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Mengesha EW, Tesfaye TD, Boltena MT, Birhanu Z, Sudhakar M, Hassen K, Kedir K, Mesfin F, Hailemeskel E, Dereje M, Hailegebrel EA, Howe R, Abebe F, Tadesse Y, Girma E, Wadilo F, Lake EA, Guta MT, Damtew B, Debebe A, Tariku Z, Amdisa D, Hiko D, Worku A, G/michael M, Abraha YG, Ababulgu SA, Fentahun N. Effectiveness of community-based interventions for prevention and control of hypertension in sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003459. [PMID: 39012878 PMCID: PMC11251591 DOI: 10.1371/journal.pgph.0003459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 06/05/2024] [Indexed: 07/18/2024]
Abstract
Hypertension poses a significant public health challenge in sub-Saharan Africa due to various risk factors. Community-based intervention for prevention and control of hypertension is an effective strategy to minimize the negative health outcomes. However, comprehensive systematic review evidence to inform effective community-based interventions for prevention and control of hypertension in low resource settings is lacking. This study aimed to synthesize the effectiveness of community-based interventions on prevention and control of hypertension in sub-Saharan Africa. A comprehensive search for studies was carried out on PubMed, CINAHL, Web of Science Core Collection, Embase, Scopus, and Google scholar databases. The result of the review was reported according to PRISMA guidelines. Studies published in English language were included. Two independent reviewers conducted critical appraisal of included studies and extracted the data using predefined excel sheet. Experimental, quasi experimental, cohort and analytical cross-sectional studies conducted on adults who have received community-based interventions for prevention and controls of hypertension in sub-Saharan Africa were included. In this systematic review, a total of eight studies were included, comprising of two interventional studies, two quasi-experimental studies, three cohort studies, and one comparative cross-sectional study. The interventions included health education, health promotion, home-based screening and diagnosis, as well as referral and treatment of hypertensive patients. The sample sizes ranged from 236 to 13,412 in the intervention group and 346 to 6,398 in the control group. This systematic review shows the effect of community-based interventions on reduction of systolic and diastolic blood pressure. However, the existing evidence is inconsistence and not strong enough to synthesize the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Hence, further primary studies need on the effect of community-based interventions for the prevention and control of hypertension in sub-Saharan Africa. Systematic review registration number: PROSPERO CRD42022342823.
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Affiliation(s)
| | | | - Minyahil Tadesse Boltena
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zewdie Birhanu
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Morankar Sudhakar
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kalkidan Hassen
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
- Ethiopian-Evidence Based Health Care and Development Centre, A JBI Centre of Excellence, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kiya Kedir
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Firaol Mesfin
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Melat Dereje
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Rawleigh Howe
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Finina Abebe
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association, Addis Ababa, Ethiopia
| | - Yordanos Tadesse
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eshetu Girma
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Ethiopian Health Education and Promotion Professionals Association, Addis Ababa, Ethiopia
| | - Fisseha Wadilo
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Eyasu Alem Lake
- College of Health Sciences and Medicine, Wolayita Sodo University, Sodo, Ethiopia
| | - Mistire Teshome Guta
- College of Health Sciences and Medicine, Wolayita Sodo University, Sodo, Ethiopia
| | - Bereket Damtew
- College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Adisalem Debebe
- College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Zerihun Tariku
- College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Demuma Amdisa
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Desta Hiko
- Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Addisu Worku
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Yoseph Gebreyohannes Abraha
- Knowledge Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Ethiopian Knowledge Translation Centre for Health, The Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Sabit Ababor Ababulgu
- Knowledge Translation Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Ethiopian Knowledge Translation Centre for Health, The Ethiopian Public Health Institute (EPHI), Addis Ababa, Ethiopia
| | - Netsanet Fentahun
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Ali RF, Iftikhar S, Shah MT, Dharma VK, Malik FR, Siddiqi DA, Chandir S. Evaluating an immunization carpool service for women in rural areas for facilitating routine childhood immunizations in Pakistan -a feasibility study on acceptability, demand, and implementation. JOURNAL OF TRANSPORT & HEALTH 2024; 36:101773. [PMID: 39035995 PMCID: PMC11256151 DOI: 10.1016/j.jth.2024.101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 07/23/2024]
Abstract
Introduction Poor accessibility of immunization services coupled with limited options for transportation and socio-cultural norms that hinder women's mobility are among the key factors contributing to poor immunization coverage in rural areas. We assessed the feasibility and acceptability of establishing a free-of-cost, women-only carpool service for immunization in a rural setting in Pakistan and evaluated its preliminary impact on immunization coverage and timeliness among children. Methods We conducted a feasibility study in four selected immunization facilities in Shikarpur District, Sindh. A local transport vehicle was hired and branded as an immunization carpool service. Women having un- or under-immunized children aged ≤2 years were invited to visit immunization facilities using carpool vehicles. Information on demographic indicators and service experience was collected. Child immunization details were extracted using the government's provincial electronic immunization registry to estimate immunization coverage and timeliness. Results Between January and October 2020, six immunization carpool vehicles provided uninterrupted service and transported 2422 women-child pairs, completing 4691 immunization visits. Majority of women reported that the carpool service improved accessibility (99.6%) by offering group travel (82.9%) and reducing their dependency on family members (93.4%). Preliminary estimates reported an increase in immunization coverage and timeliness across antigens among participating children compared to non-participating children, with significant increase in proportion for BCG coverage (38.1%; p < 0.001, CI: 32.8%, 43.4%) and measles-2 timeliness (18%; p < 0.001, CI: 13.3%, 22.4%). Conclusion A women-only immunization carpool service implemented within a rural setting is feasible and highly acceptable. Key factors contributing to the model's success include increased mobility and independence of women, cost-savings, and a culturally and contextually appropriate mechanism of transport embedded within the local setting. Increased accessibility to health services also contributed to improved immunization coverage and timeliness among children.
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Affiliation(s)
- Rozina Feroz Ali
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi, 75190, Pakistan
| | - Sundus Iftikhar
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi, 75190, Pakistan
| | | | - Vijay Kumar Dharma
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi, 75190, Pakistan
| | | | - Danya Arif Siddiqi
- IRD Global, The Great Room, Level 10, One George Street, Singapore, 049145
| | - Subhash Chandir
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi, 75190, Pakistan
- IRD Global, The Great Room, Level 10, One George Street, Singapore, 049145
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Mekonen HH, Gebru TH, Kiros KG, Gebrehiwot TG, Tesfamichael YA. Undiagnosed hypertension and associated factors among adult population in central zone of Tigray, Northern Ethiopia 2020: A cross-sectional study. Health Sci Rep 2024; 7:e2052. [PMID: 38655424 PMCID: PMC11035904 DOI: 10.1002/hsr2.2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/02/2024] [Accepted: 03/31/2024] [Indexed: 04/26/2024] Open
Abstract
Background and Aims Undiagnosed hypertension is a major risk factor for cardiovascular diseases and complications such as heart attack and stroke. Limited information is available on the prevalence of undiagnosed hypertension and its associated factors in Ethiopia, particularly in the study setting. This study aimed to assess the prevalence of undiagnosed hypertension and its associated factors in the central zone of Tigray, Northern Ethiopia. Methods A community-based cross-sectional study was conducted from April 1 to May 31, 2020. A pretested structured questionnaire was used and both face-to-face interview and physical measurement were used to collect the data. Blood pressure was measured on two different days for each study participant, and an average of the measurements were taken. In addition, 736 participants were included in this study, through a systematic random sampling technique. Data were analyzed using SPSS version 23. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with undiagnosed hypertension. Adjusted odds ratios and 95% confidence intervals were used to show the strength of the association and declare statistical significance at p < 0.05. Results In the study, the mean age of the participants was 51.9 (standard deviation: 17.9) years old. Prevalence of undiagnosed hypertension was found 15.4% (N = 113). The factors associated with undiagnosed hypertension were being divorced (adjusted odds ratio [AOR] = 15.2, 95% confidence interval [CI]: 8.2-28.3), alcohol consumption (AOR = 2.07, 95% CI: 1.22-3.51), not eating fruits (AOR = 4.1, 95% CI: 2.37-7.08), not eating vegetables (AOR = 3.47, 95% CI: 2.02-5.96) and poor knowledge (AOR = 3.05, 95% CI: 2.75-7.83). Conclusion Around one in six study participants had undiagnosed hypertension. Being divorced, drinking alcohol, not eating fruits, not consuming vegetables, and having poor knowledge of hypertension were significant factors. Public health interventions, like providing adequate hypertension health information, frequent screening, and implementation of an appropriate intervention for particular factors, are critical for reducing the burden of undiagnosed hypertension.
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Affiliation(s)
- Haftea Hagos Mekonen
- Department of Nursing, College of Medicine and Health ScienceAdigrat UniversityTigrayEthiopia
| | - Tsegu Hailu Gebru
- Department of Nursing, College of Medicine and Health ScienceAdigrat UniversityTigrayEthiopia
| | - Kbrom Gemechu Kiros
- Department of Nursing, College of Medicine and Health ScienceAdigrat UniversityTigrayEthiopia
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Prattipati S, Tarimo TG, Kweka GL, Mlangi JJ, Samuel D, Sakita FM, Tupetz A, Bettger JP, Thielman NM, Temu G, Hertz JT. Patient and provider perspectives on barriers to myocardial infarction care among persons with human immunodeficiency virus in Tanzania: A qualitative study. Int J STD AIDS 2024; 35:18-24. [PMID: 37703080 PMCID: PMC11139408 DOI: 10.1177/09564624231199507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION People with HIV (PLWH) have an increased risk myocardial infarction (MI), and evidence suggests that MI is under-diagnosed in Tanzania. However, little is known about barriers to MI care among PLWH in the region. METHODS In this qualitative study grounded in phenomenology, semi-structured interviews were conducted in northern Tanzania. Purposive sampling was used to recruit a diverse group of providers who care for PLWH and patients with HIV and electrocardiographic evidence of prior MI. Emergent themes were identified via inductive thematic analysis. RESULTS 24 physician and patient participants were interviewed. Most participants explained MI as caused by emotional shock and were unaware of the association between HIV and increased MI risk. Providers described poor provider training regarding MI, high out-of-pocket costs, and lack of diagnostic equipment and medications. Patients reported little engagement with and limited knowledge of cardiovascular care, despite high engagement with HIV care. Most provider and patient participants indicated that they would prefer to integrate cardiovascular care with routine HIV care. CONCLUSIONS PLWH face many barriers to MI care in Tanzania. There is a need for multifaceted interventions to educate providers and patients, improve access to MI diagnosis, and increase engagement with cardiovascular care among this population.
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Affiliation(s)
| | | | | | | | | | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Janet P Bettger
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA, USA
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gloria Temu
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
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Adeola J, Obiezu F, Odukoya O, Igwilo U, Usinoma A, Bahiru E, May FP. Barriers and Facilitators to Risk Reduction of Cardiovascular Disease in Hypertensive Patients in Nigeria. Ann Glob Health 2023; 89:88. [PMID: 38107602 PMCID: PMC10723016 DOI: 10.5334/aogh.4131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/14/2023] [Indexed: 12/19/2023] Open
Abstract
Background In Sub-Saharan Africa (SSA), the prevalence of hypertension is increasing due to many factors like rapid population growth, globalization, stress, and urbanization. We aimed to characterize the perceptions of cardiovascular disease (CVD) risk among individuals with hypertension living in Nigeria and identify barriers and facilitators to optimal hypertension management. Methods This cross-sectional survey study was conducted at a large teaching hospital in Lagos, Nigeria. We used a convenient sample of males and females, aged 18 or older, with a diagnosis of hypertension who presented for outpatient visits in the cardiology, nephrology, or family medicine clinics between November 1 and 30, 2020. A semiquantitative approach was utilized with a survey consisting of closed and open-ended questionnaires focused on patient knowledge, perceptions of CVD risk, and barriers and facilitators of behavioral modifications to reduce CVD risk. Results There were 256 subjects, and 62% were female. The mean age was 58.3 years (standard deviation (SD) = 12.6). The mean duration of the hypertension diagnosis was 10.1 years. Most participants were quite knowledgeable about hypertension; however, we observed some knowledge gaps, including a belief that too much "worrying or overthinking" was a major cause of hypertension and that an absence of symptoms indicated that hypertension was under control. Barriers to hypertension management include age, discomfort or pain, and lack of time as barriers to exercise. Tasteless meals and having to cook for multiple household members were barriers to decreasing salt intake. Cost and difficulty obtaining medications were barriers to medication adherence. Primary facilitators were family support or encouragement and incorporating lifestyle modifications into daily routines. Conclusion We identified knowledge gaps about hypertension and CVD among our study population. These gaps enable opportunities to develop targeted interventions by healthcare providers, healthcare systems, and local governments. Our findings also help in the promotion of community-based interventions that address barriers to hypertension control and promote community and family involvement in hypertension management in these settings.
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Affiliation(s)
- Janet Adeola
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Fiona Obiezu
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Oluwakemi Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Nigeria
| | - Ugonnaya Igwilo
- Department of Community Health and Primary Care, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Nigeria
| | - Adewunmi Usinoma
- Department of Community Health and Primary Care, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Nigeria
| | - Ehete Bahiru
- Department of Cardiology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Folasade P. May
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- UCLA Center for Cancer Prevention and Control Research, UCLA Kaiser Permanente Center for Health Equity and Department of Health Policy and Management, Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
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Teshome DF, Balcha SA, Ayele TA, Atnafu A, Gelaye KA. Undiagnosed hypertension and its determinants among hypertensive patients in rural districts of northwest Ethiopia: a mediation analysis. BMC Health Serv Res 2023; 23:222. [PMID: 36882833 PMCID: PMC9990316 DOI: 10.1186/s12913-023-09212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Early detection of hypertension is associated with improved blood pressure control and a reduced risk of cardiovascular diseases. However, in rural areas of Ethiopia, evidence is scarce where access to healthcare services is low. This study aimed to estimate the proportion of undiagnosed hypertension and identify its determinants and mediators among patients with hypertension in rural northwest Ethiopia. METHODS A community-based cross-sectional study was conducted from September to November 2020. A three-stage sampling technique was used to select a total of 2436 study participants. Blood pressure was measured using an aneroid sphygmomanometer two times, 30 min apart. A validated tool was used to assess participants' beliefs and knowledge of hypertension. The proportion, determinants, and mediators of undiagnosed hypertension were determined among patients with hypertension. The regression-based approach used to calculate the direct and indirect effects of determinants of undiagnosed hypertension. Joint significance testing was used to determine the significance of the indirect effect. RESULTS The proportion of undiagnosed hypertension was 84.0% (95% CI: 81.4-86.7%). Participants aged 25-34 years (AOR = 6.03; 95% CI: 2.11, 17.29), who drank alcohol (AOR = 2.40; 95% CI: 1.37, 4.20), were overweight (AOR = 0.41; 95% CI: 0.18, 0.98), had a family history of hypertension (AOR = 0.32; 95% CI: 0.20, 0.53), and had comorbidities (AOR = 0.28; 95% CI: 0.15, 0.54) were significantly associated with undiagnosed hypertension. The mediation analysis revealed that hypertension health information mediated 64.1% and 68.2% of the effect of family history of hypertension and comorbidities on undiagnosed hypertension, respectively. Perceived susceptibility to hypertensive disease mediated 33.3% of the total effect of age on undiagnosed hypertension. Health facility visits also mediated the effect of alcohol drinking (14.2%) and comorbidities (12.3%) on undiagnosed hypertension. CONCLUSION A higher proportion of hypertensive patients remain undiagnosed. Being young, drinking alcohol, being overweight, having a family history of hypertension, and having comorbidities were significant factors. Hypertension health information, knowledge of hypertensive symptoms, and perceived susceptibility to hypertension were identified as important mediators. Public health interventions aimed at providing adequate hypertension health information, particularly to young adults and drinkers, could improve knowledge and perceived susceptibility to hypertensive disease and reduce the burden of undiagnosed hypertension.
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Affiliation(s)
- Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Shitaye Alemu Balcha
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Gelassa FR, Birhanu A, Shibiru A, Nagari SL, Jabena DE. Undiagnosed status and associated factors of hypertension among adults living in rural of central, Ethiopia, 2020: Uncovering the hidden magnitude of hypertension. PLoS One 2022; 17:e0277709. [PMID: 36520859 PMCID: PMC9754235 DOI: 10.1371/journal.pone.0277709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 11/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hypertension is a major risk factor for cardiovascular (CVD) disease related deaths worldwide. It affects more than 20% of adults in Ethiopia, making it a major public health concern. Although it is important to uncover the hidden extent of hypertension, there is limited information on the proportion of undiagnosed hypertension in rural areas of the country. OBJECTIVE This study aimed to determine the magnitude of undiagnosed hypertension and associated factors among adults living in the rural Dano district, Central Ethiopia 2020. METHODS AND MATERIALS A quantitative, community-based cross-sectional study conducted from May to July 2020. A three-stage sampling technique was used to select a total of 605 study participants. A Validated tool was used to assess the participant's behavioral characteristics. Blood pressure was measured using digital blood pressure apparatus. The mean of three blood measurements was used to classify hypertension after intra-class correlation was tested. Standardized instruments were used to assess participants' health-seeking behavior and knowledge of the hypertensive disease. The proportion of undiagnosed hypertension was determined among patients with hypertension. The regression analyses were done to determine factors associated with undiagnosed hypertension. The adjusted odds ratio with 95% CI was estimated to measure the strength of the association. The level of statistical significance was set at a p-value < 0.05. RESULTS The prevalence of undiagnosed hypertension was 21.32% (CI: 19.95%, 25.8%). Living in a household with the low wealth index [(AOR: 3.5,95%CI: (1.6,6.4)], far distance to health facility, [(AOR: 0.155,95%CI: (0.11.0.67)], underweight, [AOR = 2.2.1,95%CI:(2.00,4.22)], use of smokeless tobacco products, [AOR = 3.2,95%Cl:(1.88,4.75)], and participants' knowledge of hypertension were independently associated with undiagnosed hypertension. CONCLUSION This study shows that undiagnosed hypertension is a major public health problem in the study area. Living in a household with a low wealth index, being far from a health facility, being underweight, using smokeless tobacco products, and having little knowledge about hypertension increase the likelihood of having undiagnosed Hypertension. Hypertension health information, particularly to smokes tobacco users, could improve the perceived susceptibility to hypertensive disease, and reduce the hidden extent of hypertension.
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Affiliation(s)
| | - Adamu Birhanu
- Ambo University, College of Medicine and Health sciences, Ambo, Ethiopia
| | - Abera Shibiru
- Ambo University, College of Medicine and Health sciences, Ambo, Ethiopia
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Hickey MD, Owaraganise A, Sang N, Opel FJ, Mugoma EW, Ayieko J, Kabami J, Chamie G, Kakande E, Petersen ML, Balzer LB, Kamya MR, Havlir DV. Effect of a one-time financial incentive on linkage to chronic hypertension care in Kenya and Uganda: A randomized controlled trial. PLoS One 2022; 17:e0277312. [PMID: 36342940 PMCID: PMC9639834 DOI: 10.1371/journal.pone.0277312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
Background Fewer than 10% of people with hypertension in sub-Saharan Africa are diagnosed, linked to care, and achieve hypertension control. We hypothesized that a one-time financial incentive and phone call reminder for missed appointments would increase linkage to hypertension care following community-based screening in rural Uganda and Kenya. Methods In a randomized controlled trial, we conducted community-based hypertension screening and enrolled adults ≥25 years with blood pressure ≥140/90 mmHg on three measures; we excluded participants with known hypertension or hypertensive emergency. The intervention was transportation reimbursement upon linkage (~$5 USD) and up to three reminder phone calls for those not linking within seven days. Control participants received a clinic referral only. Outcomes were linkage to hypertension care within 30 days (primary) and hypertension control <140/90 mmHg measured in all participants at 90 days (secondary). We used targeted minimum loss-based estimation to compute adjusted risk ratios (aRR). Results We screened 1,998 participants, identifying 370 (18.5%) with uncontrolled hypertension and enrolling 199 (100 control, 99 intervention). Reasons for non-enrollment included prior hypertension diagnosis (n = 108) and hypertensive emergency (n = 32). Participants were 60% female, median age 56 (range 27–99); 10% were HIV-positive and 42% had baseline blood pressure ≥160/100 mmHg. Linkage to care within 30 days was 96% in intervention and 66% in control (aRR 1.45, 95%CI 1.25–1.68). Hypertension control at 90 days was 51% intervention and 41% control (aRR 1.22, 95%CI 0.92–1.66). Conclusion A one-time financial incentive and reminder call for missed visits resulted in a 30% absolute increase in linkage to hypertension care following community-based screening. Financial incentives can improve the critical step of linkage to care for people newly diagnosed with hypertension in the community.
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Affiliation(s)
- Matthew D. Hickey
- Division of HIV, Infectious Disease, & Global Medicine, University of California, San Francisco, CA, United States of America
- * E-mail:
| | | | - Norton Sang
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - James Ayieko
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Gabriel Chamie
- Division of HIV, Infectious Disease, & Global Medicine, University of California, San Francisco, CA, United States of America
| | - Elijah Kakande
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Maya L. Petersen
- School of Public Health, University of California, Berkeley, CA, United States of America
| | - Laura B. Balzer
- School of Public Health, University of California, Berkeley, CA, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- School of Medicine, Makerere University, Kampala, Uganda
| | - Diane V. Havlir
- Division of HIV, Infectious Disease, & Global Medicine, University of California, San Francisco, CA, United States of America
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Perspectives of Caregivers Experiencing Persistent Food Insecurity at an Academic Primary Care Clinic. Acad Pediatr 2022; 22:892-899. [PMID: 34365031 PMCID: PMC8818048 DOI: 10.1016/j.acap.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Food insecurity (FI) is often transitory and instigated by changes in family circumstances or environmental events. Clinics have developed interventions to address FI, yet families may face persistent FI. Little is known about persistently food insecure families' experiences with clinic-based interventions. The objective of this study was to evaluate the perspectives of caregivers experiencing persistent FI in a clinical setting. METHODS We conducted 40 semistructured interviews at one academic primary care clinic between July 2019 and December 2019. The clinic routinely screened families for FI at every visit; families screening positive could meet with a care navigator and receive bags of nonperishable foods. Caregivers who received food bags at ≥3 visits, spoke English or Spanish, and were ≥18 years old were eligible to participate. Interviews were recorded, de-identified, transcribed, and systematically coded using inductive content analysis. A modified constant comparative method was used to iteratively review codes, identify emerging themes, and resolve differences through consensus. RESULTS Forty caregivers were interviewed; all were women; 45% were Hispanic/Latinx and 37.5% African American/Black. Three major themes emerged: 1) unmet social and medical needs and the challenges of caregiving complicate FI; 2) social supports help address FI and other social challenges that present barriers to accessing resources; and 3) caregivers provide practical recommendations for addressing persistent FI. CONCLUSION Families experiencing persistent FI described important social supports that help address FI and other social challenges that present barriers to accessing resources. Clinic-based resources were welcomed interventions, but their impact may be limited; practical recommendations were made.
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Youssef G, Mohamed M, Abdel Hamid M, El Remisy D. Reasons behind high rate of non-compliance to scheduled office visits in hypertensive patients: results from the Egyptian registry of specialized hypertension clinics. Egypt Heart J 2022; 74:45. [PMID: 35639186 PMCID: PMC9156586 DOI: 10.1186/s43044-022-00285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/22/2022] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Hypertensive patients' compliance to the clinic's follow-up visits is associated with a better blood pressure control. The aim of this study was to detect the reasons of non-compliance to office visits in Egyptian hypertensive patients. RESULTS This is an observational, prospective, cross-sectional research study where patients were enrolled from the registry of the specialized hypertension clinics of 9 university hospitals. Those who attended less than 3 office visits, throughout the registry period, were considered non-compliant and were contacted through the phone. A simple questionnaire was prepared, which included questions about the reasons of non-compliance to follow up. There were 3014 patients eligible for inclusion in this study but only 649 patients (21.5%) completed the questionnaire. Patients claimed that the reasons of non-compliance to the follow up visits in the specialized hypertension clinics were as follows: 444 patients (68.4%) preferred to follow up elsewhere mostly in pharmacies, 53 patients (8.2%) claimed that the healthcare service was unsatisfactory, 94 patients (14.5%) were asymptomatic, and 110 patients (16.9%) said that the clinic was far from their homes. Despite non-compliance to office visits, 366 patients (59.2%) were compliant to their antihypertensive medications and 312 (48.1%) patients were compliant to salt restriction. About 34% of patients used herbs, mainly hibiscus, as adjuvant to their antihypertensive medications. CONCLUSIONS Reasons for non-compliance to office visits in hypertensive patients were either patient-related, or healthcare-related. To improve patients' compliance, physicians need to educate their patients about hypertension, patients need to follow their doctors' instructions as regard medications, salt restriction and scheduled office visits, and governments need to provide better and cheaper healthcare services.
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Affiliation(s)
- Ghada Youssef
- Cardiovascular Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | | | - Magdy Abdel Hamid
- Cardiovascular Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Dalia El Remisy
- Cardiovascular Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
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Chiyaka ET, Lanese B, Bruckman D, Redding M, Filla J, Ferguson P, Hoornbeek J. Influence of interaction between community health workers and adults with chronic diseases on risk mitigation through care coordination. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022. [DOI: 10.1177/20534345221092515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Addressing health disparities and barriers to care requires a comprehensive approach that involves participation of health care providers, multiple organizations, and service providers in the communities affected. Given the importance of using community health workers to help address the complex and overlapping medical, social, and behavioral needs of high-risk individuals, it is of utmost importance to understand their impact on health outcomes. This study examines how in-person interaction between community health workers and their clients influence the client's level of risk mitigation achieved through care coordination using the Pathways Community HUB model. Methods The study utilized two years of data extracted from the Care Coordination Systems database for 391 adults who participated in the Northwest Ohio Pathways Community HUB program. Using multinomial logistic regression analysis, we assessed how the interaction between community health workers and adults with chronic diseases who participated in the Northwest Ohio Pathways Community HUB program influenced the successful mitigation of their social, behavioral, and other medical risks over a 2-year period. Results Our findings show that as the number of in-person contacts between the community health worker and the client increased, the likelihood of completing all Pathways increased by 27% when compared to completing less than 50% of the assigned Pathways, after adjusting for potential confounders (odds ratio: 1.27, 95% confidence interval: 1.07−1.52). Discussion Using community health workers as part of care coordination teams may be effective in connecting communities to systems of care, helping individuals manage their health conditions and connecting individuals to needed social services. Their direct in-person interaction with at-risk individuals may increase the extent to which these individuals successfully address risks to their health and well-being.
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Affiliation(s)
- Edward T Chiyaka
- Center for Public Policy & Health, College of Public Health, Kent State University, Kent, OH, USA
- School of Pharmacy, Wingate University, Wingate, NC, USA
| | - Bethany Lanese
- Center for Public Policy & Health, College of Public Health, Kent State University, Kent, OH, USA
| | - David Bruckman
- Center for Population Health Research, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Redding
- Rebecca D. Considine Research Center, Akron Children's Hospital, Akron, OH, USA
| | - Joshua Filla
- Center for Public Policy & Health, College of Public Health, Kent State University, Kent, OH, USA
| | - Pamela Ferguson
- Research & Evaluation Bureau, College of Education, Health and Human Services, Kent State University, Kent, OH, USA
| | - John Hoornbeek
- Center for Public Policy & Health, College of Public Health, Kent State University, Kent, OH, USA
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Teshome DF, Balcha SA, Ayele TA, Atnafu A, Sisay M, Asfaw MG, Mitike G, Gelaye KA. Trained health extension workers correctly identify high blood pressure in rural districts of northwest Ethiopia: a diagnostic accuracy study. BMC Health Serv Res 2022; 22:375. [PMID: 35317798 PMCID: PMC8941748 DOI: 10.1186/s12913-022-07794-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background Hypertension is a public health issue in Ethiopia. The vast majority of cases remain undiagnosed and untreated. Early and accurate identification of hypertension can help with timely management and reduce the risk of complications. In resource-constrained rural settings where poor access to care and a shortage of healthcare providers are major barriers, task-sharing of some primary healthcare duties from well-trained healthcare workers to community health workers has been found to be a cost-effective strategy. This study aimed to assess the ability of trained health extension workers to correctly identify high blood pressure among adults in rural areas of northwest Ethiopia. Methods A cross-sectional study was conducted in rural areas of northwest Ethiopia from June to October 2020. Trained health extension workers and health professionals measured the blood pressure of 1177 study participants using a calibrated aneroid sphygmomanometer. A Kappa test statistic was used to compare the two sets of measurements for agreement. The sensitivity, specificity, positive, and negative predictive values were used to assess the validity of health extension workers’ ability to identify high blood pressure in comparison to health professionals. Results The trained health extension workers and health professionals identified 219 (18.6%) and 229 (19.5%) of the participants with high blood pressure, respectively. The inter-rater agreement between health extension workers and health professionals for high blood pressure detection was 91.2% (k = 0.912, 95% CI: 0.88, 0.94, p-value = 0.000). The sensitivity and specificity of high blood pressure detection by health extension workers were 90.8% (95% CI: 89.6, 92.0) and 98.8% (95% CI: 98.1, 99.5), respectively. While the positive and negative predictive values were 95.0% (95% CI: 92.1, 97.9) and 97.8% (95% CI: 97.3, 98.3), respectively. Conclusions The inter-rater agreement between the trained health extension workers and health professionals on high blood pressure detection was excellent. The findings indicate that training health extension workers is a reliable and valid strategy for early detection of hypertension. Thus, the strategy can be integrated with the essential services provided by primary health care units at the village and health post level in rural settings.
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Affiliation(s)
- Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Shitaye Alemu Balcha
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Sisay
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Marye Getnet Asfaw
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getnet Mitike
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Teshome DF, Alemu S, Ayele TA, Atnafu A, Gelaye KA. Effect of health extension workers led home-based intervention on hypertension management in Northwest Ethiopia, 2021: study protocol for a cluster randomised controlled trial. BMJ Open 2022; 12:e051178. [PMID: 35246416 PMCID: PMC8900019 DOI: 10.1136/bmjopen-2021-051178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Although hypertension is highly prevalent in Ethiopia, it is poorly diagnosed, treated and controlled. Poor access to care and a shortage of healthcare providers are major barriers. This study aims to evaluate the effects of health extension workers' led home-based intervention on hypertension management in patients with hypertension in rural districts of northwest Ethiopia. METHODS AND ANALYSIS A two-arm cluster randomised controlled trial will be conducted among 456 hypertensive patients. Adults aged ≥25 years who have a diagnosis of hypertension both in the home-based hypertension screening study and at another measurement prior to recruitment will be eligible for the study. Randomisation will be done at the kebele level. In the intervention clusters, trained health extension workers will provide home-based intervention for hypertensive patients every 2 months for 9 months. The primary outcomes of the trial will be clinical linkage and blood pressure changes, whereas the secondary outcomes will be lifestyle modification, medication adherence and blood pressure control. Intention-to-treat analysis will be used for all primary analyses. A linear mixed-effect regression model will be used to model the change in blood pressure, while a mixed effect logistic regression model will be used to evaluate the intervention's effect on the binary outcomes. Effect sizes such as mean difference for the continuous outcomes and relative risk, attributable risk and population attributable risk for binary outcomes will be used. All statistical analyses are two sided and a p<0.05 will be used. ETHICS AND DISSEMINATION This study has been approved by institutional review board of the University of Gondar (Ref. No: V/P/RCS/05/2293/2020). The district's health office will grant permission for cluster randomisation, and each participant will provide written informed consent for participation. The findings will be presented at scientific conferences and published in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER PACTR202102729454417.
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Affiliation(s)
- Destaw Fetene Teshome
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Shitaye Alemu
- Internal Medicine, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Health System and policy, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Lien WC, Wang WM, Wang HMD, Lin FH, Yao FZ. Environmental Barriers and Functional Outcomes in Patients with Schizophrenia in Taiwan: The Capacity-Performance Discrepancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:315. [PMID: 35010575 PMCID: PMC8751039 DOI: 10.3390/ijerph19010315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/24/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
Environmental factors are crucial determinants of disability in schizophrenic patients. Using data from the 2014-2018 Certification of Disability and Care Needs dataset, we identified 3882 adult patients (46.78% females; age, 51.01 ± 13.9 years) with schizophrenia. We found that patients with severe schizophrenia had lower capacity and performance than those with moderate schizophrenia. The chances of having an access barrier to environmental chapter 1 (e1) products and technology in moderate schizophrenic patients and in severe schizophrenic patients were 29.5% and 37.8%, respectively. Logistic regression analyses demonstrated that the performance score was related to accessibility barriers in the categories described in e1, with adequate fitness of models in category e110 for personal consumption, e115 for personal usage in daily living activities, and e120 for personal outdoor and indoor mobility and transportation. Furthermore, the capacity-performance discrepancy was higher in moderate schizophrenic patients with accessibility barriers in the e110, e115, and e120 categories than that in moderate schizophrenic patients without accessibility barriers. However, severe schizophrenic patients with category e120 accessibility barriers were prone to a lower discrepancy, with institutional care a potentially decreasing factor. In conclusion, providing an e1 barrier-free environment is necessary for patients with schizophrenia to decrease their disability.
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Affiliation(s)
- Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan;
| | - Wei-Ming Wang
- Department of Statistics, College of Management, National Cheng Kung University, Tainan 701, Taiwan;
| | - Hui-Min David Wang
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan;
- Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung City 402, Taiwan
| | - Feng-Huei Lin
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan;
- Institute of Biomedical Engineering, College of Medicine and Engineering, National Taiwan University, Taipei 100, Taiwan
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Miaoli 350, Taiwan
| | - Fen-Zhi Yao
- Department of Senior Citizen Services, National Tainan Junior College of Nursing, Tainan 700, Taiwan
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Pitfalls of Single Measurement Screening for Diabetes and Hypertension in Community-Based Settings. Glob Heart 2021; 16:79. [PMID: 34900570 PMCID: PMC8641532 DOI: 10.5334/gh.1083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Cross-sectional screening programs are used to detect and refer individuals with non-communicable diseases to healthcare services. We evaluated the positive predictive value of cross-sectional measurements for Diabetes Mellitus (DM) and hypertension (HTN) as part of a community-based disease screening study, ‘Vukuzazi’ in rural South Africa. Methods: We conducted community-based screening for HTN and DM using the World Health Organization STEPS protocol and glycated haemoglobin A1c (HbA1c) testing, respectively. Nurses conducted follow-up home visits for confirmatory diagnostic testing among individuals with a screening BP above 140/90 mmHg and/or HbA1c above 6.5% at the initial screen, and without a prior diagnosis. We assessed the positive predictive value of the initial screening, compared to the follow up measure. We also sought to identify a screening threshold for HTN and DM with greater than 90% positive predictive value. Results: Of 18,027 participants enrolled, 10.2% (1,831) had a screening BP over 140/90 mmHg. Of those without a prior diagnosis, 871 (47.6%) received follow-up measurements. Only 51.2% (451) of those with completed follow-up measurements had a repeat BP>140/90 mmHg at the home visit and were referred to care. To achieve a 90% correct referral rate, a systolic BP threshold of 192 was needed at first screening. For DM screening, 1,615 (9.0%) individuals had an HbA1c > 6.5%, and of those without a prior diagnosis, 1,151 (71.2%) received a follow-up blood glucose. Of these, only 34.1% (395) met criteria for referral for DM. To ensure a 90% positive predictive value i.e. a screening HbA1c of >16.6% was needed. Conclusions: A second home-based screening visit to confirm a diagnosis of DM and HTN reduced health system referrals by 48% and 66%, respectively. Two-day screening programmes for DM and HTN screening might save individual and healthcare resources and should be evaluated carefully in future cost effectiveness evaluations.
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Prattipati S, Mlangi JJ, Tarimo TG, Kweka GL, Thielman NM, Bettger JP, Mmbaga BT, Sakita FM, Hertz JT. Knowledge, attitudes, and preventive practices regarding ischemic heart disease among HIV-positive individuals in northern Tanzania. Trop Med Int Health 2021; 26:1652-1658. [PMID: 34637597 PMCID: PMC11012094 DOI: 10.1111/tmi.13690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe knowledge, attitudes, and practices (KAP) regarding ischemic heart disease (IHD) among adults with HIV in Tanzania. METHODS Adults presenting for routine HIV care at a clinic in northern Tanzania were consecutively enrolled and were administered a standardised KAP survey. For each participant, an IHD knowledge score was calculated by tallying correct answers to the IHD knowledge questions, with maximum score 10. Individual 5-year risk of cardiovascular event was calculated using the Harvard NHANES model. Associations between participant characteristics and IHD knowledge scores were assessed via Welch's t-test. RESULTS Among the 500 participants, the mean (SD) age was 45.3 (11.4) years and 139 (27.8%) were males. Most participants recognised high blood pressure (n = 313, 62.6%) as a risk factor for IHD, but fewer identified diabetes as a risk factor (n = 241, 48.2%), or knew that aspirin reduces the risk of a secondary cardiovascular event (n = 73, 14.6%). Higher IHD knowledge score was associated with post-primary education (mean 6.27 vs. 5.35, p = 0.001) and with >10% 5-year risk of cardiovascular event (mean 5.97 vs. 5.41, p = 0.045). Most participants believed there were things they could do to reduce their chances of having a heart attack (n = 361, 72.2%). While participants indicated that they adhered to their prescribed medications (n = 488, 97.6%), only 106 (21.2%) attended regular health check-ups. CONCLUSION Efforts are needed to improve gaps in IHD knowledge, and increase uptake of cardiovascular preventative practices among Tanzanian adults with HIV.
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Affiliation(s)
| | | | | | | | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Janet P Bettger
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Duke University, Washington, District of Colombia, USA
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
- Kilimanjaro Christian Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Alizadeh F, Addepalli A, Chaudhuri SR, Budongo AM, Owembabazi I, Chaw GF, Musominali S, Paccione G. Family health sheets: a vital instrument for village health workers providing comprehensive healthcare. BMC Health Serv Res 2021; 21:1138. [PMID: 34674694 PMCID: PMC8530699 DOI: 10.1186/s12913-021-07180-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Community Health Worker (CHW) programs have long been used to provide acute care for children and women in healthcare shortage areas, but their provision of comprehensive longitudinal care for chronic problems is rare. The Village Health Worker (VHW) program, initiated in 2007, is an example of a long standing "horizontal" CHW program in rural Southwestern Uganda that has delivered village-level care for chronic disease based on a biannual village health census that identifies individual and family health risks. To facilitate continuity of care for problems identified, health census data were electronically transformed into family-specific Family Health Sheets (FHS) in 2016 which summarize the pertinent demographic and health data for each family, as well as health topics the family would like to learn more about. The FHS, evaluated and discussed here, serves as an epidemiologically-informed "bedside" tool to help VHWs provide longitudinal care in their villages. METHODS 48 VHWs in the program completed a survey on the utility of the FHS and 24 VHWs participated in small discussion groups. Responses were analyzed using both quantitative and standard conceptual content analysis models RESULTS: 46 out of 48 VHWs reported that the FHS made them a "much better VHW." In addition to helping target interventions in child health, women's health, and sanitation, the FHS assisted follow-up of non-communicable diseases in the community. In discussion groups, VHWs reported that the FHS helped them understand risks for future disease, facilitated earning stipends, and increased credibility and trust in the community. Limitations cited were the infrequent updates of the FHS, only biannually with the census, and the lack of cross-reference capability by health problem. DISCUSSION The FHS supports VHWs in providing longitudinal and comprehensive healthcare of chronic diseases in their villages. Limitations, potential solutions, and future directions are discussed.
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Affiliation(s)
- Faraz Alizadeh
- Boston Children’s Hospital & Doctor’s for Global Health, 300 Longwood Ave, Boston, MA 02115 USA
| | - Aravind Addepalli
- Albert Einstein College of Medicine & Doctor’s for Global Health, 1300 Morris Park Ave, Bronx, NY 10461 USA
| | - Shombit R. Chaudhuri
- Albert Einstein College of Medicine & Doctor’s for Global Health, 1300 Morris Park Ave, Bronx, NY 10461 USA
| | - Annie Modesta Budongo
- Kisoro District Hospital & Doctors for Global Health, Kisoro District Hospital, Kisoro, Uganda
| | - Immaculate Owembabazi
- Kisoro District Hospital & Doctors for Global Health, Kisoro District Hospital, Kisoro, Uganda
| | - Gloria Fung Chaw
- Montefiore Medical Center & Doctor’s for Global Health, 111 E 210th St, Bronx, NY 10467 USA
| | - Sam Musominali
- Kisoro District Hospital & Doctors for Global Health, Kisoro District Hospital, Kisoro, Uganda
| | - Gerald Paccione
- Montefiore Medical Center & Doctor’s for Global Health, 111 E 210th St, Bronx, NY 10467 USA
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Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010751. [PMID: 34682492 PMCID: PMC8535610 DOI: 10.3390/ijerph182010751] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/31/2022]
Abstract
In Sub-Saharan Africa, communicable and other tropical infectious diseases remain major challenges apart from the continuing HIV/AIDS epidemic. Recognition and prevalence of non-communicable diseases have risen throughout Africa, and the reimagining of healthcare delivery is needed to support communities coping with not only with HIV, tuberculosis, and COVID-19, but also cancer, cardiovascular disease, diabetes, and depression. Many non-communicable diseases can be prevented or treated with low-cost interventions, yet implementation of such care has been limited in the region. In this Perspective piece, we argue that deployment of an integrated service delivery model is an urgent next step, propose a South African model for integration, and conclude with recommendations for next steps in research and implementation. An approach that is inspired by South African experience would build on existing HIV-focused infrastructure that has been developed by Ministries of Health with strong support from the U.S. President’s Emergency Response for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. An integrated chronic healthcare model holds promise to sustainably deliver infectious disease and non-communicable disease care. Integrated care will be especially critical as health systems seek to cope with the unprecedented challenges associated with COVID-19 and future pandemic threats.
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González Fernández L, Firima E, Huber J, Raeber F, Amstutz A, Gupta R, Mokhohlane J, Belus JM, Labhardt ND. Community-based care models for arterial hypertension management in non-pregnant adults in sub-Saharan Africa: A scoping review protocol. F1000Res 2021. [DOI: 10.12688/f1000research.51929.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: Arterial hypertension (aHT) is the most important cardiovascular risk factor (CVRF) in adults living in sub-Saharan Africa (SSA), leading to an excess of cardiovascular disease (CVD) morbidity and mortality. Life-long aHT service delivery models in the region remain mostly anchored to health facilities and are provided by physicians or nurses, thus limiting access to care. Over the past years, decentralized community-based aHT care models have been piloted, aiming to improve access to prevention, diagnosis, and treatment. Although individual studies suggest that community-based care is well-received and potentially efficacious, a synthesized overview of such care models is missing. Hence, the aim of this scoping review is to map out and summarize existing interventions for community-based aHT diagnosis and care in non-pregnant adults in SSA. Additionally, we will describe outcomes in terms of acceptability, blood pressure control, patient engagement in care, and occurrence of aHT caused end-organ damage. Methods and analysis: We will apply the Arksey and O’Malley scoping review methodology and best practice, as outlined by Levac and the Joanna Briggs Institute scoping review guidelines. The research questions have been identified through a literature review and expert consultation. A systematic literature search will be conducted in four databases using a tailored search strategy, including a supplemental search through backward and forward citation. Abstracts and full text screening as well as the extraction of data will be conducted by two independent reviewers. Discrepancies will be resolved by a third reviewer. Information will be presented in both tabular and narrative form. Ethics and dissemination: This scoping review will summarize findings from existing publications, rather than primary data, and as such, does not require ethics review. Findings will be disseminated through stakeholder meetings, conference presentations, websites, and a peer-reviewed publication.
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Kasaie P, Weir B, Schnure M, Dun C, Pennington J, Teng Y, Wamai R, Mutai K, Dowdy D, Beyrer C. Integrated screening and treatment services for HIV, hypertension and diabetes in Kenya: assessing the epidemiological impact and cost-effectiveness from a national and regional perspective. J Int AIDS Soc 2021; 23 Suppl 1:e25499. [PMID: 32562353 PMCID: PMC7305418 DOI: 10.1002/jia2.25499] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/28/2020] [Accepted: 04/03/2020] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION As people with HIV age, prevention and management of other communicable and non-communicable diseases (NCDs) will become increasingly important. Integration of screening and treatment for HIV and NCDs is a promising approach for addressing the dual burden of these diseases. The aim of this study was to assess the epidemiological impact and cost-effectiveness of a community-wide integrated programme for screening and treatment of HIV, hypertension and diabetes in Kenya. METHODS Coupling a microsimulation of cardiovascular diseases (CVDs) with a population-based model of HIV dynamics (the Spectrum), we created a hybrid HIV/CVD model. Interventions were modelled from year 2019 (baseline) to 2023, and population was followed to 2033. Analyses were carried at a national level and for three selected regions (Nairobi, Coast and Central). RESULTS At a national level, the model projected 7.62 million individuals living with untreated hypertension, 692,000 with untreated diabetes and 592,000 individuals in need of ART in year 2018. Improving ART coverage from 68% at baseline to 88% in 2033 reduced HIV incidence by an estimated 64%. Providing NCD treatment to 50% of diagnosed cases from 2019 to 2023 and maintaining them on treatment afterwards could avert 116,000 CVD events and 43,600 CVD deaths in Kenya over the next 15 years. At a regional level, the estimated impact of expanded HIV services was highest in Nairobi region (averting 42,100 HIV infections compared to baseline) while Central region experienced the highest impact of expanded NCD treatment (with a reduction of 22,200 CVD events). The integrated HIV/NCD intervention could avert 7.76 million disability-adjusted-life-years (DALYs) over 15 years at an estimated cost of $6.68 billion ($445.27 million per year), or $860.30 per DALY averted. At a cost-effectiveness threshold of $2,010 per DALY averted, the probability of cost-effectiveness was 0.92, ranging from 0.71 in Central to 0.92 in Nairobi region. CONCLUSIONS Integrated screening and treatment of HIV and NCDs can be a cost-effective and impactful approach to save lives of people with HIV in Kenya, although important variation exists at the regional level. Containing the substantial costs required for scale-up will be critical for management of HIV and NCDs on a national scale.
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Affiliation(s)
- Parastu Kasaie
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian Weir
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Schnure
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chen Dun
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeff Pennington
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yu Teng
- Avenir Health, Glastonbury, CT, USA
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Integrated Initiative for Global Health, Northeastern University, Boston, MA, USA
| | | | - David Dowdy
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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21
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Louart S, Bonnet E, Ridde V. Is patient navigation a solution to the problem of "leaving no one behind"? A scoping review of evidence from low-income countries. Health Policy Plan 2021; 36:101-116. [PMID: 33212491 PMCID: PMC7938515 DOI: 10.1093/heapol/czaa093] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 12/25/2022] Open
Abstract
Patient navigation interventions, which are designed to enable patients excluded from health systems to overcome the barriers they face in accessing care, have multiplied in high-income countries since the 1990s. However, in low-income countries (LICs), indigents are generally excluded from health policies despite the international paradigm of universal health coverage (UHC). Fee exemption interventions have demonstrated their limits and it is now necessary to act on other dimensions of access to healthcare. However, there is a lack of knowledge about the interventions implemented in LICs to support the indigents throughout their care pathway. The aim of this paper is to synthesize what is known about patient navigation interventions to facilitate access to modern health systems for vulnerable populations in LICs. We therefore conducted a scoping review to identify all patient navigation interventions in LICs. We found 60 articles employing a total of 48 interventions. Most of these interventions targeted traditional beneficiaries such as people living with HIV, pregnant women and children. We utilized the framework developed by Levesque et al. (Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013;12:18) to analyse the interventions. All acted on the ability to perceive, 34 interventions on the ability to reach, 30 on the ability to engage, 8 on the ability to pay and 6 on the ability to seek. Evaluations of these interventions were encouraging, as they often appeared to lead to improved health indicators and service utilization rates and reduced attrition in care. However, no intervention specifically targeted indigents and very few evaluations differentiated the impact of the intervention on the poorest populations. It is therefore necessary to test navigation interventions to enable those who are worst off to overcome the barriers they face. It is a major ethical issue that health policies leave no one behind and that UHC does not benefit everyone except the poorest.
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Affiliation(s)
- Sarah Louart
- Univ. Lille, CNRS, UMR 8019 - CLERSE - Centre Lillois d’Études et de Recherches sociologiques et Économiques, F-59000 Lille, France
| | - Emmanuel Bonnet
- Institute for Research on Sustainable Development, UMI Résiliences 236, Bondy, France
| | - Valéry Ridde
- Institute for Research on Sustainable Development, CEPED (IRD-Université de Paris), Université de Paris, ERL INSERM SAGESUD, 45 Rue des Saints-Pères, Paris 75006, France
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22
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Stephens JH, Addepalli A, Chaudhuri S, Niyonzima A, Musominali S, Uwamungu JC, Paccione GA. Chronic Disease in the Community (CDCom) Program: Hypertension and non-communicable disease care by village health workers in rural Uganda. PLoS One 2021; 16:e0247464. [PMID: 33630935 PMCID: PMC7906377 DOI: 10.1371/journal.pone.0247464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background Although hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics. Objective/Methods We describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts. Results/Conclusions Of 4283 people ages 30–69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.
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Affiliation(s)
- Joseph H. Stephens
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
- * E-mail:
| | - Aravind Addepalli
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Shombit Chaudhuri
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Abel Niyonzima
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
| | - Sam Musominali
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
| | - Jean Claude Uwamungu
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Gerald A. Paccione
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
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23
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Peer N, Baatiema L, Kengne AP. Ischaemic heart disease, stroke, and their cardiometabolic risk factors in Africa: current challenges and outlook for the future. Expert Rev Cardiovasc Ther 2020; 19:129-140. [PMID: 33305637 DOI: 10.1080/14779072.2021.1855975] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Although cardiovascular diseases (CVDs) are among the leading causes of death in Sub-Saharan Africa (SSA), prevention is not a priority and effective treatments are not widely available. This perspective discusses the burden, challenges, and potential opportunities for improvement of CVD prevention and control efforts in SSA. AREAS COVERED This paper focuses on ischemic heart disease and stroke, and their key contributors of obesity, hypertension, diabetes and dyslipidaemia which are well-established, rapidly rising, and significant contributors to disease burden in SSA. However, their prevention, detection, treatment and control of are currently disorganized, inconsistent, unreliable, and insufficient with most SSA countries not geared to respond to this growing problem. National policies are frequently lacking or, if available, remain poorly implemented, for the control of these conditions. Primary healthcare systems have not adapted to cope with these rising CVD burdens and remain weak, underfunded and under resourced. Numerous barriers at the healthcare service, healthcare provider, and patient levels prevent optimal CVD risk factor care. EXPERT OPINION Innovative approaches such as task-shifting with the reallocation of care to lower-level healthcare workers and the potential use of inexpensive technological options should be encouraged to provide equitable CVD preventive and curative solutions to SSA's poor.
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Affiliation(s)
- Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Leonard Baatiema
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Andre-Pascal Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
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Chamie G, Hickey MD, Kwarisiima D, Ayieko J, Kamya MR, Havlir DV. Universal HIV Testing and Treatment (UTT) Integrated with Chronic Disease Screening and Treatment: the SEARCH study. Curr HIV/AIDS Rep 2020; 17:315-323. [PMID: 32507985 DOI: 10.1007/s11904-020-00500-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The growing burden of untreated chronic disease among persons with HIV (PWH) threatens to reverse heath gains from ART expansion. Universal test and treat (UTT)'s population-based approach provides opportunity to jointly identify and treat HIV and other chronic diseases. This review's purpose is to describe SEARCH UTT study's integrated disease strategy and related approaches in Sub-Saharan Africa. RECENT FINDINGS In SEARCH, 97% of adults were HIV tested, 85% were screened for hypertension, and 79% for diabetes at health fairs after 2 years, for an additional $1.16/person. After 3 years, population-level hypertension control was 26% higher in intervention versus control communities. Other mobile/home-based multi-disease screening approaches have proven successful, but data on multi-disease care delivery are extremely limited and show little effect on clinical outcomes. Integration of chronic disease into HIV in the UTT era is feasible and can achieve population level effects; however, optimization and implementation remain a huge unmet need.
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Affiliation(s)
- Gabriel Chamie
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA.
| | - Matthew D Hickey
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA
| | | | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Makerere University College of Health Sciences, Kampala, Uganda
| | - Diane V Havlir
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA
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25
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Hopkins KL, Hlongwane KE, Otwombe K, Dietrich J, Jaffer M, Cheyip M, Olivier J, van Rooyen H, Wade AN, Doherty T, Gray GE. Does peer-navigated linkage to care work? A cross-sectional study of active linkage to care within an integrated non-communicable disease-HIV testing centre for adults in Soweto, South Africa. PLoS One 2020; 15:e0241014. [PMID: 33091093 PMCID: PMC7580918 DOI: 10.1371/journal.pone.0241014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION South Africa is the HIV epidemic epicentre; however, non-communicable diseases (NCDs) will be the most common cause of death by 2030. To improve identification and initiation of care for HIV and NCDs, we assessed proportion of clients referred and linked to care (LTC) for abnormal/positive screening results and time to LTC and treatment initiation from a HIV Testing Services (HTS) Centre before and after integrated testing for NCDs with optional peer-navigated linkage to care. MATERIALS AND METHODS This two-phase prospective study was conducted at an adult HTS Centre in Soweto, South Africa. Phase 1 (February-June 2018) utilised standard of care (SOC) HTS services (blood pressure [BP], HIV rapid diagnostic testing (RDT), sexually transmitted infections [STI]/Tuberculosis [TB] symptom screening) with passive referral for abnormal/positive results. Phase 2 (June 2018-March 2019) further integrated blood glucose/cholesterol/chlamydia RDT, with optional peer-navigated referral. Enrolled referred clients completed telephonic follow-up surveys confirming LTC/treatment initiation ≤3 months post-screening. Socio-demographics, screening results, time to LTC/treatment initiation, peer-navigated referral uptake were reported. Analysis included Fisher's exact, chi-squared, Kruskal Wallis, and Student's T-tests. Thematic analysis was conducted for open-ended survey responses. RESULTS Of all 320 referrals, 40.0% were HIV-infections, 11.9% STIs, 6.6% TB, and 28.8% high/low BP. Of Phase 2-only referrals, 29.4% were for glucose and 23.5% cholesterol. Integrated NCD-HTS had significantly more clients LTC for HIV (76.7%[n = 66/86] vs 52.4%[n = 22/42], p = 0.0052) and within a shorter average time (6-8 days [Interquartile range (IQR):1-18.5] vs 8-13 days [IQR:2-32]) as compared to SOC HTS. Integrated NCD-HTS clients initiated HIV/STIs/BP treatment on average more quickly as compared to SOC HTS (5 days for STIs [IQR:1-21], 8 days for HIV/BP [IQR:5-17 and 2-13, respectively] vs 10 days for STIs [IQR: 4-32], 19.5 days for HIV [IQR:6.5-26.5], 8 days for BP [IQR:2-29)]. Participants chose passive over active referral (89.1% vs 10.9%; p<0.0001). Participants rejecting peer-navigated referral preferred to go alone (55.7% [n = 39/70]). Non-LTC was due to being busy (41.1% [n = 39/95]) and not being ready/refusing treatment (31.6% [n = 30/95]). Normalised results assessed at referral clinic (49.7% [n = 98/196]), prescribed lifestyle modification/monitoring (30.9% [n = 61/196]), and poor clinic flow/congestion and/or further testing required (10.7% [n = 21/196]) were associated with non-treatment initiation. CONCLUSION Same-day treatment initiation is not achieved across diseases, despite peer-navigated referral. There are psychosocial and health systems barriers at entry to care/treatment initiation. Additional research may identify best strategies for rapid treatment initiation.
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Affiliation(s)
- Kathryn L. Hopkins
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Khuthadzo E. Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Maya Jaffer
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Mireille Cheyip
- Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Jacobus Olivier
- Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Heidi van Rooyen
- Human and Social Development Programme, Human Sciences Research Council, Pretoria, South Africa
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alisha N. Wade
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanya Doherty
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Glenda E. Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
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Starbird LE, DiMaina C, Sun CA, Han HR. A Systematic Review of Interventions to Minimize Transportation Barriers Among People with Chronic Diseases. J Community Health 2020; 44:400-411. [PMID: 30206755 DOI: 10.1007/s10900-018-0572-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transportation is an important social determinant of health. Transportation barriers disproportionately affect the most vulnerable groups of society who carry the highest burden of chronic diseases; therefore, it is critical to identify interventions that improve access to transportation. We synthesized evidence concerning the types and impact of interventions that address transportation to chronic care management. A systematic literature search of peer-reviewed studies that include an intervention with a transportation component was performed using three electronic databases-PubMed, EMBASE, and CINAHL-along with a hand-search. We screened 478 unique titles and abstracts. Two reviewers independently evaluated 41 full-text articles and 10 studies met eligibility criteria for inclusion. The transportation interventions included one or more of the following: providing bus passes (n = 5), taxi/transport vouchers or reimbursement (n = 3), arranging or connecting participants to transportation (n = 2), and a free shuttle service (n = 1). Transportation support was offered within multi-component interventions including counseling, care coordination, education, financial incentives, motivational interviewing, and navigation assistance. Community health/outreach workers (n = 3), nurses (n = 3), and research or clinic staff (n = 3) were the most common interventionists. Studies reported improvements in cancer screening rates, chronic disease management, hospital utilization, linkage and follow up to care, and maternal empathy. Overall, transportation is a well-documented barrier to engaging in chronic care among vulnerable populations. We found evidence suggesting transportation services offered in combination with other tailored services improves patient health outcomes; however, future research is warranted to examine the separate impact of transportation interventions that are tested within multi-component studies.
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Affiliation(s)
- Laura E Starbird
- Center for Health Policy, Columbia University School of Nursing, 560 W. 168th Street, New York, NY, 10032, USA.
| | - Caitlin DiMaina
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Chun-An Sun
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Hae-Ra Han
- Center for Cardiovascular and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Center for Community Innovation and Scholarship, Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Heller DJ, Balzer LB, Kazi D, Charlebois ED, Kwarisiima D, Mwangwa F, Jain V, Kotwani P, Chamie G, Cohen CR, Clark TD, Ayieko J, Byonanabye DM, Petersen M, Kamya MR, Havlir D, Kahn JG. Hypertension testing and treatment in Uganda and Kenya through the SEARCH study: An implementation fidelity and outcome evaluation. PLoS One 2020; 15:e0222801. [PMID: 31940346 PMCID: PMC6961918 DOI: 10.1371/journal.pone.0222801] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/07/2019] [Indexed: 01/21/2023] Open
Abstract
Background Hypertension (HTN) is the single leading risk factor for human mortality worldwide, and more prevalent in sub-Saharan Africa than any other region [1]–although resources for HTN screening, treatment, and control are few. Most regional pilot studies to leverage HIV programs for HTN control have achieved blood pressure control in half of participants or fewer [2,3,4]. But this control gap may be due to inconsistent delivery of services, rather than ineffective underlying interventions. Methods We sought to evaluate the consistency of HTN program delivery within the SEARCH study (NCT01864603) among 95,000 adults in 32 rural communities in Uganda and Kenya from 2013–2016. To achieve this objective, we designed and performed a fidelity evaluation of the step-by-step process (cascade) of HTN care within SEARCH, calculating rates of HTN screening, linkage to care, and follow-up care. We evaluated SEARCH’s assessment of each participant’s HTN status against measured blood pressure and HTN history. Findings SEARCH completed blood pressure screens on 91% of participants. SEARCH HTN screening was 91% sensitive and over 99% specific for HTN relative to measured blood pressure and patient history. 92% of participants screened HTN+ received clinic appointments, and 42% of persons with HTN linked to subsequent care. At follow-up, 82% of SEARCH clinic participants received blood pressure checks; 75% received medication appropriate for their blood pressure; 66% remained in care; and 46% had normal blood pressure at their most recent visit. Conclusion The SEARCH study’s consistency in delivering screening and treatment services for HTN was generally high, but SEARCH could improve effectiveness in linking patients to care and achieving HTN control. Its model for implementing population-scale HTN testing and care through an existing HIV test-and-treat program–and protocol for evaluating the intervention’s stepwise fidelity and care outcomes–may be adapted, strengthened, and scaled up for use across multiple resource-limited settings.
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Affiliation(s)
- David J. Heller
- Arnhold Institute for Global Health, New York, New York, United States of America
- * E-mail:
| | - Laura B. Balzer
- University of Massachusetts, Amherst, Massachusetts, United States of America
| | - Dhruv Kazi
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Edwin D. Charlebois
- University of California, San Francisco, San Francisco, California, United States of America
| | | | | | - Vivek Jain
- University of California, San Francisco, San Francisco, California, United States of America
| | - Prashant Kotwani
- University of California, San Francisco, San Francisco, California, United States of America
| | - Gabriel Chamie
- University of California, San Francisco, San Francisco, California, United States of America
| | - Craig R. Cohen
- University of California, San Francisco, San Francisco, California, United States of America
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Tamara D. Clark
- University of California, San Francisco, San Francisco, California, United States of America
| | - James Ayieko
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Dathan M. Byonanabye
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maya Petersen
- University of California Berkeley School of Public Health, Berkeley, California, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Diane Havlir
- University of California, San Francisco, San Francisco, California, United States of America
| | - James G. Kahn
- University of California, San Francisco, San Francisco, California, United States of America
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Correia JC, Lachat S, Lagger G, Chappuis F, Golay A, Beran D. Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review. BMC Public Health 2019; 19:1542. [PMID: 31752801 PMCID: PMC6873661 DOI: 10.1186/s12889-019-7842-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.
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Affiliation(s)
- Jorge César Correia
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Sarah Lachat
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Grégoire Lagger
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Alain Golay
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
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Ngaruiya C, Oti S, van de Vijver S, Kyobutungi C, Free C. Target women: Equity in access to mHealth technology in a non-communicable disease care intervention in Kenya. PLoS One 2019; 14:e0220834. [PMID: 31509540 PMCID: PMC6738613 DOI: 10.1371/journal.pone.0220834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/25/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Non-Communicable Diseases (NCDs) constitute 40 million deaths annually. Eighty-percent of these deaths occur in Low- and Middle-Income Countries. MHealth provides a potentially highly effective modality for global public health, however access is poorly understood. The objective of our study was to assess equity in access to mHealth in an NCD intervention in Kenya. METHODS This is a secondary analysis of a complex NCD intervention targeting slum residents in Kenya. The primary outcomes were: willingness to receive SMS, whether SMS was received, and access to SMS compared to alternative health information modalities. Age, sex, level of education, level of income, type of work, number of hours worked, and home environment were explanatory variables considered. Multivariable regression analyses were used to test for association using likelihood ratio testing. RESULTS 7,618 individual participants were included in the analysis. The median age was 44 years old. Majority (75%, n = 3,691/ 4,927) had only attended up to primary (elementary) school. Majority reported earning "KShs 7,500 or greater" (27%, n = 1,276/ 4,736). Age and level of income had evidence of association with willingness to receive SMS, and age, sex and number of hours work with whether SMS was received. SMS was the health information modality with highest odds of being accessed in older age groups (OR 4.70, 8.72 and 28.89, for age brackets 60-69, 70-79 and 80 years or older, respectively), among women (OR = 1.86, 95% CI 1.19-2.89), and second only to Baraazas (community gatherings) among those with lowest income. CONCLUSION Women had the greatest likelihood of receiving SMS. SMS performed equitably well amongst marginalized populations (elderly, women, and low-income) as compared to alternative health information modalities, though sensitization prior to implementation of mHealth interventions may be needed. These findings provide guidance for developing mHealth interventions targeting marginalized populations in these settings.
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Affiliation(s)
- Christine Ngaruiya
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Samuel Oti
- International Development Research Centre, Nairobi, Kenya
| | - Steven van de Vijver
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | | | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Vedanthan R, Kamano JH, DeLong AK, Naanyu V, Binanay CA, Bloomfield GS, Chrysanthopoulou SA, Finkelstein EA, Hogan JW, Horowitz CR, Inui TS, Menya D, Orango V, Velazquez EJ, Were MC, Kimaiyo S, Fuster V. Community Health Workers Improve Linkage to Hypertension Care in Western Kenya. J Am Coll Cardiol 2019; 74:1897-1906. [PMID: 31487546 DOI: 10.1016/j.jacc.2019.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Elevated blood pressure (BP) is the leading global risk factor for mortality. Delay in seeking hypertension care is associated with increased mortality. OBJECTIVES This study investigated whether community health workers, equipped with behavioral communication strategies and smartphone technology, can increase linkage of individuals with elevated BP to a hypertension care program in western Kenya and significantly reduce BP. METHODS The study was a cluster randomized trial with 3 arms: 1) usual care (standard training); 2) "paper-based" (tailored behavioral communication, using paper-based tools); and 3) "smartphone" (tailored behavioral communication, using smartphone technology). The co-primary outcomes were: 1) linkage to care; and 2) change in systolic BP (SBP). A covariate-adjusted mixed-effects model was used, adjusting for differential time to follow-up. Bootstrap and multiple imputation were used to handle missing data. RESULTS A total of 1,460 individuals (58% women) were enrolled (491 usual care, 500 paper-based, 469 smartphone). Average baseline SBP was 159.4 mm Hg. Follow-up measures of linkage were available for 1,128 (77%) and BP for 1,106 (76%). Linkage to care was 49% overall, with significantly greater linkage in the usual care and smartphone arms of the trial. Average overall follow-up SBP was 149.9 mm Hg. Participants in the smartphone arm experienced a modestly greater reduction in SBP versus usual care (-13.1 mm Hg vs. -9.7 mm Hg), but this difference was not statistically significant. Mediation analysis revealed that linkage to care contributed to SBP change. CONCLUSIONS A strategy combining tailored behavioral communication and mobile health (mHealth) for community health workers led to improved linkage to care, but not statistically significant improvement in SBP reduction. Further innovations to improve hypertension control are needed. (Optimizing Linkage and Retention to Hypertension Care in Rural Kenya [LARK]; NCT01844596).
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Affiliation(s)
| | | | - Allison K DeLong
- School of Public Health, Brown University, Providence, Rhode Island
| | - Violet Naanyu
- Moi University College of Health Sciences, Eldoret, Kenya
| | | | | | | | | | - Joseph W Hogan
- School of Public Health, Brown University, Providence, Rhode Island
| | | | - Thomas S Inui
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Diana Menya
- Moi University College of Health Sciences, Eldoret, Kenya
| | - Vitalis Orango
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
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31
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Chang AY, Gómez-Olivé FX, Payne C, Rohr JK, Manne-Goehler J, Wade AN, Wagner RG, Montana L, Tollman S, Salomon JA. Chronic multimorbidity among older adults in rural South Africa. BMJ Glob Health 2019; 4:e001386. [PMID: 31423345 PMCID: PMC6688670 DOI: 10.1136/bmjgh-2018-001386] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/17/2019] [Accepted: 06/01/2019] [Indexed: 12/16/2022] Open
Abstract
Introduction The rapid ageing of populations around the world is accompanied by increasing prevalence of multimorbidity. This study is one of the first to present the prevalence of multimorbidity that includes HIV in the complex epidemiological setting of South Africa, thus filling a gap in the multimorbidity literature that is dominated by studies in high-income or low-HIV prevalence settings. Methods Out of the full sample of 5059 people aged 40+, we analysed cross-sectional data on 10 conditions from 3889 people enrolled in the Health and Ageing in Africa: A longitudinal study of an INDEPTH Community in South Africa (HAALSI) Programme. Two definitions of multimorbidity were applied: the presence of more than one condition and the presence of conditions from more than one of the following categories: cardiometabolic conditions, mental disorders, HIV and anaemia. We conducted descriptive and regression analyses to assess the relationship between prevalence of multimorbidity and sociodemographic factors. We examined the frequencies of the most prevalent combinations of conditions and assessed relationships between multimorbidity and physical and psychological functioning. Results 69.4 per cent (95% CI 68.0 to 70.9) of the respondents had at least two conditions and 53.9% (52.4–55.5) of the sample had at least two categories of conditions. The most common condition groups and multimorbid profiles were combinations of cardiometabolic conditions, cardiometabolic conditions and depression, HIV and anaemia and combinations of mental disorders. The commonly observed positive relationships between multimorbidity and age and decreasing wealth were not observed in this population, namelydue to different epidemiological profiles in the subgroups, with higher prevalence of HIV and anaemia in the poorer and younger groups, and higher prevalence of cardiometabolic conditions in the richer and older groups. Both physical functioning and well-being negatively associated with multimorbidity. Discussion More coordinated, long-term integrated care management across multiple chronic conditions should be provided in rural South Africa.
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Affiliation(s)
- Angela Y Chang
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Collin Payne
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Julia K Rohr
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Livia Montana
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, USA
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joshua A Salomon
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Adinan J, Manongi R, Temu GA, Kapologwe N, Marandu A, Wajanga B, Dika H, Maongezi S, Laizer S, Manyuti R, Nassir RA, Renju J, Todd J. Preparedness of health facilities in managing hypertension & diabetes mellitus in Kilimanjaro, Tanzania: a cross sectional study. BMC Health Serv Res 2019; 19:537. [PMID: 31366384 PMCID: PMC6670222 DOI: 10.1186/s12913-019-4316-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hypertension and Diabetes mellitus are risk factors for cardiovascular diseases that cause 17 million deaths globally. Many of these deaths could have been prevented if hypertensive and diabetic patients had their blood pressure and glucose controlled. Less than 30% of hypertensive and diabetic patients on management have controlled their blood pressure and glucose respectively. This study aimed to determine the preparedness of health facilities in managing hypertensive and diabetic patients in terms of personnel; laboratory services provision, and local use of routinely collected data, and shows differences in preparedness between the levels of facilities. Methods We conducted a cross-sectional study in Government, faith-based and private health facilities in two districts in Kilimanjaro region in Tanzania from March to July 2017. We collected data through interviews and observations on the preparedness of the facilities for managing hypertension and DM. Results Forty-three (43) health facilities and 62 healthcare workers (HCW) participated in the survey. Services for hypertension and DM were available in 37 (86%) and 34 (79%) health facilities respectively. Eighteen (53%) and five (15%) facilities had HCW trained on hypertension and DM management respectively within two years preceding the survey. Regular adherence to treatment guideline was reported in 18 (53%) of the health facilities. More than third of health facilities were without basic equipment for managing hypertension and DM. All the recommended laboratory tests were only available in four (15%) hospitals and one health center. Valid first line medicines for both hypertension and DM were available in six (50%) health centers, four (24%) dispensaries and in four (80.0%) hospitals. Health data collection, analysis and local use for planning were reported in all hospitals, nine (75%) health centers and four (24%) dispensaries. Conclusions Health facilities are not fully prepared to manage hypertension and DM. Health centers and dispensaries are mostly affected levels of health facilities. Government interventions to improve facility factors and collaborative approaches to build capacity to HCW are needed to enable health facilities be responsive to these diseases.
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Affiliation(s)
- Juma Adinan
- School of AMO KCMC, 3010, Moshi, Kilimanjaro, Tanzania. .,Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania. .,Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania.
| | - Rachel Manongi
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | - Gloria August Temu
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | - Ntuli Kapologwe
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania.,President's Office - Regional Administration and Local Government (PORALG), Dodoma, Tanzania
| | - Annette Marandu
- Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro, Tanzania
| | - Bahati Wajanga
- Catholic University of Health and Allied Sciences, 1464, Mwanza, Tanzania
| | - Haruna Dika
- Catholic University of Health and Allied Sciences, 1464, Mwanza, Tanzania
| | - Sarah Maongezi
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Sweetness Laizer
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | - Ridhiwani Manyuti
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania
| | | | - Jenny Renju
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania.,Department of Population Health, LSHTM, London, UK
| | - Jim Todd
- Kilimanjaro Christian Medical University College, 2240, Moshi, Kilimanjaro, Tanzania.,Department of Population Health, LSHTM, London, UK
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Chen S, Sudharsanan N, Huang F, Liu Y, Geldsetzer P, Bärnighausen T. Impact of community based screening for hypertension on blood pressure after two years: regression discontinuity analysis in a national cohort of older adults in China. BMJ 2019; 366:l4064. [PMID: 31296584 PMCID: PMC6619453 DOI: 10.1136/bmj.l4064] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To estimate the causal impact of community based blood pressure screening on subsequent blood pressure levels among older adults in China. DESIGN Regression discontinuity analysis using data from a national cohort study. SETTING 2011-12 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, a national cohort of older adults in China. PARTICIPANTS 3899 older adults who had previously undiagnosed hypertension. INTERVENTION Community based hypertension screening among older adults in 2011-12. MAIN OUTCOME MEASURE Blood pressure two years after initial screening. RESULTS The intervention reduced systolic blood pressure: -6.3 mm Hg in the model without covariates (95% confidence interval -11.2 to -1.3) and -8.3 mm Hg (-13.6 to -3.1) in the model that adjusts additionally for demographic, social, and behavioural covariates. The impact on diastolic blood pressure was smaller and non-significant in all models. The results were similar when alternative functional forms were used to estimate the impact and the bandwidths around the intervention threshold were changed. The results did not vary by demographic and social subgroups. CONCLUSIONS Community based hypertension screening and encouraging people with raised blood pressure to seek care and adopt blood pressure lowering behaviour changes could have important long term impact on systolic blood pressure at the population level. This approach could address the high burden of cardiovascular diseases in China and other countries with large unmet need for hypertension diagnosis and care.
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Affiliation(s)
- Simiao Chen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
- Harvard Center for Population and Development Studies, Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | - Feng Huang
- School of Economics and Key Laboratory of Mathematical Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Yuanli Liu
- School of Public Health, Peking Union Medical College, Beijing, China
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, 69120 Heidelberg, Germany
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
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Mayer CM, Owaraganise A, Kabami J, Kwarisiima D, Koss CA, Charlebois ED, Kamya MR, Petersen ML, Havlir DV, Jewell BL. Distance to clinic is a barrier to PrEP uptake and visit attendance in a community in rural Uganda. J Int AIDS Soc 2019; 22:e25276. [PMID: 31037845 PMCID: PMC6488759 DOI: 10.1002/jia2.25276] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/14/2019] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Geographic and transportation barriers are associated with poorer HIV-related health outcomes in sub-Saharan Africa, but data on the impact of these barriers on prevention interventions are limited. We estimated the association between distance to clinic and other transportation-related barriers on pre-exposure prophylaxis (PrEP) uptake and initial clinic visit attendance in a rural community in southwestern Uganda enrolled in the ongoing SEARCH study (NCT01864603). METHODS Community-wide HIV testing was conducted and offered to adult (≥15 years) participants in Ruhoko. Participants were eligible for PrEP based on an empiric risk score, having an HIV-discordant partner, or self-referral at either the community health campaign or during home-based testing from March to April 2017. We collected data from PrEP-eligible households on GPS-measured distance to clinic, walking time to clinic and road difficulty. A sample of participants was also asked to identify their primary barriers to PrEP use with a semi-quantitative questionnaire. We used multivariable logistic regression to evaluate the association between transportation barriers and (1) PrEP uptake among PrEP-eligible individuals and (2) four-week clinic visit attendance among PrEP initiators. RESULTS Of the 701 PrEP-eligible participants, 272 (39%) started PrEP within four weeks; of these, 45 (17%) were retained at four weeks. Participants with a distance to clinic of ≥2 km were less likely to start PrEP (aOR 0.34; 95% CI 0.15 to 0.79, p = 0.012) and less likely to be retained on PrEP once initiated (aOR 0.29; 95% CI 0.10 to 0.84; p = 0.024). Participants who were deemed eligible during home-based testing and did not have the option of same-day PrEP start were also substantially less likely to initiate PrEP (aOR 0.16, 95% CI 0.07 to 0.37, p < 0.001). Of participants asked to name barriers to PrEP use (N = 98), the most frequently cited were "needing to take PrEP every day" (N = 18) and "low/no risk of getting HIV" (N = 18). Transportation-related barriers, including "clinic is too far away" (N = 6) and "travel away from home" (N = 4) were also reported. CONCLUSIONS Distance to clinic is a significant predictor of PrEP uptake and four-week follow-up visit attendance in a community in rural Uganda. Interventions that address geographic and transportation barriers may improve PrEP uptake and retention in sub-Saharan Africa.
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Affiliation(s)
| | | | - Jane Kabami
- Infectious Diseases Research CollaborationKampalaUganda
| | | | | | | | | | | | - Diane V Havlir
- University of California San FranciscoSan FranciscoCAUSA
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Noubiap JJ, Nansseu JR, Endomba FT, Ngouo A, Nkeck JR, Nyaga UF, Kaze AD, Bigna JJ. Active smoking among people with diabetes mellitus or hypertension in Africa: a systematic review and meta-analysis. Sci Rep 2019; 9:588. [PMID: 30679752 PMCID: PMC6345945 DOI: 10.1038/s41598-018-37858-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/15/2018] [Indexed: 12/27/2022] Open
Abstract
The objective was to summarize existing data on the prevalence of active tobacco smoking among patients with hypertension or diabetes mellitus in Africa. We searched PubMed, EMBASE, and AJOL to include studies published from January 01, 2000 to August 23, 2017 reporting on the prevalence of active smoking in individuals aged ≥15 years with hypertension or diabetes mellitus residing inside Africa. We used a random-effects meta-analysis model to pool studies. The pooled prevalence of active smoking among patients with hypertension or diabetes was 12.9% (95%CI: 10.6–15.3; 50 studies; 16,980 patients) and 12.9% (95%CI: 9.6–16.6; 42 studies; 18,564 patients), respectively. For both conditions, the prevalence of active smoking was higher in males than in females (p < 0.001), and in Northern compared to sub-Saharan Africa (p < 0.001). There was no difference between urban and rural settings, and between community-based and hospital-based studies, except for patients with diabetes for whom the prevalence was higher in hospital-based studies (p = 0.032). The prevalence of active smoking is high among patients with hypertension or diabetes mellitus in Africa, with the heaviest burden in Northern Africa. Interventions for smoking prevention or cessation should be implemented in these high risk populations, targeting particularly the males.
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Affiliation(s)
- Jean Jacques Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Jobert Richie Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.,Department for the Control of Disease, Epidemics and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Francky Teddy Endomba
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Anderson Ngouo
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jan René Nkeck
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Arnaud D Kaze
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon. .,Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France.
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Siedner MJ, Baisley K, Orne-Gliemann J, Pillay D, Koole O, Wong EB, Matthews P, Tanser F, Herbst K, Barnighausen T, Bachmann M. Linkage to primary care after home-based blood pressure screening in rural KwaZulu-Natal, South Africa: a population-based cohort study. BMJ Open 2018; 8:e023369. [PMID: 30530475 PMCID: PMC6286496 DOI: 10.1136/bmjopen-2018-023369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The expanding burden of non-communicable diseases (NCDs) globally will require novel public health strategies. Community-based screening has been promoted to augment efficiency of diagnostic services, but few data are available on the downstream impact of such programmes. We sought to assess the impact of a home-based blood pressure screening programme on linkage to hypertension care in rural South Africa. SETTING We conducted home-based blood pressure screening withinin a population cohort in rural KwaZulu-Natal, using the WHO Stepwise Approach to Surveillance (STEPS) protocol. PARTICIPANTS Individuals meeting criteria for raised blood pressure (≥140 systolic or ≥90 diastolic averaged over two readings) were referred to local health clinics and included in this analysis. We defined linkage to care based on self-report of presentation to clinic for hypertension during the next 2 years of cohort observation. We estimated the population proportion of successful linkage to care with inverse probability sampling weights, and fit multivariable logistic regression models to identify predictors of linkage following a positive hypertension screen. RESULTS Of 11 694 individuals screened, 14.6% (n=1706) were newly diagnosed with elevated pressure. 26.9% (95% CI 24.5% to 29.4%) of those sought hypertension care in the following 2 years, and 38.1% (95% CI 35.6% to 40.7%) did so within 5 years. Women (adjusted OR (aOR) 2.41, 95% CI 1.68 to 3.45), those of older age (aOR 11.49, 95% CI 5.87 to 22.46, for 45-59 years vs <30) and those unemployed (aOR 1.71, 95% CI 1.10 to 2.65) were more likely to have linked to care. CONCLUSIONS Linkage to care after home-based identification of elevated blood pressure was rare in rural South Africa, particularly among younger individuals, men and the employed. Improved understanding of barriers and facilitators to NCD care is needed to enhance the effectiveness of blood pressure screening in the region.
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Affiliation(s)
- Mark J Siedner
- Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kathy Baisley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Epidemiology and Medical Statistics, London School of Tropical Medicine and Hygiene, London, UK
| | - Joanna Orne-Gliemann
- Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Deenan Pillay
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University College London, London, UK
| | - Olivier Koole
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Epidemiology and Medical Statistics, London School of Tropical Medicine and Hygiene, London, UK
| | - Emily B Wong
- Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Frank Tanser
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kobus Herbst
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Till Barnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- University College London, London, UK
- Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Harvard School of Public Health, Boston, Massachusetts, USA
| | - Max Bachmann
- Population Health and Primary Care, University of East Anglia, Norwich, UK
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Njuguna B, Vorkoper S, Patel P, Reid MJ, Vedanthan R, Pfaff C, Park PH, Fischer L, Laktabai J, Pastakia SD. Models of integration of HIV and noncommunicable disease care in sub-Saharan Africa: lessons learned and evidence gaps. AIDS 2018; 32 Suppl 1:S33-S42. [PMID: 29952788 PMCID: PMC6779053 DOI: 10.1097/qad.0000000000001887] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To describe available models of HIV and noncommunicable disease (NCD) care integration in sub-Saharan Africa (SSA). DESIGN Narrative review of published articles describing various models of HIV and NCD care integration in SSA. RESULTS We identified five models of care integration across various SSA countries. These were integrated community-based screening for HIV and NCDs in the general population; screening for NCDs and NCD risk factors among HIV patients enrolled in care; integration of HIV and NCD care within clinics; differentiated care for patients with HIV and/or NCDs; and population healthcare for all. We illustrated these models with descriptive case studies highlighting the lessons learned and evidence gaps from the various models. CONCLUSION Leveraging existing HIV infrastructure for NCD care is feasible with various approaches possible depending on available program capacity. Process and clinical outcomes for existing models of care integration are not yet described but are urgently required to further advise policy decisions on HIV/NCD care integration.
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Affiliation(s)
- Benson Njuguna
- Department of Pharmacy, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Pragna Patel
- Centers for Disease Control and Prevention, Center of Global Health, Division of Global HIV and TB, Atlanta, Georgia
| | - Mike J.A. Reid
- Institute for Global Health Delivery & Diplomacy, Global Health Sciences, UCSF & Divisions of HIV, Infectious Diseases and Global Health, UCSF, San Francisco, California
| | - Rajesh Vedanthan
- Department of Medicine, Department of Population Health Science and Policy, and Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Colin Pfaff
- Department of Family Medicine, College of Medicine, Dignitas International, Zomba, Malawi
| | - Paul H. Park
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lydia Fischer
- Department of Pediatrics and Psychiatry, Indiana University, Bloomington, Indiana, USA
| | - Jeremiah Laktabai
- Department of Family Medicine, College of Health Sciences, Moi University School of Medicine, Eldoret, Kenya
| | - Sonak D. Pastakia
- Department of Family Medicine, Purdue University College of Pharmacy, West Lafayette, Indiana, USA
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From HIV prevention to non-communicable disease health promotion efforts in sub-Saharan Africa: A Narrative Review. AIDS 2018; 32 Suppl 1:S63-S73. [PMID: 29952792 DOI: 10.1097/qad.0000000000001879] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To synthesize published literature on noncommunicable disease (NCD) behavior change communication (BCC) interventions in sub-Saharan Africa (SSA) among persons living with HIV (PLHIV) and in the general population to inform efforts to adopt similar HIV and NCD BCC intervention activities. METHODS We conducted a literature review of NCD BCC interventions and included 20 SSA-based studies. Inclusion criteria entailed describing a BCC intervention targeting any four priority NCDs (cardiovascular disease, type 2 diabetes, cervical cancer, and depression) or both HIV and any of the NCDs. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to assess potential public health impact of these studies. We also solicited expert opinions from 10 key informants on the topic of HIV/NCD health promotion in five SSA countries. RESULTS The BCC interventions reviewed targeted multiple parts of the HIV and NCD continuum at both individual and community levels. Various strategies (i.e. health education, social marketing, motivational interviewing, mobile health, and peer support) were employed. However, few studies addressed more than one dimension of the RE-AIM framework. Opinions solicited from the key informants supported the feasibility of integrating HIV and NCD BCC interventions in SSA potentially improving access, service provision and service demand, especially for marginalized and vulnerable populations. CONCLUSION Although HIV/NCD integration can improve effectiveness of preventive services at individual and community levels, potential public health impact of such approaches remain unknown as reach, adoptability, and sustainability of both integrated and nonintegrated NCD BCC approaches published to date have not been well characterized.
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Nelissen HE, Okwor TJ, Khalidson O, Osibogun A, Van’t Hoog AH. Low uptake of hypertension care after community hypertension screening events in Lagos, Nigeria. Glob Health Action 2018; 11:1548006. [PMID: 30474518 PMCID: PMC6263098 DOI: 10.1080/16549716.2018.1548006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/07/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In Lagos, Nigeria, approximately 33% of the population suffers from hypertension, yet antihypertensive treatment coverage is low. To improve access to care, a decentralized pharmacy-based hypertension care model was piloted. This study reports on the recruitment strategies used and is part of a larger study to evaluate the feasibility of the care model. OBJECTIVE To describe our experience executing three different strategies to recruit hypertensive patients in the program: community hypertension screenings, hospital and pharmacy referral. METHODS Individuals with elevated blood pressure and no history of cardiovascular disease were referred to the program's recruitment days to see a medical doctor for hypertension diagnosis and enrollment. Individuals were referred from community screenings, tertiary hospital outpatient clinics, and pharmacies participating in the program. For the community screenings, we report the number needed to screen (NNS) to find one individual with elevated blood pressure, the NNS to enroll one individual in the program, and factors associated with enrollment in the program among participants referred. RESULTS We recruited 226 individuals (69%) in the program via the pharmacies, 97 (30%) via the community screenings, and 2 (<1%) via hospital referral. At the community screenings 3,204 individuals participated, 729 (23%) had elevated blood pressure and 618 (85%) were eligible for referral of whom 142 (23%) visited the recruitment days, and 97 (16%) enrolled. The NNS to find one individual with elevated blood pressure was 5, and the NNS to enroll one individual was 34. Enrollment in the program was associated with advancing age, blood pressure ≥160/100 and currently using antihypertensive medication. CONCLUSIONS Despite the potential attractiveness of community screenings to identify and refer individuals with hypertension, enrollment in the program was low. For future programs we recommend pharmacy referral as individuals seem more inclined to access care through healthcare providers they are familiar with.
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Affiliation(s)
- Heleen Elise Nelissen
- Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Tochi Joy Okwor
- Centre for Epidemiology and Health Development, Lagos, Nigeria
- Department of Community Health, University of Nigeria Teaching Hospital Enugu, Enugu, Nigeria
| | | | - Akin Osibogun
- Centre for Epidemiology and Health Development, Lagos, Nigeria
- Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Anja Helena Van’t Hoog
- Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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Huchko MJ, Kahn JG, Smith JS, Hiatt RA, Cohen CR, Bukusi E. Study protocol for a cluster-randomized trial to compare human papillomavirus based cervical cancer screening in community-health campaigns versus health facilities in western Kenya. BMC Cancer 2017; 17:826. [PMID: 29207966 PMCID: PMC5717798 DOI: 10.1186/s12885-017-3818-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite guidelines for cervical cancer prevention in low-resource countries, a very small proportion of women in these settings undergo screening, and even fewer women are successfully treated. Using pilot data from western Kenya and World Health Organization recommendations, we developed a protocol to implement evidence-based cervical cancer screening and linkage to treatment strategies to the rural communities. We describe the protocol for a cluster-randomized trial to compare two implementation strategies for human-papillomavirus (HPV)-based cervical cancer screening program using metrics described in the RE-AIM (reach, efficacy, adaption, implementation and maintenance) framework. METHODS The study is a three-year, two-phase cluster-randomized trial in 18 communities in western Kenya. During Phase 1, six control communities were offered screening in health facilities; and six intervention communities were offered screening in community health campaigns. Screening was done with human-papillomavirus testing through self-collected specimens. Phase 1 ended and we are working in partnership with communities to further contextualize the implementation strategy for screening, and develop an enhanced linkage to treatment plan. This plan will be tested in an additional six communities in Phase 2 (enhanced intervention). We will compare the reach, efficacy, cost-effectiveness and adaptability of the implementation strategies. DISCUSSION Effective low-cost cervical cancer prevention technologies are becoming more widely available in low- and middle-income countries. Despite increasing government support for cervical cancer prevention, there remains a sizeable gap in service availability. We will use implementation science to identify the most effective strategies to fill this gap through development of context-specific evidence-based solutions. This protocol design and results can help guide implementation of cervical cancer screening in similar settings, where women are most underserved and at highest risk for disease. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov , NCT02124252 .
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Affiliation(s)
- Megan J Huchko
- Duke University, Global Health Institute and Department of Obstetrics and Gynecology, 310 Trent Drive, Room 204, Durham, NC, 27708, USA.
| | - James G Kahn
- Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, San Francisco, CA, 94143-0560, USA
| | - Jennifer S Smith
- Department of Epidemiology, University of North Carolina, 2103 McGavran-Greenberg Hall Campus, Box# 7435, Chapel Hill, NC, 27599-7435, USA
| | - Robert A Hiatt
- Department of Epidemiology and Biostatistics, University of California San Francisco, Box 0560, San Francisco, CA, 94143-0560, USA
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, Box 1280, 560 Mission Street, 3rd Floor, San Francisco, CA, 94143, USA
| | - Elizabeth Bukusi
- Kenya Medical Research Institute, Center for Microbiology Research, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya.,Department of Obstetrics and Gynecology, University of Nairobi, P.O. Box 54840 00200, Mbagathi Road, Nairobi, Kenya
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Watt N, Sigfrid L, Legido-Quigley H, Hogarth S, Maimaris W, Otero-García L, Perel P, Buse K, McKee M, Piot P, Balabanova D. Health systems facilitators and barriers to the integration of HIV and chronic disease services: a systematic review. Health Policy Plan 2017; 32:iv13-iv26. [PMID: 28666336 PMCID: PMC5886067 DOI: 10.1093/heapol/czw149] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 01/15/2023] Open
Abstract
Integration of services for patients with more than one diagnosed condition has intuitive appeal but it has been argued that the empirical evidence to support it is limited. We report the findings of a systematic review that sought to identify health system factors, extrinsic to the integration process, which either facilitated or hindered the integration of services for two common disorders, HIV and chronic non-communicable diseases. Findings were initially extracted and organized around a health system framework, followed by a thematic cross-cutting analysis and validation steps. Of the 150 articles included, 67% (n = 102) were from high-income countries. The articles explored integration with services for one or several chronic disorders, the most studied being alcohol or substance use disorders (47.7%), and mental health issues (29.5%). Four cross-cutting themes related to the health system were identified. The first and most common theme was the requirement for effective collaboration and coordination: formal and informal productive relationships throughout the system between providers and within teams, and between staff and patients. The second was the need for adequate and appropriately skilled and incentivized health workers-with the right expertise, training and operational support for the programme. The third was the need for supportive institutional structures and dedicated resources. The fourth was leadership in terms of political will, effective managerial oversight and organizational culture, indicating that actual implementation is as important as programme design. A fifth theme, outside the health system, but underpinning all aspects of the system operation, was that placing the patient at the centre of service delivery and responding holistically to their diverse needs. This was an important facilitator of integration. These findings confirm that integration processes in service delivery depend substantially for their success on characteristics of the health systems in which they are embedded.
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Affiliation(s)
- Nicola Watt
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Louise Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Dept. of Medicine, University of Oxford, Oxford, UK
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Tahir Foundation Building, 117549 Singapore
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Sue Hogarth
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Public Health Consultant at Tower Hamlets Together
| | - Will Maimaris
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
- Public Health Consultant, Haringey Council, London
| | - Laura Otero-García
- Nursing Section, Faculty of Medicine, Universidad Autonoma de Madrid, Arzobispo Morcillo Av., 4, Madrid and CIBER of Epidemiology and Public 15 Health (CIBERESP), Madrid, Spain
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Kent Buse
- Chief, Strategic Policy Directions, UNAIDS, Geneva, Switzerland
| | - Martin McKee
- The Centre for Health and Social Change (ECOHOST), London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place London, London WC1H 9SH, UK
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Accessing clinical services and retention in care following screening for hypertension and diabetes among Malawian adults: an urban/rural comparison. J Hypertens 2017; 34:2172-9. [PMID: 27552644 DOI: 10.1097/hjh.0000000000001070] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Interventions to impact on the burden of chronic noncommunicable diseases, such as hypertension and diabetes, include screening of asymptomatic adults, but little is known about the subsequent course of clinical care. We report on the uptake of referral for clinical assessment and retention in care, following a large urban/rural population screening program in Malawi. METHODS Adult residents were screened for raised blood pressure and raised fasting blood glucose at a demographic surveillance site in rural Karonga District and in urban Area 25, Lilongwe with well supported chronic care clinics. Successful uptake was defined as presenting for clinical assessment within 6 weeks of referral, and nonattenders were followed at home. Logistic regression was used to examine association of uptake with demographic and clinical factors. Retention was assessed using survival analysis techniques. RESULTS A total of 27 305 participants were screened for hypertension and diabetes between May 2013 and September 2015. Of these, 4075 (14.9%) were referred for suspected hypertension (3640), diabetes (172), or both (263). Among those referred, 2480 (60.9%), reported for clinical assessment. Factors associated with uptake of care included being female, rural residency, older age, unemployment, prior medication, and diabetes. Retention, for those enrolled in care following a formal clinical assessment, was associated with the final diagnosis following clinical assessment, rural residency, and older age. CONCLUSION Screening for hypertension and diabetes identifies large numbers of individuals who need further clinical assessment, but strategies are needed to ensure better linkage and retention into care.
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Determinants of high blood pressure and barriers to diagnosis and treatment in Dar es Salaam, Tanzania. J Hypertens 2017; 34:2353-2364. [PMID: 27648720 DOI: 10.1097/hjh.0000000000001117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We assessed the prevalence and determinants of high blood pressure (BP), and barriers to diagnosis and treatment, in Dar es Salaam, Tanzania. METHODS We surveyed and screened 2174 community-dwelling adults aged at least 40 years in 2014 and conducted a follow-up after 1 year. RESULTS Median BP was 131/81 mmHg, and hypertension prevalence was 37%. Mean adjusted difference in SBP was 4.0 mmHg for overweight, 6.3 mmHg for obese class I, and 10.5 mmHg for obese class II/III compared with normal weight participants. Those who were physically inactive had 4.8 mmHg higher SBP compared with those with more than 24 h of moderate or vigorous activity per week. Drinkers of at least 10 g of alcohol per day had 4.5 mmHg higher SBP than did nondrinkers. Among hypertensive participants, 48% were previously diagnosed, 22% were treated, and 10% were controlled. Hypertensive participants without health insurance were 12% less likely to have been previously diagnosed than insured hypertensive participants. Of referred participants, 68% sought care, but only 27% were on treatment and 8% had controlled BP at follow-up. Reasons for not seeking care included lack of symptoms, cost of visit, and lack of time. Reasons for not being on treatment included lack of symptoms, not being prescribed treatment, and having finished one course of treatment. CONCLUSION Major risk factors for hypertension in Dar es Salaam are overweight, obesity, inadequate physical activity, and limited access to quality medical care. Increased insurance coverage and community-based screening, along with quality medical care and patient education, may help control this burgeoning epidemic.
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Haldane V, Legido-Quigley H, Chuah FLH, Sigfrid L, Murphy G, Ong SE, Cervero-Liceras F, Watt N, Balabanova D, Hogarth S, Maimaris W, Buse K, McKee M, Piot P, Perel P. Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review. AIDS Care 2017; 30:103-115. [PMID: 28679283 DOI: 10.1080/09540121.2017.1344350] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Non-communicable diseases (NCDs), including cardiovascular diseases (CVD), hypertension and diabetes together with HIV infection are among the major public health concerns worldwide. Health services for HIV and NCDs require health systems that provide for people's chronic care needs, which present an opportunity to coordinate efforts and create synergies between programs to benefit people living with HIV and/or AIDS and NCDs. This review included studies that reported service integration for HIV and/or AIDS with coronary heart diseases, chronic CVD, cerebrovascular diseases (stroke), hypertension or diabetes. We searched multiple databases from inception until October 2015. Articles were screened independently by two reviewers and assessed for risk of bias. 11,057 records were identified with 7,616 after duplicate removal. After screening titles and abstracts, 14 papers addressing 17 distinct interventions met the inclusion criteria. We categorized integration models by diseases (HIV with diabetes, HIV with hypertension and diabetes, HIV with CVD and finally HIV with hypertension and CVD and diabetes). Models also looked at integration from micro (patient focused integration) to macro (system level integrations). Most reported integration of hypertension and diabetes with HIV and AIDS services and described multidisciplinary collaboration, shared protocols, and incorporating screening activities into community campaigns. Integration took place exclusively at the meso-level, with no micro- or macro-level integrations described. Most were descriptive studies, with one cohort study reporting evaluative outcomes. Several innovative initiatives were identified and studies showed that CVD and HIV service integration is feasible. Integration should build on existing protocols and use the community as a locus for advocacy and health services, while promoting multidisciplinary teams, including greater involvement of pharmacists. There is a need for robust and well-designed studies at all levels - particularly macro-level studies, research looking at long-term outcomes of integration, and research in a more diverse range of countries.
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Affiliation(s)
- Victoria Haldane
- a Saw Swee Hock School of Public Health National University of Singapore , Singapore , Singapore
| | - Helena Legido-Quigley
- a Saw Swee Hock School of Public Health National University of Singapore , Singapore , Singapore.,b London School of Hygiene and Tropical Medicine , London , UK
| | - Fiona Leh Hoon Chuah
- a Saw Swee Hock School of Public Health National University of Singapore , Singapore , Singapore
| | - Louise Sigfrid
- c Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine , University of Oxford , Oxford , UK
| | - Georgina Murphy
- c Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine , University of Oxford , Oxford , UK
| | - Suan Ee Ong
- a Saw Swee Hock School of Public Health National University of Singapore , Singapore , Singapore
| | | | - Nicola Watt
- d The Centre for Health and Social Change (ECOHOST) , London School of Hygiene & Tropical Medicine , London , UK
| | - Dina Balabanova
- e Department of Global Health & Development , London School of Hygiene & Tropical Medicine , London , UK
| | - Sue Hogarth
- b London School of Hygiene and Tropical Medicine , London , UK.,f Public Health Consultant at London Borough of Waltham Forest , London , UK
| | - Will Maimaris
- b London School of Hygiene and Tropical Medicine , London , UK.,g Public Health Consultant at Haringey Council , London , UK
| | - Kent Buse
- h UNAIDS, Chief Political Affairs and Strategy , Geneva , Switzerland
| | - Martin McKee
- d The Centre for Health and Social Change (ECOHOST) , London School of Hygiene & Tropical Medicine , London , UK
| | - Peter Piot
- b London School of Hygiene and Tropical Medicine , London , UK
| | - Pablo Perel
- b London School of Hygiene and Tropical Medicine , London , UK.,i The World Heart Federation , Geneva , Switzerland
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Turner EL, Prague M, Gallis JA, Li F, Murray DM. Review of Recent Methodological Developments in Group-Randomized Trials: Part 2-Analysis. Am J Public Health 2017; 107:1078-1086. [PMID: 28520480 PMCID: PMC5463203 DOI: 10.2105/ajph.2017.303707] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2017] [Indexed: 12/13/2022]
Abstract
In 2004, Murray et al. reviewed methodological developments in the design and analysis of group-randomized trials (GRTs). We have updated that review with developments in analysis of the past 13 years, with a companion article to focus on developments in design. We discuss developments in the topics of the earlier review (e.g., methods for parallel-arm GRTs, individually randomized group-treatment trials, and missing data) and in new topics, including methods to account for multiple-level clustering and alternative estimation methods (e.g., augmented generalized estimating equations, targeted maximum likelihood, and quadratic inference functions). In addition, we describe developments in analysis of alternative group designs (including stepped-wedge GRTs, network-randomized trials, and pseudocluster randomized trials), which require clustering to be accounted for in their design and analysis.
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Affiliation(s)
- Elizabeth L Turner
- Elizabeth L. Turner and John A. Gallis are with the Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, and the Duke Global Health Institute, Duke University. Melanie Prague is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, and Inria, project team SISTM, Bordeaux, France. Fan Li is with the Department of Biostatistics and Bioinformatics, Duke University. David M. Murray is with the Office of Disease Prevention, Division of Program Coordination and Strategic Planning, and the Office of the Director, National Institutes of Health, Rockville, MD
| | - Melanie Prague
- Elizabeth L. Turner and John A. Gallis are with the Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, and the Duke Global Health Institute, Duke University. Melanie Prague is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, and Inria, project team SISTM, Bordeaux, France. Fan Li is with the Department of Biostatistics and Bioinformatics, Duke University. David M. Murray is with the Office of Disease Prevention, Division of Program Coordination and Strategic Planning, and the Office of the Director, National Institutes of Health, Rockville, MD
| | - John A Gallis
- Elizabeth L. Turner and John A. Gallis are with the Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, and the Duke Global Health Institute, Duke University. Melanie Prague is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, and Inria, project team SISTM, Bordeaux, France. Fan Li is with the Department of Biostatistics and Bioinformatics, Duke University. David M. Murray is with the Office of Disease Prevention, Division of Program Coordination and Strategic Planning, and the Office of the Director, National Institutes of Health, Rockville, MD
| | - Fan Li
- Elizabeth L. Turner and John A. Gallis are with the Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, and the Duke Global Health Institute, Duke University. Melanie Prague is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, and Inria, project team SISTM, Bordeaux, France. Fan Li is with the Department of Biostatistics and Bioinformatics, Duke University. David M. Murray is with the Office of Disease Prevention, Division of Program Coordination and Strategic Planning, and the Office of the Director, National Institutes of Health, Rockville, MD
| | - David M Murray
- Elizabeth L. Turner and John A. Gallis are with the Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, and the Duke Global Health Institute, Duke University. Melanie Prague is with the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, and Inria, project team SISTM, Bordeaux, France. Fan Li is with the Department of Biostatistics and Bioinformatics, Duke University. David M. Murray is with the Office of Disease Prevention, Division of Program Coordination and Strategic Planning, and the Office of the Director, National Institutes of Health, Rockville, MD
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Pastakia SD, Manyara SM, Vedanthan R, Kamano JH, Menya D, Andama B, Chesoli C, Laktabai J. Impact of Bridging Income Generation with Group Integrated Care (BIGPIC) on Hypertension and Diabetes in Rural Western Kenya. J Gen Intern Med 2017; 32:540-548. [PMID: 27921256 PMCID: PMC5400758 DOI: 10.1007/s11606-016-3918-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/08/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Rural settings in Sub-Saharan Africa (SSA) consistently report low participation in non-communicable disease (NCD) treatment programs and poor outcomes. OBJECTIVE The objective of this study is to assess the impact of the implementation of a patient-centered rural NCD care delivery model called Bridging Income Generation through grouP Integrated Care (BIGPIC). DESIGN The study prospectively tracked participation and health outcomes for participants in a screening event and compared linkage frequencies to a historical comparison group. PARTICIPANTS Rural Kenyan participants attending a voluntary NCD screening event were included within the BIGPIC model of care. INTERVENTIONS The BIGPIC model utilizes a contextualized care delivery model designed to address the unique barriers faced in rural settings. This model emphasizes the following steps: (1) find patients in the community, (2) link to peer/microfinance groups, (3) integrate education, (4) treat in the community, (5) enhance economic sustainability and (6) generate demand for care through incentives. MAIN MEASURES The primary outcome is the linkage frequency, which measures the percentage of patients who return for care after screening positive for either hypertension and/or diabetes. Secondary measures include retention frequencies defined as the percentage of patients remaining engaged in care throughout the 9-month follow-up period and changes in systolic (SBP) and diastolic blood pressure (DBP) and blood sugar over 12 months. KEY RESULTS Of the 879 individuals who were screened, 14.2 % were confirmed to have hypertension, while only 1.4 % were confirmed to have diabetes. The implementation of a comprehensive microfinance-linked, community-based, group care model resulted in 72.4 % of screen-positive participants returning for subsequent care, of which 70.3 % remained in care through the 12 months of the evaluation period. Patients remaining in care demonstrated a statistically significant mean decline of 21 mmHg in SBP [95 % CI (13.9 to 28.4), P < 0.01] and 5 mmHg drop in DBP [95 % CI (1.4 to 7.6), P < 0.01]. CONCLUSIONS The implementation of a contextualized care delivery model built around the unique needs of rural SSA participants led to statistically significant improvements in linkage to care and blood pressure reduction.
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Affiliation(s)
- Sonak D Pastakia
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.
- Moi Teaching and Referral Hospital, Eldoret, Kenya.
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
- College of Pharmacy, Purdue University, West Lafayette, IN, USA.
| | - Simon M Manyara
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- College of Pharmacy, Purdue University, West Lafayette, IN, USA
| | | | - Jemima H Kamano
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Diana Menya
- College of Health Sciences, School of Public Health, Moi University, Eldoret, Kenya
| | - Benjamin Andama
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Cleophas Chesoli
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Jeremiah Laktabai
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Webuye District Hospital, Webuye, Kenya
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47
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Kwarisiima D, Balzer L, Heller D, Kotwani P, Chamie G, Clark T, Ayieko J, Mwangwa F, Jain V, Byonanebye D, Petersen M, Havlir D, Kamya MR. Population-Based Assessment of Hypertension Epidemiology and Risk Factors among HIV-Positive and General Populations in Rural Uganda. PLoS One 2016; 11:e0156309. [PMID: 27232186 PMCID: PMC4883789 DOI: 10.1371/journal.pone.0156309] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/12/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Antiretroviral therapy scale-up in Sub-Saharan Africa has created a growing, aging HIV-positive population at risk for non-communicable diseases such as hypertension. However, the prevalence and risk factors for hypertension in this population remain incompletely understood. METHODS We measured blood pressure and collected demographic data on over 65,000 adults attending multi-disease community health campaigns in 20 rural Ugandan communities (SEARCH Study: NCT01864603). Our objectives were to determine (i) whether HIV is an independent risk factor for hypertension, and (ii) awareness and control of hypertension in HIV-positive adults and the overall population. RESULTS Hypertension prevalence was 14% overall, and 11% among HIV-positive individuals. 79% of patients were previously undiagnosed, 85% were not taking medication, and 50% of patients on medication had uncontrolled blood pressure. Multivariate predictors of hypertension included older age, male gender, higher BMI, lack of education, alcohol use, and residence in Eastern Uganda. HIV-negative status was independently associated with higher odds of hypertension (OR 1.2, 95% CI: 1.1-1.4). Viral suppression of HIV did not significantly predict hypertension among HIV-positives. SIGNIFICANCE The burden of hypertension is substantial and inadequately controlled, both in HIV-positive persons and overall. Universal HIV screening programs could provide counseling, testing, and treatment for hypertension in Sub-Saharan Africa.
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Affiliation(s)
| | - Laura Balzer
- Harvard University, Boston, Massachusetts, United States of America
- University of California, San Francisco, San Francisco, California, United States of America
| | - David Heller
- University of California, San Francisco, San Francisco, California, United States of America
| | - Prashant Kotwani
- University of California, San Francisco, San Francisco, California, United States of America
| | - Gabriel Chamie
- University of California, San Francisco, San Francisco, California, United States of America
| | - Tamara Clark
- University of California, San Francisco, San Francisco, California, United States of America
| | - James Ayieko
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Vivek Jain
- University of California, San Francisco, San Francisco, California, United States of America
| | | | - Maya Petersen
- University of California, Berkeley, California, United States of America
| | - Diane Havlir
- University of California, San Francisco, San Francisco, California, United States of America
| | - Moses R. Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
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48
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Naanyu V, Vedanthan R, Kamano JH, Rotich JK, Lagat KK, Kiptoo P, Kofler C, Mutai KK, Bloomfield GS, Menya D, Kimaiyo S, Fuster V, Horowitz CR, Inui TS. Barriers Influencing Linkage to Hypertension Care in Kenya: Qualitative Analysis from the LARK Hypertension Study. J Gen Intern Med 2016; 31:304-14. [PMID: 26728782 PMCID: PMC4762819 DOI: 10.1007/s11606-015-3566-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/24/2015] [Accepted: 12/04/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hypertension, the leading global risk factor for mortality, is characterized by low treatment and control rates in low- and middle-income countries. Poor linkage to hypertension care contributes to poor outcomes for patients. However, specific factors influencing linkage to hypertension care are not well known. OBJECTIVE To evaluate factors influencing linkage to hypertension care in rural western Kenya. DESIGN Qualitative research study using a modified Health Belief Model that incorporates the impact of emotional and environmental factors on behavior. PARTICIPANTS Mabaraza (traditional community assembly) participants (n = 242) responded to an open invitation to residents in their respective communities. Focus groups, formed by purposive sampling, consisted of hypertensive individuals, at-large community members, and community health workers (n = 169). APPROACH We performed content analysis of the transcripts with NVivo 10 software, using both deductive and inductive codes. We used a two-round Delphi method to rank the barriers identified in the content analysis. We selected factors using triangulation of frequency of codes and themes from the transcripts, in addition to the results of the Delphi exercise. Sociodemographic characteristics of participants were summarized using descriptive statistics. KEY RESULTS We identified 27 barriers to linkage to hypertension care, grouped into individual (cognitive and emotional) and environmental factors. Cognitive factors included the asymptomatic nature of hypertension and limited information. Emotional factors included fear of being a burden to the family and fear of being screened for stigmatized diseases such as HIV. Environmental factors were divided into physical (e.g. distance), socioeconomic (e.g. poverty), and health system factors (e.g. popularity of alternative therapies). The Delphi results were generally consistent with the findings from the content analysis. CONCLUSIONS Individual and environmental factors are barriers to linkage to hypertension care in rural western Kenya. Our analysis provides new insights and methodological approaches that may be relevant to other low-resource settings worldwide.
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Affiliation(s)
- Violet Naanyu
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Rajesh Vedanthan
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, USA. .,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya.
| | - Jemima H Kamano
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Jackson K Rotich
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Kennedy K Lagat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Peninah Kiptoo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Claire Kofler
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, USA.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Kennedy K Mutai
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Gerald S Bloomfield
- Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya.,Duke University Medical Center, Durham, NC, USA
| | - Diana Menya
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Sylvester Kimaiyo
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Valentin Fuster
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, USA.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya.,Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Carol R Horowitz
- Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, USA.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya
| | - Thomas S Inui
- Moi University College of Health Sciences, Eldoret, Kenya.,Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.,Kenya Medical Research Institute/Centers for Disease Control Research and Public Health Collaboration, Center for Global Health Research, Kisumu, Kenya.,Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA
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49
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Katende D, Mutungi G, Baisley K, Biraro S, Ikoona E, Peck R, Smeeth L, Hayes R, Munderi P, Grosskurth H. Readiness of Ugandan health services for the management of outpatients with chronic diseases. Trop Med Int Health 2015; 20:1385-95. [PMID: 26095069 PMCID: PMC4758403 DOI: 10.1111/tmi.12560] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Traditionally, health systems in sub-Saharan Africa have focused on acute conditions. Few data exist on the readiness of African health facilities (HFs) to address the growing burden of chronic diseases (CDs), specifically chronic, non-communicable diseases (NCDs). METHODS A stratified random sample of 28 urban and rural Ugandan HFs was surveyed to document the burden of selected CDs by analysing the service statistics, service availability and service readiness using a modified WHO Service Availability and Readiness Assessment questionnaire. Knowledge, skills and practice in the management of CDs of 222 health workers were assessed through a self-completed questionnaire. RESULTS Among adult outpatient visits at hospitals, 33% were for CDs including HIV vs. 14% and 4% at medium-sized and small health centres, respectively. Many HFs lacked guidelines, diagnostic equipment and essential medicines for the primary management of CDs; training and reporting systems were weak. Lower-level facilities routinely referred patients with hypertension and diabetes. HIV services accounted for most CD visits and were stronger than NCD services. Systems were weaker in lower-level HFs. Non-doctor clinicians and nurses lacked knowledge and experience in NCD care. CONCLUSION Compared with higher level HFs, lower-level ones are less prepared and little used for CD care. Health systems in Uganda, particularly lower-level HFs, urgently need improvement in managing common NCDs to cope with the growing burden. This should include the provision of standard guidelines, essential diagnostic equipment and drugs, training of health workers, supportive supervision and improved referral systems. Substantially better HIV basic service readiness demonstrates that improved NCD care is feasible.
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Affiliation(s)
- David Katende
- Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda
| | | | - Kathy Baisley
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Samuel Biraro
- Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda
| | | | - Robert Peck
- Mwanza Intervention Trials Unit and Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Paula Munderi
- Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Heiner Grosskurth
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
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50
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Schwartz JI, Dunkle A, Akiteng AR, Birabwa-Male D, Kagimu R, Mondo CK, Mutungi G, Rabin TL, Skonieczny M, Sykes J, Mayanja-Kizza H. Towards reframing health service delivery in Uganda: the Uganda Initiative for Integrated Management of Non-Communicable Diseases. Glob Health Action 2015; 8:26537. [PMID: 25563451 PMCID: PMC4292588 DOI: 10.3402/gha.v8.26537] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) is accelerating. Given that the capacity of health systems in LMICs is already strained by the weight of communicable diseases, these countries find themselves facing a double burden of disease. NCDs contribute significantly to morbidity and mortality, thereby playing a major role in the cycle of poverty, and impeding development. METHODS Integrated approaches to health service delivery and healthcare worker (HCW) training will be necessary in order to successfully combat the great challenge posed by NCDs. RESULTS In 2013, we formed the Uganda Initiative for Integrated Management of NCDs (UINCD), a multidisciplinary research collaboration that aims to present a systems approach to integrated management of chronic disease prevention, care, and the training of HCWs. DISCUSSION Through broad-based stakeholder engagement, catalytic partnerships, and a collective vision, UINCD is working to reframe integrated health service delivery in Uganda.
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Affiliation(s)
- Jeremy I Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda; Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA;
| | - Ashley Dunkle
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda; Global Health Corps, New York, NY, USA
| | - Ann R Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda; Department of Community Health, Government of Uganda Ministry of Health, Kampala, Uganda
| | - Doreen Birabwa-Male
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda; Mulago National Referral Hospital, Kampala, Uganda
| | - Richard Kagimu
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda; Global Health Corps, New York, NY, USA
| | - Charles K Mondo
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda; Mulago National Referral Hospital, Kampala, Uganda
| | - Gerald Mutungi
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda; Department of Community Health, Government of Uganda Ministry of Health, Kampala, Uganda
| | - Tracy L Rabin
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda; Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Jamila Sykes
- Yale Global Health Leadership Institute, New Haven, CT, USA
| | - Harriet Mayanja-Kizza
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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