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Manyara AM, Mwaniki E, Gill JMR, Gray CM. Perceptions of diabetes risk and prevention in Nairobi, Kenya: A qualitative and theory of change development study. PLoS One 2024; 19:e0297779. [PMID: 38349938 PMCID: PMC10863861 DOI: 10.1371/journal.pone.0297779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Type 2 diabetes is increasing in Kenya, especially in urban settings, and prevention interventions based on local evidence and context are urgently needed. Therefore, this study aimed to explore diabetes risk and co-create a diabetes prevention theory of change in two socioeconomically distinct communities to inform future diabetes prevention interventions. METHODS In-depth interviews were conducted with middle-aged residents in two communities in Nairobi (one low-income (n = 15), one middle-income (n = 14)), and thematically analysed. The theory of change for diabetes prevention was informed by analysis of the in-depth interviews and the Behaviour Change Wheel framework, and reviewed by a sub-set (n = 13) of interviewees. RESULTS The key factors that influenced diabetes preventive practices in both communities included knowledge and skills for diabetes prevention, understanding of the benefits/consequences of (un)healthy lifestyle, social influences (e.g., upbringing, societal perceptions), and environmental contexts (e.g., access to (un)healthy foods and physical activity facilities). The proposed strategies for diabetes prevention included: increasing knowledge and understanding about diabetes risk and preventive measures particularly in the low-income community; supporting lifestyle modification (e.g., upskilling, goal setting, action planning) in both communities; identifying people at high risk of diabetes through screening in both communities; and creating social and physical environments for lifestyle modification (e.g., positive social influences on healthy living, access to healthy foods and physical activity infrastructure) particularly in the low-income community. Residents from both communities agreed that the strategies were broadly feasible for diabetes prevention but proposed the addition of door-to-door campaigns and community theatre for health education. However, residents from the low-income community were concerned about the lack of government prioritisation for implementing population-level interventions, e.g., improving access to healthy foods and physical activity facilities/infrastructure. CONCLUSION Diabetes prevention initiatives in Kenya should involve multicomponent interventions for lifestyle modification including increasing education and upskilling at individual level; promoting social and physical environments that support healthy living at population level; and are particularly needed in low-income communities.
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Affiliation(s)
- Anthony Muchai Manyara
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Department of Health Systems Management and Public Health, Technical University of Kenya, Nairobi, Kenya
- Global Health and Ageing Research Unit, University of Bristol, Bristol, United Kingdom
| | - Elizabeth Mwaniki
- Department of Health Systems Management and Public Health, Technical University of Kenya, Nairobi, Kenya
| | - Jason M. R. Gill
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M. Gray
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
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潘 杰, 王 秀, 王 朝, 徐 东, 邹 锟, 李 芹. [Evolution and Application of Disease Control Priorities]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:95-100. [PMID: 38322541 PMCID: PMC10839486 DOI: 10.12182/20240160603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Indexed: 02/08/2024]
Abstract
Disease control priority (DCP) is an important public health intervention strategy. Diseases that should be prioritized for prevention and control are first screened with a series of criteria, including the severity of the disease burden, the effectiveness of disease control technologies, the prevention and control capacity of the existing health system, etc. Then, the prevention and control technologies for these diseases undergo qualitative evaluation (eg, face-to-face interviews, expert consultation, workshops, etc) and quantitative evaluation (eg, cost-benefit analysis, multi-criteria decision analysis, etc). Finally, the public health initiatives that should be prioritized are identified. From the conception of the idea, to the formal proposition of the concept, to guidance for practice, DCP has gone through more than 70 years of development. Through DCP, significant contributions has been made to improving the efficiency of health care service systems and promoting the health of populations in developing countries. Herein, we systematically reviewed the background, development history, realization method, and practical applications of DCP, focusing on exploring the application potential of DCP in health governance and providing technical support and decision-making reference for the comprehensive promotion of the Healthy China Initiative.
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Affiliation(s)
- 杰 潘
- 四川大学华西公共卫生学院/四川大学华西第四医院 HEOA Group (成都 610041)HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- 四川大学中国南亚研究中心 (成都 610064)China Center for South Asian Studies, Sichuan University, Chengdu 610064, China
| | - 秀丽 王
- 四川大学华西公共卫生学院/四川大学华西第四医院 HEOA Group (成都 610041)HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- 四川大学中国南亚研究中心 (成都 610064)China Center for South Asian Studies, Sichuan University, Chengdu 610064, China
| | - 朝辉 王
- 四川大学华西公共卫生学院/四川大学华西第四医院 HEOA Group (成都 610041)HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- 四川大学中国南亚研究中心 (成都 610064)China Center for South Asian Studies, Sichuan University, Chengdu 610064, China
| | - 东 徐
- 四川大学华西公共卫生学院/四川大学华西第四医院 HEOA Group (成都 610041)HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- 四川大学中国南亚研究中心 (成都 610064)China Center for South Asian Studies, Sichuan University, Chengdu 610064, China
| | - 锟 邹
- 四川大学华西公共卫生学院/四川大学华西第四医院 HEOA Group (成都 610041)HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- 四川大学中国南亚研究中心 (成都 610064)China Center for South Asian Studies, Sichuan University, Chengdu 610064, China
| | - 芹 李
- 四川大学华西公共卫生学院/四川大学华西第四医院 HEOA Group (成都 610041)HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- 四川大学中国南亚研究中心 (成都 610064)China Center for South Asian Studies, Sichuan University, Chengdu 610064, China
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Atwal S, Schmider J, Buchberger B, Boshnakova A, Cook R, White A, El Bcheraoui C. Prioritisation processes for programme implementation and evaluation in public health: A scoping review. Front Public Health 2023; 11:1106163. [PMID: 37050947 PMCID: PMC10083497 DOI: 10.3389/fpubh.2023.1106163] [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: 11/23/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
BackgroundProgramme evaluation is an essential and systematic activity for improving public health programmes through useful, feasible, ethical, and accurate methods. Finite budgets require prioritisation of which programmes can be funded, first, for implementation, and second, evaluation. While criteria for programme funding have been discussed in the literature, a similar discussion around criteria for which programmes are to be evaluated is limited. We reviewed the criteria and frameworks used for prioritisation in public health more broadly, and those used in the prioritisation of programmes for evaluation. We also report on stakeholder involvement in prioritisation processes, and evidence on the use and utility of the frameworks or sets of criteria identified. Our review aims to inform discussion around which criteria and domains are best suited for the prioritisation of public health programmes for evaluation.MethodsWe reviewed the peer-reviewed literature through OVID MEDLINE (PubMed) on 11 March 2022. We also searched the grey literature through Google and across key websites including World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC), and the International Association of National Public Health Institutes (IANPHI) (14 March 2022). Articles were limited to those published between 2002 and March 2022, in English, French or German.ResultsWe extracted over 300 unique criteria from 40 studies included in the analysis. These criteria were categorised into 16 high-level conceptual domains to allow synthesis of the findings. The domains most frequently considered in the studies were “burden of disease” (33 studies), “social considerations” (30 studies) and “health impacts of the intervention” (28 studies). We only identified one paper which proposed criteria for use in the prioritisation of public health programmes for evaluation. Few prioritisation frameworks had evidence of use outside of the setting in which they were developed, and there was limited assessment of their utility. The existing evidence suggested that prioritisation frameworks can be used successfully in budget allocation, and have been reported to make prioritisation more robust, systematic, transparent, and collaborative.ConclusionOur findings reflect the complexity of prioritisation in public health. Development of a framework for the prioritisation of programmes to be evaluated would fill an evidence gap, as would formal assessment of its utility. The process itself should be formal and transparent, with the aim of engaging a diverse group of stakeholders including patient/public representatives.
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Affiliation(s)
- Shaileen Atwal
- Economist Impact, Health Policy and Insights, London, United Kingdom
| | - Jessica Schmider
- Economist Impact, Health Policy and Insights, London, United Kingdom
| | - Barbara Buchberger
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Anelia Boshnakova
- Economist Impact, Health Policy and Insights, London, United Kingdom
| | - Rob Cook
- Economist Impact, Health Policy and Insights, London, United Kingdom
| | - Alicia White
- Economist Impact, Health Policy and Insights, London, United Kingdom
| | - Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
- *Correspondence: Charbel El Bcheraoui,
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Mbau R, Oliver K, Vassall A, Gilson L, Barasa E. A qualitative evaluation of priority-setting by the Health Benefits Package Advisory Panel in Kenya. Health Policy Plan 2022; 38:49-60. [PMID: 36373870 PMCID: PMC9849713 DOI: 10.1093/heapol/czac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/12/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
Abstract
Kenya's Ministry of Health established the Health Benefits Package Advisory Panel (HBPAP) in 2018 to develop a benefits package for universal health coverage. This study evaluated HBPAP's process for developing the benefits package against the normative procedural (acceptable way of doing things) and outcome (acceptable consequences) conditions of an ideal healthcare priority-setting process as outlined in the study's conceptual framework. We conducted a qualitative case study using in-depth interviews with national-level respondents (n = 20) and document reviews. Data were analysed using a thematic approach. HBPAP's process partially fulfilled the procedural and outcome conditions of the study's evaluative framework. Concerning the procedural conditions, transparency and publicity were partially met and were limited by the lack of publication of HBPAP's report. While HBPAP used explicit and evidence-based priority-setting criteria, challenges included lack of primary data and local cost-effectiveness threshold, weak health information systems, short timelines and political interference. While a wide range of stakeholders were engaged, this was limited by short timelines and inadequate financial resources. Empowerment of non-HBPAP members was limited by their inadequate technical knowledge and experience in priority-setting. Finally, appeals and revisions were limited by short timelines and lack of implementation of the proposed benefits package. Concerning the outcome conditions, stakeholder understanding was limited by the technical nature of the process and short timelines, while stakeholder acceptance and satisfaction were limited by lack of transparency. HBPAP's benefits package was not implemented due to stakeholder interests and opposition. Priority-setting processes for benefits package development in Kenya could be improved by publicizing the outcome of the process, allocating adequate time and financial resources, strengthening health information systems, generating local evidence and enhancing stakeholder awareness and engagement to increase their empowerment, understanding and acceptance of the process. Managing politics and stakeholder interests is key in enhancing the success of priority-setting processes.
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Affiliation(s)
- Rahab Mbau
- *Corresponding author. Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail:
| | - Kathryn Oliver
- Department of Public Health Environment and Society, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK,Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, South Africa
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, P.O. BOX 43640-00100, 197 Lenana Place, Nairobi Kenya,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Campus, Roosevelt Drive, Oxford OX3 7LG, UK,Institute of Healthcare Management, Strathmore University, Karen Ole Sangale Road, P.O. BOX 59857-00200, Nairobi, Kenya
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Horgan D, Mia R, Erhabor T, Hamdi Y, Dandara C, Lal JA, Fokom Domgue J, Ewumi O, Nyawira T, Meyer S, Kondji D, Francisco NM, Ikeda S, Chuah C, De Guzman R, Paul A, Reddy Nallamalla K, Park WY, Tripathi V, Tripathi R, Johns A, Singh MP, Phipps ME, Dube F, Whittaker K, Mukherji D, Rasheed HMA, Kozaric M, Pinto JA, Doral Stefani S, Augustovski F, Aponte Rueda ME, Fujita Alarcon R, Barrera-Saldana HA. Fighting Cancer around the World: A Framework for Action. Healthcare (Basel) 2022; 10:2125. [PMID: 36360466 PMCID: PMC9690702 DOI: 10.3390/healthcare10112125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/11/2022] [Accepted: 10/21/2022] [Indexed: 09/05/2023] Open
Abstract
Tackling cancer is a major challenge right on the global level. Europe is only the tip of an iceberg of cancer around the world. Prosperous developed countries share the same problems besetting Europe-and the countries and regions with fewer resources and less propitious conditions are in many cases struggling often heroically against a growing tide of disease. This paper offers a view on these geographically wider, but essentially similar, challenges, and on the prospects for and barriers to better results in this ceaseless battle. A series of panels have been organized by the European Alliance for Personalised Medicine (EAPM) to identify different aspects of cancer care around the globe. There is significant diversity in key issues such as NGS, RWE, molecular diagnostics, and reimbursement in different regions. In all, it leads to disparities in access and diagnostics, patients' engagement, and efforts for a better understanding of cancer.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium;
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India; (J.A.L.); (V.T.)
| | - Rizwana Mia
- Grants, Innovation & Product Development, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town 7505, South Africa;
| | - Tosan Erhabor
- Medical Laboratory Science Council of Nigeria (MLSCN), Durumi, Abuja 900110, Nigeria;
| | - Yosr Hamdi
- Laboratory of Biomedical Genomics and Oncogenetics, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis 1002, Tunisia;
- Laboratory of Human and Experimental Pathology, Institut Pasteur de Tunis, Tunis 1002, Tunisia
| | - Collet Dandara
- Division of Human Genetics, Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Observatory, Cape Town 7925, South Africa;
| | - Jonathan A. Lal
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India; (J.A.L.); (V.T.)
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, GROW School of Oncology and Developmental Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Joel Fokom Domgue
- Departments of Epidemiology, and Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA;
- Department of Obstetrics and Gynecology, Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde VF7W+4M9, Cameroon
| | - Oladimeji Ewumi
- Freelance Health Care, Life Sciences, Medical Artificial Intelligence Content Writer, Lagos 100253, Nigeria;
| | - Teresia Nyawira
- National Commission for Science, Technology and Innovation in Kenya (NACOSTI), Nairobi 00100, Kenya;
| | | | - Dominique Kondji
- Health & Development Communication, Building Capacities for Better Health in Africa, Yaounde P.O. Box 2032, Cameroon;
| | - Ngiambudulu M. Francisco
- Grupo de Investigação Microbiana e Imunológica, Instituto Nacional de Investigação em Saúde (National Institute for Health Research), Luanda 3635, Angola;
| | - Sadakatsu Ikeda
- Department of Precision Cancer Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
| | - Chai Chuah
- Singularity University, P.O. Box 165, Gold Coast, QLD 4227, Australia;
| | - Roselle De Guzman
- Oncology and Pain Management Section, Manila Central University–Filemon D. Tanchoco Medical Foundation Hospital, Caloocan 1400, Philippines;
| | - Anupriya Paul
- Department of Mathematics and Statistics, Faculty of Science, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India;
| | | | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Centre, Sungkyunkwan University, Seoul 06351, Korea;
| | - Vijay Tripathi
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj 211007, India; (J.A.L.); (V.T.)
| | - Ravikant Tripathi
- Ministry of Labor, Health Department Government of India, New Delhi 110001, India;
| | - Amber Johns
- Garvan Institute of Medical Research and the Kinghorn Cancer Centre, Cancer Division, Sydney, NSW 2010, Australia;
| | - Mohan P. Singh
- Centre of Biotechnology, University of Allahabad, Allahabad 211002, India;
| | - Maude E. Phipps
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya 47500, Selangor, Malaysia;
| | - France Dube
- Astra Zeneca, 1800 Concord Pike, Wilmington, DE 19803, USA;
| | | | - Deborah Mukherji
- Global Health Institute, American University of Beirut, Beirut VFXP+7QF, Lebanon;
- Department of Hematology/Oncology, American University of Beirut Medical Centre, Beirut P.O. Box 11-0236, Lebanon
| | | | - Marta Kozaric
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium;
| | - Joseph A. Pinto
- Centre for Basic and Translational Research, Auna Ideas, Lima 15036, Peru;
| | | | - Federico Augustovski
- Health Technology Assessment and Health Economics, Department of the Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires C1056ABH, Argentina;
| | | | - Ricardo Fujita Alarcon
- Centro de Genética y Biología Molecular, Universidad de San Martín de Porres, Lima 15024, Peru;
| | - Hugo A. Barrera-Saldana
- Innbiogem SC/Vitagenesis SA at National Laboratory for Services of Research, Development, and Innovation for the Pharma and Biotech Industries (LANSEIDI) of CONACyT Vitaxentrum Group, Monterrey 64630, Mexico;
- Schools of Medicine and Biology, Autonomous University of Nuevo Leon, Monterrey 66451, Mexico
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Wanjau MN, Aminde LN, Veerman JL. The avoidable disease burden associated with overweight and obesity in Kenya: A modelling study. EClinicalMedicine 2022; 50:101522. [PMID: 35799846 PMCID: PMC9253160 DOI: 10.1016/j.eclinm.2022.101522] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, there is a rising burden of non-communicable diseases related to high body mass index (BMI). Estimation of the magnitude of the avoidable disease burden related to high BMI in Kenya could inform priority setting in health. METHODS Using a proportional multistate life table model, we estimated the impact of the elimination of exposure to high BMI (>22·5 kg/m2) on health adjusted life years, health adjusted life expectancy, and burden of 27 obesity-related diseases. Participants were the 2019 Kenyan population modelled over their remaining lifetime. FINDINGS Elimination of high BMI could save approximately 83·5 million health-adjusted life years and increase the health-adjusted life expectancy by 2·3 (95% UI 2·0-2·8) years for females and 1·0 (95% UI 0·8-1·1) years for males. Over the first 25 years, over 7·4 million new cases of BMI-related diseases could be avoided and approximately half a million BMI related deaths postponed. The cumulative number of new cases of type 2 diabetes could reduce by approximately 1·6 million, cardiovascular diseases by over 1·3 million, chronic kidney disease by 850,473 and cancer would reduce by 55,624 estimated cases. In 2044, an estimated 867,664 prevalent cases of musculoskeletal disease would be prevented. INTERPRETATION The magnitude of avoidable high BMI-related disease burden in Kenya underscores the need to prioritise the control and prevention of overweight and obesity globally, especially in low- and middle-income settings, where obesity rates are rising rapidly. Reducing population BMI is challenging, but sustained and well-enforced system-wide approaches could be a great starting point. FUNDING Mary Njeri Wanjau is supported by the Griffith University International Postgraduate Research Scholarship (GUIPRS) and Griffith University Postgraduate Research Scholarship (GUPRS).
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Affiliation(s)
- Mary Njeri Wanjau
- University of Nairobi, School of Nursing Sciences, Nairobi, Kenya
- Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Corresponding author at: Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Gold Coast campus, Parklands Drive, Southport, Queensland 4222, Australia.
| | - Leopold Ndemnge Aminde
- Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Non-communicable Disease Unit, Clinical Research Education, Networking & Consultancy, Douala, Cameroon
| | - J. Lennert Veerman
- Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
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