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Odayar J, Rusch J, Dave JA, Van Der Westhuizen DJ, Mukonda E, Lesosky M, Myer L. Transfers between health facilities of people living with diabetes attending primary health care services in the Western Cape Province of South Africa: A retrospective cohort study. Trop Med Int Health 2024; 29:489-498. [PMID: 38514897 PMCID: PMC11147718 DOI: 10.1111/tmi.13990] [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: 03/23/2024]
Abstract
OBJECTIVES Transfers between health facilities of people living with HIV attending primary health care (PHC) including hospital to PHC facility, PHC facility to hospital and PHC facility to PHC facility transfers occur frequently, affect health service planning, and are associated with disengagement from care and viraemia. Data on transfers among people living with diabetes attending PHC, particularly transfers between PHC facilities, are few. We assessed the transfer incidence rate of people living with diabetes attending PHC, and the association between transfers between PHC facilities and subsequent HbA1c values. METHODS We analysed data on HbA1c tests at public sector facilities in the Western Cape Province (2016-March 2020). Individuals with an HbA1c in 2016-2017 were followed-up for 27 months and included in the analysis if ≥18 years at first included HbA1c, ≥2 HbA1cs during follow-up and ≥1 HbA1c at a PHC facility. A visit interval was the duration between two consecutive HbA1cs. Successive HbA1cs at different facilities of any type indicated any transfer, and HbA1cs at different PHC facilities indicated a transfer between PHC facilities. Mixed effects logistic regression adjusted for sex, age, rural/urban facility attended at the start of the visit interval, disengagement (visit interval >14 months) and a hospital visit during follow-up assessed the association between transfers between PHC facilities and HbA1c >8%. RESULTS Among 102,813 participants, 22.6% had ≥1 transfer of any type. Including repeat transfers, there were 29,994 transfers (14.4 transfers per 100 person-years, 95% confidence interval [CI] 14.3-14.6). A total of 6996 (30.1%) of those who transferred had a transfer between PHC facilities. Visit intervals with a transfer between PHC facilities were longer (349 days, interquartile range [IQR] 211-503) than those without any transfer (330 days, IQR 182-422). The adjusted relative odds of an HbA1c ≥8% after a transfer between PHC facilities versus no transfer were 1.20 (95% CI 1.05-1.37). CONCLUSION The volume of transfers involving PHC facilities requires consideration when planning services. Individuals who transfer between PHC facilities require additional monitoring and support.
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Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Jody Rusch
- Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Joel A Dave
- Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Diederick J Van Der Westhuizen
- Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Elton Mukonda
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
- Department of Clinical Medicine, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
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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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Habebo TT, Jaafaripooyan E, Mosadeghrad AM, Foroushani AR, Gebriel SY, Babore GO. A Mixed Methods Multicenter Study on the Capabilities, Barriers, and Opportunities for Diabetes Screening and Management in the Public Health System of Southern Ethiopia. Diabetes Metab Syndr Obes 2022; 15:3679-3692. [PMID: 36465989 PMCID: PMC9709844 DOI: 10.2147/dmso.s391926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background More than half of diabetics' in Ethiopia live undiagnosed, and the majority of those who already knew their status also struggle to manage their diseases. However, the underlying challenges are less understood in the study area. Therefore, this study aimed to assess diabetes screening and management capabilities, barriers, and opportunities in southern Ethiopia. Methods We applied a mixed methods study. To assess the healthcare systems' capabilities, we collected quantitative data from randomly selected ten hierarchically organized healthcare facilities, and purposive maximum variation sampling was applied to recruit twenty-nine individuals for face-to-face in-depth interviewing. The interviews were audio recorded, transcribed verbatim, thematically analyzed, and presented accordingly. Results Our study findings indicated that there were good opportunities and encouraging capabilities like government commitment and expansion of services to improve diabetes screening and management in southern Ethiopia. Nevertheless, poor governance, the system's structural problems, skilled professionals' inaccessibility and lack of teamwork, poor service integration, poor planning, and lack of monitoring and evaluation mechanisms have been hampering the service delivery at the system level. While service unaffordability, low awareness level, and lifestyle modification problems were the main challenges at the patient level. Furthermore, outdated paper-based medical record documentation, frequent essential drug stock-outing, essential laboratory service interruptions, and none-use of some available services like HbA1c have been contributing to the barriers. Conclusion Despite favorable capabilities available, diabetes management in southern Ethiopia has been struggling with solvable structural defects, poor service delivery and inaccessibility, and patients' poor lifestyle modification. Therefore, public health system restructuring, optimum financing, computerization of medical records documentation, and health system and patient capacity building are strongly recommended interventions to tackle the problem at the grass-root level.
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Affiliation(s)
- Teshome Tesfaye Habebo
- Disease Prevention and Control Directorate, Kembata Tembaro Zone Health Department, Durame, SNNPRS, Ethiopia
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ebrahim Jaafaripooyan
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Mohammad Mosadeghrad
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Getachew Ossabo Babore
- Department of Nursing, College of Health Sciences and Medicine, Wachemo University, Hossana, Ethiopia
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Chamba NG, Byashalira KC, Shayo PJ, Ramaiya KL, Manongi RN, Daud P, Mmbaga BT, Ntinginya NE, Lillebaek T, Bygbjerg IC, Christensen DL, Mpagama SG. Where can Tanzania health system integrate clinical management of patients with dual tuberculosis and diabetes mellitus? A cross-sectional survey at varying levels of health facilities. PUBLIC HEALTH IN PRACTICE 2022; 3:100242. [PMID: 36101768 PMCID: PMC9461549 DOI: 10.1016/j.puhip.2022.100242] [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: 04/09/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/01/2022] Open
Abstract
Objective Study design Methods Results Conclusion
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Te V, Wouters E, Buffel V, Van Damme W, van Olmen J, Ir P. Generation of cascades of care for diabetes and hypertension care continuum in Cambodia: a population-based survey protocol (Preprint). JMIR Res Protoc 2022; 11:e36747. [PMID: 36053576 PMCID: PMC9482065 DOI: 10.2196/36747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vannarath Te
- Health Policy and Systems Research Unit, National Institute of Public Health, Phnom Penh, Cambodia
- Health Policy Unit, Department of Public Health, Institute of Tropical Medicine (Antwerp), Antwerp, Belgium
- Quality of Integrated Care, Spearhead Research Public Health & Primary Care, The University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Center for Longitudinal & Life Course Studies, Department of Sociology, The University of Antwerp, Antwerp, Belgium
| | - Veerle Buffel
- Center for Longitudinal & Life Course Studies, Department of Sociology, The University of Antwerp, Antwerp, Belgium
| | - Wim Van Damme
- Health Policy Unit, Department of Public Health, Institute of Tropical Medicine (Antwerp), Antwerp, Belgium
| | - Josefien van Olmen
- Quality of Integrated Care, Spearhead Research Public Health & Primary Care, The University of Antwerp, Antwerp, Belgium
| | - Por Ir
- Health Policy and Systems Research Unit, National Institute of Public Health, Phnom Penh, Cambodia
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van Crevel R, Critchley JA. The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice. Trop Med Infect Dis 2021; 6:tropicalmed6010008. [PMID: 33435609 PMCID: PMC7838867 DOI: 10.3390/tropicalmed6010008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetes Mellitus increases the risk of developing Tuberculosis (TB) disease by about three times; it also doubles the risk of death during TB treatment and other poor TB treatment outcomes. Diabetes may increase the risk of latent infection with Mycobacterium tuberculosis (LTBI), but the magnitude of this effect is less clear. Whilst this syndemic has received considerable attention, most of the published research has focussed on screening for undiagnosed diabetes in TB patients or observational follow-up of TB treatment outcomes by diabetes status. There are thus substantial research and policy gaps, particularly with regard to prevention of TB disease in people with diabetes and management of patients with TB-diabetes, both during TB treatment and after successful completion of TB treatment, when they likely remain at high risk of TB recurrence, mortality from TB and cardiovascular disease. Potential strategies to prevent development of TB disease might include targeted vaccination programmes, screening for LTBI and preventive therapy among diabetes patients or, perhaps ideally, improved diabetes management and prevention. The cost-effectiveness of each of these, and in particular how each strategy might compare with targeted TB prevention among other population groups at higher risk of developing TB disease, is also unknown. Despite research gaps, clinicians urgently need practical management advice and more research evidence on the choice and dose of different anti-diabetes medication and effective medical therapies to reduce cardiovascular risks (statins, anti-hypertensives and aspirin). Substantial health system strengthening and integration may be needed to prevent these at risk patients being lost to care at the end of TB treatment.
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Affiliation(s)
- Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Correspondence:
| | - Julia A. Critchley
- Population Health Research Institute, St George’s, University of London, London SW17 ORE, UK;
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Karachaliou F, Simatos G, Simatou A. The Challenges in the Development of Diabetes Prevention and Care Models in Low-Income Settings. Front Endocrinol (Lausanne) 2020; 11:518. [PMID: 32903709 PMCID: PMC7438784 DOI: 10.3389/fendo.2020.00518] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/26/2020] [Indexed: 12/15/2022] Open
Abstract
In low- and middle-income countries (LMICs), the burden of non-communicable diseases such as diabetes is rapidly rising, overpassing the existing burden of communicable diseases. Patients with diabetes living in low-income communities face unique challenges related to lack of awareness, difficulty in accessing health care systems and medications, and consequently failure in achieving optimal diabetes management and preventing complications. Effective diabetes prevention and care models could help reduce the rising burden by standardizing guidelines for prevention and management, improving access to care, engaging community and peers, improving the training of professionals and patients and using the newest technology in the management of the disease. In this article, we review the latest research and evidence on effective models of diabetes prevention and diabetes care delivery in low- income settings. We also provide existing evidence relating to the effectiveness of these models in low-resource contexts, with the aim to highlight characteristics and strengths that make their implementation successful and long-lasting.
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Affiliation(s)
- Feneli Karachaliou
- Unit of Endocrinology, Diabetes and Metabolism, 3rd University Pediatric Department, Attikon University Hospital, Athens, Greece
| | - George Simatos
- Department of Breast Surgery, Agios Savvas Hospital, Athens, Greece
| | - Aristofania Simatou
- Unit of Endocrinology, Diabetes and Metabolism, 3rd University Pediatric Department, Attikon University Hospital, Athens, Greece
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Odayar J, Myer L. Transfer of primary care patients receiving chronic care: the next step in the continuum of care. Int Health 2020; 11:432-439. [PMID: 31081907 DOI: 10.1093/inthealth/ihz014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/11/2019] [Indexed: 12/26/2022] Open
Abstract
The burden of chronic conditions is increasing rapidly in low- and middle-income countries. Chronic conditions require long-term and continuous care, including for patients transferring between facilities. Patient transfer is particularly important in the context of health service decentralization, which has led to increasing numbers of primary care facilities at which patients can access care, and high levels of migration, which suggest that patients might require care at multiple facilities. This article provides a critical review of existing evidence regarding transfer of stable patients receiving primary care for chronic conditions. Patient transfer has received limited consideration in people living with HIV, with growing concern that patients who transfer are at risk of poor outcomes; this appears similar for people with TB, although studies are few. There are minimal data on transfer of patients with non-communicable diseases, including diabetes. Patient transfer for chronic conditions has thus received surprisingly little attention from researchers; considering the potential risks, more research is urgently required regarding reasons for and outcomes of transfers, transfer processes and interventions to optimize transfers, for different chronic conditions. Ultimately, it is the responsibility of health systems to facilitate successful transfers, and this issue requires increased attention from researchers and policy-makers.
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Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Amberbir A, Lin SH, Berman J, Muula A, Jacoby D, Wroe E, Maliwichi-Nyirenda C, Mwapasa V, Crampin A, Makwero M, Singogo E, Phiri S, Gordon S, Tobe SW, Masiye J, Newsome B, Hosseinipour M, Nyirenda MJ, van Oosterhout JJ. Systematic Review of Hypertension and Diabetes Burden, Risk Factors, and Interventions for Prevention and Control in Malawi: The NCD BRITE Consortium. Glob Heart 2020; 14:109-118. [PMID: 31324364 DOI: 10.1016/j.gheart.2019.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022] Open
Abstract
Recent studies have found an increasing burden of noncommunicable diseases in sub-Saharan Africa. A compressive search of PubMed, Medline, EMBASE, and the World Health Organization Global Health Library databases was undertaken to identify studies reporting on the prevalence, risk factors, and interventions for hypertension and diabetes in Malawi. The findings from 23 included studies revealed a high burden of hypertension and diabetes in Malawi, with estimates ranging from 15.8% to 32.9% and from 2.4% to 5.6%, respectively. Associated risk factors included old age, tobacco smoking, excessive alcohol consumption, obesity, physical inactivity, high salt and sugar intake, low fruit and vegetable intake, high body mass index, and high waist-to-hip ratio. Certain antiretroviral therapy regimens were also associated with increased diabetes and hypertension risk in human immunodeficiency virus patient populations. Nationwide, the quality of clinical care was generally limited and demonstrated a need for innovative and targeted interventions to prevent, control, and treat noncommunicable diseases in Malawi.
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Affiliation(s)
- Alemayehu Amberbir
- Dignitas International, Zomba, Malawi; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Sabrina H Lin
- Dignitas International, Zomba, Malawi; Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Adamson Muula
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Darren Jacoby
- Center for Innovative Global Health Technologies, Northwestern University, Chicago, Illinois, USA
| | | | | | - Victor Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Martha Makwero
- College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Sam Phiri
- University of North Carolina-Malawi Project, Lilongwe, Malawi
| | | | - Sheldon W Tobe
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Malawi-Liverpool Wellcome Trust, Blantyre, Malawi
| | - Jones Masiye
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | | | - Mina Hosseinipour
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Joep J van Oosterhout
- Dignitas International, Zomba, Malawi; College of Medicine, University of Malawi, Blantyre, Malawi
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Ekoru K, Doumatey A, Bentley AR, Chen G, Zhou J, Shriner D, Fasanmade O, Okafor G, Eghan B, Agyenim-Boateng K, Adeleye J, Balogun W, Amoah A, Acheampong J, Johnson T, Oli J, Adebamowo C, Collins F, Dunston G, Adeyemo A, Rotimi C. Type 2 diabetes complications and comorbidity in Sub-Saharan Africans. EClinicalMedicine 2019; 16:30-41. [PMID: 31832618 PMCID: PMC6890980 DOI: 10.1016/j.eclinm.2019.09.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/30/2019] [Accepted: 09/05/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Context-specific evidence of the spectrum of type 2 diabetes (T2D) burden is essential for setting priorities and designing interventions to reduce associated morbidity and mortality. However, there are currently limited data on the burden of T2D complications and comorbidity in sub-Saharan Africa (SSA). METHODS T2D complications and comorbidities were assessed in 2,784 participants with diabetes enrolled from tertiary health centres and contextualised in 3,209 individuals without diabetes in Nigeria, Ghana and Kenya. T2D complications and comorbidities evaluated included cardiometabolic, ocular, neurological and renal characteristics. FINDINGS The most common complications/comorbidities among the T2D participants were hypertension (71%; 95% CI 69-73), hyperlipidaemia (34%; 95% CI 32-36), and obesity (27%; 95% CI 25-29). Additionally, the prevalence of cataracts was 32% (95% CI 30-35), diabetic retinopathy 15% (95% CI 13-17), impaired renal function 13% (95% CI 12-15), and erectile dysfunction (in men) 35% (95% CI 32-38). T2D population-attributable fraction for these comorbidities ranged between 6 and 64%. INTERPRETATION The burden of diabetes complications and comorbidity is substantial in SSA highlighting the urgent need for innovative public health strategies that prioritise promotion of healthy lifestyles for prevention and early detection of T2D. Also needed are strategies to strengthen health care system capacities to provide treatment and care for diabetes complications.
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Affiliation(s)
- Kenneth Ekoru
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ayo Doumatey
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amy R. Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Guanjie Chen
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jie Zhou
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Daniel Shriner
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | | | | | - Albert Amoah
- University of Ghana Medical School, Accra, Ghana
| | | | | | - Johnnie Oli
- University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Clement Adebamowo
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, MD, USA
| | | | - Georgia Dunston
- National Human Genome Center at Howard University, Washington, DC, USA
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
- Corresponding authors.
| | - Charles Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
- Corresponding authors.
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Pfaff C, Singano V, Akello H, Amberbir A, Berman J, Kwekwesa A, Banda V, Speight C, Allain T, van Oosterhout JJ. Early experiences integrating hypertension and diabetes screening and treatment in a human immunodeficiency virus clinic in Malawi. Int Health 2019; 10:495-501. [PMID: 30052987 DOI: 10.1093/inthealth/ihy049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/07/2018] [Indexed: 12/13/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) programmes can be leveraged to manage the growing burden of non-communicable diseases (NCDs). Methods In October 2015, a model of integrated HIV-NCD care was developed at a large HIV clinic in southeast Malawi. Blood pressure was measured in adults at every visit and random blood glucose was determined every 2 y. Uncomplicated antiretroviral therapy (ART)-only care was provided by nurses, integrated HIV-NCD management was provided by clinical officers. Waiting times were assessed using the electronic medical record system. The team met monthly to identify bottlenecks. Results All (n=6036) adult HIV patients were screened and 765 were diagnosed with hypertension (prevalence 12.7% [95% confidence interval {CI} 11.9-13.5). A total of 2979 adult HIV patients were screened and 25 were diagnosed with diabetes mellitus (prevalence 0.8% [95% CI 0.6-1.2]). The mean duration of ART visits by clinical officers increased from 80.5 to 90 min during the first quarter following HIV-NCD integration but returned to 75 min the following quarter. The mean number of patients seen per day by clinical officers increased from 6 to 11 and for nurses decreased from 92 to 82 in that time period. The robust vertical HIV system made the design of integrated tools demanding. Challenges of integrated HIV-NCD care were related to patient flow, waiting times, NCD drug availability, data collection, clinic workload and the timing of diabetes and hypertension screening. Conclusions Integrated HIV-NCD services provision was feasible in our clinic.
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Affiliation(s)
- Colin Pfaff
- Dignitas International, Zomba, Malawi.,College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | | | | | | | | | | | | | - Colin Speight
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Theresa Allain
- College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Joep J van Oosterhout
- Dignitas International, Zomba, Malawi.,College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
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12
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Patel P, Sabin K, Godfrey-Faussett P. Approaches to Improve the Surveillance, Monitoring, and Management of Noncommunicable Diseases in HIV-Infected Persons: Viewpoint. JMIR Public Health Surveill 2018; 4:e10989. [PMID: 30573446 PMCID: PMC6320411 DOI: 10.2196/10989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/13/2018] [Accepted: 09/20/2018] [Indexed: 01/13/2023] Open
Abstract
Low-income and middle-income countries (LMICs) are undergoing an epidemiological transition, in which the burden of noncommunicable diseases (NCDs) is rising and mortality will shift from infectious diseases to NCDs. Specifically, cardiovascular disease, diabetes, renal diseases, chronic respiratory diseases, and cancer are becoming more prevalent. In some regions, particularly sub-Saharan Africa, the dual HIV and NCD epidemics will pose challenges because their joint burden will have adverse effects on the quality of life and will likely increase global inequities. Given the austere clinical infrastructure in many LMICs, innovative models of care delivery are needed to provide comprehensive care in resource-limited settings. Improved data collection and surveillance of NCDs among HIV-infected persons in LMICs are necessary to inform integrated NCD-HIV prevention, care, and treatment models that are effective across a range of geographic settings. These efforts will preserve the considerable investments that have been made to prevent the number of lives lost to HIV, promote healthy aging of persons living with HIV, and contribute to meeting United Nations Sustainable Development Goals.
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Affiliation(s)
- Pragna Patel
- Centres for Disease Control and Prevention, Atlanta, GA, United States
| | - Keith Sabin
- Joint United Nations Programme on AIDS, Geneva, Switzerland
| | - Peter Godfrey-Faussett
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Allain TJ, Mang'anda G, Kasiya M, Khomani P, Banda NP, Gonani A, Peterson I, Dreyer G. Use of an electronic medical record to monitor efficacy of diabetes care in out-patients in a central hospital in Malawi: Patterns of glycaemic control and lessons learned. Malawi Med J 2018; 29:322-326. [PMID: 29963288 PMCID: PMC6019548 DOI: 10.4314/mmj.v29i4.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The Malawian health sector has a strong tradition of systematic data collection for monitoring and evaluation of large-scale services. A highly successful adapted Directly Observed Treatment, Short course “DOTS” framework, based on patient registers and paper-based mastercards was introduced to facilitate the management and monitoring of the scale up of antiretroviral therapy. Subsequently, a simple, touch-screen based electronic medical record system (EMRs) was effectively introduced at high burden ART sites. Based on this model, in 2010, a diabetes specific EMRs was introduced in the diabetes clinic at Queen Elizabeth Central Hospital. In this paper we report on the first 3 years experience with the diabetes EMRs. We highlight the strengths and weaknesses of the diabetes EMRs and present data on glycaemic control recorded in the system.
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Affiliation(s)
| | - Grieves Mang'anda
- College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Marrianne Kasiya
- College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | | | - Ndaziona P Banda
- College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Andrew Gonani
- Ministry of Health, Queen Elizabeth Hospital Blantyre, Malawi
| | - Ingrid Peterson
- Malawi Liverpool Wellcome Trust Clinical Research Programme, PO Box Blantyre, Malawi
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Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis. AIDS 2018; 32 Suppl 1:S5-S20. [PMID: 29952786 DOI: 10.1097/qad.0000000000001888] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To appropriately identify and treat noncommunicable diseases (NCDs) among persons living with HIV (PLHIV) in low-and-middle-income countries (LMICs), it is imperative to understand the burden of NCDs among PLHIV in LMICs and the current management of the diseases. DESIGN Systematic review and meta-analysis. METHODS We examined peer-reviewed literature published between 1 January 2010 and 31 December 2016 to assess currently available evidence regarding HIV and four selected NCDs (cardiovascular disease, cervical cancer, depression, and diabetes) in LMICs with a focus on sub-Saharan Africa. The databases, PubMed/MEDLINE, Cochrane Review, and Scopus, were searched to identify relevant literature. For conditions with adequate data available, pooled estimates for prevalence were generated using random fixed effects models. RESULTS Six thousand one hundred and forty-three abstracts were reviewed, 377 had potentially relevant prevalence data and 141 were included in the summary; 57 were selected for quantitative analysis. Pooled estimates for NCD prevalence were hypertension 21.2% (95% CI 16.3-27.1), hypercholesterolemia 22.2% (95% CI 14.7-32.1), elevated low-density lipoprotein 23.2% (95% CI 15.2-33.6), hypertriglyceridemia 27.2% (95% CI 20.7-34.8), low high-density lipoprotein 52.3% (95% CI 35.6-62.8), obesity 7.8% (95% CI 4.3-13.9), and depression 24.4% (95% CI 12.5-42.1). Invasive cervical cancer and diabetes prevalence were 1.3-1.7 and 1.3-18%, respectively. Few NCD-HIV integrated programs with screening and management approaches that are contextually appropriate for resource-limited settings exist. CONCLUSION Improved data collection and surveillance of NCDs among PLHIV in LMICs are necessary to inform integrated HIV/NCD care models. Although efforts to integrate care exist, further research is needed to optimize the efficacy of these programs.
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Glezeva N, Chisale M, McDonald K, Ledwidge M, Gallagher J, Watson CJ. Diabetes and complications of the heart in Sub-Saharan Africa: An urgent need for improved awareness, diagnostics and management. Diabetes Res Clin Pract 2018; 137:10-19. [PMID: 29287838 DOI: 10.1016/j.diabres.2017.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/21/2017] [Accepted: 12/21/2017] [Indexed: 12/24/2022]
Abstract
Type 2 diabetes mellitus is no longer a disease of high income countries but a global health pandemic. With the continued and rapid increase in its prevalence worldwide it is forecasted that diabetes will be a leading cause of morbidity and mortality. A major concern stems from its role in development and progression of cardiovascular disease, including cardiac dysfunction and heart failure. Within low- and middle-income areas such as Sub-Saharan Africa the burden of diabetes is already significant driven by many factors, including, socioeconomic (urbanisation), nutritional (high-calorie "western-diet", obesity) and lifestyle (physical inactivity) changes. Insufficient economic and community resources, poor health care system development and chronic disease management, poor education, and a lack of preventative and diagnostic measures further aggravate the severity of the diabetes problem. This review outlines the burden of type 2 diabetes mellitus in Sub-Saharan Africa and highlights the need for improved community health care and regulations to reduce its epidemiological spread and devastating impact on health.
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Affiliation(s)
- Nadezhda Glezeva
- gHealth Research Group, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland
| | | | - Kenneth McDonald
- gHealth Research Group, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland
| | - Mark Ledwidge
- gHealth Research Group, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland
| | - Joe Gallagher
- gHealth Research Group, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Ireland
| | - Chris J Watson
- Centre for Experimental Medicine, Queen's University Belfast, Northern Ireland, United Kingdom.
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16
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Nuche-Berenguer B, Kupfer LE. Readiness of Sub-Saharan Africa Healthcare Systems for the New Pandemic, Diabetes: A Systematic Review. J Diabetes Res 2018; 2018:9262395. [PMID: 29670916 PMCID: PMC5835275 DOI: 10.1155/2018/9262395] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/25/2017] [Indexed: 01/27/2023] Open
Abstract
Background Effective health systems are needed to care for the coming surge of diabetics in sub-Saharan Africa (SSA). Objective We conducted a systematic review of literature to determine the capacity of SSA health systems to manage diabetes. Methodology We used three different databases (Embase, Scopus, and PubMed) to search for studies, published from 2004 to 2017, on diabetes care in SSA. Results Fifty-five articles met the inclusion criteria, covering the different aspects related to diabetes care such as availability of drugs and diagnostic tools, the capacity of healthcare workers, and the integration of diabetes care into HIV and TB platforms. Conclusion Although chronic care health systems in SSA have developed significantly in the last decade, the capacity for managing diabetes remains in its infancy. We identified pilot projects to enhance these capacities. The scale-up of these pilot interventions and the integration of diabetes care into existing robust chronic disease platforms may be a feasible approach to begin to tackle the upcoming pandemic in diabetes. Nonetheless, much more work needs to be done to address the health system-wide deficiencies in diabetes care. More research is also needed to determine how to integrate diabetes care into the healthcare system in SSA.
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Affiliation(s)
- Bernardo Nuche-Berenguer
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-1804, USA
| | - Linda E. Kupfer
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20814, USA
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17
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Directly Observed Therapy in Hypertension (DOT-HTN). DRUG ADHERENCE IN HYPERTENSION AND CARDIOVASCULAR PROTECTION 2018. [DOI: 10.1007/978-3-319-76593-8_6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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18
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Atun R, Davies JI, Gale EAM, Bärnighausen T, Beran D, Kengne AP, Levitt NS, Mangugu FW, Nyirenda MJ, Ogle GD, Ramaiya K, Sewankambo NK, Sobngwi E, Tesfaye S, Yudkin JS, Basu S, Bommer C, Heesemann E, Manne-Goehler J, Postolovska I, Sagalova V, Vollmer S, Abbas ZG, Ammon B, Angamo MT, Annamreddi A, Awasthi A, Besançon S, Bhadriraju S, Binagwaho A, Burgess PI, Burton MJ, Chai J, Chilunga FP, Chipendo P, Conn A, Joel DR, Eagan AW, Gishoma C, Ho J, Jong S, Kakarmath SS, Khan Y, Kharel R, Kyle MA, Lee SC, Lichtman A, Malm CP, Mbaye MN, Muhimpundu MA, Mwagomba BM, Mwangi KJ, Nair M, Niyonsenga SP, Njuguna B, Okafor OLO, Okunade O, Park PH, Pastakia SD, Pekny C, Reja A, Rotimi CN, Rwunganira S, Sando D, Sarriera G, Sharma A, Sidibe A, Siraj ES, Syed AS, Van Acker K, Werfalli M. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol 2017; 5:622-667. [PMID: 28688818 DOI: 10.1016/s2213-8587(17)30181-x] [Citation(s) in RCA: 280] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Rifat Atun
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Justine I Davies
- Centre for Global Health, King's College London, Weston Education Centre, London, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Parktown, South Africa
| | | | - Till Bärnighausen
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Institute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany; Africa Health Research Institute, KwaZulu, South Africa
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Naomi S Levitt
- Division of Diabetic Medicine & Endocrinology, University of Cape Town, Cape Town, South Africa; Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Moffat J Nyirenda
- Department of NCD Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; NCD Theme, MRC/UVRI Uganda Research Unit, Entebbe, Uganda
| | - Graham D Ogle
- International Diabetes Federation Life for a Child Program, Glebe, NSW, Australia; Diabetes NSW & ACT, Glebe, NSW, Australia
| | | | - Nelson K Sewankambo
- Department of Medicine, and Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Eugene Sobngwi
- University of Newcastle at Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Solomon Tesfaye
- Sheffield Teaching Hospitals and University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - John S Yudkin
- Institute of Cardiovascular Science, Division of Medicine, University College London, London, UK
| | - Sanjay Basu
- Center for Population Health Sciences and Center for Primary Care and Outcomes Research, Department of Medicine and Department of Health Research and Policy, Stanford University, Palo Alto, CA, USA
| | - Christian Bommer
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Esther Heesemann
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Jennifer Manne-Goehler
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Iryna Postolovska
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Vera Sagalova
- University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Sebastian Vollmer
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Goettingen, Centre for Modern Indian Studies & Department of Economics, Goettingen, Germany
| | - Zulfiqarali G Abbas
- Muhimbili University of Health and Allied Sciences, and Abbas Medical Centre, Dar es Salaam, Tanzania
| | - Benjamin Ammon
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Akhila Annamreddi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ananya Awasthi
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Agnes Binagwaho
- Harvard Medical School, Harvard University, Boston, MA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA; University of Global Health Equity, Kigali, Rwanda
| | | | - Matthew J Burton
- International Centre for Eye Health, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeanne Chai
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Felix P Chilunga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | - Anna Conn
- The Fletcher School of Law and Diplomacy, Tufts University, Medford, MA, USA
| | - Dipesalema R Joel
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Arielle W Eagan
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | | | - Julius Ho
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simcha Jong
- Leiden University, Science Based Business, Leiden, Netherlands
| | - Sujay S Kakarmath
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Ramu Kharel
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Kyle
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Seitetz C Lee
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Amos Lichtman
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Maïmouna N Mbaye
- Clinique Médicale II, Centre de diabétologie Marc Sankale, Hôpital Abass Ndao, Dakar, Senegal
| | - Marie A Muhimpundu
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | | | - Mohit Nair
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Simon P Niyonsenga
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Obiageli L O Okafor
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Oluwakemi Okunade
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Paul H Park
- Partners In Health, Rwinkwavu, South Kayonza, Rwanda
| | - Sonak D Pastakia
- Purdue University College of Pharmacy (Purdue Kenya Partnership), Indiana Institute for Global Health, Uasin Gishu, Kenya
| | | | - Ahmed Reja
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Institutes of Health, Bethesda, MD, USA
| | - Samuel Rwunganira
- The Institute of HIV/AIDS, Disease Prevention & Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - David Sando
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Anshuman Sharma
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | | | - Azhra S Syed
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kristien Van Acker
- Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Mahmoud Werfalli
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Patel P, Ordunez P, DiPette D, Escobar MC, Hassell T, Wyss F, Hennis A, Asma S, Angell S. Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project. J Clin Hypertens (Greenwich) 2016; 18:1284-1294. [PMID: 27378199 PMCID: PMC5476955 DOI: 10.1111/jch.12861] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/16/2016] [Accepted: 05/20/2016] [Indexed: 01/12/2023]
Abstract
Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems-strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.
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Affiliation(s)
- Pragna Patel
- Centers for Disease Control and PreventionAtlantaGA
| | | | - Donald DiPette
- University of South CarolinaColumbiaSC
- University of South Carolina School of MedicineColumbiaSC
| | | | | | - Fernando Wyss
- Interamerican Society of CardiologyGuatemala CityGuatemala
| | | | - Samira Asma
- Centers for Disease Control and PreventionAtlantaGA
| | - Sonia Angell
- Centers for Disease Control and PreventionAtlantaGA
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Rodriguez-Fernandez R, Ng N, Susilo D, Prawira J, Bangs MJ, Amiya RM. The double burden of disease among mining workers in Papua, Indonesia: at the crossroads between Old and New health paradigms. BMC Public Health 2016; 16:951. [PMID: 27609056 PMCID: PMC5016925 DOI: 10.1186/s12889-016-3630-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/02/2016] [Indexed: 12/21/2022] Open
Abstract
Background As the global shift toward non-communicable diseases overlaps with the unfinished agenda of confronting infectious diseases in low- and middle-income countries, epidemiological links across both burdens must be recognized. This study examined the non-communicable disease-infectious disease overlap in the specific comorbidity rates for key diseases in an occupational cohort in Papua, Indonesia. Methods Diagnosed cases of ischaemic heart disease, stroke, hypertension, diabetes (types 1 and 2), chronic obstructive pulmonary disease, asthma, cancer, HIV and AIDS, tuberculosis, and malaria were extracted from 22,550 patient records (21,513 men, 1037 women) stored in identical electronic health information systems from two clinic sites in Papua, Indonesia. Data were collected as International Classification of Diseases, 10th Revision, entries from records spanning January-December 2013. A novel application of Circos software was used to visualize the interconnectedness between the disease burdens as overlapping prevalence estimates representing comorbidities. Results Overall, NCDs represented 38 % of all disease cases, primarily in the form of type 2 diabetes (n = 1440) and hypertension (n = 1398). Malaria cases represented the largest single portion of the disease burden with 5310 recorded cases, followed by type 2 diabetes with 1400 cases. Tuberculosis occurred most frequently alongside malaria (29 %), followed by chronic obstructive pulmonary disease (19 %), asthma (17 %), and stroke (12 %). Hypertension-tuberculosis (4 %), tuberculosis-cancer (4 %), and asthma-tuberculosis (2 %) comorbidities were also observed. Conclusions The high prevalence of multimorbidity, preponderance of non-communicable diseases, and extensive interweaving of non-communicable and infectious disease comorbidities highlighted in this cohort of mining workers in Papua, Indonesia reflect the markedly double disease burden increasingly plaguing Indonesia and other similar low- and middle-income countries – a challenge with which their over-stretched, under-resourced health systems are ill-equipped to cope. Integrated, person-centered treatment and control strategies rooted in the primary healthcare sector will be critical to reverse this trend.
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Affiliation(s)
| | - Nawi Ng
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Dwidjo Susilo
- Center for Health Policy and Management, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - John Prawira
- Center for Health Policy and Management, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Rachel M Amiya
- Freeport Public Health and Malaria Control, International SOS, Papua, Indonesia.,Department of Family Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,NCD Asia Pacific Alliance, Tokyo, Japan
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Singh K, Ranjani H, Rhodes E, Weber MB. International Models of Care that Address the Growing Diabetes Prevalence in Developing Countries. Curr Diab Rep 2016; 16:69. [PMID: 27313071 DOI: 10.1007/s11892-016-0768-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Diabetes care involves a complex interaction between patients, physicians, the health care system, and society. In low- and middle-income countries (LMICs), where the majority of individuals with diabetes live, there is a shortage of resources and infrastructure for diabetes care. Translation of proven interventions for diabetes prevention and care from experimental settings to the real world is a major challenge, and there is limited evidence from LMICs. To curtail the diabetes burden in LMICs, it is crucial to develop and execute innovative diabetes care models that improve access to care, knowledge, and outcomes. Additionally, adequate training of local health professionals and community engagement can help LMICs become self-sufficient in delivery of diabetes care. In this paper, we reviewed the existing models of diabetes care and prevention in LMICs and provided recommendations to guide the development of a comprehensive and effective future model for diabetes care in LMICs.
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Affiliation(s)
- Kavita Singh
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Biotechnology Block, 3rd Floor, Ansari Nagar, New Delhi, 110 029, India.
- Centre for Chronic Disease Control, New Delhi, India.
| | - Harish Ranjani
- Madras Diabetes Research Foundation, 4B Conron Smith Road, Gopalapuram, Chennai, 600086, India
| | - Elizabeth Rhodes
- Laney Graduate School, Nutrition and Health Sciences, Emory University, 1518 Clifton Road, NE, Atlanta, GA, USA
| | - Mary Beth Weber
- Hubert Department of Global Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA, USA
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Manjomo RC, Mwagomba B, Ade S, Ali E, Ben-Smith A, Khomani P, Bondwe P, Nkhoma D, Douglas GP, Tayler-Smith K, Chikosi L, Harries AD, Gadabu OJ. Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi. Public Health Action 2016; 6:60-5. [PMID: 27358797 DOI: 10.5588/pha.16.0003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/07/2016] [Indexed: 12/20/2022] Open
Abstract
SETTING Patients with chronic non-communicable diseases attending a primary health care centre, Lilongwe, Malawi. OBJECTIVE Using an electronic medical record monitoring system, to describe the quarterly and cumulative disease burden, management and outcomes of patients registered between March 2014 and June 2015. DESIGN A cross-sectional study. RESULTS Of 1135 patients, with new registrations increasing each quarter, 66% were female, 21% were aged ⩾65 years, 20% were obese, 53% had hypertension alone, 18% had diabetes alone, 12% had asthma, 10% had epilepsy and 7% had both hypertension and diabetes. In every quarter, about 30% of patients did not attend the clinic and 19% were registered as lost to follow-up (not seen for ⩾1 year) in the last quarter. Of those attending, over 90% were prescribed medication, and 80-90% with hypertension and/or diabetes had blood pressure/blood glucose measured. Over 85% of those with epilepsy had no seizures and 60-75% with asthma had no severe attacks. Control of blood pressure (41-51%) and diabetes (15-38%) was poor. CONCLUSION It is feasible to manage patients with non-communicable diseases in a primary health care setting in Malawi, although more attention is needed to improve clinic attendance and the control of hypertension and diabetes.
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Affiliation(s)
| | - B Mwagomba
- Department of Non-Communicable Diseases, Ministry of Health, Lilongwe, Malawi
| | - S Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France ; National Tuberculosis Programme, Cotonou, Benin
| | - E Ali
- Medical Department, Operational Centre Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - A Ben-Smith
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - P Khomani
- Baobab Health Trust, Lilongwe, Malawi
| | - P Bondwe
- Baobab Health Trust, Lilongwe, Malawi
| | - D Nkhoma
- Baobab Health Trust, Lilongwe, Malawi
| | - G P Douglas
- Center for Health Informatics for the Underserved, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - K Tayler-Smith
- Medical Department, Operational Centre Brussels, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - L Chikosi
- Area 25 Urban Health Centre, Lilongwe, Malawi
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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Letebo M, Shiferaw F. Adapting HIV patient and program monitoring tools for chronic non-communicable diseases in Ethiopia. Global Health 2016; 12:26. [PMID: 27255329 PMCID: PMC4890485 DOI: 10.1186/s12992-016-0163-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 05/09/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Chronic non-communicable diseases (NCDs) have become a huge public health concern in developing countries. Many resource-poor countries facing this growing epidemic, however, lack systems for an organized and comprehensive response to NCDs. Lack of NCD national policy, strategies, treatment guidelines and surveillance and monitoring systems are features of health systems in many developing countries. Successfully responding to the problem requires a number of actions by the countries, including developing context-appropriate chronic care models and programs and standardization of patient and program monitoring tools. METHODS In this cross-sectional qualitative study we assessed existing monitoring and evaluation (M&E) tools used for NCD services in Ethiopia. Since HIV care and treatment program is the only large-scale chronic care program in the country, we explored the M&E tools being used in the program and analyzed how these tools might be adapted to support NCD services in the country. Document review and in-depth interviews were the main data collection methods used. The interviews were held with health workers and staff involved in data management purposively selected from four health facilities with high HIV and NCD patient load. Thematic analysis was employed to make sense of the data. RESULTS Our findings indicate the apparent lack of information systems for NCD services, including the absence of standardized patient and program monitoring tools to support the services. We identified several HIV care and treatment patient and program monitoring tools currently being used to facilitate intake process, enrolment, follow up, cohort monitoring, appointment keeping, analysis and reporting. Analysis of how each tool being used for HIV patient and program monitoring can be adapted for supporting NCD services is presented. CONCLUSION Given the similarity between HIV care and treatment and NCD services and the huge investment already made to implement standardized tools for HIV care and treatment program, adaptation and use of HIV patient and program monitoring tools for NCD services can improve NCD response in Ethiopia through structuring services, standardizing patient care and treatment, supporting evidence-based planning and providing information on effectiveness of interventions.
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Affiliation(s)
- Mekitew Letebo
- Clinton Health Access Initiative, Addis Ababa, Ethiopia.
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Workneh MH, Bjune GA, Yimer SA. Assessment of health system challenges and opportunities for possible integration of diabetes mellitus and tuberculosis services in South-Eastern Amhara Region, Ethiopia: a qualitative study. BMC Health Serv Res 2016; 16:135. [PMID: 27095028 PMCID: PMC4837556 DOI: 10.1186/s12913-016-1378-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/12/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The double burden of tuberculosis (TB) and diabetes mellitus (DM) is a significant public health problem in low and middle income countries. However, despite the known synergy between the two disease conditions, services for TB and DM have separately been provided. The objective of this study was to explore health system challenges and opportunities for possible integration of DM and TB services. METHODS This was a descriptive qualitative study which was conducted in South-Eastern Amhara Region, Ethiopia. Study participants included health workers (HWs), program managers and other stakeholders involved in TB and DM prevention and control activities. Purposive sampling was applied to select respondents. In order to capture diversity of opinions among participants, maximum variation sampling strategy was applied in the recruitment of study subjects. Data were collected by conducting four focus group discussions and 12 in-depth interviews. Collected data were transcribed verbatim and were thematically analyzed using NVivo 10 software program. RESULT A total of 44 (12 in-depth interviews and 32 focus group discussion) participants were included in the study. The study participants identified a number of health system challenges and opportunities affecting the integration of TB-DM services. The main themes identified were: 1. Unavailability of system for continuity of DM care. 2. Inadequate knowledge and skills of health workers. 3. Frequent stockouts of DM supplies. 4. Patient's inability to pay for DM services. 5. Poor DM data management. 6. Less attention given to DM care. 7. Presence of a well-established TB control program up to the community level. 8. High level of interest and readiness among HWs, program managers and leaders at different levels of the health care delivery system. CONCLUSION The study provided insights into potential health systems challenges and opportunities that need to be considered in the integration of TB-DM services. Piloting TB and DM integrated services in selected HFs of the study area is needed to assess feasibility for possible full scale integration of services for the two comorbid conditions.
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Affiliation(s)
- Mahteme Haile Workneh
- />Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- />Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
| | - Gunnar Aksel Bjune
- />Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- />Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- />Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- />Department of Microbiology, Oslo University Hospital, Oslo, Norway
- />Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
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Harries AD, Kumar AMV, Satyanarayana S, Lin Y, Zachariah R, Lönnroth K, Kapur A. Diabetes mellitus and tuberculosis: programmatic management issues. Int J Tuberc Lung Dis 2016; 19:879-86. [PMID: 26162352 PMCID: PMC4497633 DOI: 10.5588/ijtld.15.0069] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In August 2011, the World Health Organization and the International Union Against Tuberculosis and Lung Disease launched the Collaborative Framework for Care and Control of Tuberculosis (TB) and diabetes mellitus (DM) to guide policy makers and implementers in combatting the epidemics of both diseases. Progress has been made, and includes identifying how best to undertake bidirectional screening for both diseases, how to provide optimal treatment and care for patients with dual disease and the most suitable framework for monitoring and evaluation. Key programmatic challenges include the following: whether screening should be directed at all patients or targeted at those with high-risk characteristics; the most suitable technologies for diagnosing TB and diabetes in routine settings; the best time to screen TB patients for DM; how to provide an integrated, coordinated approach to case management; and finally, how to persuade non-communicable disease programmes to adopt a cohort analysis approach, preferably using electronic medical records, for monitoring and evaluation. The link between DM and TB and the implementation of the collaborative framework for care and control have the potential to stimulate and strengthen the scale-up of non-communicable disease care and prevention programmes, which may help in reducing not only the global burden of DM but also the global burden of TB.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; London School of Hygiene & Tropical Medicine, London, UK
| | - A M V Kumar
- The Union South-East Asia Regional Office, New Delhi, India
| | | | - Y Lin
- The Union China Office, Beijing, China
| | - R Zachariah
- Medical Department, Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Luxembourg
| | - K Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - A Kapur
- World Diabetes Foundation, Gentofte, Denmark
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Ojji DB, Opie LH, Lecour S, Lacerda L, Adeyemi OM, Sliwa K. The proposed role of plasma NT pro-brain natriuretic peptide in assessing cardiac remodelling in hypertensive African subjects. Cardiovasc J Afr 2015; 25:233-8. [PMID: 25629540 PMCID: PMC4241593 DOI: 10.5830/cvja-2014-050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 08/18/2014] [Indexed: 01/19/2023] Open
Abstract
AIM Although plasma NT-proBNP differentiates hypertension (HT) with or without left ventricular hypertrophy (LVH) from hypertensive heart failure (HHF), most of the published data are based on studies in Western populations. Also, most previous studies did not consider left ventricular (LV) diastolic function and right ventricular (RV) function. We therefore examined the relation between NT-proBNP on LV and RV remodelling in an African hypertensive cohort. METHODS Subjects were subdivided into three groups after echocardiography: hypertensives without LVH (HT) (n = 83); hypertensives with LVH (HT + LVH) (n = 50); and those with hypertensive heart failure (HHF) (n = 77). RESULTS Subjects with HHF had significantly higher NT-proBNP levels compared to the HT + LVH group (p < 0.0002). NT-proBNP correlated positively with right atrial area, an indirect measure of RV function. CONCLUSIONS NT-proBNP is proposed as a useful biomarker in differentiating hypertension with or without LVH from hypertensive heart failure in black hypertensive subjects.
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Affiliation(s)
- Dike B Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja; Hatter Institute for Cardiovascular Research in Africa, MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Lionel H Opie
- Hatter Institute for Cardiovascular Research in Africa, MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa, MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Lydia Lacerda
- Hatter Institute for Cardiovascular Research in Africa, MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Olusoji M Adeyemi
- Department of Medical Laboratory Sciences, University of Abuja Teaching Hospital, Gwagwalada, Abuja
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, MRC Inter-Cape Heart Unit, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa ; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand
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Ruby A, Knight A, Perel P, Blanchet K, Roberts B. The Effectiveness of Interventions for Non-Communicable Diseases in Humanitarian Crises: A Systematic Review. PLoS One 2015; 10:e0138303. [PMID: 26406317 PMCID: PMC4583445 DOI: 10.1371/journal.pone.0138303] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/28/2015] [Indexed: 12/18/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are of increasing concern in low- and middle-income countries (LMICs) affected humanitarian crises. Humanitarian agencies and governments are increasingly challenged with how to effectively tackle NCDs. Reviewing the evidence of interventions for NCDs in humanitarian crises can help guide future policies and research by identifying effective interventions and evidence gaps. The aim of this paper is to systematically review evidence on the effectiveness of interventions targeting NCDs during humanitarian crises in LMICs. Methods A systematic review methodology was followed using PRISMA standards. Studies were selected on NCD interventions with civilian populations affected by humanitarian crises in low- and middle-income countries. Five bibliographic databases and a range of grey literature sources were searched. Descriptive analysis was applied and a quality assessment conducted using the Newcastle-Ottawa Quality Assessment Scale for observational studies and the Cochrane Risk of Bias Tool for experimental studies. Results The search yielded 4919 references of which 8 studies met inclusion criteria. Seven of the 8 studies were observational, and one study was a non-blinded randomised-controlled trial. Diseases examined included hypertension, heart failure, diabetes mellitus, chronic kidney disease, thalassaemia, and arthritis. Study settings included locations in the Middle East, Eastern Europe, and South Asia. Interventions featuring disease-management protocols and/or cohort monitoring demonstrated the strongest evidence of effectiveness. No studies examined intervention costs. The quality of studies was limited, with a reliance on observational study designs, limited use of control groups, biases associated with missing data and inadequate patient-follow-up, and confounding was poorly addressed. Conclusions The review highlights the extremely limited quantity and quality of evidence on this topic. Interventions that incorporate standardisation and facilitate patient follow-up appear beneficial. However, substantially more research is needed, including data on costs.
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Affiliation(s)
- Alexander Ruby
- ECOHOST–The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Abigail Knight
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pablo Perel
- Centre for Global Non Communicable Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Karl Blanchet
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bayard Roberts
- ECOHOST–The Centre for Health and Social Change, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Kumpatla S, Sekar A, Achanta S, Sharath BN, Kumar AMV, Harries AD, Viswanathan V. Characteristics of patients with diabetes screened for tuberculosis in a tertiary care hospital in South India. Public Health Action 2015; 3:S23-8. [PMID: 26393064 DOI: 10.5588/pha.13.0035] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/17/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Tertiary care hospital for diabetes mellitus (DM) in Tamil Nadu, South India. OBJECTIVE To compare the socio-demographic, clinical and biochemical characteristics in DM patients with and without tuberculosis (TB). DESIGN A descriptive study involving a review of routinely maintained records to capture the results of screening of DM patients for TB between March and December 2012. DM patients were first asked whether they already had TB, and if not they were screened for TB symptoms, followed by investigations for and possible diagnosis of TB. RESULTS Of 7083 DM patients, 38 already had TB. Of the remainder, 125 (1.8%) had TB symptoms; 71 were investigated and 12 were newly diagnosed with TB. Of the 50 TB patients, 64% had smear-positive pulmonary TB (PTB). DM-TB patients were older, and had lower education level and economic status, a higher frequency of alcohol use, lower body mass index, a longer duration of DM, a greater likelihood of receiving insulin and poorer glycaemic control. CONCLUSION Screening of DM patients for TB was feasible in a tertiary care hospital. The yield of new TB cases was low and merits further investigation. Socio-demographic and clinical characteristics were different in patients with DM and TB compared to those with DM only.
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Affiliation(s)
- S Kumpatla
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, India (World Health Organization Collaborating Centre for Research, Education and Training in Diabetes)
| | - A Sekar
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, India (World Health Organization Collaborating Centre for Research, Education and Training in Diabetes)
| | - S Achanta
- World Health Organization Country Office in India, New Delhi, India
| | - B N Sharath
- World Health Organization Country Office in India, New Delhi, India ; Department of Community Medicine, Employees State Insurance Corporation (ESIC) Medical College, Bangalore, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - A D Harries
- The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - V Viswanathan
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, India (World Health Organization Collaborating Centre for Research, Education and Training in Diabetes)
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Khader A, Ballout G, Shahin Y, Hababeh M, Farajallah L, Zeidan W, Abu-Zayed I, Kochi A, Harries AD, Zachariah R, Kapur A, Shaikh I, Seita A. Diabetes mellitus and treatment outcomes in Palestine refugees in UNRWA primary health care clinics in Jordan. Public Health Action 2015; 3:259-64. [PMID: 26393043 DOI: 10.5588/pha.13.0083] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/17/2013] [Indexed: 12/22/2022] Open
Abstract
SETTING Six primary health care clinics in Jordan, serving Palestine refugees diagnosed with diabetes mellitus (DM). OBJECTIVES To report on the number and characteristics of new DM patients registered in the second quarter of 2013 and of all DM patients ever registered by 30 June 2013, with treatment outcomes and cumulative burden of late-stage complications. DESIGN A descriptive cohort study using routine data collected through e-Health. RESULTS Of the 288 new patients in Q2 2013 and 12 548 patients ever registered with DM by 30 June 2013, smoking, physical inactivity and obesity were recorded in 19%, 50% and 47%, respectively. In Q2 2013, 9740 (78%) patients attended a clinic, with >99% having undergone disease control measures: of these, 72% had postprandial blood glucose ⩽ 180 mg/dl, 71% had blood cholesterol < 200 mg/dl, 82% had blood pressure < 140/90 and 40% had body mass index < 30 kg/m(2). Late-stage complications were present in 1130 (11.6%) patients who attended a clinic, with cardiovascular disease and stroke being the most common. Several differences in outcomes were found between males and females. CONCLUSION There is a high burden of disease due to DM at primary health care clinics in Jordan. Cohort analysis using e-Health is a vital way to assess management and follow-up.
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Affiliation(s)
- A Khader
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - G Ballout
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - Y Shahin
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - M Hababeh
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - L Farajallah
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - W Zeidan
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - I Abu-Zayed
- Field Health Programme, UNRWA, Amman, Jordan
| | - A Kochi
- Tokyo University Medical School, Tokyo, Japan
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - R Zachariah
- Medical Department, Operational Research Unit, Brussels Operational Center, Médecins Sans Frontières, Luxembourg
| | - A Kapur
- World Diabetes Foundation, Gentofte, Denmark
| | - I Shaikh
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
| | - A Seita
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, United Nations Relief and Works Agency (UNRWA) Headquarters (A), Amman, Jordan
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30
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Harries AD, Zachariah R. Applying DOTS principles for operational research capacity building. Public Health Action 2015; 2:101-2. [PMID: 26392964 DOI: 10.5588/pha.12.0075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rony Zachariah
- Médecins Sans Frontières, Medical Department, Operational Research Unit, Brussels Operational Center-Luxembourg, Luxembourg
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Zam K, Kumar AMV, Achanta S, Bhat P, Naik B, Zangpo K, Dorji T, Wangdi Y, Zachariah R. A first country-wide review of Diabetes Mellitus care in Bhutan: time to do better. BMC Health Serv Res 2015; 15:389. [PMID: 26384311 PMCID: PMC4573946 DOI: 10.1186/s12913-015-1026-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 08/27/2015] [Indexed: 11/20/2022] Open
Abstract
Background There is an increasing trend of non-communicable diseases in Bhutan including Diabetes Mellitus (DM). To address this problem, a National Diabetes Control Programme was launched in 1996. There is anecdotal evidence that many patients do not visit the DM clinics regularly, but owing to lack of cohort monitoring, the magnitude of such attrition from care is unknown. Knowledge of the extent of this problem will provide a realistic assessment of the situation on the ground and would be helpful to initiate corrective actions. In this first country-wide audit, we thus aimed to determine among type 2 DM patients registered for care the i) pre-treatment attrition ii) one-year programme outcomes including retention in care, died and Lost–to-follow-up (LTFU, defined as not having visited the clinic at least once within a year of registration) iii) factors associated with attrition from care (death + LTFU) and iv) quality of follow-up care, measured by adherence to recommended patient-monitoring protocols including glycaemic control. Methods A retrospective cohort study involving a review of records routinely maintained under the National Diabetes Control Programme. All type 2 DM patients registered between 1st January and 31st December 2012 in 18 district hospitals of Bhutan were included. Glycaemic control was defined as glycosylated haemoglobin of <7 % or [Fasting Blood Sugar of <130 mg/dl and, Post-prandial Blood Sugar of <180 mg/dl]. Results Of 350 registered DM patients (52 % female, median age 55 years), 63(18 %) were LTFU before treatment initiation (pre-treatment attrition). Of the remaining 287 individuals who started treatment, 226(79 %) were retained in care while 61(21 %) either died or were LTFU. Glycaemic control was achieved in 85(38 %) patients retained in care. Between 7 and 98 % of monitoring parameters had missing data. Conclusion Nearly one-third of DM patients were LTFU and there were short comings in monitoring. Qualitative research is urgently needed to find out the reasons for high attrition. Given the high political commitment by the Royal Government of Bhutan, the findings provide ample grounds for instituting corrective measures and propelling DM care further. It is time to do better!
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Affiliation(s)
- Kinley Zam
- Policy and Planning Division, Ministry of Health, Thimphu, Bhutan.
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
| | | | | | - Balaji Naik
- WHO Country Office for India, New Delhi, India.
| | - Kado Zangpo
- Policy and Planning Division, Ministry of Health, Thimphu, Bhutan.
| | - Tandin Dorji
- Department of Public Health, Ministry of Health, Thimphu, Bhutan.
| | - Yeshey Wangdi
- National Diabetes Control Programme, Department of Medical Services, Ministry of Health, Thimphu, Bhutan.
| | - Rony Zachariah
- Medecins Sans Frontieres, Brussels Operational Center(Operational Research), Luxembourg City, Luxembourg.
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Driessen J, Limula H, Gadabu OJ, Gamadzi G, Chitandale E, Ben-Smith A, Alide N, Douglas GP. Informatics solutions for bridging the gap between clinical and laboratory services in a low-resource setting. Afr J Lab Med 2015; 4:1-7. [PMID: 38440308 PMCID: PMC10911650 DOI: 10.4102/ajlm.v4i1.176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/13/2015] [Indexed: 03/06/2024] Open
Abstract
Background There has been little formal analysis of laboratory systems in resource-limited settings, despite widespread consensus around the importance of a strong laboratory infrastructure. Objectives This study details the informational challenges faced by the laboratory at Kamuzu Central Hospital, a tertiary health facility in Malawi; and proposes ways in which informatics can bolster the efficiency and role of low-resource laboratory systems. Methods We evaluated previously-collected data on three different aspects of laboratory use. A four-week quality audit of laboratory test orders quantified challenges associated with collecting viable specimens for testing. Data on tests run by the laboratory over a one-year period described the magnitude of the demand for laboratory services. Descriptive information about the laboratory workflow identified informational process breakdowns in the pre-analytical and post-analytical phases and was paired with a 24-hour sample of laboratory data on results reporting. Results The laboratory conducted 242 242 tests over a 12-month period. The four-week quality audit identified 54% of samples as untestable. Prohibitive paperwork errors were identified in 16% of samples. Laboratory service workflows indicated a potential process breakdown in sample transport and results reporting resulting from the lack of assignment of these tasks to any specific employee cadre. The study of result reporting time showed a mean of almost six hours, with significant variation. Conclusions This analysis identified challenges in each phase of laboratory testing. Informatics could improve the management of this information by streamlining test ordering and the communication of test orders to the laboratory and results back to the ordering physician.
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Affiliation(s)
- Julia Driessen
- Department of Health Policy and Management, University of
Pittsburgh, Pittsburgh, United States
| | - Henry Limula
- Kamuzu Central Hospital, Ministry of Health, Lilongwe,
Malawi
| | | | - Gervase Gamadzi
- Kamuzu Central Hospital, Ministry of Health, Lilongwe,
Malawi
| | | | - Anne Ben-Smith
- Department of Biomedical Informatics, University of
Pittsburgh, United States
| | - Noor Alide
- Kamuzu Central Hospital, Ministry of Health, Lilongwe,
Malawi
| | - Gerald P. Douglas
- Center for Health Informatics for the Underserved,
University of Pittsburgh, United States
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JING LIFENG, LI SHUANG, LI QIN. Akt/hypoxia-inducible factor-1α signaling deficiency compromises skin wound healing in a type 1 diabetes mouse model. Exp Ther Med 2015; 9:2141-2146. [PMID: 26136949 PMCID: PMC4473382 DOI: 10.3892/etm.2015.2394] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/17/2015] [Indexed: 01/13/2023] Open
Abstract
The aim of the present study was to investigate the mechanisms for impaired skin wound healing in subjects with diabetes. Type 1 diabetes (T1DM) was induced in BALB/c mice using streptozotocin. One month after the establishment of the T1DM mouse model, a wound was formed on the back of the mice, and tissues from the wounds and the margins were collected on days 0, 3, 7 and 10. Protein levels of cluster of differentiation 31 (CD31) were detected using immunohistochemistry, and the mRNA levels of Akt, hypoxia-inducible factor-1α (Hif-1α), vascular endothelial growth factor (Vegf), VEGF receptor 2 (Vegfr2), stromal cell-derived growth factor-1α (Sdf-1α) and CXC chemokine receptor 4 (Cxcr4) were determined using reverse transcription-quantitative polymerase chain reaction analysis. The corresponding protein levels were determined using western blotting. The skin wound healing rate in the T1DM mice was significantly lower than that in the control mice, and the protein level of CD31 in the wounded skin of the T1DM mice was significantly decreased. Furthermore, the overall mRNA levels of Akt, Hif-1α, Vegf, Vegfr2, Sdf-1α and Cxcr4 in the T1DM mice were significantly lower than those in the control mice, and similar trends were observed in the protein levels. In conclusion, skin wound healing was impaired in the T1DM mice, and this may have been caused by a deficiency of Akt/HIF-1α and downstream signaling, as well as delayed angiogenesis.
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Affiliation(s)
- LIFENG JING
- Graduate School of Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - SHUANG LI
- Graduate School of Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - QIN LI
- Department of Plastic Surgery, General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China
- Correspondence to: Professor Qin Li, Department of Plastic Surgery, General Hospital of Guangzhou Military Command, 111 Liuhua Street, Guangzhou, Guangdong 510010, P.R. China, E-mail:
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Shahin Y, Kapur A, Seita A. Diabetes care in refugee camps: the experience of UNRWA. Diabetes Res Clin Pract 2015; 108:1-6. [PMID: 25680680 DOI: 10.1016/j.diabres.2015.01.035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) was established in 1949 and has delivered health care services for over 65 years. The epidemiological transition in disease burden is changing the context in which UNRWA's health programme operates and poses new challenges that require new ways of providing health services. Hypertension and diabetes are two major health problems for Palestine refugees. UNRWA has been providing diabetes and hypertension care since 1992 in its primary health care centres. Of late, through a structured process of care delivery the UNRWA health system is making significant strides in addressing diabetes and hypertension and consequently the nine voluntary global targets as envisaged in the WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020. Given that most developing countries either have no or only rudimentary services for diabetes and hypertension at the primary care level and may face similar resource and capacity constraints, UNRWA's efforts can serve as a model and inspiration to set up similar initiatives.
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Affiliation(s)
| | - Anil Kapur
- World Diabetes Foundation (WDF), Denmark
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Abstract
This review will highlight the current challenges and barriers to diabetes management in low and lower middle income countries using the World Health Organization's 6 Building Blocks for Health Systems (service delivery; healthcare workforce; information; medical products, vaccines and technologies; financing; and leadership and governance). Low and lower middle income countries are characterized by low levels of income and insufficient health expenditure. These countries face a shift in disease burden from communicable to non-communicable diseases including diabetes. Many argue that health systems in these countries do not have the capacity to meet the needs of people with chronic conditions such as diabetes. A variety of barriers exist in terms of organization of health systems and care, human resources, sufficient information for decision-making, availability and affordability of medicines, policies, and alleviating the financial burden of care. These health system barriers need to be addressed, taking into account the need to have diabetes included in the global development agenda and also tailoring the response to local contexts including the needs of people with diabetes.
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Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 6, CH-1211, Geneva 14, Switzerland,
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Harries AD, Kumar AMV, Karpati A, Jahn A, Douglas GP, Gadabu OJ, Chimbwandira F, Zachariah R. Monitoring treatment outcomes in patients with chronic disease: lessons from tuberculosis and HIV/AIDS care and treatment programmes. Trop Med Int Health 2015; 20:961-4. [DOI: 10.1111/tmi.12506] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Anthony D. Harries
- International Union against Tuberculosis and Lung Disease; Paris France
- London School of Hygiene and Tropical Medicine; London UK
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease; South-East Asia Regional Office; New Delhi India
| | - Adam Karpati
- International Union Against Tuberculosis and Lung Disease; North America Office; New York NY USA
| | - Andreas Jahn
- Department of HIV and AIDS; Ministry of Health; Lilongwe Malawi
- ITECH; Malawi and University of Washington; Seattle WA USA
| | - Gerald P. Douglas
- Center for Health Informatics for the Underserved; University of Pittsburgh; Pittsburgh PA USA
| | | | | | - Rony Zachariah
- Medecins sans Frontieres; Medical Department; Operational Research Unit; Brussels Operational Centre; Luxembourg Luxembourg
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Gadabu OJ, Manjomo RC, Mwakilama SG, Douglas GP, Harries AD, Moyo C, Makonokaya LD, Kang'oma S, Chitedze P, Chinsinga FB. An electronic register for vital registration in a rural village with no electricity in Malawi. Public Health Action 2014; 4:145-9. [PMID: 26400800 DOI: 10.5588/pha.14.0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 05/02/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Chalasa village, Traditional Authority Mtema, Lilongwe District, Malawi. OBJECTIVES To report on the deployment of an electronic register in a rural village with no electricity. Specific objectives were to document 1) challenges in setting up the electronic village register (EVR); 2) demographics of village residents, along with births and deaths over three quarters; and 3) the costs of setting up the system. DESIGN A descriptive study. RESULTS The main challenges were slow adoption of the EVR by the village headman, lack of health passports for village residents, double counting of some residents and difficult connectivity. These challenges were overcome. In terms of data, of 790 village residents, 379 (48%) were male, 417 (53%) were aged <15 years and 29 (3.6%) ⩾65 years. From April to December 2013, there were 18 births and 5 deaths. The cost of the EVR, including maintenance costs for 12 months, was US$6210. CONCLUSION An EVR was successfully deployed in Chalasa village, rural Malawi, and data on the resident village population, along with quarterly births and deaths, are now available. This is the first step towards a village-level civil registration system in rural Africa.
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Affiliation(s)
| | | | | | - G P Douglas
- Center for Health Informatics for the Underserved, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - C Moyo
- Central Monitoring and Evaluation Division, Ministry of Health, Lilongwe
| | - L D Makonokaya
- Ministry of Local Government and Rural Development, Lilongwe
| | - S Kang'oma
- National Registration Bureau, Office of the President and Cabinet, Lilongwe, Malawi
| | - P Chitedze
- National Registration Bureau, Office of the President and Cabinet, Lilongwe, Malawi
| | - F B Chinsinga
- National Registration Bureau, Office of the President and Cabinet, Lilongwe, Malawi
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Riza AL, Pearson F, Ugarte-Gil C, Alisjahbana B, van de Vijver S, Panduru NM, Hill PC, Ruslami R, Moore D, Aarnoutse R, Critchley JA, van Crevel R. Clinical management of concurrent diabetes and tuberculosis and the implications for patient services. Lancet Diabetes Endocrinol 2014; 2:740-53. [PMID: 25194887 PMCID: PMC4852378 DOI: 10.1016/s2213-8587(14)70110-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in patients with tuberculosis, and screening and preventive therapy for latent tuberculosis infections in individuals with diabetes. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher risk of drug toxicity than tuberculosis patients without diabetes. Good glycaemic control, which reduces long-term diabetes complications and could also improve tuberculosis treatment outcomes, is hampered by chronic inflammation, drug-drug interactions, suboptimum adherence to drug treatments, and other factors. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. From a health systems point of view, delivery of optimum care and integration of services for tuberculosis and diabetes is a huge challenge in many countries. Experience from the combined tuberculosis and HIV/AIDS epidemic could serve as an example, but more studies are needed that include economic assessments of recommended screening and systems to manage concurrent tuberculosis and diabetes.
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Affiliation(s)
- Anca Lelia Riza
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands; Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Fiona Pearson
- Population Health Research Institute, St Georges University, London, UK
| | - Cesar Ugarte-Gil
- Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bachti Alisjahbana
- Center for TB-HIV research, Medical Faculty, Padjadjaran University, Hasan Sadikin Hosptial, Bandung, Indonesia
| | - Steven van de Vijver
- African Population and Health Research Center, Nairobi, Kenya; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Nicolae M Panduru
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania; 2nd Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Philip C Hill
- Centre for International Health, Faculty of Medicine, Otago University, Dunedin, New Zealand
| | - Rovina Ruslami
- Department of Pharmacology and Therapy, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - David Moore
- London School of Hygiene and Tropical Medicine, London, UK
| | - Rob Aarnoutse
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Julia A Critchley
- Population Health Research Institute, St Georges University, London, UK
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
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Khader A, Farajallah L, Shahin Y, Hababeh M, Abu-Zayed I, Zachariah R, Kochi A, Kapur A, Harries AD, Shaikh I, Seita A. Hypertension and treatment outcomes in Palestine refugees in United Nations Relief and Works Agency primary health care clinics in Jordan. Trop Med Int Health 2014; 19:1276-83. [DOI: 10.1111/tmi.12356] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A. Khader
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
| | - L. Farajallah
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
| | - Y. Shahin
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
| | - M. Hababeh
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
| | - I. Abu-Zayed
- Field Health Programme; United Nations Relief and Works Agency; Amman Jordan
| | - R. Zachariah
- Medical Department; Brussels Operational Center; Medecins Sans Frontieres; Luxembourg
| | - A. Kochi
- Tokyo University Medical School; Tokyo Japan
| | - A. Kapur
- World Diabetes Foundation; Gentofte Denmark
| | - A. D. Harries
- International Union Against Tuberculosis and Lung Disease; Paris France
- London School of Hygiene and Tropical Medicine; London UK
| | - I. Shaikh
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
| | - A. Seita
- United Nations Relief and Works Agency for Palestine Refugees in the Near East; Amman Jordan
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Kodouda SF, Zachariah R, Khogali M, van Griensven J, Saeed M, Ibrahim EH, Schneider S, Adulazeem S, El Sadig HA, Atta R, Mahgoub NG, El Sony AI. How well are asthma treatment cards filled out in public health centres in Gazeera State, Sudan? Public Health Action 2014; 4:116-21. [PMID: 26399211 PMCID: PMC4539030 DOI: 10.5588/pha.14.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 04/29/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Four public district hospitals offering asthma treatment in Gazeera State, Sudan. Incomplete recording of patient data directly affects the quality of asthma care and the evaluation of asthma management programmes. OBJECTIVE To assess the completeness of filling out of treatment cards and accuracy of calculating peak expiratory flow (PEF) for confirming diagnosis and grading severity of asthma. DESIGN Cross-sectional audit of asthma treatment cards from asthma centres, 2006-2012. RESULTS Of 959 patient cards assessed, completeness ranged from 47% to 98%. Six of 13 variables had an unsatisfactory grade of completeness (<80% complete). Calculated PEF was indicated in 885 (92%) cards, but was correct in only 609 (69%). PEF variability was recorded in 835 (87%) cards, but was correctly calculated in 442 (53%). A scheduled follow-up visit was attended by only 359 (37%) patients, indicating 63% loss to follow-up. Contact telephone numbers were missing from 453 (47%) cards. CONCLUSION This is the first study in Africa to assess the data completeness and integrity of asthma patient cards, identifying important shortcomings. This affects quality of management of asthma patients and programme evaluation. Steps to rectify this situation are urgently needed.
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Affiliation(s)
| | - R. Zachariah
- Medical Department Operational Research Unit/Operations, Operational Centre Brussels, Médecins Sans Frontières –MSF-Luxembourg, Luxembourg
| | - M. Khogali
- Medical Department Operational Research Unit/Operations, Operational Centre Brussels, Médecins Sans Frontières –MSF-Luxembourg, Luxembourg
| | | | - M. Saeed
- The Epidemiological Laboratory, Khartoum, Sudan
| | | | - S. Schneider
- Centre for Toxicology and Public Research, University of Luxembourg, Luxembourg
| | | | | | - R. Atta
- The Epidemiological Laboratory, Khartoum, Sudan
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41
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Harries AD, Jahn A, Ben-Smith A, Gadabu OJ, Douglas GP, Seita A, Khader A, Zachariah R. Cohort analysis of antenatal care and delivery outcomes in pregnancy: a basis for improving maternal health. Public Health Action 2014; 4:75-8. [PMID: 26399202 PMCID: PMC4539035 DOI: 10.5588/pha.13.0103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 02/27/2014] [Indexed: 11/10/2022] Open
Abstract
Cohort analysis has been the cornerstone of tuberculosis (TB) monitoring and evaluation for nearly two decades; these principles have been adapted for patients with the human immunodeficiency virus/acquired immune-deficiency syndrome on antiretroviral treatment and patients with diabetes mellitus and hypertension. We now make the case for using cohort analyses for monitoring pregnant women during antenatal care, up to and including childbirth. We believe that this approach would strengthen the current monitoring and evaluation systems used in antenatal care by providing more precise information at regular time intervals. Accurate real-time data on how many pregnant women are enrolled in antenatal care, their characteristics, the interventions they are receiving and the outcomes for mother and child should provide a solid basis for action to reduce maternal mortality.
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Affiliation(s)
- A. D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
| | - A. Jahn
- Department for HIV and AIDS, Ministry of Health, Lilongwe, Malawi
- International Training & Education Centre for Health, Malawi, and University of Washington, Seattle, Washington, USA
| | - A. Ben-Smith
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - G. P. Douglas
- Center for Health Informatics for the Underserved, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - A. Seita
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, UNRWA Headquarters, Amman, Jordan
| | - A. Khader
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, UNRWA Headquarters, Amman, Jordan
| | - R. Zachariah
- Médecins Sans Frontières, Medical Department, Brussels Operational Centre, MSF-Luxembourg, Luxembourg
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A three-tier framework for monitoring antiretroviral therapy in high HIV burden settings. J Int AIDS Soc 2014; 17:18908. [PMID: 24780511 PMCID: PMC4005043 DOI: 10.7448/ias.17.1.18908] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 03/10/2014] [Accepted: 03/20/2014] [Indexed: 01/14/2023] Open
Abstract
The provision of antiretroviral therapy (ART) in low and middle-income countries is a chronic disease intervention of unprecedented magnitude and is the dominant health systems challenge for high-burden countries, many of which rank among the poorest in the world. Substantial external investment, together with the requirement for service evolution to adapt to changing needs, including the constant shift to earlier ART initiation, makes outcome monitoring and reporting particularly important. However, there is growing concern at the inability of many high-burden countries to report on the outcomes of patients who have been in care for various durations, or even the number of patients in care at a particular point in time. In many instances, countries can only report on the number of patients ever started on ART. Despite paper register systems coming under increasing strain, the evolution from paper directly to complex electronic medical record solutions is not viable in many contexts. Implementing a bridging solution, such as a simple offline electronic version of the paper register, can be a pragmatic alternative. This paper describes and recommends a three-tiered monitoring approach in low- and middle-income countries based on the experience implementing such a system in the Western Cape province of South Africa. A three-tier approach allows Ministries of Health to strategically implement one of the tiers in each facility offering ART services. Each tier produces the same nationally required monthly enrolment and quarterly cohort reports so that outputs from the three tiers can be aggregated into a single database at any level of the health system. The choice of tier is based on context and resources at the time of implementation. As resources and infrastructure improve, more facilities will transition to the next highest and more technologically sophisticated tier. Implementing a three-tier monitoring system at country level for pre-antiretroviral wellness, ART, tuberculosis and mother and child health services can be an efficient approach to ensuring system-wide harmonization and accurate monitoring of services, including long term retention in care, during the scale-up of electronic monitoring solutions.
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Abstract
Public health professionals’ functions are rapidly expanding beyond their countries’ borders. Many academic centers are recognizing the importance of global health and are creating programs to train students to meet this growing demand. Global health centers and institutes also are being created to focus on the research and programmatic efforts needed to understand the burden of disease worldwide, as well as the financial, political, medical, policy, workforce, and infrastructure issues surrounding any solutions. Due to this emerging interest by the public health community, we need to understand where the intersection between global health and informatics occurs. For many years, the promise of what technology can do to alleviate suffering and support disease surveillance and other public health activities took precedence over understanding the environment in which the technology has to function. People and their participation in the implementation of the technological solution are critical for success. In resource-poor environments, the deployment of technological solutions faces other challenges for success. Lack of stable electrical power, availability of Internet connections, and a workforce that can support the information technology remain barriers to successful implementation. Yet, through experiences in the implementation of information technology as supported by international donors and the US President’s Emergency Plan for AIDS Relief, lessons are being learned to move forward towards the benefits that global health informatics can bring.
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Affiliation(s)
- J.A. Magnuson
- Department of Medical Informatics, Oregon Health & Science University, Portland, Oregon USA
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Khader A, Ballout G, Shahin Y, Hababeh M, Farajallah L, Zeidan W, Abu-Zayed I, Kochi A, Harries AD, Zachariah R, Kapur A, Shaikh I, Seita A. Treatment outcomes in a cohort of Palestine refugees with diabetes mellitus followed through use of E-Health over 3 years in Jordan. Trop Med Int Health 2013; 19:219-23. [PMID: 24341942 DOI: 10.1111/tmi.12241] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to use E-Health to report on 12-month, 24-month and 36-month outcomes and late-stage complications of a cohort of Palestine refugees with diabetes mellitus (DM) registered in the second quarter of 2010 in a primary healthcare clinic in Amman, Jordan. METHOD Retrospective cohort study with treatment outcomes censored at 12-month time points using E-Health in UNRWA's Nuzha Primary Health Care Clinic. RESULTS Of 119 newly registered DM patients, 61% were female, 90% were aged ≥40 years, 92% had type 2 DM with 73% of those having hypertension and one-third of patients were newly diagnosed. In the first 3 years of follow-up, the proportion of clinic attendees decreased from 72% to 64% and then to 61%; the proportion lost to-follow-up increased from 9% to 19% and then to 29%. At the three time points of follow-up, 71-78% had blood glucose ≤180 mg/dl; 63-74% had cholesterol <200 mg/dl; and about 90% had blood pressure <140/90 mmHg. Obesity remained constant at 50%. The proportion of patients with late-stage complications increased from 1% at baseline to 7% at 1 year, 14% at 2 years and 15% at 3 years. CONCLUSION Nuzha PHC Clinic was able to monitor a cohort of DM patients for 3 years using E-Health and the principles of cohort analysis. This further endorses the use of cohort analysis for managing patients with DM and other non-communicable diseases.
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Affiliation(s)
- Ali Khader
- United Nations Relief and Works Agency for Palestine Refugees in the Near East, UNRWA HQ (A), Amman, Jordan
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Kapur A, Harries AD. Cohort monitoring - as a tool to improve diabetes care services. Diabetes Res Clin Pract 2013; 102:260-4. [PMID: 24139846 DOI: 10.1016/j.diabres.2013.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 09/20/2013] [Indexed: 11/15/2022]
Abstract
The need to stem the rising tide of non-communicable diseases (NCDs) including diabetes has been recognised at the highest levels through the UN political declaration. Diabetes care services are largely unavailable in the primary care setting in most developing countries and where available the services are unstructured, with poor record keeping, stock outs and frequent disruption in supplies. With no systematic monitoring of care and programme implementation, treatment outcomes are poor and are consequently associated with a high economic burden. Systematic evaluation of programmes through cohort monitoring has been shown to be effective in large-scale interventions for two chronic infectious diseases-tuberculosis and HIV/AIDS. Can the same simple tool of cohort monitoring be applied to improve diabetes care delivery in the developing world? Pilot projects show it is possible, but scale up and expansion would require investment in information technology. In a scenario where systems for NCD are just beginning to be set up, it makes sense to learn from and build further on the initial pilot programmes.
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Affiliation(s)
- Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark.
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46
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Xiong XY, Li QH, Li YP, Guo L, Li ZL, Gong YC. Pluronic P85/poly(lactic acid) vesicles as novel carrier for oral insulin delivery. Colloids Surf B Biointerfaces 2013; 111:282-8. [DOI: 10.1016/j.colsurfb.2013.06.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/06/2013] [Accepted: 06/10/2013] [Indexed: 11/17/2022]
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Harries AD, Zachariah R, Maher D. The power of data: using routinely collected data to improve public health programmes and patient outcomes in low- and middle-income countries. Trop Med Int Health 2013; 18:1154-1156. [DOI: 10.1111/tmi.12159] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anthony D. Harries
- International Union against Tuberculosis and Lung Disease; Paris France
- London School of Hygiene and Tropical Medicine; London UK
| | - Rony Zachariah
- Medecins sans Frontieres, Medical Department, Operational Research Unit, Brussels Operational Centre; Luxembourg Luxembourg
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Kapur A, Harries AD. The double burden of diabetes and tuberculosis - public health implications. Diabetes Res Clin Pract 2013; 101:10-9. [PMID: 23305899 DOI: 10.1016/j.diabres.2012.12.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/10/2012] [Indexed: 01/04/2023]
Abstract
Diabetes mellitus (DM) and tuberculosis (TB) have existed for thousands of years and even now the global disease burden from DM and TB is huge. The incidence of TB is declining slowly but it still remains a big problem in many populous large low and middle income countries. On the other, hand the burden of diabetes is increasing very rapidly, particularly in the very same countries where TB is endemic. The intersecting double burden is therefore ominous particularly as several studies and systematic reviews have indicated that DM increases the risk of TB disease and results in poor treatment outcomes. To address the double burden, WHO and the International Union Against Tuberculosis and Lung Disease (The Union) in 2011 launched a collaborative framework for the care and control of diabetes and tuberculosis, to encourage collaborative research and implement bidirectional screening of the two diseases in routine settings. This review article (i) explores some of the new evidence for the association between TB and DM, (ii) discusses issues with regard to clinical presentation and outcomes, (iii) presents the evidence, challenges and strategies for bidirectional screening based on field studies to implement the framework and (iv) finally presents suggestions on how diabetes care delivery may benefit from the lessons of the TB DOTS approach and public health principles for structured care delivery.
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Affiliation(s)
- Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark.
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Diseases, Paris, France; London School of Hygiene and Tropical Medicine, London, UK
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Abstract
OBJECTIVE To assess the feasibility, results and challenges of screening patients with diabetes mellitus (DM) for tuberculosis (TB) within the healthcare setting of six DM clinics in tertiary hospitals across India. METHOD Agreement on how to screen, monitor and record the screening was reached in October 2011 at a national stakeholders' meeting, and training was carried out for staff in the six tertiary care facilities in December 2011. Implementation started in the first quarter of 2012, and we report on activities up to 30th September 2012. Patients with DM were screened for TB on each clinic attendance using a symptom-based enquiry, and those with positive symptoms were referred for TB investigations. RESULTS In the three quarters, 26% of 7218, 52% of 12237 and 48% of 11691 patients with DM were screened for TB. A total of 254 patients were identified with TB, of whom 46% had smear-positive pulmonary disease. There were 18 patients newly diagnosed with TB as a result of screening and referral, with the remainder being patients already diagnosed from elsewhere. TB case rates per 100,000 patients attending the DM clinic each quarter were 859, 956 and 642. Almost 90% of patients with TB were recorded as starting or being on anti-TB treatment. Major implementation challenges related to human resources and recording systems. CONCLUSION In India, it is feasible to screen patients with DM for TB resulting in high rates of TB detection. More attention to detail, human resource requirements and electronic medical records are needed to improve performance.
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50
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Jeon CY, Murray MB, Baker MA. Managing tuberculosis in patients with diabetes mellitus: why we care and what we know. Expert Rev Anti Infect Ther 2013; 10:863-8. [PMID: 23030325 DOI: 10.1586/eri.12.75] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
As the global prevalence of diabetes mellitus (DM) increases, especially in low-to-middle income countries where tuberculosis (TB) remains endemic, we will encounter a growing number of TB patients with DM. This is a major concern for TB control programs, clinicians and patients alike because DM patients are at an increased risk of TB and are more likely to face poor TB treatment outcomes, including treatment failure, relapse and even death. Priority should be placed on early detection of both diseases through active screening, monitoring of adherence to medications for both diseases, and integration of TB and DM management strategies that would facilitate the provision of more comprehensive services that TB patients with DM require.
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Affiliation(s)
- Christie Y Jeon
- Columbia University School of Nursing, 617 W 168th St 355, New York, NY 10032, USA.
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