIV-related stigma; lack of hypertension knowledge; insufficient hypertension training; inefficient prescribing practices; challenges with counselling; capacity limitations in hypertension care; high costs of care; and lack of routine hypertension screening and follow-up. Opportunities for improvement focused on prioritizing resources and funding towards hypertension care. System-related challenges were the underlying cause of barriers at individual levels. Strategies that focus on strengthening capacity and utilize existing HIV platforms to promote hypertension care delivery are urgently needed to improve cardiovascular outcomes among PWH.
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Affiliation(s)
- Preeti Manavalan
- 3463University of Florida, Gainesville, FL, USA.,3065Division of Infectious Diseases at Duke Medical Centre, Durham, NC, USA.,199688Duke Global Health Institute, Durham, NC, USA
| | - Lisa Wanda
- 108095Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Sophie W Galson
- 3065Division of Infectious Diseases at Duke Medical Centre, Durham, NC, USA.,199688Duke Global Health Institute, Durham, NC, USA
| | - Nathan M Thielman
- 3065Division of Infectious Diseases at Duke Medical Centre, Durham, NC, USA.,199688Duke Global Health Institute, Durham, NC, USA
| | - Blandina T Mmbaga
- 199688Duke Global Health Institute, Durham, NC, USA.,108095Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,108094Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Melissa H Watt
- 199688Duke Global Health Institute, Durham, NC, USA.,University of Utah, Salt Lake City, UT, USA
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Miselli MA, Cavallin F, Marwa S, Ndunguru B, Itambu RJ, Mutalemwa K, Rizzi M, Ciccarelli G, Conte S, Taddei S, Azzimonti G, Putoto G, Torelli GF. An Integrated Management System for Noncommunicable Diseases Program Implementation in a Sub-Saharan Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11619. [PMID: 34770132 PMCID: PMC8583607 DOI: 10.3390/ijerph182111619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/26/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022]
Abstract
Morbidity and mortality due to noncommunicable diseases (NCDs) are growing exponentially across Tanzania. The limited availability of dedicated services and the disparity between rural and urban areas represent key factors for the increased burden of NCDs in the country. From March 2019, an integrated management system was started in the Iringa District Council. The system implements an integrated management of hypertension and diabetes between the hospital and the peripheral health centers and introduces the use of paper-based treatment cards. The aim of the study was to present the results of the first 6 months' roll-out of the system, which included 542 patients. Data showed that 46.1% of patients returned for the reassessment visit (±1 month), more than 98.4% of patients had blood pressure measured and were checked for complication, more than 88.6% of patients had blood sugar tested during follow-up visit, and blood pressure was at target in 42.8% of patients with hypertension and blood sugar in 37.3% of diabetic patients. Most patients who were lost to follow-up or did not reach the targets were those without medical insurance or living in remote peripheries. Our findings suggest that integrated management systems connecting primary health facilities and referral hospitals may be useful in care and follow-up of patients with hypertension and diabetes.
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Affiliation(s)
- Maria Agata Miselli
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | | | - Samwel Marwa
- District Medical Office, Iringa District Council, Iringa P.O. Box 162, Tanzania; (S.M.); (B.N.)
| | - Bruno Ndunguru
- District Medical Office, Iringa District Council, Iringa P.O. Box 162, Tanzania; (S.M.); (B.N.)
| | - Rehema John Itambu
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | - Katunzi Mutalemwa
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | - Monica Rizzi
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | - Giulia Ciccarelli
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | - Simone Conte
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | - Stefano Taddei
- Department of Internal Medicine, University of Pisa, 56122 Pisa, Italy;
| | - Gaetano Azzimonti
- Doctors with Africa CUAMM, Tosamaganga, Iringa P.O. Box 11, Tanzania; (M.A.M.); (R.J.I.); (K.M.); (M.R.); (G.C.); (S.C.); (G.A.)
- Department of Medicine, Tosamaganga District Designated Hospital, Tosamaganga, Iringa P.O. Box 11, Tanzania
| | | | - Giovanni Fernando Torelli
- Doctors with Africa CUAMM, Dar es Salaam P.O. Box 23447, Tanzania
- Department of Hematology, Oncology and Dermatology, Policlinico Umberto 1, 00161 Rome, Italy
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Birungi J, Kivuyo S, Garrib A, Mugenyi L, Mutungi G, Namakoola I, Mghamba J, Ramaiya K, Wang D, Maongezi S, Musinguzi J, Mugisha K, Etukoit BM, Kakande A, Niessen LW, Okebe J, Shiri T, Meshack S, Lutale J, Gill G, Sewankambo N, Smith PG, Nyirenda MJ, Mfinanga SG, Jaffar S. Integrating health services for HIV infection, diabetes and hypertension in sub-Saharan Africa: a cohort study. BMJ Open 2021; 11:e053412. [PMID: 34728457 PMCID: PMC8565555 DOI: 10.1136/bmjopen-2021-053412] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND HIV, diabetes and hypertension have a high disease burden in sub-Saharan Africa. Healthcare is organised in separate clinics, which may be inefficient. In a cohort study, we evaluated integrated management of these conditions from a single chronic care clinic. OBJECTIVES To determined the feasibility and acceptability of integrated management of chronic conditions in terms of retention in care and clinical indicators. DESIGN AND SETTING Prospective cohort study comprising patients attending 10 health facilities offering primary care in Dar es Salaam and Kampala. INTERVENTION Clinics within health facilities were set up to provide integrated care. Patients with either HIV, diabetes or hypertension had the same waiting areas, the same pharmacy, were seen by the same clinical staff, had similar provision of adherence counselling and tracking if they failed to attend appointments. PRIMARY OUTCOME MEASURES Retention in care, plasma viral load. FINDINGS Between 5 August 2018 and 21 May 2019, 2640 patients were screened of whom 2273 (86%) were enrolled into integrated care (832 with HIV infection, 313 with diabetes, 546 with hypertension and 582 with multiple conditions). They were followed up to 30 January 2020. Overall, 1615 (71.1%)/2273 were female and 1689 (74.5%)/2266 had been in care for 6 months or more. The proportions of people retained in care were 686/832 (82.5%, 95% CI: 79.9% to 85.1%) among those with HIV infection, 266/313 (85.0%, 95% CI: 81.1% to 89.0%) among those with diabetes, 430/546 (78.8%, 95% CI: 75.4% to 82.3%) among those with hypertension and 529/582 (90.9%, 95% CI: 88.6 to 93.3) among those with multimorbidity. Among those with HIV infection, the proportion with plasma viral load <100 copies/mL was 423(88.5%)/478. CONCLUSION Integrated management of chronic diseases is a feasible strategy for the control of HIV, diabetes and hypertension in Africa and needs evaluation in a comparative study.
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Affiliation(s)
- Josephine Birungi
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- The AIDS Support Organization, Kampala, Uganda
| | - Sokoine Kivuyo
- Muhimbili Medical Research Centre, National Institute for Medical Research Muhimbili Research Centre, Dar Es Salaam, Tanzania
| | - Anupam Garrib
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Gerald Mutungi
- Non-Communicable Diseases Control Programme, Ministry of Health, Kampala, Uganda
| | - Ivan Namakoola
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Janneth Mghamba
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | | | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sarah Maongezi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | | | | | | | - Ayoub Kakande
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Louis Wihelmus Niessen
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joseph Okebe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tinevimbo Shiri
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Janet Lutale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Geoff Gill
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Peter G Smith
- MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Moffat J Nyirenda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe and Karonga, Malawi
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sayoki Godfrey Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research Muhimbili Research Centre, Dar Es Salaam, Tanzania
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Shabbar Jaffar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Kavishe BB, Kweka BV, Nitsch D, PrayGod G, Jeremiah K, Faurholt-Jepsen D, Filteau S, Olsen MF, Kitilya BW, Krogh-Madsen R, Friis H, Peck R. Risk factors for impaired renal function in HIV-infected and HIV-uninfected adults: cross-sectional study in North-Western Tanzania. BMC Nephrol 2021; 22:355. [PMID: 34715799 PMCID: PMC8555220 DOI: 10.1186/s12882-021-02563-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/13/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Although the burden of impaired renal function is rising in sub-Saharan Africa (SSA), little is known about correlates of impaired renal function in the region. We determined factors associated with estimated glomerular filtration rate (eGFR) and impaired renal function in HIV-infected and HIV-uninfected adults. METHODS We undertook cross-sectional analysis of data from 1947 adults at enrolment for a cohort study on diabetes and associated complications in HIV patients in Mwanza, north-western Tanzania. A structured questionnaire was used to collect data on sociodemography, smoking, alcohol, physical activity, antiretroviral therapy (ART) and anthropometry. We measured blood pressure, tested blood samples for creatinine, glucose and HIV, and performed Kato Katz for Schistosoma mansoni. Correlates of eGFR (mL/min/1.73 m2) and impaired renal function (eGFR< 60 mL/min/1.73 m2) were determined using linear regression and logistic regression, respectively. RESULTS 655 (34%) participants were HIV-uninfected, 956 (49%) were ART-naive HIV-infected and 336 (17%) were HIV-infected adults on ART. The mean age was 41 years (SD12) and majority (59%) were females. Overall, the mean eGFR was 113.6 mL/min/1.73 m2 but 111.2 mL/min/1.73 m2 in HIV-uninfected, 109.7 mL/min/1.73 m2 in ART-naive HIV-infected and 129.5 mL/min/1.73 m2 in HIV-infected ART-experienced adults, and respective prevalence of impaired renal function was 7.0, 5.7, 8.1 and 6.3%. Correlates of lower eGFR were increasing age, higher socioeconomic status, unhealthy alcohol drinking, higher body mass index and diabetes mellitus. Anaemia was associated with 1.9 (95% Confidence Interval (CI):1.2, 2.7, p = 0.001) higher odds of impaired renal function compared to no anaemia and this effect was modified by HIV status (p value 0.02 for interaction). CONCLUSION Impaired renal function is prevalent in this middle-aged study population. Interventions for prevention of impaired renal function are needed in the study population with special focus in HIV-infected adults and those with high socioeconomic status. Interventions targeting modifiable risk factors such as alcohol and weight reduction are warranted.
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Affiliation(s)
| | - Belinda V Kweka
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Kidola Jeremiah
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mette Frahm Olsen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Brenda W Kitilya
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Robert Peck
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Weill Cornell Medical College, New York, USA
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