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Yousuf AM, Abdikarim H, Hussein MA, Abdi AN, Warsame HI, Muse AH. Cardiovascular disease prevalence and associated factors in a low-resource setting: A multilevel analysis from Somalia's first demographic health survey. Curr Probl Cardiol 2024; 49:102861. [PMID: 39317303 DOI: 10.1016/j.cpcardiol.2024.102861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 09/21/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are a leading cause of death globally, with low- and middle-income countries disproportionately affected. Somalia, a nation grappling with persistent humanitarian crises and a rising burden of non-communicable diseases, has limited data on CVD prevalence and its risk factors. This study, the first of its kind in Somalia, leverages data from the inaugural nationally representative demographic health survey to examine the prevalence and associated factors of CVD among Somali adults. METHODS A cross-sectional analysis was conducted using data from the 2020 Somali Demographic Health Survey, encompassing 5062 participants aged 35 years and older. Multilevel logistic regression was utilized to explore associations between individual-level and community-level factors and CVD prevalence. Individual-level factors included age, sex, marital status, education, wealth, smoking, and khat chewing. Community-level factors encompassed region and type of residence. RESULTS The prevalence of CVD in Somalia was found to be 7.1%. Community-level factors were significantly associated with CVD prevalence. Residents of Sool region exhibited higher odds of CVD, while those in Banadir region had lower odds. Nomadic communities demonstrated lower CVD risk compared to urban areas. School attendance was marginally associated with CVD risk. After controlling for other factors, sex of the household head remained significant, with females having slightly lower odds of CVD. CONCLUSION This study underscores the critical influence of community-level factors, particularly region and type of residence, on CVD prevalence in Somalia. The findings highlight the need for targeted interventions that address geographic disparities and promote healthy lifestyles within communities. Future research should delve deeper into the underlying mechanisms of these associations and explore the impact of individual-level factors like school attendance and sex on CVD risk.
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Affiliation(s)
- Abdirashid M Yousuf
- Faculty of Science and Humanities, School of Postgraduate Studies and Research (SPGSR), Amoud University, Borama 25263, Somalia.
| | - Hodo Abdikarim
- Faculty of Science and Humanities, School of Postgraduate Studies and Research (SPGSR), Amoud University, Borama 25263, Somalia.
| | - Mohamed A Hussein
- Faculty of Science and Humanities, School of Postgraduate Studies and Research (SPGSR), Amoud University, Borama 25263, Somalia.
| | - Abdikadir N Abdi
- Faculty of Science and Humanities, School of Postgraduate Studies and Research (SPGSR), Amoud University, Borama 25263, Somalia.
| | - Harun I Warsame
- Freshman Department, Amoud University, Borama 25263, Awdal, Somalia.
| | - Abdisalam Hassan Muse
- Faculty of Science and Humanities, School of Postgraduate Studies and Research (SPGSR), Amoud University, Borama 25263, Somalia.
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Al-Ajlouni YA, Abouzid M, Tanashat M, Basheer AA, Al Ta'ani O, Bilgin-Badur N, Islam M. Temporal trends in lower extremity amputation in Middle East and North Africa (MENA) region: analysis of the GBD dataset 1990-2019. Int J Equity Health 2024; 23:178. [PMID: 39227932 PMCID: PMC11370275 DOI: 10.1186/s12939-024-02264-7] [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: 05/21/2024] [Accepted: 08/27/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. METHODS The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. RESULTS From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. CONCLUSION The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region.
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Affiliation(s)
- Yazan A Al-Ajlouni
- Department of Rehabilitation, Montefiore Medical Center, Bronx, NY, USA.
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA.
| | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St, Poznan, 60-806, Poland
- Doctoral School, Poznan University of Medical Sciences, Poznan, 60-812, Poland
| | | | - Ahmed Ahmed Basheer
- Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Beni Suef University, Beni Suef Governorate, Egypt
| | | | | | - Mohammad Islam
- Department of Physical Medicine and Rehabilitation, Metropolitan Hospital, New York, NY, USA
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Doh D, Dahwa R, Renzaho AMN. A Scoping Review of Non-Communicable Diseases among the Workforce as a Threat to Global Peace and Security in Low-Middle Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1143. [PMID: 39338026 PMCID: PMC11431123 DOI: 10.3390/ijerph21091143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/20/2024] [Accepted: 08/26/2024] [Indexed: 09/30/2024]
Abstract
Non-communicable diseases (NCDs) continue to pose a threat to public health. Although their impact on the workforce is widely recognized, there needs to be more understanding of how NCDs affect peace and security, particularly in low-middle-income countries. To address this, we conducted a scoping review and presented a narrative to explore how NCDs in the workforce threaten peace and security. Out of 570 papers screened, 34 articles, comprising 26 peer review and 8 grey literature, met the study criteria. Our findings reveal that while no study has drawn a direct relationship between NCDs in the workforce in LMICs and peace and security, several studies have demonstrated a relationship between NCDs and economic growth on one hand and economic growth and peace and security on the other. Therefore, using economic growth as a proximal factor, our findings show three pathways that link NCDs in the workforce to peace and security: (i) NCDs lead to low productivity and poor economic growth, which can threaten public peace and security; (ii) NCDs in the workforce can result in long-term care needs, which then puts pressure on public resources and have implications for public expenditure on peace and security; and (iii) household expenditures on caring for a family member with an NCD can destabilize families and create an unfavourable condition that threatens peace and security. This research highlights the dual threat of NCDs to health and security, as they impact human resources and community structures crucial for peace and security. The results underscore the importance of considering the workplace as a strategic setting for NCD prevention, which will have long-term implications for economic growth and peace and security.
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Affiliation(s)
- Daniel Doh
- School of Allied Health, University of Western Australia, Perth, WA 6009, Australia;
| | - Rumbidzai Dahwa
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box MP 167, Zimbabwe;
| | - Andre M. N. Renzaho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2060, Australia
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James O, Abbou-Abbas L, Vijayasingham L. Living with and managing type 1 diabetes in humanitarian settings: A qualitative synthesis of lived experience and stakeholder tacit knowledge. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003027. [PMID: 38905318 PMCID: PMC11192347 DOI: 10.1371/journal.pgph.0003027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/28/2024] [Indexed: 06/23/2024]
Abstract
Humanitarian health actors are beginning to better consider and manage non-communicable diseases, such as diabetes, in emergency and protracted crisis settings. However, a focus on the more globally prevalent type 2 diabetes (T2D) dominates. Blind spots prevail in the unmet needs for type 1 diabetes (T1D), a chronic autoimmune condition where individuals are unable to produce insulin, thereby dependent on lifelong insulin therapy and blood glucose management. Although some T1D management requirements overlap with those of T2D, the immediate risk of fatal complications following insulin therapy disruption, the earlier age of onset during childhood, adolescence or young adulthood, and its lower prevalence compared to T2D within communities and local health systems mean that T1D requires nuanced consideration and targeted interventions. Intending to inform program and policy design for people with T1D (PWT1D), we synthesized themes of lived experience from PLWT1D and their caregivers, and the tacit working knowledge of health providers and policymakers in the context of local humanitarian operations. Through a strategic search of health databases (up to July 2023), we identified 11 articles that include interview excerpts from PWT1D, caregivers, healthcare providers and policymakers about T1D management in humanitarian settings. We used reflexive thematic analysis to guide data extraction, coding, and synthesis, resulting in the identification of four overarching themes: food and insulin security, family relations, knowledge translation, and response to diagnosis. The narratives highlight harsh trade-offs made by PWT1D and their families in the face of insulin and food insecurity, as well as the damaging impact of low T1D education in families, communities and health systems. Targeted family and community-based solutions are urgently required, alongside systemic reforms and international collaboration to enable better T1D coping and management in humanitarian settings.
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Affiliation(s)
- Oria James
- MSc Public Health Graduate Class of 2023, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Linda Abbou-Abbas
- International Committee of the Red Cross, Beirut Delegation, Lebanon
- INSPECT-LB (Institut de Santé Publique, Epidemiologie Clinique et Toxicologie-Liban), Beirut, Lebanon
| | - Lavanya Vijayasingham
- NCD in Humanitarian Settings Research Group and Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Nguyen GT, Gauvreau C, Mansuri N, Wight L, Wong B, Neposlan J, Petricca K, Denburg A. Implementation factors of non-communicable disease policies and programmes for children and youth in low-income and middle-income countries: a systematic review. BMJ Paediatr Open 2024; 8:e002556. [PMID: 38830723 PMCID: PMC11149138 DOI: 10.1136/bmjpo-2024-002556] [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: 02/05/2024] [Accepted: 05/14/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Despite declared life-course principles in non-communicable disease (NCD) prevention and management, worldwide focus has been on older rather than younger populations. However, the burden from childhood NCDs has mounted; particularly in low-income and middle-income countries (LMICs). There is limited knowledge regarding the implementation of paediatric NCD policies and programmes in LMICs, despite their disproportionate burden of morbidity and mortality. We aimed to understand the barriers to and facilitators of paediatric NCD policy and programme implementation in LMICs. METHODS We systematically searched medical databases, Web of Science and WHOLIS for studies on paediatric NCD policy and programme implementation in LMICs. Screening and quality assessment were performed independently by researchers, using consensus to resolve differences. Data extraction was conducted within the WHO health system building-blocks framework. Narrative thematic synthesis was conducted. RESULTS 93 studies (1992-2020) were included, spanning 86 LMICs. Most were of moderate or high quality. 78% reported on paediatric NCDs outside the four major NCD categories contributing to the adult burden. Across the framework, more barriers than facilitators were identified. The most prevalently reported factors were related to health service delivery, with system fragmentation impeding the continuity of age-specific NCD care. A significant facilitator was intersectoral collaborations between health and education actors to deliver care in trusted community settings. Non-health factors were also important to paediatric NCD policies and programmes, such as community stakeholders, sociocultural support to caregivers and school disruptions. CONCLUSIONS Multiple barriers prevent the optimal implementation of paediatric NCD policies and programmes in LMIC health systems. The low sociopolitical visibility of paediatric NCDs limits their prioritisation, resulting in fragmented service delivery and constraining the integration of programmes across key sectors impacting children, including health, education and social services. Implementation research is needed to understand specific contextual solutions to improve access to paediatric NCD services in diverse LMIC settings.
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Affiliation(s)
- Gina T Nguyen
- University College Dublin School of Medicine, Dublin, Ireland
| | - Cindy Gauvreau
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Lisa Wight
- The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada
| | - Bryan Wong
- Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Josh Neposlan
- University of Western Ontario Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Kadia Petricca
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Avram Denburg
- Child Health and Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Amarasena L, Zwi K, Hu N, Lingam R, Raman S. Changing landscape of paediatric refugee health in South Western Sydney, Australia: a retrospective observational study. BMJ Open 2023; 13:e064497. [PMID: 37852766 PMCID: PMC10603544 DOI: 10.1136/bmjopen-2022-064497] [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: 09/06/2022] [Accepted: 07/04/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES To examine the changing health needs of refugee children and young people (CYP) entering Australia, in relation to key government policy changes. STUDY DESIGN Retrospective analysis of health service use data over 11 years. SETTING Paediatric refugee clinics in South Western Sydney (SWS), the Australian region with the largest annual resettlement of refugees. PARTICIPANTS Refugee CYP (≤25 years) attending the SWS paediatric refugee clinics for their first visit between 2009 and 2019. MEASURES Clinician defined health conditions categorised as communicable and non-communicable disease (NCD). RESULTS Data were analysed for 359 CYP, mean age 9.3 years; 212 male (59.1%). Most CYP (n=331, 92.2%) had health problems identified; 292 (81.3%) had ≥1 NCD and 24 (6.7%) had ≥1 communicable disease. The most frequent individual NCDs were dental disease (n=128, 35.7%) and vitamin D deficiency (n=72, 20.1%). Trend analysis showed increased odds of identifying an NCD from 2013 onwards (crude OR 1.77, 95% CI 1.06 to 2.96). Neurodevelopmental problems, especially Global Developmental Delay (n=31, 8.6%), emerged as more prevalent issues in the latter half of the decade. There were significantly increased odds of identifying a neurodevelopmental problem in 2016-2019, especially in 2016-2017 (adjusted OR 2.93, 95% CI 1.34 to 6.40). Key policy changes during this period included acceptance of refugees with disabilities from 2012, additional Australian Humanitarian Programme intake from the Eastern Mediterranean region and mandatory offshore processing for those seeking asylum by boat from 2013. In response to the changing needs, local health services adopted nurse-led primary healthcare screening, early childhood services, youth and disability clinics. CONCLUSIONS Refugee CYP in Australia are presenting with a growing burden of NCDs, with neurodevelopmental problems contributing. Government policy changes affect the sociodemographics of resettled populations, influencing health profiles. Paediatric refugee health services need to be responsive to the changing needs of these populations to optimise well-being.
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Affiliation(s)
- Lahiru Amarasena
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Karen Zwi
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Nan Hu
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Shanti Raman
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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Prusaczyk A, Bogdan M, Vinker S, Gujski M, Żuk P, Kowalska-Bobko I, Karczmarz S, Oberska J, Lewtak K. Health Care Organization in Poland in Light of the Refugee Crisis Related to the Military Conflict in Ukraine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3831. [PMID: 36900836 PMCID: PMC10001563 DOI: 10.3390/ijerph20053831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Poland is witnessing a migration crisis caused by the ongoing military conflict in Ukraine. In addition to housing and necessities, 1.8 million Ukrainians that had taken refuge in Poland must have access to medical care. We aim to propose a strategy for implementing the changes in the Polish health care system in response to the Ukrainian refugee crisis. METHODS A literature review on organizational changes in the functioning of health care systems during the migration crises worldwide in recent years and brainstorming in order to develop a strategy for implementing changes in the Polish health care system in response to the Ukrainian refugee crisis. RESULTS The proposed strategy for implementing the changes in the Polish health care system is based on building health care resilience and adaptation to different crises. The operational objectives of organization-related activities are: (1) preparation of medical facilities to provide help for refugees, (2) development and implementation of the communication system, (3) implementation of available digital solutions, (4) organization of the diagnostic and medical services, (5) and implementation of changes in the management of medical facilities. CONCLUSIONS Urgent reorganization is required to respond to an unavoidable increase in the demand for health care services.
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Affiliation(s)
| | - Magdalena Bogdan
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Mariusz Gujski
- Department of Public Health, Medical University of Warsaw, 00-097 Warsaw, Poland
| | - Paweł Żuk
- Medical and Diagnostic Center, 08-110 Siedlce, Poland
| | - Iwona Kowalska-Bobko
- Institute of Public Health, Faculty of Health Science, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | | | - Joanna Oberska
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland
| | - Katarzyna Lewtak
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland
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Shortland T, McGranahan M, Stewart D, Oyebode O, Shantikumar S, Proto W, Malik B, Yau R, Cobbin M, Sabouni A, Rudge G, Kidy F. A systematic review of the burden of, access to services for and perceptions of patients with overweight and obesity, in humanitarian crisis settings. PLoS One 2023; 18:e0282823. [PMID: 37093795 PMCID: PMC10124894 DOI: 10.1371/journal.pone.0282823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 02/23/2023] [Indexed: 04/25/2023] Open
Abstract
INTRODUCTION Excess body weight causes 4 million deaths annually across the world. The number of people affected by humanitarian crises stands at a record high level with 1 in 95 people being forcibly displaced. These epidemics overlap. Addressing obesity is a post-acute phase activity in non-communicable disease management in humanitarian settings. Information is needed to inform guidelines and timing of interventions. The objective of this review was to explore the prevalence of overweight and obesity in populations directly affected by humanitarian crises; the cascade of care in these populations and perceptions of patients with overweight and obesity. METHODS Literature searches were carried out in five databases. Grey literature was identified. The population of interest was non-pregnant, civilian adults who had experience of humanitarian crises (armed conflict, complex emergencies and natural disasters). All study types published from January 1st, 2011, were included. Screening, data extraction and quality appraisal were carried out in duplicate. A narrative synthesis is presented. RESULTS Fifty-six reports from forty-five studies were included. Prevalence estimates varied widely across the studies and by subgroups. Estimates of overweight and obesity combined ranged from 6.4% to 82.8%. Studies were heterogenous. Global distribution was skewed. Increasing adiposity was seen over time, in older adults and in women. Only six studies were at low risk of bias. Body mass index was the predominant measure used. There were no studies reporting cascade of care. No qualitative studies were identified. CONCLUSION Overweight and obesity varied in crisis affected populations but were rarely absent. Improved reporting of existing data could provide more accurate estimates. Worsening obesity may be prevented by acting earlier in long-term crises and targeting risk groups. The use of waist circumference would provide useful additional information. Gaps remain in understanding the existing cascade of care. Cultural norms around diet and ideal body size vary.
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Affiliation(s)
- Thomas Shortland
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Majel McGranahan
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Daniel Stewart
- National Public Health Specialty Training Programme, South West Training Scheme, Bristol, United Kingdom
| | - Oyinlola Oyebode
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Saran Shantikumar
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - William Proto
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Bassit Malik
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Roger Yau
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Maddie Cobbin
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | | - Gavin Rudge
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Farah Kidy
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Masis L, Kanya L, Kiogora J, Kiapi L, Tulloch C, Alani AH. Estimating treatment costs for uncomplicated diabetes at a hospital serving refugees in Kenya. PLoS One 2022; 17:e0276702. [PMID: 36288390 PMCID: PMC9604983 DOI: 10.1371/journal.pone.0276702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
Diabetes mellitus (DM) is increasing markedly in low- and middle-income countries where over three-quarters of global deaths occur due to non-communicable diseases. Unfortunately, these conditions are considered costly and often deprioritized in humanitarian settings with competing goals. Using a mixed methods approach, this study aimed to quantify the cost of outpatient treatment for uncomplicated type-1 (T1DM) and type-2 (T2DM) diabetes at a secondary care facility serving refugees in Kenya. A retrospective cost analysis combining micro- and gross-costings from a provider perspective was employed. The main outcomes included unit costs per health service activity to cover the total cost of labor, capital, medications and consumables, and overheads. A care pathway was mapped out for uncomplicated diabetes patients to identify direct and indirect medical costs. Interviews were conducted to determine inputs required for diabetes care and estimate staff time allocation. A total of 360 patients, predominantly Somali refugees, were treated for T2DM (92%, n = 331) and T1DM (8%, n = 29) in 2017. Of the 3,140 outpatient consultations identified in 2017; 48% (n = 1,522) were for males and 52% (n = 1,618) for females. A total of 56,144 tests were run in the setting, of which 9,512 (16.94%) were Random Blood Sugar (RBS) tests, and 90 (0.16%) HbA1c tests. Mean costs were estimated as: $2.58 per outpatient consultation, $1.37 per RBS test and $14.84 per HbA1c test. The annual pharmacotherapy regimens cost $91.93 for T1DM and $20.34 for T2DM. Investment in holistic and sustainable non-communicable disease management should be at the forefront of humanitarian response. It is expected to be beneficial with immediate implications on the COVID-19 response while also reducing the burden of care over time. Despite study limitations, essential services for the management of uncomplicated diabetes in a humanitarian setting can be modest and affordable. Therefore, integrating diabetes care into primary health care should be a fundamental pillar of long-term policy response by stakeholders.
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Affiliation(s)
- Lizah Masis
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Lucy Kanya
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- * E-mail:
| | | | - Lilian Kiapi
- International Rescue Committee, London, United Kingdom
| | - Caitlin Tulloch
- International Rescue Committee, New York City, NY, United States of America
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Harris P, Kirkland R, Masanja S, Le Feuvre P, Montgomery S, Ansbro É, Woodman M, Harris M. Strengthening the primary care workforce to deliver high-quality care for non-communicable diseases in refugee settings: lessons learnt from a UNHCR partnership. BMJ Glob Health 2022; 7:bmjgh-2021-007334. [PMID: 35798443 PMCID: PMC9272076 DOI: 10.1136/bmjgh-2021-007334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/27/2022] [Indexed: 12/21/2022] Open
Abstract
Non-communicable disease (NCD) prevention and care in humanitarian contexts has been a long-neglected issue. Healthcare systems in humanitarian settings have focused heavily on communicable diseases and immediate life-saving health needs. NCDs are a significant cause of morbidity and mortality in refugee settings, however, in many situations NCD care is not well integrated into primary healthcare services. Increased risk of poorer outcomes from COVID-19 for people living with NCDs has heightened the urgency of responding to NCDs and shone a spotlight on their relative neglect in these settings. Partnering with the United Nations Refugee Agency (UNHCR) since 2014, Primary Care International has provided clinical guidance and Training of Trainer (ToT) courses on NCDs to 649 health professionals working in primary care in refugee settings in 13 countries. Approximately 2300 healthcare workers (HCW) have been reached through cascade trainings over the last 6 years. Our experience has shown that, despite fragile health services, high staff turnover and competing clinical priorities, it is possible to improve NCD knowledge, skills and practice. ToT programmes are a feasible and practical format to deliver NCD training to mixed groups of HCW (doctors, nurses, technical officers, pharmacy technicians and community health workers). Clinical guidance must be adapted to local settings while co-creating an enabling environment for health workers is essential to deliver accessible, high-quality continuity of care for NCDs. On-going support for non-clinical systems change is equally critical for sustained impact. A shared responsibility for cascade training—and commitment from local health partners—is necessary to raise NCD awareness, influence local and national policy and to meet the UNHCR’s objective of facilitating access to integrated prevention and control of NCDs.
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Affiliation(s)
| | | | - Saimon Masanja
- School of Public Health, Catholic University of Health and Allied Sciences (CUHAS), Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Éimhín Ansbro
- Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, London, UK
| | - Michael Woodman
- The Office of the United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Ngaruiya C, Bernstein R, Leff R, Wallace L, Agrawal P, Selvam A, Hersey D, Hayward A. Systematic review on chronic non-communicable disease in disaster settings. BMC Public Health 2022; 22:1234. [PMID: 35729507 PMCID: PMC9210736 DOI: 10.1186/s12889-022-13399-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 05/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment. METHODS A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769). RESULTS Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity. CONCLUSIONS An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.
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Affiliation(s)
- Christine Ngaruiya
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA.
| | - Robyn Bernstein
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Rebecca Leff
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lydia Wallace
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, USA
| | - Denise Hersey
- Director, Dana Medical Library, University of Vermont, Burlington, VT, USA
| | - Alison Hayward
- Division of Global Emergency Medicine, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, USA
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Bhutta ZA, Salam RA, Gomber A, Lewis-Watts L, Narang T, Mbanya JC, Alleyne G. A century past the discovery of insulin: global progress and challenges for type 1 diabetes among children and adolescents in low-income and middle-income countries. Lancet 2021; 398:1837-1850. [PMID: 34774146 DOI: 10.1016/s0140-6736(21)02247-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/11/2022]
Abstract
Type 1 diabetes is on the rise globally; however, the burden of mortality remains disproportionate in low-income and middle-income countries (LMICs). As 2021 marks 100 years since the discovery of insulin, we revisit progress, global burden of type 1 diabetes trends, and understanding of the pathogenesis and management practices related to the disease. Despite much progress, inequities in access and availability of insulin formulations persist and are reflected in differences in survival and morbidity patterns related to the disease. Some of these inequities have also been exacerbated by health-system challenges during the COVID-19 pandemic. There is a clear opportunity to improve access to insulin and related essential technologies for improved management of type 1 diabetes in LMICs, especially as a part of universal health coverage. These improvements will require concerted action and investments in human resources, community engagement, and education for the timely diagnosis and management of type 1 diabetes, as well as adequate health-care financing. Further research in LMICs, especially those in Africa, is needed to improve our understanding of the burden, risk factors, and implementation strategies for managing type 1 diabetes.
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Affiliation(s)
- Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
| | | | - Apoorva Gomber
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Laura Lewis-Watts
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Tanya Narang
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - George Alleyne
- Pan American Health Organization and Regional Office of the World Health Organization, Washington DC, USA
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13
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Pérez-Lamela C, Franco I, Falqué E. Impact of High-Pressure Processing on Antioxidant Activity during Storage of Fruits and Fruit Products: A Review. Molecules 2021; 26:5265. [PMID: 34500700 PMCID: PMC8434123 DOI: 10.3390/molecules26175265] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022] Open
Abstract
Fruits and fruit products are an essential part of the human diet. Their health benefits are directly related to their content of valuable bioactive compounds, such as polyphenols, anthocyanins, or vitamins. Heat treatments allow the production of stable and safe products; however, their sensory quality and chemical composition are subject to significant negative changes. The use of emerging non-thermal technologies, such as HPP (High Pressure Processing), has the potential to inactivate the microbial load while exerting minimal effects on the nutritional and organoleptic properties of food products. HPP is an adequate alternative to heat treatments and simultaneously achieves the purposes of preservation and maintenance of freshness characteristics and health benefits of the final products. However, compounds responsible for antioxidant activity can be significantly affected during treatment and storage of HPP-processed products. Therefore, this article reviews the effect of HPP treatment and subsequent storage on the antioxidant activity (oxygen radical absorbance capacity (ORAC) assay), 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging capacity assay, ferric reducing antioxidant power (FRAP) assay, 2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) radical scavenging capacity assay or Trolox equivalent antioxidant capacity (TEAC) assay), and on the total phenolic, flavonoid, carotenoid, anthocyanin and vitamin contents of fruits and different processed fruit-based products.
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Affiliation(s)
- Concepción Pérez-Lamela
- Nutrition and Bromatology Group, Department of Analytical and Food Chemistry, Faculty of Sciences, University of Vigo—Ourense Campus, E32004 Ourense, Spain
| | - Inmaculada Franco
- Food Technology Area, Faculty of Sciences, University of Vigo—Ourense Campus, E32004 Ourense, Spain;
| | - Elena Falqué
- Analytical Chemistry Group, Department of Analytical and Food Chemistry, Faculty of Sciences, University of Vigo–Ourense Campus, E32004 Ourense, Spain;
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14
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Shah S, Padhani ZA, Als D, Munyuzangabo M, Gaffey MF, Ahmed W, Siddiqui FJ, Meteke S, Kamali M, Jain RP, Radhakrishnan A, Ataullahjan A, Das JK, Bhutta ZA. Delivering nutrition interventions to women and children in conflict settings: a systematic review. BMJ Glob Health 2021; 6:bmjgh-2020-004897. [PMID: 33832950 PMCID: PMC8039262 DOI: 10.1136/bmjgh-2020-004897] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/19/2021] [Accepted: 03/20/2021] [Indexed: 11/07/2022] Open
Abstract
Background Low/middle-income countries (LMICs) face triple burden of malnutrition associated with infectious diseases, and non-communicable diseases. This review aims to synthesise the available data on the delivery, coverage, and effectiveness of the nutrition programmes for conflict affected women and children living in LMICs. Methods We searched MEDLINE, Embase, CINAHL, and PsycINFO databases and grey literature using terms related to conflict, population, and nutrition. We searched studies on women and children receiving nutrition-specific interventions during or within five years of a conflict in LMICs. We extracted information on population, intervention, and delivery characteristics, as well as delivery barriers and facilitators. Data on intervention coverage and effectiveness were tabulated, but no meta-analysis was conducted. Results Ninety-one pubblications met our inclusion criteria. Nearly half of the publications (n=43) included population of sub-Saharan Africa (n=31) followed by Middle East and North African region. Most publications (n=58) reported on interventions targeting children under 5 years of age, and pregnant and lactating women (n=27). General food distribution (n=34), micronutrient supplementation (n=27) and nutrition assessment (n=26) were the most frequently reported interventions, with most reporting on intervention delivery to refugee populations in camp settings (n=63) and using community-based approaches. Only eight studies reported on coverage and effectiveness of intervention. Key delivery facilitators included community advocacy and social mobilisation, effective monitoring and the integration of nutrition, and other sectoral interventions and services, and barriers included insufficient resources, nutritional commodity shortages, security concerns, poor reporting, limited cooperation, and difficulty accessing and following-up of beneficiaries. Discussion Despite the focus on nutrition in conflict settings, our review highlights important information gaps. Moreover, there is very little information on coverage or effectiveness of nutrition interventions; more rigorous evaluation of effectiveness and delivery approaches is needed, including outside of camps and for preventive as well as curative nutrition interventions. PROSPERO registration number CRD42019125221.
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Affiliation(s)
- Shailja Shah
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zahra Ali Padhani
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Daina Als
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mariella Munyuzangabo
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle F Gaffey
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wardah Ahmed
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fahad J Siddiqui
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.,Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Sarah Meteke
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
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15
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Gaffey MF, Waldman RJ, Blanchet K, Amsalu R, Capobianco E, Ho LS, Khara T, Martinez Garcia D, Aboubaker S, Ashorn P, Spiegel PB, Black RE, Bhutta ZA. Delivering health and nutrition interventions for women and children in different conflict contexts: a framework for decision making on what, when, and how. Lancet 2021; 397:543-554. [PMID: 33503457 DOI: 10.1016/s0140-6736(21)00133-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/06/2020] [Accepted: 10/01/2020] [Indexed: 01/07/2023]
Abstract
Existing global guidance for addressing women's and children's health and nutrition in humanitarian crises is not sufficiently contextualised for conflict settings specifically, reflecting the still-limited evidence that is available from such settings. As a preliminary step towards filling this guidance gap, we propose a conflict-specific framework that aims to guide decision makers focused on the health and nutrition of women and children affected by conflict to prioritise interventions that would address the major causes of mortality and morbidity among women and children in their particular settings and that could also be feasibly delivered in those settings. Assessing local needs, identifying relevant interventions from among those already recommended for humanitarian settings or universally, and assessing the contextual feasibility of delivery for each candidate intervention are key steps in the framework. We illustratively apply the proposed decision making framework to show what a framework-guided selection of priority interventions might look like in three hypothetical conflict contexts that differ in terms of levels of insecurity and patterns of population displacement. In doing so, we aim to catalyse further iteration and eventual field-testing of such a decision making framework by local, national, and international organisations and agencies involved in the humanitarian health response for women and children affected by conflict.
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Affiliation(s)
- Michelle F Gaffey
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ronald J Waldman
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA; Doctors of the World USA, New York, NY, USA
| | - Karl Blanchet
- The Geneva Centre of Humanitarian Studies, University of Geneva, The Graduate Institute, Geneva, Switzerland; Health in Humanitarian Crises Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ribka Amsalu
- Save the Children, San Francisco, CA, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, USA
| | - Emanuele Capobianco
- International Federation of Red Cross and Red Crescent Societies, Geneva, Switzerland
| | - Lara S Ho
- International Rescue Committee, Washington, DC, USA; Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Daniel Martinez Garcia
- Women and Child Health Unit, Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
| | | | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Paul B Spiegel
- Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Robert E Black
- Institute for International Programs, Johns Hopkins University, Baltimore, MD, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
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