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Hertz JT, Sakita FM, Rahim FO, Mmbaga BT, Shayo F, Kaboigora V, Mtui J, Bloomfield GS, Bosworth HB, Bettger JP, Thielman NM. Multicomponent Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Protocol for a Pilot Implementation Trial. JMIR Res Protoc 2024; 13:e59917. [PMID: 39316783 PMCID: PMC11462132 DOI: 10.2196/59917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Although the incidence of acute myocardial infarction (AMI) is rising in sub-Saharan Africa, the uptake of evidence-based care for the diagnosis and treatment of AMI is limited throughout the region. In Tanzania, studies have revealed common misdiagnosis of AMI, infrequent administration of aspirin, and high short-term mortality rates following AMI. OBJECTIVE This study aims to evaluate the implementation and efficacy outcomes of an intervention, the Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC), which was developed to improve the delivery of evidence-based AMI care in Tanzania. METHODS This single-arm pilot trial will be conducted in the emergency department (ED) at a referral hospital in northern Tanzania. The MIMIC intervention will be implemented by the ED staff for 1 year. Approximately 400 adults presenting to the ED with possible AMI symptoms will be enrolled, and research assistants will observe their care. Thirty days later, a follow-up survey will be administered to assess mortality and medication use. The primary outcome will be the acceptability of the MIMIC intervention, which will be measured by the Acceptability of Intervention Measurement (AIM) instrument. Acceptability will further be assessed via in-depth interviews with key stakeholders. Secondary implementation outcomes will include feasibility and fidelity. Secondary efficacy outcomes will include the following: the proportion of participants who receive electrocardiogram and cardiac biomarker testing, the proportion of participants with AMI who receive aspirin, 30-day mortality among participants with AMI, and the proportion of participants with AMI taking aspirin 30 days following enrollment. RESULTS Implementation of MIMIC began on September 1, 2023. Enrollment is expected to be completed by September 1, 2024, and the first results are expected to be published by December 31, 2024. CONCLUSIONS This study will be the first to evaluate an intervention for improving AMI care in sub-Saharan Africa. If MIMIC is found to be acceptable, the findings from this study will inform a future cluster-randomized trial to assess effectiveness and scalability. TRIAL REGISTRATION ClinicalTrials.gov NCT04563546; https://clinicaltrials.gov/study/NCT04563546. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/59917.
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Affiliation(s)
- Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Faraan O Rahim
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Frida Shayo
- Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Vivian Kaboigora
- Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Julius Mtui
- Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Gerald S Bloomfield
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Hayden B Bosworth
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Janet P Bettger
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Internal Medicine, Duke University School of Medicine, Durham, NC, United States
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Hoffman CM, Versluis A, Chirila S, Kirenga BJ, Khan A, Saeed S, Sooronbaev T, Tsiligianni I, Arvind DK, Bauld LC, van den Brand FA, Chavannes NH, Pinnock H, Powell PD, van der Schans J, Siddiqi K, Williams S, van der Kleij MJJR. The FRESHAIR4Life study: Global implementation research on non-communicable disease prevention targeting adolescents' exposure to tobacco and air pollution in disadvantaged populations. NPJ Prim Care Respir Med 2024; 34:14. [PMID: 38834570 DOI: 10.1038/s41533-024-00367-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/03/2024] [Indexed: 06/06/2024] Open
Abstract
The FRESHAIR4Life study aims to reduce the non-communicable disease (NCD) burden by implementing preventive interventions targeting adolescents' exposure to tobacco use and air pollution (AP) worldwide. This paper presents the FRESHAIR4Life methodology and initial rapid review results. The rapid review, using various databases and PubMed, aimed to guide decision-making on risk factor focus, target areas, and populations. It showed variable NCD mortality rates related to tobacco use and AP across the participating countries, with tobacco as the main risk factor in the Kyrgyz Republic, Greece, and Romania, and AP prevailing in Pakistan and Uganda. Adolescent exposure levels, sources, and correlates varied. The study will continue with an in-depth situational analysis to guide the selection, adaptation, and integration of evidence-based interventions into the FRESHAIR4Life prevention package. This package will be implemented, evaluated, assessed for cost-effectiveness, and iteratively refined. The research places a strong emphasis on co-creation, capacity building, and comprehensive communication and dissemination.
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Affiliation(s)
- Charlotte M Hoffman
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Sergiu Chirila
- Faculty of Medicine, Ovidius University of Constanta, Constanta, Romania
| | - Bruce J Kirenga
- Lung Institute & Department of Medicine, Makerere University, Kampala, Uganda
| | | | - Saima Saeed
- Indus Hospital and Health Network, Karachi, Pakistan
| | - Talant Sooronbaev
- National Center of Cardiology and Internal Medicine named after academician Mirrakhimov, Bishkek, Kyrgyzstan
| | | | - D K Arvind
- School of Informatics, University of Edinburgh, Edinburgh, Scotland, UK
| | - Linda C Bauld
- Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
| | - Floor A van den Brand
- Department of Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Jurjen van der Schans
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Siân Williams
- International Primary Care Respiratory Group, London, UK
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Siiba A, Kangmennaang J, Baatiema L, Luginaah I. The relationship between climate change, globalization and non-communicable diseases in Africa: A systematic review. PLoS One 2024; 19:e0297393. [PMID: 38394170 PMCID: PMC10889617 DOI: 10.1371/journal.pone.0297393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/04/2024] [Indexed: 02/25/2024] Open
Abstract
Climate change and non-communicable diseases (NCDs) are considered the 21st Century's major health and development challenges. Both pose a disproportionate burden on low- and middle-income countries that are unprepared to cope with their synergistic effects. These two challenges pose risks for achieving many of the sustainable development goals (SDGs) and are both impacted by globalization through different pathways. While there are important insights on how climate change and or globalization impact NCDs in the general literature, comprehensive research that explores the influence of climate change and or globalization on NCDs is limited, particularly in the context of Africa. This review documents the pathways through which climate change and or globalization influence NCDs in Africa. We conducted a comprehensive literature search in eight electronic databases-Web of Science, PubMed, Scopus, Global Health Library, Science Direct, Medline, ProQuest, and Google Scholar. A total of 13864 studies were identified. Studies that were identified from more than one of the databases were automatically removed as duplicates (n = 9649). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 27 studies were eventually included in the final review. We found that the impacts of climate change and or globalization on NCDs act through three potential pathways: reduction in food production and nutrition, urbanization and transformation of food systems. Our review contributes to the existing literature by providing insights into the impact of climate change and or globalization on human health. We believe that our findings will help enlighten policy makers working on these pathways to facilitate the development of effective policy and public health interventions to mitigate the effects of climate change and globalization on the rising burden of NCDs and goal 3 of the SDG, in particular.
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Affiliation(s)
- Alhassan Siiba
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Joseph Kangmennaang
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana Legon, Greater Accra Region, Ghana
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Isaac Luginaah
- Department of Geography and Environment, University of Western Ontario, Ontario, Canada
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Loffreda G, Arakelyan S, Bou-Orm I, Holmer H, Allen LN, Witter S, Ager A, Diaconu K. Barriers and Opportunities for WHO "Best Buys" Non-communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review. Int J Health Policy Manag 2024; 13:7989. [PMID: 38618832 PMCID: PMC11016278 DOI: 10.34172/ijhpm.2023.7989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 12/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Improving the adoption and implementation of policies to curb non-communicable diseases (NCDs) is a major challenge for better global health. The adoption and implementation of such policies remain deficient in various contexts, with limited insights into the facilitating and inhibiting factors. These policies have traditionally been treated as technical solutions, neglecting the critical influence of political economy dynamics. Moreover, the complex nature of these interventions is often not adequately incorporated into evidence for policy-makers. This study aims to systematically review and evaluate the factors affecting NCD policy adoption and implementation. METHODS We conducted a complex systematic review of articles discussing the adoption and implementation of World Health Organization's (WHO's) "best buys" NCD policies. We identified political economy factors and constructed a causal loop diagram (CLD) program theory to elucidate the interplay between factors influencing NCD policy adoption and implementation. A total of 157 papers met the inclusion criteria. RESULTS Our CLD highlights a central feedback loop encompassing three vital variables: (1) the ability to define, (re)shape, and pass appropriate policy into law; (2) the ability to implement the policy (linked to the enforceability of the policy and to addressing NCD local burden); and (3) ability to monitor progress, evaluate and correct the course. Insufficient context-specific data impedes the formulation and enactment of suitable policies, particularly in areas facing multiple disease burdens. Multisectoral collaboration plays a pivotal role in both policy adoption and implementation. Effective monitoring and accountability systems significantly impact policy implementation. The commercial determinants of health (CDoH) serve as a major barrier to defining, adopting, and implementing tobacco, alcohol, and diet-related policies. CONCLUSION To advance global efforts, we recommend focusing on the development of robust accountability, monitoring, and evaluation systems, ensuring transparency in private sector engagement, supporting context-specific data collection, and effectively managing the CDoH. A system thinking approach can enhance the implementation of complex public health interventions.
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Affiliation(s)
- Giulia Loffreda
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Stella Arakelyan
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Musselburgh, UK
| | - Ibrahim Bou-Orm
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Hampus Holmer
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Luke N. Allen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Sophie Witter
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Alastair Ager
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | - Karin Diaconu
- NIHR Research Unit of Health in Fragility, Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
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Kangmennaang J, Siiba A, Dassah E, Kansanga M. The role of social support and the built environment on diabetes management among structurally exposed populations in three regions in Ghana. BMC Public Health 2023; 23:2495. [PMID: 38093227 PMCID: PMC10717308 DOI: 10.1186/s12889-023-17376-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
Sub-Saharan Africa is undergoing an epidemiological transition driven by rapid, unprecedented demographic, socio-cultural, and economic transitions. These transitions are driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs). As NCDs rise, several attempts have been made to understand the individual level factors that increase NCDs risks, knowledge, and attitudes around specific NCDs as well as how people live and manage NCDs. While these studies are important, and enhance knowledge on chronic diseases, little attention has been given to the role of social and cultural environment in managing chronic NCDs in underserved settings. Using purposive sampling among persons living with Diabetes Mellitus (PLWD) and participating in diabetes programs from regional and municipal hospitals in the three underserved regions in Ghana (n = 522), we assessed diabetes management and supportive care needs of PLWDs using linear latent and mixed models (gllamm) with binomial and a logit(log) link function. The result indicates that PLWDs with strong perceived social support (OR = 2.27, p ≤ 0.05) were more likely to report good diabetes management compared to PLWDs with weak perceived social support. The built environment, living with other health conditions, household wealth, ethnicity and age were associated with diabetes management. Overall, the study contributes to wider discussions on the role changing built and socio-cultural environments in the rise of diet-related diseases and their management as many Low- and Middle-Income Countries (LMICs) experience rapid epidemiological and nutrition transitions.
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Affiliation(s)
- Joseph Kangmennaang
- School of Kinesiology and Health Studies, Queen's University, Building 28 Division Street, Kingston, ON, K7L 3N6, Canada
| | - Alhassan Siiba
- School of Kinesiology and Health Studies, Queen's University, Building 28 Division Street, Kingston, ON, K7L 3N6, Canada
| | - Ebenezer Dassah
- Department of Global and International Health, Kwame Nkrumah University of Science and Technology, Ghana Post GPS AK-385-19, Kumasi, Ghana.
| | - Moses Kansanga
- Department of Geography, The George Washington University, Samson Hall, Second Floor 2036 H St. NW, Washington, D.C, 20052, USA
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Vaidya A, Simkhada P, Lee A, Jones S, Mukumbang FC. Implementing a package of essential non-communicable diseases interventions in low- and middle-income countries: a realist review protocol. BMJ Open 2023; 13:e074336. [PMID: 37775288 PMCID: PMC10546118 DOI: 10.1136/bmjopen-2023-074336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/20/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION The burden of non-communicable diseases (NCDs) is increasing rapidly, particularly in low- and middle-income countries (LMIC), accounting for 85% of premature deaths in the region. LMICs have been facing an increasing trend of a double burden of disease (infectious diseases and NCDs) that has led to multiple challenges in prioritising strategies for NCDs control amidst limited resources. Evidence indicates that measures such as the WHO's package of essential non-communicable (PEN) diseases interventions can prevent and control NCDs. However, because of the complexity of such health interventions, there is limited evidence that explains how the intervention works, for whom and in what context. We aim to unpack the causal mechanisms explaining how, why, for whom and in what context PEN prevents and controls NCDs. METHODS AND ANALYSIS We propose a realist review to understand how, why, for whom and under what circumstances PEN works or does not work. The review process includes five steps applied iteratively throughout the study: clarification of review scope, searching for evidence, appraising and extracting data, synthesising evidence and drawing conclusions, and disseminating the findings. Programme theories will be developed using the realist logic for theory formulation-Retroductive Theorising. The context-mechanism-outcome (CMO) heuristic tool will be used to develop the programme theories. Portions of the reviewed documents describing constructs of context, mechanism and outcomes will be coded inductively and extracted. These extracted constructs will then be linked abductively to formulate CMO configurations. ETHICS AND DISSEMINATION Formal ethical approval is not required for this review. Study findings will be disseminated through publications in peer-reviewed journals, conference presentations and formal and informal reports.
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Affiliation(s)
- Anju Vaidya
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Padam Simkhada
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Andrew Lee
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Susan Jones
- Health Sciences, University of Liverpool, Liverpool, UK
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Bou-Orm I, deVos P, Diaconu K. Experiences of communities with Lebanon's model of care for non-communicable diseases: a cross-sectional household survey from Greater Beirut. BMJ Open 2023; 13:e070580. [PMID: 37666549 PMCID: PMC10481840 DOI: 10.1136/bmjopen-2022-070580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 08/16/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVES Assess community perceptions of the Lebanese care model for non-communicable diseases (NCDs) and trust in the health system among others, and test association between them. DESIGN Cross-sectional study using multistage random sampling and targeting adult community members living with NCDs. SETTING Households in Greater Beirut-Lebanon. PARTICIPANTS 941 respondents including 574 Lebanese community members and 367 Syrian refugees. PRIMARY AND SECONDARY OUTCOMES Three main outcomes (barriers to care seeking, perceptions of the care model and trust in healthcare) were assessed including by multiple linear regressions. RESULTS Reported NCDs were hypertension (51.3%) and diabetes (34.5%), followed by chronic respiratory conditions (21.9%) and other cardiovascular diseases (20.0%). Communities reported seeking care from different sources. While 78% of Lebanese participants had visited private clinics at least once within the 6 months preceding the survey, 56% of Syrian refugees had done so. Determinants of access to care were health coverage, gender, and employment among Lebanese, and socioeconomic status among Syrian refugees. Lebanese community members had more positive perceptions of the care model compared with Syrian refugees and determinants included sociodemographic characteristics and the type of providers. Trust in the health system was higher among Syrian compared with Lebanese participants and was significantly influenced by the care model score and barriers to care seeking. CONCLUSION Our study generated evidence about the experience of people living with NCDs with Lebanon's care model and can inform service delivery interventions towards a more inclusive person-centred approach.
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Affiliation(s)
- Ibrahim Bou-Orm
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Pol deVos
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
- Public Health Department, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Karin Diaconu
- NIHR Global Health Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Bakhtiari A, Takian A, Ostovar A, Behzadifar M, Mohamadi E, Ramezani M. Developing an organizational capacity assessment tool and capacity-building package for the National Center for Prevention and Control of Noncommunicable Diseases in Iran. PLoS One 2023; 18:e0287743. [PMID: 37384743 PMCID: PMC10309984 DOI: 10.1371/journal.pone.0287743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 06/13/2023] [Indexed: 07/01/2023] Open
Abstract
Non-communicable diseases represent 71% of all deaths worldwide. In 2015, Sustainable Development Goals, including target 3.4 of SDGs, were seated on the world agenda; "By 2030, reduce premature mortality from NCDs by one-third. More than half of the world's countries are not on track to reach SDG 3.4, and the COVID-19 crisis has hampered the delivery of essential NCD services globally, which means the premature death of millions of people and indicates the need for capacity building for health systems. We designed a tool to measure the capacity of the National Center for Non-Communicable Disease and then presented the proposed policy package to enhance the national center's organizational capacity. The data for this explanatory sequential mixed method study was collected using quantitative and qualitative approaches between February 2020 and December 2021. The tool for assessing organizational capacity for NCDs was developed, and its validity and reliability were measured. The developed tool assessed the organizational capacity by evaluating NCNCD's managers and experts. Following the quantitative phase, a qualitative phase focused on the low-capacity points revealed by the tool. The causes of low capacity were investigated, as well as potential interventions to improve capacity. The developed tool comprises six main domains and eighteen subdomains, including (Governance, Organizational Management, Human Resources Management, Financial Management, Program Management, and Relations Management) which verified validity and reliability. In seven separate National Center for Non-Communicable Disease units, the organizational capacity was measured using the designed tool. (Cardiovascular disease and hypertension; diabetes; chronic respiratory disease; obesity and physical activity; tobacco and alcohol; nutrition; and cancers). The organizational management dimensions and the sub-dimensions of the organizational structure of the Ministry of Health and Medical Education and units affiliated with the national center, in all cases, were almost one of the main challenges that affected the country's capacity to fight against NCDs. However, all units had a relatively good situation in terms of governance (mission statement, vision, and written strategic plan). The content analysis of experts' opinions on the low-capacity subdomains highlighted challenges and recommended capacity-building interventions. Transparency in methods and processes is necessary to allocate funding among various health programs and evaluate their effects through cost-effectiveness indicators. This study identified weak points or areas where capacity building is required. The root causes of low capacity and interventions to build capacity are listed in each dimension of the tool. Some of the proposed interventions, such as strengthening organizational structures, have the potential to impact other domains. Improving organizational capacity for NCDs can assist countries to achieve national and global goals with greater efficiency.
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Affiliation(s)
- Ahad Bakhtiari
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Efat Mohamadi
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ramezani
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Xi JY, Zhang WJ, Chen Z, Zhang YT, Chen LC, Zhang YQ, Lin X, Hao YT. Potential Gains in Health-Adjusted Life Expectancy by Reducing Burden of Noncommunicable Diseases in 188 Countries: A Population-Based Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:802-809. [PMID: 36549356 DOI: 10.1016/j.jval.2022.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This article quantifies the potential gains in health-adjusted life expectancy for people aged 30 to 70 years (HALE[30-70]) by examining the reductions in disability in addition to premature mortality from noncommunicable diseases (NCDs). METHODS We extracted data from the Global Burden of Disease Study 2019 for 4 major NCDs (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes mellitus) in 188 countries from 2010 to 2019. Estimates of the potential gains in HALE[30-70] were based on a counterfactual analysis involving 3 alternative future scenarios: (1) achieve Sustainable Development Goals target 3.4 but do not make any progress on disability reduction, (2) achieve Sustainable Development Goals target 3.4 and eliminate NCD-related disability, and (3) eliminate all NCD-related mortality and disability. RESULTS In all scenarios, the high-income group has the greatest potential gains in HALE[30-70], above the global average. For all specific causes, potential gains in HALE[30-70] decrease as income levels fall. Across these 3 scenarios, the potential gains in HALE[30-70] globally of reducing premature mortality for 4 major NCDs are 3.13 years, 4.53 years, and 7.32 years, respectively. In scenario A, all income groups have the greatest potential gains in HALE[30-70] from diabetes and chronic respiratory diseases. In scenarios B and C, the high-income group has the greatest potential gains in HALE[30-70] from cancer intervention, and the other income groups have the greatest potential gains in HALE[30-70] from cardiovascular diseases intervention. CONCLUSION Reducing premature death and disability from 4 major NCDs at once and attaching equal importance to each lead to a sizable improvement in HALE[30-70].
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Affiliation(s)
- Jun-Yan Xi
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wang-Jian Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA; School of Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo, China
| | - Yan-Ting Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li-Chang Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yu-Qin Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiao Lin
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Yuan-Tao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China; Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China; Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China; Center for Health Information Research, Sun Yat-sen University, Guangzhou, China.
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Kanerva N, Wachira LJ, Uusi-Ranta N, Anono EL, Walsh HM, Erkkola M, Ochola S, Swindell N, Salmela J, Vepsäläinen H, Stratton G, Onywera V, Fogelholm M. Wealth and Sedentary Time Are Associated With Dietary Patterns Among Preadolescents in Nairobi City, Kenya. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:322-330. [PMID: 36914443 DOI: 10.1016/j.jneb.2023.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The study aimed to compare dietary patterns in preadolescents in urban areas with different physical activity and socioeconomic profiles in Nairobi, Kenya. DESIGN Cross-sectional. PARTICIPANTS Preadolescents aged 9-14 years (n = 149) living in low- or middle-income areas in Nairobi. VARIABLES MEASURED Sociodemographic characteristics were collected using a validated questionnaire. Weight and height were measured. Diet was assessed using a food frequency questionnaire and physical activity by accelerometer. ANALYSIS Dietary patterns (DP) were formed through principal component analysis. Associations of age, sex, parental education, wealth, body mass index, physical activity, and sedentary time with DPs were analyzed with linear regression. RESULTS Three DPs explained 36% of the total variance in food consumption: (1) snacks, fast food, and meat; (2) dairy products and plant protein; and (3) vegetables and refined grains. Higher wealth was associated with higher scores of the first DP (P < 0.05). CONCLUSIONS AND IMPLICATIONS Consumption of foods often deemed unhealthy (eg, snacks and fast food) was more frequent among preadolescents whose families were wealthier. Interventions that seek ways to promote healthy lifestyles among families residing in urban areas of Kenya are warranted.
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Affiliation(s)
- Noora Kanerva
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland.
| | - Lucy Joy Wachira
- Department of Physical Education, Exercise and Sports Science, Kenyatta University, Nairobi, Kenya
| | - Noora Uusi-Ranta
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Esther L Anono
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Hanna M Walsh
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Sophie Ochola
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Nils Swindell
- Department of Sport Sciences, Swansea University, Swansea, United Kingdom
| | - Jatta Salmela
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Henna Vepsäläinen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Gareth Stratton
- Department of Paediatric Exercise Science, Sport and Exercise Sciences, Swansea University, Swansea, United Kingdom
| | - Vincent Onywera
- Department of Physical Education, Exercise and Sports Science, Kenyatta University, Nairobi, Kenya
| | - Mikael Fogelholm
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
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Singh A, Smith K, Hellowell M, Logo DD, Marten R, Suu K, Owusu-Dabo E. An exploration of stakeholder views and perceptions on taxing tobacco, alcohol and sugar-sweetened beverages in Ghana. BMJ Glob Health 2023; 8:e012054. [PMID: 37257939 PMCID: PMC10255295 DOI: 10.1136/bmjgh-2023-012054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/14/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) account for nearly 43% of Ghana's all-cause mortality. Unhealthy commodities (such as alcohol, sugar and tobacco) are an important factor in the growing NCD burden in the region of sub-Saharan Africa (SSA). Despite health taxes on tobacco, alcohol and sugar-sweetened beverages (SSBs) gaining renewed attention, adoption and implementation in SSA remain limited. This study aims to unpack the contextual politics and to examine current perceptions of opportunities and barriers for health taxes in Ghana. METHODS Semistructured qualitative interviews (n=19) conducted with purposively sampled stakeholders representing four sectors: government, civil society, media and international organisations, and two group interviews with nine industry stakeholders, informed by a review of relevant literature and policy/advocacy documents. RESULTS Stakeholders had a general belief that such taxes are primarily useful for revenue generation (for health spending) rather than for reducing consumption and improving health. There do appear to be opportunities for health taxes with stakeholders broadly supportive of taxing SSBs. This support could be strengthened via 'health' framing of any new tax proposals, the generation of Ghana-specific evidence about the potential impacts of such taxes and greater public awareness. Industry actors and some government representatives opposed health taxes, citing concerns about the potential to increase illicit trade and economic harm. Some stakeholders also believed that links between politicians and affected industries represent an important barrier. CONCLUSION These findings identify opportunities to introduce health taxes but also underline the potential resistance from affected industry stakeholders. Nevertheless, a strategic approach that focuses on achieving policy coherence (between central government, health and economic ministries), combined with efforts to strengthen stakeholder and public support, may weaken the lobbying position of industry. Such efforts could be supported by research to help demonstrate the value of different designs of health taxes for achieving Ghana's health goals and to better understand industry-political links.
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Affiliation(s)
- Arti Singh
- School of Public Health, KNUST, Kumasi, Ghana
| | - Katherine Smith
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Mark Hellowell
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | | | - Robert Marten
- WHO Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Kaung Suu
- Alliance For Health Policy and System Research, Geneva, Switzerland
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Akter K, Kuddus A, Jeny T, Nahar T, Shaha S, Ahmed N, King C, Pires M, Haghparast-Bidgoli H, Azad K, Fottrell E, Morrison J. Stakeholder perceptions on scaling-up community-led interventions for prevention and control of non-communicable diseases in Bangladesh: a qualitative study. BMC Public Health 2023; 23:719. [PMID: 37081438 PMCID: PMC10116471 DOI: 10.1186/s12889-023-15551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/28/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Engaging communities is an important component of multisectoral action to address the growing burden of non-communicable diseases (NCDs) in low- and middle-income countries. We conducted research with non-communicable disease stakeholders in Bangladesh to understand how a community-led intervention which was shown to reduce the incidence of type 2 diabetes in rural Bangladesh could be scaled-up. METHODS We purposively sampled any actor who could have an interest in the intervention, or that could affect or be affected by the intervention. We interviewed central level stakeholders from donor agencies, national health policy levels, public, non-governmental, and research sectors to identify scale-up mechanisms. We interviewed community health workers, policy makers, and non-governmental stakeholders, to explore the feasibility and acceptability of implementing the suggested mechanisms. We discussed scale-up options in focus groups with community members who had attended a community-led intervention. We iteratively developed our data collection tools based on our analysis and re-interviewed some participants. We analysed the data deductively using a stakeholder analysis framework, and inductively from codes identified in the data. RESULTS Despite interest in addressing NCDs, there was a lack of a clear community engagement strategy at the government level, and most interventions have been implemented by non-governmental organisations. Many felt the Ministry of Health and Family Welfare should lead on community engagement, and NCD screening and referral has been added to the responsibilities of community health workers and health volunteers. Yet there remains a focus on reproductive health and NCD diagnosis and referral instead of prevention at the community level. There is potential to engage health volunteers in community-led interventions, but their present focus on engaging women for reproductive health does not fit with community needs for NCD prevention. CONCLUSIONS Research highlighted the need for a preventative community engagement strategy to address NCDs, and the potential to utilise existing cadres to scale-up community-led interventions. It will be important to work with key stakeholders to address gender issues and ensure flexibility and responsiveness to community concerns. We indicate areas for further implementation research to develop scaled-up models of community-led interventions to address NCDs.
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Affiliation(s)
- Kohenour Akter
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Abdul Kuddus
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Tasnova Jeny
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Sanjit Shaha
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Naveed Ahmed
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Carina King
- Karolinska Institutet, K9 Global Folkhälsa, K9 GPH Stålsby Lundborg Alfvén, Stockholm, 171 77, Sweden
| | - Malini Pires
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | | | - Kishwar Azad
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Edward Fottrell
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Joanna Morrison
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
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Bardach AE, Espínola N, Cairoli FR, Perelli L, Balan D, Palacios A, Augustovski F, Pichón-Riviere A, Alcaraz AO. The burden of disease and economic impact of sugar-sweetened beverages' consumption in Argentina: A modeling study. PLoS One 2023; 18:e0279978. [PMID: 36821592 PMCID: PMC9949658 DOI: 10.1371/journal.pone.0279978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Approximately two-thirds of Argentine adults are overweight or obese, and 11% have diabetes. Over the last two decades, all population groups have increased their consumption of ultra-processed foods and sugar-sweetened beverages (SSB). We aimed to estimate the disease burden-deaths, events, and costs to the health system-attributed to SSB consumption in Argentina. METHODS We used a comparative risk assessment framework to estimate the health and economic impacts that would be avoided in a scenario without sugar-sweetened beverage (SSB) consumption. We calculated the direct effects on diabetes, cardiovascular disease, and BMI, and then estimated the effects of BMI on disease incidence. Finally, we applied the population attributable factor to calculate the health and economic burden avoided in Argentina in 2020. RESULTS Our model estimated that about 4,425 deaths, 110,000 healthy life years lost to premature death and disability, more than 520,000 cases of overweight and obesity in adults, and 774,000 in children and adolescents would be attributed to SSB Consumption in Argentina. This disease burden corresponds to 23% of type-2 diabetes cases and other significant proportions of cardiovascular disease and cancer. The overweight and obesity costs attributable to SSB totaled approximately $47 million in adults and $15 million in children and adolescents. CONCLUSION A significant number of disease cases, deaths, and health care costs could be attributed to SSB consumption in Argentina. Implementing measures to reduce the sugar content in beverages is a pending debt for the country and could lead to measurable improvements in population health, especially among children and adolescents.
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Affiliation(s)
- Ariel Esteban Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
- * E-mail:
| | - Natalia Espínola
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | | | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Darío Balan
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Andrés Pichón-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Andrea Olga Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina
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Owolade A, Mashavakure H, Babatunde AO, Aborode AT. Time to relook into Non-Communicable Diseases (NCDs) in Africa: A silent threat overwhelming global health in Africa. Ann Med Surg (Lond) 2022; 82:104522. [PMID: 36164642 PMCID: PMC9508432 DOI: 10.1016/j.amsu.2022.104522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 11/18/2022] Open
Abstract
In Sub Saharan Africa, the morbidity and mortality rate from Non-Communicable Diseases is increasing more than in any place in the world. However, Sub-Saharan Africa faces many challenges such as problems with financing, health system issues, contending interests from industry actors as well as low NCD awareness levels, which have impeded all efforts to curb the burden of these diseases. This perspective discussed the causes, effects and the need to the prioritize prevention and control of non-communicable diseases in Africa, together with practical recommendations. Some of the causes include fast urbanization, dietary changes, lack of health insurance and political instability amongst others, these have had huge implications on not only health indices but also socio-economic development in African countries. There is a need for political will and engagement, community engagement, behavioral changes, and interdisciplinary coordination to reduce the prevalence of NCDs in Africa. In Sub Saharan Africa, the morbidity and mortality rate from Non-Communicable diseases is increasing. Some of the causes include fast urbanization, dietary changes, lack of health insurance and political instability amongst others. There is a need for political will and engagement, community engagement, behavioral changes, and interdisciplinary coordination to reduce the prevalence of NCDs in Africa.
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Sujarwoto, Maharani A. Participation in community-based healthcare interventions and non-communicable diseases early detection of general population in Indonesia. SSM Popul Health 2022; 19:101236. [PMID: 36177484 PMCID: PMC9513697 DOI: 10.1016/j.ssmph.2022.101236] [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: 05/30/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Community-based Healthcare Interventions (CBHIs) are regarded as a critical component of healthcare task-sharing in LMICs and have the potential to address LMICs’ health system weaknesses to improve NCDs prevention care. This study aims to investigate the relationship between participation in CBHIs and NCDs early detection at medical facilities among Indonesians. Methods Data come from the fifth Indonesian Family Life Survey (2014–2015), a total of 27,692 individuals (14,820 female and 12,872 male individuals age 15 and older). Multiple ordered logistics and logistics regression was used to assess the association between individual participation in CBHI and early detection of NCDs at medical facilities. Findings Participation in CBHIs are associated with higher odds of having regular blood pressure test (adjusted odds ratio [OR], 3.09; 95% confidence interval [CI], 2.67–3.58), cholesterol test (adjusted OR, 1.88; 95% CI, 1.60–2.22), blood glucose test (adjusted OR, 1.88; 95% CI, 1.58–2.23), electrocardiogram (adjusted OR, 1.37; 95% CI, 1.06–1.76) and basic dental examination (adjusted OR, 1.32; 95% CI, 1.09–1.60) at medical facilities. The odds of having pap smears (adjusted OR, 2.20; 95% CI, 1.62–2.98) and breast self-examination (adjusted OR, 1.73; 95% CI, 1.37–2.19) among females who participated in CBHIs are substantially larger than those who did not participate in CBHIs. No significant association is shown for the basic vision examination (adjusted OR, 1.14; 95% CI, 0.95–1.37), while the association of participation in CBHIs on prostate cancer checkup (adjusted OR, 0.18; 95% CI, 0.04–0.76) was negative and significant. The results were controlled with a wide range of predisposing, enabling and need factors for NCDs early detection. Conclusion and recommendation: CBHIs may benefit NCDs early detection for the general population in Indonesia. Policymakers and health practitioners need to design CBHIs programs that are attractive to the population, especially men and younger people. CBHIs are a distinct mode of healthcare delivery and are regarded as a critical component of healthcare task-sharing in LMICs. CBHIs have the potential to address LMICs' health system weaknesses to improve NCDs prevention care. Participation in CBHIs are associated with regular blood pressure, cholesterol, blood glucose, electrocardiogram, and dental tests.
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Affiliation(s)
- Sujarwoto
- Department of Public Administration Brawijaya University, Malang, Indonesia
| | - Asri Maharani
- Department of Nursing, Faculty of Health and Education, Manchester Metropolitan University, UK
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Allen LN, Wigley S, Holmer H. Study protocol: assessing the association between corporate financial influence and implementation of policies to tackle commercial determinants of non-communicable diseases: a cross-sectional analysis of 172 countries. BMJ Open 2022; 12:e055656. [PMID: 36041766 PMCID: PMC9438081 DOI: 10.1136/bmjopen-2021-055656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION There are many case studies of corporations that have worked to undermine health policy implementation. It is unclear whether countries that are more exposed to corporate financial influence are systematically less likely to implement robust health policies that target firms' financial interests. We aim to assess the association between corporate financial influence and implementation of WHO-recommended policies to constrain sales, marketing and consumption of tobacco, alcohol and unhealthy foods. METHODS AND ANALYSIS We will perform a cross-sectional analysis of 172 WHO Member States using national datasets from 2015, 2017 and 2020. We will use random effects generalised least squares regression to test the association between implementation status of 12 WHO-recommended tobacco, alcohol and diet policies, and corporate financial influence, a metric that combines disclosure of campaign donations, public campaign finance, corporate campaign donations, legislature corrupt activities, disclosure by politicians and executive oversight. We will control for GDP per capita, population aged >65 years (%), urbanisation (%), level of democracy, continent, ethno-linguistic fractionalisation, legal origin, UN-defined 'Small Island Developing States' and Muslim population (%) (to capture alcohol policy differences). We will include year dummies to address the possibility of a spurious relationship between the outcome variable and the independent variables of interests. For example, there may be an upward global trend in policy implementation that coincides with an upward global trend in the regulation of lobbying and campaign finance. ETHICS AND DISSEMINATION As this study uses publicly available data, ethics approval is not required. The authors have no conflicts of interest to declare. Findings will be submitted to a peer-reviewed journal for publication in the academic literature. All data, code and syntax will be made publicly available on GitHub.
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Affiliation(s)
- Luke Nelson Allen
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Wigley
- Department of Philosophy, Bilkent University, Ankara, Turkey
| | - Hampus Holmer
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Chaiyasong S, Gao J, Bundhamcharoen K. Estimated Impacts of Alcohol Control Policies on NCD Premature Deaths in Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159623. [PMID: 35954980 PMCID: PMC9368053 DOI: 10.3390/ijerph19159623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022]
Abstract
Background: This study aimed to assess the impacts of achieving a 10% alcohol reduction target and different alcohol policy interventions on NCD premature deaths during 2010–2025 in Thailand. Methods: The researchers estimated the impacts on three main NCDs: cancers, cardiovascular diseases, and diabetes. These represent two ideal scenarios, which are the target reduction and five intervention scenarios. These intervention scenarios comprise taxation with 50% price increases, a total ban on advertisements, availability restriction by shortening sales times, early psychological intervention, and combined interventions. Consumption data and mortality trends were obtained from available national data. Relative risks and intervention effects were derived from the literature. Results: Achieving a 10% reduction target would lead to 3903–7997 avoidable NCD deaths. Taxation was the most effective intervention, with the highest number of avoidable NCD deaths, followed by early psychological intervention, availability restriction, and an advertisement ban. A combination of these four interventions would reduce 13,286 NCD deaths among men and 4994 NCD deaths among women, accounting for 46.8% of the NCD mortality target. Conclusion: This study suggests using Thailand as an example for low- and middle-income countries to enhance implementation and enforcement of the recommended effective alcohol policies for achieving the global targets.
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Affiliation(s)
- Surasak Chaiyasong
- Alcohol and Health Promotion Policy Research Unit and Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Mahasarakham 44150, Thailand
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand
- Correspondence: ; Tel.: +66-091-935-5369
| | - Jie Gao
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Kanitta Bundhamcharoen
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand
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Giancola A, Hauerslev M, Ndinda C, Farmer M, Musah L, Msengi G, Bhutta Z. Addressing the double-burden of malnutrition among children and adolescents in sub-Saharan Africa. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.36904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Amanda Giancola
- Centre for Global Child Health, The Hospital for Sick Children
| | | | - Catherine Ndinda
- Human and Social Capabilities (HSC); Human Sciences Research Council (HSRC)
| | | | | | | | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children; Institute for Global Health and Development, The Aga Khan University
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Hategeka C, Adu P, Desloge A, Marten R, Shao R, Tian M, Wei T, Kruk ME. Implementation research on noncommunicable disease prevention and control interventions in low- and middle-income countries: A systematic review. PLoS Med 2022; 19:e1004055. [PMID: 35877677 PMCID: PMC9359585 DOI: 10.1371/journal.pmed.1004055] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 08/08/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While the evidence for the clinical effectiveness of most noncommunicable disease (NCD) prevention and treatment interventions is well established, care delivery models and means of scaling these up in a variety of resource-constrained health systems are not. The objective of this review was to synthesize evidence on the current state of implementation research on priority NCD prevention and control interventions provided by health systems in low- and middle-income countries (LMICs). METHODS AND FINDINGS On January 20, 2021, we searched MEDLINE and EMBASE databases from 1990 through 2020 to identify implementation research studies that focused on the World Health Organization (WHO) priority NCD prevention and control interventions targeting cardiovascular disease, cancer, diabetes, and chronic respiratory disease and provided within health systems in LMICs. Any empirical and peer-reviewed studies that focused on these interventions and reported implementation outcomes were eligible for inclusion. Given the focus on this review and the heterogeneity in aims and methodologies of included studies, risk of bias assessment to understand how effect size may have been compromised by bias is not applicable. We instead commented on the distribution of research designs and discussed about stronger/weaker designs. We synthesized extracted data using descriptive statistics and following the review protocol registered in PROSPERO (CRD42021252969). Of 9,683 potential studies and 7,419 unique records screened for inclusion, 222 eligible studies evaluated 265 priority NCD prevention and control interventions implemented in 62 countries (6% in low-income countries and 90% in middle-income countries). The number of studies published has been increasing over time. Nearly 40% of all the studies were on cervical cancer. With regards to intervention type, screening accounted for 49%, treatment for 39%, while prevention for 12% (with 80% of the latter focusing on prevention of the NCD behavior risk factors). Feasibility (38%) was the most studied implementation outcome followed by adoption (23%); few studies addressed sustainability. The implementation strategies were not specified well enough. Most studies used quantitative methods (86%). The weakest study design, preexperimental, and the strongest study design, experimental, were respectively employed in 25% and 24% of included studies. Approximately 72% of studies reported funding, with international funding being the predominant source. The majority of studies were proof of concept or pilot (88%) and targeted the micro level of health system (79%). Less than 5% of studies report using implementation research framework. CONCLUSIONS Despite growth in implementation research on NCDs in LMICs, we found major gaps in the science. Future studies should prioritize implementation at scale, target higher levels health systems (meso and macro levels), and test sustainability of NCD programs. They should employ designs with stronger internal validity, be more conceptually driven, and use mixed methods to understand mechanisms. To maximize impact of the research under limited resources, adding implementation science outcomes to effectiveness research and regional collaborations are promising.
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Affiliation(s)
- Celestin Hategeka
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Prince Adu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allissa Desloge
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, United States of America
| | - Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | | | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Ting Wei
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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Lencucha R, Neupane S. The use, misuse and overuse of the 'low-income and middle-income countries' category. BMJ Glob Health 2022; 7:bmjgh-2022-009067. [PMID: 35672116 PMCID: PMC9185671 DOI: 10.1136/bmjgh-2022-009067] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/23/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
- Raphael Lencucha
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Sujaya Neupane
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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Wang Z, Liu D, Zhao Y, Li M, Bai Y, Mi S, Liang X, Zhao W. Recommendations and Future Direction for Population-Based Prevention and Control of Behavioral Risk Factors for NCDs. China CDC Wkly 2022; 4:407-410. [PMID: 35685123 PMCID: PMC9167604 DOI: 10.46234/ccdcw2022.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Zhuoqun Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China,NCDs Control and Prevention Society, Chinese Preventive Medicine Association, Beijing, China
| | - Dan Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou City, Guangdong Province, China
| | - Yanfang Zhao
- National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
| | - Man Li
- Department of Epidemiology and Statistic, Hebei Key Laboratory of Environment and Human Health, Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | - Yamin Bai
- National Center for Chronic and Non-communicable Disease Control and Prevention, CDC China, Beijing, China
| | - Shengquan Mi
- College of Biochemical Engineering, Beijing Union University, Beijing, China
| | - Xiaofeng Liang
- Disease Control and Prevention Institute, Jinan University, Guangzhou City, Guangdong Province, China,Jinan University-BioKangtai Vaccine Institute, Jinan University, Guangzhou City, Guangdong Province, China,Wenhua Zhao,
| | - Wenhua Zhao
- NCDs Control and Prevention Society, Chinese Preventive Medicine Association, Beijing, China,National Institute for Nutrition and Health, CDC China, Beijing, China,Xiaofeng Liang,
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22
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Birhanu MM, Zaman SB, Thrift AG, Evans RG, Zengin A. Risk factors for incident cardiovascular events among adults in low- and middle-income countries: A systematic review and meta-analysis of prospective cohort studies. Prev Med 2022; 158:107036. [PMID: 35358600 DOI: 10.1016/j.ypmed.2022.107036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/03/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
The relative contributions of risk factors for cardiovascular events at a population level has received little attention in low- and middle-income countries (LMICs). We estimated the population attributable fraction (PAF) of risk factors associated with incident cardiovascular events in LMICs. We searched six databases for relevant articles, supplemented with a manual search of reference lists. Articles included in the meta-analyses were those based on prospective community-based cohorts and incorporating adjusted hazard ratios (HR) or relative risks with 95% confidence intervals (95% CI) for associations between risk factors and a composite cardiovascular and/or stroke endpoint. Pooled HRs and 95% CI were calculated using the random effects model. We assessed heterogeneity using the I2 test and study quality using the Newcastle-Ottawa Scale. We calculated the PAF of each associated risk factor. The protocol was registered in PROSPERO (CRD42019122741). We identified 18 cohorts from LMICs with 1,125,846 participants, 77,045 composite cardiovascular events and 42,216 strokes. Substantial proportions of incident cardiovascular events were attributable to hypertension (HR [95% CI], 2.23 [2.01-2.48], PAF = 28%); current smoking (1.44 [1.31-1.58], PAF = 10%); and diabetes mellitus (1.93 [1.67-2.23], PAF = 8%). Other risk factors identified included number of children, depression, bone mineral density, and air pollution. A substantial proportion of incident cardiovascular events were linked to traditional metabolic and behavioural modifiable risk factors. However, other novel risk factors also appear to contribute. Targeting of these established and novel risk factors has the potential to reduce the burden of CVD in LMICs.
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Affiliation(s)
- Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Sojib Bin Zaman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia; Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
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23
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Jakovljevic M, Lamnisos D, Timofeyev Y, Khan HN, Ranabhat CL, Godman B. Editorial: Emerging Markets’ Health and Pharmaceutical Sectors at the Dawn of a Potential Global Financial Crisis of early 2020s. Front Pharmacol 2022; 13:907612. [PMID: 35548362 PMCID: PMC9081560 DOI: 10.3389/fphar.2022.907612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Petersburg Polytechnic University, St.Petersburg, Russia
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
- *Correspondence: Mihajlo Jakovljevic,
| | - Demetris Lamnisos
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | | | | | - Chhabi Lal Ranabhat
- Department of Health Promotion and Administration, Eastern Kentucky University, Richmond, United States
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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24
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Drapkina OM, Kontsevaya AV, Kalinina AM, Avdeev SM, Agaltsov MV, Alexandrova LM, Antsiferova AA, Aronov DM, Akhmedzhanov NM, Balanova YA, Balakhonova TV, Berns SA, Bochkarev MV, Bochkareva EV, Bubnova MV, Budnevsky AV, Gambaryan MG, Gorbunov VM, Gorny BE, Gorshkov AY, Gumanova NG, Dadaeva VA, Drozdova LY, Egorov VA, Eliashevich SO, Ershova AI, Ivanova ES, Imaeva AE, Ipatov PV, Kaprin AD, Karamnova NS, Kobalava ZD, Konradi AO, Kopylova OV, Korostovtseva LS, Kotova MB, Kulikova MS, Lavrenova EA, Lischenko OV, Lopatina MV, Lukina YV, Lukyanov MM, Mayev IV, Mamedov MN, Markelova SV, Martsevich SY, Metelskaya VA, Meshkov AN, Milushkina OY, Mukaneeva DK, Myrzamatova AO, Nebieridze DV, Orlov DO, Poddubskaya EA, Popovich MV, Popovkina OE, Potievskaya VI, Prozorova GG, Rakovskaya YS, Rotar OP, Rybakov IA, Sviryaev YV, Skripnikova IA, Skoblina NA, Smirnova MI, Starinsky VV, Tolpygina SN, Usova EV, Khailova ZV, Shalnova SA, Shepel RN, Shishkova VN, Yavelov IS. 2022 Prevention of chronic non-communicable diseases in Of the Russian Federation. National guidelines. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2022. [DOI: 10.15829/1728-8800-2022-3235] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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25
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Elliott LM, Dalglish SL, Topp SM. Health Taxes on Tobacco, Alcohol, Food and Drinks in Low- and Middle-Income Countries: A Scoping Review of Policy Content, Actors, Process and Context. Int J Health Policy Manag 2022; 11:414-428. [PMID: 32945639 PMCID: PMC9309941 DOI: 10.34172/ijhpm.2020.170] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/25/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Taxation of tobacco, food, alcohol and other beverages has gained renewed attention in responding to non-communicable diseases (NCDs). While largely built on evidence from high-income countries (HICs), the projected economic and health benefits of these measures have increased calls for their use in price-sensitive low- and middle-income countries (LMICs). However, uptake has been sporadic and there remains little research on why and how LMICs utilise fiscal measures in response to NCDs. METHODS This scoping review analyses factors influencing the design and implementation of health-related fiscal measures in LMICs. Utilising Arksey and O'Malley's scoping review methodology and Walt and Gilson's policy triangle, we considered the contextual, procedural, content and stakeholder-related factors that influenced measures. RESULTS We identified 75 papers focussing on health-related fiscal measures, with 47 (63%) focused on tobacco, 5 on alcohol, 6 on soft drink and 4 studies on food-related fiscal regulation. Thirteen papers analysed multiple measures and most papers (n = 66, 88%) were less than a decade old. Key factors enabling the design and implementation of measures included localised health and economic evidence, policy championing, inter-ministerial support, and global or regional momentum. Impeding factors encompassed negative framing and retaliation by industry, vested interests and governmental policy disjuncture. Aligning with theoretic insights from the policy triangle, findings consistently demonstrated that the interplay between factors - rather than the presence or absence of particular factors - has the most profound impact on policy implementation. CONCLUSION Given the growing urgency to address NCDs in LMICs, this review highlights the need for recognition and rigorous exploration of political economy factors influencing the design and implementation of fiscal measures. Broader LMIC-specific empirical research is needed to overcome an implication noted in much of the literature: that mechanisms used to enact tobacco taxation are universally applicable to measures targeting foods, alcohol and other beverages.
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Affiliation(s)
- Lana M. Elliott
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sarah L. Dalglish
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Institute for Global Health, University College London, London, UK
| | - Stephanie M. Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
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26
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Collins T, Akselrod S, Berlina D, Allen LN. Unleashing implementation research to accelerate national noncommunicable disease responses. Global Health 2022; 18:6. [PMID: 35073947 PMCID: PMC8785572 DOI: 10.1186/s12992-021-00790-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
Noncommunicable diseases (NCDs) are the leading cause of death and disability worldwide. They exact a disproportionate toll in low and middle-income countries, and the world is not on-track to meet international targets for reductions in premature NCD mortality. Largely, we know which policies work for tackling NCDs, and the World Health Organization (WHO) has developed a package of 'best buy' policies that are highly cost effective. However, we don't necessarily know how to adapt and implement these policies in new populations and cultures. Implementation Research (IR) is emerging as a potent tool for gearing the international response, providing a scientific approach to study the processes used to implement policies and interventions and the contextual factors that affect these processes. Amidst growing interest from policymakers, we identify four main areas for action: high-level engagement with IR among international NCD leaders; domestic investment in technical capacity-building; the creation of new financing streams for IR research; and the development of multi-stakeholder engagement mechanisms that can convene and leverage the perspectives and resources of multiple actors with overlapping aims.
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Affiliation(s)
- Tea Collins
- World Health Organization, Room 4059, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
| | - Svetlana Akselrod
- World Health Organization, Room 4059, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
| | - Daria Berlina
- World Health Organization, Room 4059, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
| | - Luke N Allen
- Department of Clinical Research London School of Hygiene and Tropical Medicine, London, UK
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27
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Fritz M, Fromell H. How to dampen the surge of non-communicable diseases in Southeast Asia: insights from a systematic review and meta-analysis. Health Policy Plan 2022; 37:152-167. [PMID: 34791261 PMCID: PMC8757494 DOI: 10.1093/heapol/czab138] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 10/07/2021] [Accepted: 11/12/2021] [Indexed: 01/04/2023] Open
Abstract
Non-communicable diseases (NCDs), such as diabetes, cancer, cardiovascular diseases and chronic respiratory diseases, have overtaken infectious diseases as the number one cause of death worldwide. The rise of these diseases is especially grave in Southeast Asia, where existing research however falls short on offering guidance on how policy can best prevent and control NCDs in the region. Additionally, low- and middle-income countries in Southeast Asia cannot directly incorporate lessons drawn from interventions in richer countries, since health system capacities and human and financial resources are thoroughly different. Preventive interventions, thus, need to correspond to local capacities and require contextual solutions. In this article, we provide a systematic review of a wide scope of NCD interventions conducted in Southeast Asia to inform about existing intervention designs and to derive sound evidence of their effectiveness. Our literature search results in 51 studies from five Southeast Asian countries from which we can extract 204 estimates. We sort the studies into six intervention categories and analyse them with respect to 23 different health and behavioural outcomes. While we find positive and significant average effects across all six types of interventions, we also document evidence of substantial publication bias. Using a meta-regression approach in which we correct for the publication bias, we instead fail to confirm positive average effects for some interventions. Especially dietary and physical activity interventions fail to achieve improvements in analysed health outcomes, while programs focusing on smoking cessation, on the take-up of preventive screening activities or educating patients on how to cope with NCDs achieve sizeable effects. We also present evidence that the size of the effect differs with the participants' characteristics as well as with design features of the intervention. For local policymakers, the results provide important knowledge on how to address the increasing NCD burden in the coming years.
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Affiliation(s)
- Manuela Fritz
- Faculty of Economics, Business and Information Systems, Chair of Development Economics, University of Passau, Innstraße 29, Passau 94032, Germany
- Department of Economics, Econometrics and Finance, University of Groningen, Nettelbosje 2, Groningen 9747 AE, The Netherlands
| | - Hanna Fromell
- Department of Economics, Econometrics and Finance, University of Groningen, Nettelbosje 2, Groningen 9747 AE, The Netherlands
- Department of Economics and Business Economics, Aarhus University, Fuglesangs Allé 4, Aarhus V 8210, Denmark
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28
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Denekew TW, Gautam Y, Bhandari D, Gautam GP, Sherchand JB, Pokhrel AK, Jha AR. Prevalence and determinants of hypertension in underrepresented indigenous populations of Nepal. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000133. [PMID: 36962278 PMCID: PMC10021878 DOI: 10.1371/journal.pgph.0000133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022]
Abstract
Indigenous populations residing in low- and middle-income countries (LMICs) are highly underrepresented in medicine and public health research. Specifically, data on non-communicable diseases (NCDs) from indigenous populations remains scarce. Despite the increasing burden of NCDs in the Himalayan region, their prevalence in many indigenous populations remains understudied. The nationally representative public health surveys often do not include the indigenous communities, especially those that reside in rural areas or exist in small numbers. This observational cross-sectional survey study aimed to assess the prevalence of three NCD risk factors namely obesity, hypertension, and tachycardia and identify dietary and lifestyle variables associated with them across underrepresented indigenous populations of Nepal. A total of 311 individuals (53.3% women, 46.7% men) with mean age 43±15 years from 12 indigenous Nepali communities residing in rural (47.9%) or semi-urban (52.1%) areas volunteered to participate in this study. Univariate tests and multivariable logistic regressions were used to analyze the survey data. The mean systolic and diastolic blood pressures were 121.3±19.5 mmHg and 81.3±11.8 mmHg respectively. Overall, the prevalence of obesity and tachycardia was low (0.64% and 3.22%, respectively) but hypertension was prevalent at 23.8%. Hypertension was not significantly different across populations, but it was associated with age, BMI, and tobacco use, and collectively, these variables explained 13.9% variation in hypertension prevalence. Although we were unable to detect direct associations between individual determinants of hypertension identified in non-indigenous Nepalis, such as education levels, alcohol consumption, and smoking in this study, having one or more determinants increased the odds of hypertension in the indigenous participants. Furthermore, ~14% of the hypertensive individuals had none of the universally identified hypertension risk factors. The lack of association between previously identified risk factors for hypertension in these individuals indicates that the additional determinants of hypertension remain to be identified in indigenous Nepali populations.
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Affiliation(s)
- Tsedenia Workneh Denekew
- Genetic Heritage Group, Program in Biology, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Yoshina Gautam
- Genetic Heritage Group, Program in Biology, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Himalayan Diversity Project, Department of Biomedical Data Science, Stanford University, Stanford, Palo Alto, United States of America
| | - Dinesh Bhandari
- School of Public Health, University of Adelaide, Adelaide, Australia
- Public Health Research Lab, Tribhuvan University Institute of Medicine, Maharajgunj, Nepal
| | | | | | - Amod K Pokhrel
- Society for Legal and Environmental Analysis and Development Research, Kathmandu, Nepal
- On-Campus/On-Line MPH program, School of Public Health, University of California, Berkeley, CA, United States of America
| | - Aashish R Jha
- Genetic Heritage Group, Program in Biology, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- Himalayan Diversity Project, Department of Biomedical Data Science, Stanford University, Stanford, Palo Alto, United States of America
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29
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Jakovljevic M, Çalışkan Z, Fernandes PO, Mouselli S, Otim ME. Editorial: Health Financing and Spending in Low- and Middle-Income Countries. Front Public Health 2021; 9:800333. [PMID: 34993173 PMCID: PMC8724126 DOI: 10.3389/fpubh.2021.800333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mihajlo Jakovljevic
- Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
| | - Zafer Çalışkan
- Department of Economics, Hacettepe University, Ankara, Turkey
| | - Paula Odete Fernandes
- Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Bragança, Bragança, Portugal
| | - Sulaiman Mouselli
- Faculty of Business Administration, Arab International University, Daraa, Syria
| | - Michael Ekubu Otim
- Department of Health Services Administration, University of Sharjah, Sharjah, United Arab Emirates
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30
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Protocol for a Multi-Level Policy Analysis of Non-Communicable Disease Determinants of Diet and Physical Activity: Implications for Low- and Middle-Income Countries in Africa and the Caribbean. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413061. [PMID: 34948671 PMCID: PMC8700960 DOI: 10.3390/ijerph182413061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 12/01/2022]
Abstract
Non-communicable diseases (NCDs) are the leading cause of death globally. Despite significant global policy development for addressing NCDs, the extent to which global policies find expression in low-and-middle income countries’ (LMIC) policies, designed to mitigate against NCDs, is unclear. This protocol is part of a portfolio of projects within the Global Diet and Activity Research (GDAR) Network, which aims to support the prevention of NCDs in LMICs, with a specific focus on Kenya, Cameroon, South Africa and Jamaica. This paper outlines the protocol for a study that seeks to explore the current policy environment in relation to the reduction of key factors influencing the growing epidemic of NCDs. The study proposes to examine policies at the global, regional and country level, related to the reduction of sugar and salt intake, and the promotion of physical activity (as one dimension of healthy placemaking). The overall study will comprise several sub-studies conducted at a global, regional and country level in Cameroon, Kenya and South Africa. In combination with evidence generated from other GDAR workstreams, results from the policy analyses will contribute to identifying opportunities for action in the reduction of NCDs in LMICs.
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31
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Asiki G, Kadengye D, Calvert C, Wamukoya M, Mohamed SF, Ziraba A, Iddi S, Bangha M, Wekesah F, Chikozho C, Price A, Crampin M, Kyobutungi C. Trends and risk factors for non-communicable diseases mortality in Nairobi slums (2008-2017). GLOBAL EPIDEMIOLOGY 2021; 3:100049. [PMID: 34977550 PMCID: PMC8683743 DOI: 10.1016/j.gloepi.2021.100049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tracking progress in reaching global targets for reducing premature mortality from non-communicable diseases (NCDs) requires accurately collected population based longitudinal data. However, most African countries lack such data because of weak or non-existent civil registration systems. We used data from the Nairobi Urban Health and Demographic Surveillance System (NUDSS) to estimate NCD mortality trends over time and to explore the determinants of NCD mortality. METHODS Deaths identified in the NUHDSS were followed up with a verbal autopsy to determine the signs and symptoms preceding the death. Causes of death were then assigned using InSilicoVA algorithm. We calculated the rates of NCD mortality in the whole NUHDSS population between 2008 and 2017, looking at how these changed over time. We then merged NCD survey data collected in 2008, which contains information on potential determinants of NCD mortality in a sub-sample of the NUHDSS population, with follow up information from the full NUHDSS including whether any of the participants died of an NCD or non-NCD cause. Poisson regression models were used to identify independent risk factors (broadly categorized as socio-demographic, behavioural and physiological) for NCD mortality, as well as non-NCD mortality. RESULTS In the total NUHDSS population of adults age 18 and over, 23% were assigned an NCD as the most likely cause of death. There was evidence that NCD mortality decreased over the study period, with rates of NCD mortality dropping from 1.32 per 1000 person years in 2008-10 (95% CI: 1.13-1.54) to 0.93 per 1000 person years in 2014-17 (95% CI: 0.80-1.08). Of 5115 individuals who participated in the NCD survey in 2008, 421 died during the follow-up period of which 43% were attributed to NCDs. Increasing age, lower education levels, ever smoking and having high blood pressure were identified as independent determinants of NCD mortality in multivariate analyses. CONCLUSION We found that NCDs account for one-quarter of mortality in Nairobi slums, although we document a reduction in the rate of NCD mortality over time. This may be attributed to increased surveillance and introduction of population-wide NCD interventions and health system improvements from research activities in the slums. To achieve further decline there is a need to strengthen health systems to respond to NCD care and prevention along with addressing social factors such as education.
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Affiliation(s)
- Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
- Department of women's and children's health, Karolinska Institutet, Stockholm, Sweden
| | - Damazo Kadengye
- African Population and Health Research Center, Nairobi, Kenya
| | - Clara Calvert
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Abdhalah Ziraba
- African Population and Health Research Center, Nairobi, Kenya
| | - Samuel Iddi
- African Population and Health Research Center, Nairobi, Kenya
| | - Martin Bangha
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | - Alison Price
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mia Crampin
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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32
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Gibbs JF, Newman A, Stefanacci RG. Value-based focused global population health management. J Gastrointest Oncol 2021; 12:S275-S289. [PMID: 34422392 DOI: 10.21037/jgo-2019-gi-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/09/2020] [Indexed: 01/06/2023] Open
Abstract
In 2018, approximately 18 million people worldwide were diagnosed with cancer and are predicted to double by 2040. The global quality chasm in improving health care worldwide requires "systems thinking" as the key to success. Aligning the goal around person-centered care captures the total needs of care of a population and not just disease categories. The integration of the Institute of Medicine's (IOM) six aims of quality termed "value-based focused" and population health management (PHM) provides all health care leaders grappling with improving the health care of the populations a framework for the communities they serve. In this context, the question becomes finding solutions to providing high quality, compassionate and patient-centered health care delivery. Over the last two decades, three paradigms have emerged; the six aims of quality, outcome-focused population health, and the "Quadruple Aim". We have termed the intersection of these concepts as Value-based focused Population Health Management (VBPHM). This review applies VBPHM across the geographic county and community levels in the United States. Specifically, we examine VBPHM at the county or county-equivalents and community levels within the United States. Lastly, the potential role of Community-based Participatory Research and it is applicability to our framework is discussed. VBPHM can comparably be applied globally to improve population health, especially in preventing and treating cancer better.
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Affiliation(s)
- John F Gibbs
- Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
| | - Ashley Newman
- Rutgers-Robert Woods Johnson, New Brunswick, NJ, USA
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Goli S, Sakita FM, Kweka GL, Tarimo TG, Temu G, Thielman NM, Bettger JP, Bloomfield GS, Limkakeng AT, Hertz JT. Thirty-day outcomes and predictors of mortality following acute myocardial infarction in northern Tanzania: A prospective observational cohort study. Int J Cardiol 2021; 342:23-28. [PMID: 34364908 DOI: 10.1016/j.ijcard.2021.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/28/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a rising burden of myocardial infarction (MI) within sub-Saharan Africa. Prospective studies of detailed MI outcomes in the region are lacking. METHODS Adult patients with confirmed MI from a prospective surveillance study in northern Tanzania were enrolled in a longitudinal cohort study after baseline health history, medication use, and sociodemographic data were obtained. Thirty days following hospital presentation, symptom status, rehospitalizations, medication use, and mortality were assessed via telephone or in-person interviews using a standardized follow-up questionnaire. Multivariate logistic regression was performed to identify baseline predictors of thirty-day mortality. RESULTS Thirty-day follow-up was achieved for 150 (98.7%) of 152 enrolled participants. Of these, 85 (56.7%) survived to thirty-day follow-up. Of the surviving participants, 71 (83.5%) reported persistent anginal symptoms, four (4.7%) reported taking aspirin regularly, seven (8.2%) were able to identify MI as the reason for their hospitalization, and 17 (20.0%) had unscheduled rehospitalizations. Self-reported history of diabetes at baseline (OR 0.32, 95% CI 0.10-0.89, p = 0.04), self-reported history of hypertension at baseline (OR 0.34, 95% CI 0.15-0.74, p = 0.01), and antiplatelet use at initial presentation (OR 0.19, 95% CI 0.04-0.65, p = 0.02) were all associated with lower odds of thirty-day mortality. CONCLUSIONS In northern Tanzania, thirty-day outcomes following acute MI are poor, and mortality is associated with self-awareness of comorbidities and medication usage. Further investigation is needed to develop interventions to improve care and outcomes of MI in Tanzania.
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Affiliation(s)
- Sumana Goli
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA.
| | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Godfrey L Kweka
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Tumsifu G Tarimo
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Gloria Temu
- Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Nathan M Thielman
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA; Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Janet P Bettger
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA; Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA
| | - Gerald S Bloomfield
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA; Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA
| | | | - Julian T Hertz
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, USA; Duke University School of Medicine, 2301 Erwin Rd, Durham, NC 27710, USA
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Jailobaeva K, Falconer J, Loffreda G, Arakelyan S, Witter S, Ager A. An analysis of policy and funding priorities of global actors regarding noncommunicable disease in low- and middle-income countries. Global Health 2021; 17:68. [PMID: 34187499 PMCID: PMC8240078 DOI: 10.1186/s12992-021-00713-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs), including mental health, have become a major concern in low- and middle-income countries. Despite increased attention to them over the past decade, progress toward addressing NCDs has been slow. A lack of bold policy commitments has been suggested as one of the contributors to limited progress in NCD prevention and management. However, the policies of key global actors (bilateral, multilateral, and not-for-profit organisations) have been understudied. METHODS This study aimed to map the key global actors investing in action regarding NCDs and review their policies to examine the articulation of priorities regarding NCDs. Narrative synthesis of 70 documents and 31 policy papers was completed, and related to data collated from the Global Health Data Visualisation Tool. RESULTS In 2019 41% of development assistance for health committed to NCDs came from private philanthropies, while that for other global health priorities from this source was just 20%. Through a range of channels, bilateral donors were the other major source of NCD funding (contributing 41% of NCD funding). The UK and the US were the largest bilateral investors in NCDs, each contributing 8%. However, NCDs are still under-prioritised within bilateral portfolios - receiving just 0.48% of US funding and 1.66% of the UK. NGOs were the key channels of funding for NCDs, spending 48% of the funds from donors in 2019. The reviewed literature generally focused on NCD policies of WHO, with policies of multilateral and bilateral donors given limited attention. The analysis of policies indicated a limited prioritisation of NCDs in policy documents. NCDs are framed in the policies as a barrier to economic growth, poverty reduction, and health system sustainability. Bilateral donors prioritise prevention, while multilateral actors offer policy options for NCD prevention and care. Even where stated as a priority, however, funding allocations are not aligned. CONCLUSION The growing threat of NCDs and their drivers are increasingly recognised. However, global actors' policy priorities and funding allocations need to align better to address these NCD threats. Given the level of their investment and engagement, more research is needed into the role of private philanthropies and NGOs in this area.
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Affiliation(s)
- Kanykey Jailobaeva
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Jennifer Falconer
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Giulia Loffreda
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Stella Arakelyan
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
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Aminde LN, Phung HN, Phung D, Cobiac LJ, Veerman JL. Dietary Salt Reduction, Prevalence of Hypertension and Avoidable Burden of Stroke in Vietnam: Modelling the Health and Economic Impacts. Front Public Health 2021; 9:682975. [PMID: 34150712 PMCID: PMC8213032 DOI: 10.3389/fpubh.2021.682975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Dietary salt reduction has been recommended as a cost-effective population-wide strategy to prevent cardiovascular disease. The health and economic impact of salt consumption on the future burden of stroke in Vietnam is not known. Objective: To estimate the avoidable incidence of and deaths from stroke, as well as the healthy life years and healthcare costs that could be gained from reducing salt consumption in Vietnam. Methods: This was a macrosimulation health and economic impact assessment study. Data on blood pressure, salt consumption and stroke epidemiology were obtained from the Vietnam 2015 STEPS survey and the Global Burden of Disease study. A proportional multi-cohort multistate lifetable Markov model was used to estimate the impact of achieving the Vietnam national salt targets of 8 g/day by 2025 and 7 g/day by 2030, and to the 5 g/day WHO recommendation by 2030. Probabilistic sensitivity analysis was conducted to quantify the uncertainty in our projections. Results: If the 8 g/day, 7 g/day, and 5 g/day targets were achieved, the prevalence of hypertension could reduce by 1.2% (95% uncertainty interval [UI]: 0.5 to 2.3), 2.0% (95% UI: 0.8 to 3.6), and 3.5% (95% UI: 1.5 to 6.3), respectively. This would translate, respectively, to over 80,000, 180,000, and 257,000 incident strokes and over 18,000, 55,000, and 73,000 stroke deaths averted. By 2025, over 56,554 stroke-related health-adjusted life years (HALYs) could be gained while saving over US$ 42.6 million in stroke healthcare costs. By 2030, about 206,030 HALYs (for 7 g/day target) and 262,170 HALYs (for 5 g/day target) could be gained while saving over US$ 88.1 million and US$ 122.3 million in stroke healthcare costs respectively. Conclusion: Achieving the national salt reduction targets could result in substantial population health and economic benefits. Estimated gains were larger if the WHO salt targets were attained and if changes can be sustained over the longer term. Future work should consider the equity impacts of specific salt reduction programs.
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Affiliation(s)
| | - Hai N Phung
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Dung Phung
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Linda J Cobiac
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Laar A. The role of food environment policies in making unhealthy foods unattractive and healthy foods available in Africa. EClinicalMedicine 2021; 36:100908. [PMID: 34041465 PMCID: PMC8144727 DOI: 10.1016/j.eclinm.2021.100908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 11/26/2022] Open
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Alonzo D, Popescu M. Utilizing social media platforms to promote mental health awareness and help seeking in underserved communities during the COVID-19 pandemic. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:156. [PMID: 34222531 PMCID: PMC8224506 DOI: 10.4103/jehp.jehp_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND COVID-19 virus has resulted in significant psychological distress for many individuals, particularly, those in underserved communities. Social media have the potential to be one of the most effective tools for mental health campaigns, reaching wide audiences in the shortest amount of time. In this paper, the potential of harnessing social media platforms to address mental health needs in underserved populations is presented. In addition, description of the preliminary implementation of a social media mental health campaign, the 5 × 5 campaign, is described as an example of the feasibility and benefits of such efforts. Key implications gleaned from the implementation process are also presented. MATERIALS AND METHODS Utilizing a participatory approach, the 5 × 5 campaign aimed to improve recognition of mental health symptoms, promote help seeking, and provide immediate strategies for self-care for individuals experiencing psychological distress related to the COVID-19 pandemic in low-income, high-risk communities in and around Guatemala City. Campaign content was promoted on Facebook, Instagram, and WhatsApp from April 2020 to June 2020. RESULTS Preliminary analysis of the 5 × 5 campaign demonstrated feasibility and substantial impact with over 84,000 individuals reached by the campaigns through initial messaging and shares. CONCLUSION The 5 × 5 highlights the feasibility of using social media campaigns for mental health promotion and key factors that should be incorporated in the planning of social media mental health campaigns aimed at promoting awareness, engaging underserved communities, and encouraging help seeking.
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Affiliation(s)
- Dana Alonzo
- Graduate School of Social Service, Fordham University, West Harrison, NY, USA
| | - Marciana Popescu
- Graduate School of Social Service, Fordham University, West Harrison, NY, USA
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Sipido KR, Nagyova I. Health research and knowledge translation for achieving the sustainable development goals: tackling the hurdles. Eur J Public Health 2021; 30:i36-i40. [PMID: 32391902 PMCID: PMC7213555 DOI: 10.1093/eurpub/ckaa032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We are far from reaching the sustainable development goals (SDGs) for health despite a wealth of novel insights in disease mechanisms and possible solutions. Why have we failed in knowledge translation and implementation? Starting from the case of cardiovascular diseases as one of the most prevalent non-communicable diseases, we examine barriers and hurdles, and perspectives for future health research. Health has multiple links with other SDGs. To accelerate the progress towards a healthy society, health research needs to take a broader view and become more cross-disciplinary and cross-sectoral. As one example, behavioural studies will underpin better prevention and treatment adherence. The next generation workforce in health and research needs an adapted education and training to implement more effective health approaches. As well, only effective dialogue and communication between researchers, practitioners, society and policymakers can lead to translation of evidence into policies, addressing the complexity of socioeconomic factors and commercial interests. Within Europe, health research needs a comprehensive vision and strategy that connects to achieving better health, as one of the interconnected SDGs.
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Affiliation(s)
- Karin R Sipido
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
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Jaung MS, Willis R, Sharma P, Aebischer Perone S, Frederiksen S, Truppa C, Roberts B, Perel P, Blanchet K, Ansbro É. Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review. Health Policy Plan 2021; 36:509-532. [PMID: 33693657 PMCID: PMC8128021 DOI: 10.1093/heapol/czab007] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 01/02/2023] Open
Abstract
Care for non-communicable diseases, including hypertension and diabetes (HTN/DM), is recognized as a growing challenge in humanitarian crises, particularly in low- and middle-income countries (LMICs) where most crises occur. There is little evidence to support humanitarian actors and governments in designing efficient, effective, and context-adapted models of care for HTN/DM in such settings. This article aimed to systematically review the evidence on models of care targeting people with HTN/DM affected by humanitarian crises in LMICs. A search of the MEDLINE, Embase, Global Health, Global Indexus Medicus, Web of Science, and EconLit bibliographic databases and grey literature sources was performed. Studies were selected that described models of care for HTN/DM in humanitarian crises in LMICs. We descriptively analysed and compared models of care using a conceptual framework and evaluated study quality using the Mixed Methods Appraisal Tool. We report our findings according to PRISMA guidelines. The search yielded 10 645 citations, of which 45 were eligible for this review. Quantitative methods were most commonly used (n = 34), with four qualitative, three mixed methods, and four descriptive reviews of specific care models were also included. Most studies detailed primary care facility-based services for HTN/DM, focusing on health system inputs. More limited references were made to community-based services. Health care workforce and treatment protocols were commonly described framework components, whereas few studies described patient centredness, quality of care, financing and governance, broader health policy, and sociocultural contexts. There were few programme evaluations or effectiveness studies, and only one study reported costs. Most studies were of low quality. We concluded that an increasing body of literature describing models of care for patients with HTN/DM in humanitarian crises demonstrated the development of context-adapted services but showed little evidence of impact. Our conceptual framework could be used for further research and development of NCD models of care.
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Affiliation(s)
- Michael S Jaung
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- Department of Emergency Medicine, Baylor College of Medicine, 1504 Ben Taub Loop, Houston, 77030, TX, USA
| | - Ruth Willis
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Piyu Sharma
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sigiriya Aebischer Perone
- Health Unit, international Committee of the Red Cross, Avenue de la Paix 19, 1202 Geneva, Switzerland
| | | | - Claudia Truppa
- Health Unit, international Committee of the Red Cross, Avenue de la Paix 19, 1202 Geneva, Switzerland
| | - Bayard Roberts
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Pablo Perel
- Department of Non-Communicable Disease Epidemiology and Centre for Global Chronic Conditions, Faculty of Epidemiology and Population Health, Keppel Street, London WC1E 7HT, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, 24 rue du Général-Dufour, Geneva, Switzerland
| | - Éimhín Ansbro
- Department of Health Services Research & Policy and Centre for Global Chronic Conditions, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Genade LP, Webb EM, Wolvaardt JE, Janse Van Rensburg C. The clinical outcomes of patients with diabetes and hypertension in a peri-urban area, Johannesburg, South Africa. Prim Care Diabetes 2021; 15:212-217. [PMID: 32863147 DOI: 10.1016/j.pcd.2020.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/15/2020] [Indexed: 11/23/2022]
Abstract
AIM To describe the clinical outcomes of patients with type 2 diabetes (DM2) and hypertension (HT) who received treatment and care at a specialized primary healthcare facility. METHODS A cross-sectional study was conducted and data retrieved from 349 patient's records. The clinical outcomes were linked to individual risk factors and demographic profiles. Patients with HT who had at least four blood pressure (BP) measurements and patients with DM2 who had at least two HbA1c measurements in a 12-month period were included. RESULTS More females had controlled HT than males. There was no sex difference observed for the control of DM2. Patients with HT visited the clinic for a median period of 96 days (IQR 35-257). Among 59.1% (n = 159) patients who achieved at least one controlled BP measurement, 64.2% (n = 102) had a controlled BP at the last visit. Patients with DM2 visited the clinic for a median period of 851 days (IQR 449.5-1254). From a total of 34 patients (43.5%) who achieved at least one controlled HbA1c measurement, 55.9% (n = 19) had a controlled HbA1c at the last visit. CONCLUSION Despite the difference in patient profiles, more than half of the patients who received specialised DM2 and HT care managed to achieve BP and HbA1c control.
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Affiliation(s)
- Leisha P Genade
- Perinatal HIV Research Unit, Chris Hani Baragwaneth Soweto, University of Witwatersrand, Johannesburg, South Africa; School of Health Systems and Public Health, University of Pretoria, Faculty of Health Sciences, HW Snyman Building, University of Pretoria, Private Bag x20, Hatfield, 0028, South Africa
| | - Elizabeth M Webb
- School of Health Systems and Public Health, University of Pretoria, Faculty of Health Sciences, HW Snyman Building, University of Pretoria, Private Bag x20, Hatfield, 0028, South Africa.
| | - Jacqueline E Wolvaardt
- School of Health Systems and Public Health, University of Pretoria, Faculty of Health Sciences, HW Snyman Building, University of Pretoria, Private Bag x20, Hatfield, 0028, South Africa
| | - Charl Janse Van Rensburg
- Biostatistics Research Unit, South African Medical Research Council SAMRC, 1 Soutpansberg, Hatfield, Pretoria, South Africa
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Turner-Moss E, Razavi A, Unwin N, Foley L. Evidence for factors associated with diet and physical activity in African and Caribbean countries. Bull World Health Organ 2021; 99:464-472I. [PMID: 34108757 PMCID: PMC8164182 DOI: 10.2471/blt.20.269308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 01/28/2021] [Accepted: 02/11/2021] [Indexed: 12/18/2022] Open
Abstract
Objective To identify and describe summarized evidence on factors associated with diet and physical activity in low- and middle-income countries in Africa and the Caribbean by performing a scoping review of reviews. Methods We searched the Medline®, LILACS, Scopus, Global Health and Web of Science databases for reviews of factors associated with diet or physical activity published between 1998 and 2019. At least 25% of studies in reviews had to come from African or Caribbean countries. Factors were categorized using Dahlgren and Whitehead's social model of health. There was no quality appraisal. Findings We identified 25 reviews: 13 on diet, four on physical activity and eight on both. Eighteen articles were quantitative systematic reviews. In 12 reviews, 25-50% of studies were from Africa or the Caribbean. Only three included evidence from the Caribbean. Together, the 25 reviews included primary evidence published between 1926 and 2018. Little of the summarized evidence concerned associations between international health or political factors and diet or associations between any factor and physical activity across all categories of the social model of health. Conclusion The scoping review found a wide range of factors reported to be associated with diet and physical activity in Africa and the Caribbean, but summarized evidence that could help inform policies encouraging behaviours linked to healthy diets and physical activity in these regions were lacking. Further reviews are needed to inform policy where the evidence exists, and to establish whether additional primary research is needed.
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Affiliation(s)
- Eleanor Turner-Moss
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, England
| | - Ahmed Razavi
- Global Public Health Division, Public Health England, London, England
| | - Nigel Unwin
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, England
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, England
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Rivas-Echeverría CA, Thirlwell C, Molina LI, Rivas FI, Sánchez RE, González SB, Rivas CA. Sleep apnea, "the Ugly Duckling of the Cinderellas" in cardiovascular prevention and rehabilitation. Panminerva Med 2021; 63:133-145. [PMID: 33709678 DOI: 10.23736/s0031-0808.21.04273-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cardiovascular diseases are the leading cause of death and account for the largest share of health expenditure worldwide, mainly invested in hospital and secondary care. Prevention and rehabilitation strategies are nearly neglected, therefore "the Cinderellas," in the health-care budget. The World Health Organization has proposed cost-effective interventions to reduce the impact of cardiovascular diseases that include polydrug treatment for hypertension and diabetes, counselling, diet, exercise, and others. Obstructive sleep apnea is not even mentioned among these interventions; consequently, it could be "the Ugly Duckling of the Cinderellas." Obstructive sleep apnea (OSA) is characterized by the presence of obstructive apneas or hypopneas during sleep, accompanied by hypoxia; and it is a highly prevalent but under-diagnosed condition. Although awareness of sleep apnea has recently increased most facts about it remains ignored by many. Robust evidence suggests that OSA is associated with, or is an independent risk factor for, hypertension, cerebrovascular disease, ischemic heart disease, heart failure and arrhythmias and that its prevalence among some of these cardiovascular diseases is higher than 80%. The efficacy of continuous positive airway pressure treatment for obstructive sleep apnea has been established. If obstructive sleep apnea plays a significant role in cardiovascular diseases, then screening and timely appropriate treatment could reduce morbidity and mortality. Thus, the public health and economic impact of these conditions could be included in the "best buy" list of interventions. This narrative review discusses the relationship between OSA and cardiovascular diseases and how neglected the link is.
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Affiliation(s)
- Carlos A Rivas-Echeverría
- The Glenfield Surgery, NHS, Leicester, UK - .,SLEEPCARE Clinic of Respiratory and Sleep Medicine, Soria, Spain -
| | | | | | - Francklin I Rivas
- Department of Information Technology, Federico Santa María Technical University, Valparaíso, Chile
| | - Racely E Sánchez
- SLEEPCARE Clinic of Respiratory and Sleep Medicine, Soria, Spain
| | | | - Carlos A Rivas
- Faculty of Medicine, University of Navarra, Pamplona, Spain
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Marten R, Mikkelsen B, Shao R, Dal Zennaro L, Berdzuli N, Fernando T, Hammerich A, Hennis A, Shin HR, Shongwe S, Ghaffar A. Committing to implementation research for health systems to manage and control non-communicable diseases. Lancet Glob Health 2021; 9:e108-e109. [PMID: 33357502 PMCID: PMC7815625 DOI: 10.1016/s2214-109x(20)30485-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva 1202, Switzerland
| | - Bente Mikkelsen
- Non-Communicable Diseases Department, WHO, Geneva 1202, Switzerland
| | - Ruitai Shao
- Non-Communicable Diseases Department, WHO, Geneva 1202, Switzerland
| | - Livia Dal Zennaro
- Alliance for Health Policy and Systems Research, WHO, Geneva 1202, Switzerland
| | - Nino Berdzuli
- Regional Office for Europe, WHO, Copenhagen, Denmark
| | | | - Asmus Hammerich
- Regional Office for the Eastern Mediterranean, WHO, Cairo, Egypt
| | - Anselm Hennis
- Regional Office for the Americas, WHO, Washington, DC, USA
| | - Hai-Rim Shin
- Regional Office for the Western Pacific, WHO, Manila, Philippines
| | - Steven Shongwe
- Regional Office for Africa, WHO, Brazzaville, Republic of Congo
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, WHO, Geneva 1202, Switzerland
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Moucheraud C, Kawale P, Kafwafwa S, Bastani R, Hoffman RM. Health care workers' experiences with implementation of "screen and treat" for cervical cancer prevention in Malawi: A qualitative study. Implement Sci Commun 2020; 1:112. [PMID: 33317633 PMCID: PMC7734769 DOI: 10.1186/s43058-020-00097-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/25/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cervical cancer remains a major cause of mortality and morbidity in low- and middle-income countries, despite the availability of effective prevention approaches. "Screen and treat" (a single-visit strategy to identify and remove abnormal cervical cells) is the recommended secondary prevention approach in low-resource settings, but there has been relatively scarce robust implementation science evidence on barriers and facilitators to providing "screen and treat" from the provider perspective, or about thermocoagulation as a lesion removal technique. METHODS Informed by the Consolidated Framework for Implementation Research (CFIR), we conducted interviews with ten experienced "screen and treat" providers in Malawi. We asked questions based on the CFIR Guide, used the CFIR Guide codebook for a descriptive analysis in NVivo, and added recommended modifications for studies in low-income settings. RESULTS Seven CFIR constructs were identified as positively influencing implementation, and six as negatively influencing implementation. The two strong positive influences were the relative advantage of thermocoagulation versus cryotherapy (Innovation Characteristics) and respondents' knowledge and beliefs about providing "screen and treat" (Individual Characteristics). The two strong negative influences were the availability of ongoing refresher trainings to stay up-to-date on skills (Inner Setting, Implementation Climate) and insufficient resources (staffing, infrastructure, supplies) to provide "screen and treat" to all women who need it (Inner Setting, Readiness for Implementation). Weak positive factors included perceived scalability and access to knowledge/information, as well as compatibility, leadership engagement, and team characteristics, but these latter three were mixed in valence. Weak negative influences were structural characteristics and donor priorities; and mixed but weakly negative influences were relative priority and engaging clients. Cross-cutting themes included the importance of broad buy-in (including different cadres of health workers and leadership at the facility and in the government) and the opportunities and challenges of offering integrated care (screening plus other services). CONCLUSIONS Although "screen and treat" is viewed as effective and important, many implementation barriers remain. Our findings suggest that implementation strategies will need to be multi-level, include a diverse set of stakeholders, and explicitly address both screening and treatment.
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Affiliation(s)
- Corrina Moucheraud
- University of California Fielding School of Public Health, Los Angeles, CA USA
| | - Paul Kawale
- African Institute for Development Policy, Lilongwe, Malawi
| | | | - Roshan Bastani
- University of California Fielding School of Public Health, Los Angeles, CA USA
| | - Risa M. Hoffman
- University of California Geffen School of Medicine, Los Angeles, CA USA
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Tesema A, Joshi R, Abimbola S, Ajisegiri WS, Narasimhan P, Peiris D. Addressing barriers to primary health-care services for noncommunicable diseases in the African Region. Bull World Health Organ 2020; 98:906-908. [PMID: 33293751 PMCID: PMC7716106 DOI: 10.2471/blt.20.271239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Azeb Tesema
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, Australia
| | - Whenayon Simeon Ajisegiri
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
| | | | - David Peiris
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
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Ahmed KY, Abrha S, Page A, Arora A, Shiferaw S, Tadese F, Seifu CN, Yeneabat T, Alemu E, Gebremichael DY, Seiko A, Ogbo FA. Trends and determinants of underweight and overweight/obesity among urban Ethiopian women from 2000 to 2016. BMC Public Health 2020; 20:1276. [PMID: 32838771 PMCID: PMC7447570 DOI: 10.1186/s12889-020-09345-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 08/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nutritional, epidemiological and demographic transitions have been associated with the emergence of the double burden of malnutrition globally. In Ethiopia, there has been no nationally representative investigation of trends and determinants of both underweight and overweight/obesity among urban women. This study examined the trends and determinants of underweight and overweight/obesity in urban Ethiopian women from 2000 to 2016. METHODS Trends in the prevalence of underweight and overweight/obesity were investigated based on a series of the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 2559), 2005 (n = 1112), 2011 (n = 3569), and 2016 (n = 3106). Multivariable multinomial logistic regression was used to investigate the association between socioeconomic, demographic, behavioural, and community-level factors with underweight and overweight/obesity. RESULTS The prevalence of underweight in urban Ethiopian women reduced significantly from 23.2% (95% confidence interval [CI]: 20.3, 26.3%) in 2000 to 14.8% (95% CI: 13.1, 16.7%) in 2016, while overweight/obesity increased significantly from 10.9% (95% CI: 9.1, 13.0%) in 2000 to 21.4% (95% CI: 18.2, 25.1%) in 2016. Urban women from rich households and those who had never married were less likely to be underweight. Urban women who were from wealthy households and those who attained at least secondary education were more likely to be overweight/obese. Women who were informally employed and listened to the radio were less likely to be overweight/obese compared to those who were unemployed and did not listen to the radio, respectively. CONCLUSION The prevalence of overweight/obesity increased from 2000 to 2016, with a concurrent reduction in the prevalence of underweight. Interventions aiming to reduce overweight and obesity should target urban women with higher education, those who resided in wealthier households and those who watched the television.
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Affiliation(s)
- Kedir Y. Ahmed
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
- College of Medicine and Health Sciences, Samara University, Samara-Logia, Ethiopia
| | - Solomon Abrha
- School of Public Health, College of Medicine and Health Sciences, Wolayta Sodo University, Wolayta Sodo, Ethiopia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
| | - Amit Arora
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
- School of Health Sciences, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, Sydney, NSW Australia
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Westmead, Sydney, NSW Australia
| | - Solomon Shiferaw
- School of Public Health, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fentaw Tadese
- College of Medicine and Health Sciences, School of Public Health, Wollo University, Dessie, Ethiopia
| | - Canaan Negash Seifu
- School of Nursing and Midwifery, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
| | - Tebikew Yeneabat
- Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW Australia
| | - Emana Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Abdulaziz Seiko
- CARE Ethiopia, Partner for The Resilience Project, Afar, Samara-Logia, Ethiopia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW Australia
- General Practice Unit, Prescot Specialist Medical Centre, Makurdi, Benue State Nigeria
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Hertz JT, Sakita FM, Kweka GL, Bloomfield GS, Bartlett JA, Tarimo TG, Temu G, Bettger JP, Thielman NM. Effect of a Triage-Based Screening Protocol on Diagnosis and Treatment of Acute Coronary Syndrome in a Tanzanian Emergency Department: A Prospective Pre-Post Study. J Am Heart Assoc 2020; 9:e016501. [PMID: 32772764 PMCID: PMC7660831 DOI: 10.1161/jaha.120.016501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/08/2020] [Indexed: 01/07/2023]
Abstract
Background Evidence suggests that acute coronary syndrome (ACS) is underdiagnosed in sub-Saharan Africa. Triage-based interventions have improved ACS diagnosis and management in high-income settings but have not been evaluated in sub-Saharan African emergency departments (EDs). Our objective was to estimate the effect of a triage-based screening protocol on ACS diagnosis and care in a Tanzanian ED. Methods and Results All adults presenting to a Tanzanian ED with chest pain or shortness of breath were prospectively enrolled. Treatments and clinician-documented diagnoses were observed and recorded. In the preintervention phase (August 2018 through January 2019), ACS testing and treatment were dictated by physician discretion, as per usual care. A triage-based protocol was then introduced, and in the postintervention phase (January 2019 through October 2019), research assistants performed ECG and point-of-care troponin I testing on all patients with chest pain or shortness of breath upon ED arrival. Pre-post analyses compared ACS care between phases. Of 1020 total participants (339 preintervention phase, 681 postintervention phase), mean (SD) age was 58.9 (19.4) years. Six (1.8%) preintervention participants were diagnosed with ACS, versus 83 (12.2%) postintervention participants (odds ratio [OR], 7.51; 95% CI, 3.52-19.7; P<0.001). Among all participants, 3 (0.9%) preintervention participants received aspirin, compared with 50 (7.3%) postintervention participants (OR, 8.45; 95% CI, 3.07-36.13; P<0.001). Conclusions Introduction of a triage-based ACS screening protocol in a Tanzanian ED was associated with significant increases in ACS diagnoses and aspirin administration. Additional research is needed to determine the effect of ED-based interventions on ACS care and clinical end points in sub-Saharan Africa.
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Affiliation(s)
- Julian T. Hertz
- Department of SurgeryDuke University School of MedicineDurhamNC
- Duke Global Health InstituteDuke UniversityDurhamNC
| | - Francis M. Sakita
- Department of Emergency MedicineKilimanjaro Christian Medical CentreMoshiTanzania
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
| | | | - Gerald S. Bloomfield
- Duke Global Health InstituteDuke UniversityDurhamNC
- Department of MedicineDuke University School of MedicineDurhamNC
| | - John A. Bartlett
- Duke Global Health InstituteDuke UniversityDurhamNC
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of MedicineDuke University School of MedicineDurhamNC
| | | | - Gloria Temu
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of MedicineKilimanjaro Christian Medical CentreMoshiTanzania
| | - Janet P. Bettger
- Duke Global Health InstituteDuke UniversityDurhamNC
- Department of Orthopaedic SurgeryDuke University School of MedicineDurhamNC
| | - Nathan M. Thielman
- Duke Global Health InstituteDuke UniversityDurhamNC
- Department of MedicineDuke University School of MedicineDurhamNC
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Achwoka D, Mutave R, Oyugi JO, Achia T. Tackling an emerging epidemic: the burden of non-communicable diseases among people living with HIV/AIDS in sub-Saharan Africa. Pan Afr Med J 2020; 36:271. [PMID: 33088400 PMCID: PMC7546015 DOI: 10.11604/pamj.2020.36.271.22810] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022] Open
Abstract
Sub-Saharan Africa (SSA) is at a crossroad. Over the last decade, successes in the scale up of HIV care and treatment programs has led to a burgeoning number of people living with HIV (PLHIV) in care. At the same time, an epidemiologic shift has been witnessed with a concomitant rise in non-communicable diseases (NCD) related morbidity and mortality. Against low levels of domestic financing and strained healthcare delivery platforms, the NCD-HIV syndemic threatens to reverse gains made in care of people living with HIV (PLHIV). NCDs are the global health disruptor of the future. In this review, we draw three proposals for low and middle-income countries (LMICs) based on existing literature, that if contextually adopted would mitigate against impending poor NCD-HIV care outcomes. First, we call for an adoption of universal health coverage by countries in SSA. Secondly, we recommend leveraging on comparably formidable HIV healthcare delivery platforms through integration. Lastly, we advocate for institutional-response building through a multi-stakeholder governance and coordination mechanism. Based on our synthesis of existing literature, adoption of these three strategies would be pivotal to sustain gains made so far for NCD-HIV care in SSA.
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Affiliation(s)
- Dunstan Achwoka
- University of Nairobi, Institute of Tropical and Infectious Diseases (UNITID), College of Health Sciences, Nairobi, Kenya
| | - Regina Mutave
- University of Nairobi, Institute of Tropical and Infectious Diseases (UNITID), College of Health Sciences, Nairobi, Kenya
| | - Julius Otieno Oyugi
- University of Nairobi, Institute of Tropical and Infectious Diseases (UNITID), College of Health Sciences, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Thomas Achia
- University of Nairobi, Institute of Tropical and Infectious Diseases (UNITID), College of Health Sciences, Nairobi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Castillo-Carandang NT, Buenaventura RD, Chia YC, Do Van D, Lee C, Duong NL, Ng CH, Robles YR, Santoso A, Sigua HS, Sukonthasarn A, Tan R, Viora E, Zakaria H, Brizuela GE, Ratnasingham P, Thomas M, Majumdar A. Moving Towards Optimized Noncommunicable Disease Management in the ASEAN Region: Recommendations from a Review and Multidisciplinary Expert Panel. Risk Manag Healthc Policy 2020; 13:803-819. [PMID: 32765135 PMCID: PMC7371561 DOI: 10.2147/rmhp.s256165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/12/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality in the Association of Southeast Asian Nations (ASEAN) member states. Progress has been slow despite the World Health Organization action plan for the prevention and control of NCDs in the region. This paper presents recommendations focused on practical strategies for optimizing NCD management in the ASEAN region. Methods A multidisciplinary group of experts from six ASEAN member states convened for two face-to-face meetings to discuss barriers and possible recommendations for optimizing NCD management, focused on cardiovascular diseases and mental disorders, in the region. Multiple approaches, ie, analysis of insights from the meetings and a review of existing literature on NCD programs in the ASEAN region were followed. The proposed recommendations were also based on selected successful interventions in ASEAN member states, thus providing actionable strategies. Results The gaps identified in NCD management for cardiovascular diseases and mental disorders in the ASEAN region were classified into gaps relating to policies and to clinical and public health practice. The proposed solutions addressing policy gaps include fostering multisectoral public–private partnerships, employing “whole-of-government” and “whole-of-society” approaches and promoting “health-in-all policies approach” to manage issues with financing, accessibility, efficiency and quality of health services. Whereas proposed solutions to bridge clinical and public health practice gaps entail strengthening primary care services, building the capacity of trained healthcare workers and employing collaborative care for holistic management of patients. Conclusion The scale of premature and preventable deaths from NCDs in the ASEAN region remains a serious public health concern and requires a “whole-of-system approach”. The interventions proposed in this paper build on regional collaborations and knowledge sharing to help develop a concerted and targeted response to NCDs.
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Affiliation(s)
- Nina T Castillo-Carandang
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; and Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Robert D Buenaventura
- Department of Psychiatry, Manila Theological College - College of Medicine, Manila, Philippines
| | - Yook-Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Selangor, Malaysia
| | - Dung Do Van
- The University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Cheng Lee
- National Addictions Management Service, Institute of Mental Health, Singapore
| | - Ngoc Long Duong
- Department of Research, Education and Technology, Vietnam National Heart Institute, Hanoi, Vietnam
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Yolanda R Robles
- College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology, Vascular Medicine, National Cardiovascular Centre - Harapan Kita Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Helen S Sigua
- University of the Philippines Open University, Laguna, Philippines
| | - Apichard Sukonthasarn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Roger Tan
- Roger Kidney Clinic, Gleneagles Hospital, Singapore
| | - Eka Viora
- Indonesia Psychiatrist Association, Jakarta, Indonesia
| | - Hazli Zakaria
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Grace E Brizuela
- Research, Development and Medical, Pfizer Upjohn, Manila, Philippines
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Schouw DD, Mash R. Cost and consequence analysis of the Healthy Choices at Work programme to prevent non-communicable diseases in a commercial power plant, South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e8. [PMID: 32634016 PMCID: PMC7343951 DOI: 10.4102/phcfm.v12i1.2217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 03/17/2020] [Accepted: 01/15/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The workplace is an ideal setting for the implementation of a health promotion programmes to prevent non-communicable diseases (NCD). There are limited resources assigned to workplace health promotion programmes in low-and middle-income countries (LMIC). AIM This study aimed to conduct a cost and consequence analysis of the Healthy Choices at Work programme. SETTING This study was conducted at a commercial power plant in South Africa. METHODS Incremental costs were obtained for the activities of the Healthy Choices at Work programme over a two-year period. A total of 156 employees were evaluated in the intervention, although the effect was experienced by all employees. An annual health risk factor assessment at baseline and follow up evaluated the consequences of the programme. RESULTS The total incremental costs over the two-year period accumulated to $4015 for 1743 employees. The cost per employee on an annual basis was $1.15 and was associated with a -10.2mmHg decrease in systolic blood pressure, -3.87mmHg in diastolic blood pressure, -0.45mmol/l in total cholesterol and significant improvement in harmful alcohol use, fruit and vegetable intake and physical inactivity (p 0.001). There was no correlation between sickness absenteeism and risk factors for NCDs. CONCLUSION The cost to implement the multicomponent HCW programme was low with significant beneficial consequences in transforming the workplace environment and reducing risks factors for NCDs. Findings of this study will be useful for small, medium and large organisations, the national department of health, and similar settings in LMICs.
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Affiliation(s)
- Darcelle D Schouw
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town.
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