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Madede T, Mavume Mangunyane E, Munguambe K, Govo V, Beran D, Levitt N, Damasceno A. Human resources challenges in the management of diabetes and hypertension in Mozambique. PLoS One 2024; 19:e0297676. [PMID: 38551894 PMCID: PMC10980202 DOI: 10.1371/journal.pone.0297676] [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: 07/21/2023] [Accepted: 01/11/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND The major burden of non-communicable diseases (NCDs) globally occurs in low-and middle-income countries, where this trend is expected to increase dramatically over the coming years. The resultant change in demand for health care will imply significant adaptation in how NCD services are provided. This study aimed to explore self-reported training and competencies of healthcare providers, and the barriers they face in NCD services provision. METHODS A qualitative design was used to conduct this study. Data was collected through semi-structured interviews with government officials within the Mozambican Ministry of Health, district health authorities, health facility managers, and health providers at urban and rural health facilities of Maputo, in Mozambique. The data was then analyzed under three domains: provider´s capacity building, health system structuring, and policy. RESULTS A total of 24 interviews of the 26 planed with managers and healthcare providers at national, district, and health facility levels were completed. The domains analyzed enabled the identification and description of three themes. First, the majority of health training courses in Mozambique are oriented towards infectious diseases. Therefore, healthcare workers perceive that they need to consolidate and broaden their NCD-related knowledge or else have access to NCD-related in-service training to improve their capacity to manage patients with NCDs. Second, poor availability of diagnostic equipment, tools, supplies, and related medicines were identified as barriers to appropriate NCD care and management. Finally, insufficient NCD financing reflects the low level of prioritization felt by managers and healthcare providers. CONCLUSION There is a gap in human, financial, and material resources to respond to the country's health needs, which is more significant for NCDs as they currently compete against major infectious disease programming, which is better funded by external partners. Healthcare workers at the primary health care level of Mozambique's health system are inadequately skilled to provide NCD care and they lack the diagnostic equipment and tools to adequately provide such care. Any increase in global and national responses to the NCD challenge must include investments in human resources and appropriate equipment.
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Affiliation(s)
- Tavares Madede
- Department of Community Health, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Elzier Mavume Mangunyane
- Department of Community Health, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Khátia Munguambe
- Department of Community Health, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Valério Govo
- Research Unit, Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Albertino Damasceno
- Research Unit, Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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Ojangba T, Boamah S, Miao Y, Guo X, Fen Y, Agboyibor C, Yuan J, Dong W. Comprehensive effects of lifestyle reform, adherence, and related factors on hypertension control: A review. J Clin Hypertens (Greenwich) 2023. [PMID: 37161520 DOI: 10.1111/jch.14653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 05/11/2023]
Abstract
Despite the effectiveness of currently available antihypertensive medications, there is still a need for new treatment strategies that are more effective in certain groups of hypertensive and for additional resources to combat hypertension. However, medication non-adherence was previously recognized as a major problem in the treatment of hypertension. The mechanisms behind the positive impacts of lifestyle changes might occur in different ways. In comparison with other studies, the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials. However, in this review, the attitudinal lifestyle modifications and barriers to blood pressure control were elaborated on. An effective method for reducing blood pressure (BP) and preventing cardiovascular events with antihypertensive medications has been outlined. Maintaining healthy lifestyle factors (body mass index, diet, smoking, alcohol consumption, sodium excretion, and sedentary behavior) could lower systolic blood pressure BP by 3.5 mm Hg and reduce the risk of cardiovascular disease (CVD) by about 30%, regardless of genetic susceptibility to hypertension. Conducting a lifestyle intervention using health education could improve lifestyle factors, such as reducing salt, sodium, and fat intake, changing eating habits to include more fruits and vegetables, not smoking, consuming less alcohol, exercising regularly, maintaining healthy body weight, and minimizing stressful conditions. Each behavior could affect BP by modulating visceral fat accumulation, insulin resistance, the renin-angiotensin-aldosterone system, vascular endothelial function, oxidative stress, inflammation, and autonomic function. Evidence of the joint effect of antihypertensive medications and lifestyle reforms suggests a pathway to reduce hypertension.
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Affiliation(s)
- Theodora Ojangba
- Department of Social Science and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
- Henan Research Center for HTA, Zhengzhou, China
- Department of Food Science and Technology, University for Development Studies, Tamale, Ghana
| | - Solomon Boamah
- Department of Food Science and Technology, University for Development Studies, Tamale, Ghana
- College of Plant Protection, Gansu Agricultural University, Lanzhou, China
| | - Yudong Miao
- Department of Social Science and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
- Henan Research Center for HTA, Zhengzhou, China
| | - Xinghong Guo
- Department of Social Science and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
- Henan Research Center for HTA, Zhengzhou, China
| | - Yifei Fen
- Department of Social Science and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
- Henan Research Center for HTA, Zhengzhou, China
| | - Clement Agboyibor
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Jingjing Yuan
- College of Plant Protection, Gansu Agricultural University, Lanzhou, China
| | - Wenyong Dong
- Department of Hypertension, People's Hospital of Zhengzhou University, Zhengzhou, China
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Access to Essential Medicines and Diagnostic Tests for Cardiovascular Diseases in Maputo City, Mozambique. Glob Heart 2023; 18:8. [PMID: 36874443 PMCID: PMC9983496 DOI: 10.5334/gh.1186] [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: 07/31/2022] [Accepted: 01/23/2023] [Indexed: 03/04/2023] Open
Abstract
Background To tackle the increasing burden of non-communicable diseases (NCDs) and reduce premature cardiovascular (CV) mortality by a third by the year 2030, countries must achieve 80% availability of affordable essential medicines (EMs) and technologies in all health facilities. Objectives To evaluate access to EMs and diagnostics for CV diseases in Maputo City, Mozambique. Methods Using a modified version of World Health Organization (WHO)/Health Action International (HAI) methodology, we collected data on availability and price of 14 WHO Core EMs and 35 CV EMs in all 6 public-sector hospitals, 6 private-sector hospitals, and 30 private-retail pharmacies. Data on 19 tests and 17 devices were collected from hospitals. Medicine prices were compared with international reference prices (IRPs). Medicines were considered unaffordable if the lowest paid worker had to spend more than one day's wage to purchase a monthly supply. Results Mean availability of CV EMs was lower than that of WHO Core EMs in both public (hospitals: 20.7% vs. 52.6%) and private sectors (retail pharmacies: 21.5% vs. 59.8%; hospitals: 22.2% vs. 50.0%). Mean availability of CV diagnostic tests and devices was lower in public (55.6% and 58.3%, respectively) compared to private sector (89.5% and 91.7%, respectively). Across WHO Core and CV EMs, the median price of lowest priced generic (LPG) and most sold generic (MSG) versions were 4.43 and 3.20 times the IRP, respectively. Relative to the IRP, median price of CV medicines was higher than that of Core EMs (LPG: 4.51 vs. 2.93). The lowest paid worker would spend 14.0 to 17.8 days' wage monthly to undergo secondary prevention. Conclusion Access to CV EMs is limited in Maputo City owing to low availability and poor affordability. Public-sector hospitals are not well equipped with essential CV diagnostics. This data could inform evidence-based policies for improving access to CV care in Mozambique.
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Noormahomed EV, Noormahomed S, Hlashwayo D, Martins E, Ismail M, Bickler SW, Nachega J, Mahoche M, Barrett KE, Benson CA, Schooley RT. Fostering Sustainable Biomedical Research Training in Mozambique: A Spin-Off of the Medical Education Partnership Initiative. Ann Glob Health 2022; 88:65. [PMID: 35974986 PMCID: PMC9354555 DOI: 10.5334/aogh.3684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background The further development of research capacity in low- and middle-income countries is critical to the delivery of evidence-based healthcare, the design of sound health policy and effective resource allocation. Research capacity is also critical for the retention of highly skilled faculty and staff and for institutional internationalization. Objectives We summarize the accomplishments, challenges and legacy of a five-year program to train biomedical researchers entitled "Enhanced Advanced Biomedical Research Training for Mozambique (EABRTM)". Methods A program conducted from 2015-2021 built upon the Medical Education Partnership Initiative to develop research capacity at Eduardo Mondlane University (UEM) and allied institutions. The project included design and implementation of postgraduate training programs and bolstered physical and human research infrastructure. Findings The program supported development and implementation of UEM's first doctoral (Bioscience and Public Health) and master (Biosciences) programs with 31 and 23 students enrolled to date, respectively. Three master programs were established at Lúrio University from which 176/202 (87.1%) and 107/202 (53.0%) students obtained a Postgraduate Diploma or master's degree, respectively. Scholarships were awarded to 39 biomedical researchers; 13 completed master degrees, one completed a PhD and five remain in doctoral studies. Thirteen administrative staff and four biomedical researchers were trained in research administration and in biostatistics, respectively. A total of 119 courses and seminars benefited 2,142 participants. Thirty-five manuscripts have been published to date in peer-reviewed international journals of which 77% are first-authored by Mozambicans and 44% last-authored by Africans. Sustainability was achieved through 59 research projects awarded by international agencies, totaling $16,363,656.42 and funds ($ 7,319,366.11) secured through 2025. Conclusions The EABRTM program substantially increased research and mentorship capacity and trained a new generation of biostatisticians and research administrators. These programmatic outcomes significantly increased the confidence of early stage Mozambican researchers in their ability to successfully pursue their career goals.
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Affiliation(s)
- Emília Virgínia Noormahomed
- Department of Microbiology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Maputo, MZ
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego (UCSD), US
- Mozambique Institute for Health Education and Research (MIHER), Maputo, MZ
| | - Sérgio Noormahomed
- Mozambique Institute for Health Education and Research (MIHER), Maputo, MZ
| | - Delfina Hlashwayo
- Department of Biological Sciences, Faculty of Sciences, Universidade Eduardo Mondlane (UEM), Maputo, MZ
| | - Emília Martins
- Mozambique Institute for Health Education and Research (MIHER), Maputo, MZ
| | - Mamudo Ismail
- Department of Pathology, Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Maputo, MZ
| | | | - Jean Nachega
- Department of Medicine, Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
- Department of Epidemiology, Infectious Diseases and Microbiology, and Center for Global Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Manuel Mahoche
- Mozambique Institute for Health Education and Research (MIHER), Maputo, MZ
- Faculty of Health Sciences, Lúrio University, Nampula, MZ
| | - Kim E. Barrett
- Division of Gastroenterology, Department of Medicine, University of California San Diego (UCSD), USA
- Department of Physiology and Membrane Biology, University of California Davis School of Medicine, USA
| | - Constance A. Benson
- Department of Medicine Division of Infectious Diseases and Global Public Health, University of California, San Diego, California, USA
| | - Robert T. Schooley
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego (UCSD), US
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Empowering Frontline Primary Healthcare Workers in a Global Health Partnership Training of Trainers Intervention to Strengthen the Prevention and Control of Cardiovascular Disease in Mozambique. Glob Heart 2022; 17:51. [PMID: 36051314 PMCID: PMC9354556 DOI: 10.5334/gh.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/30/2022] [Indexed: 11/20/2022] Open
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Kang Y, Hur Y. Health capacity building for middle-aged Laotian women with a risk of metabolic syndrome through a non-communicable disease prevention program. Health Care Women Int 2021; 43:1218-1233. [PMID: 34427549 DOI: 10.1080/07399332.2021.1958819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aims of the researchers were to develop an NCD prevention program including training for professionals who implement such programs, and to evaluate its effects on diabetes mellitus knowledge, hypertension knowledge, self-efficacy, and self-care in community-dwelling, middle-aged Laotian women. The study design was a randomized controlled trial. The study sample was composed of Laotian women aged 40 to 59 years living in Vientiane, Laos who fulfilled more than one diagnostic criterion for metabolic syndrome. This study provides a guide for low- and middle-income countries to develop future health capacity building programs for NCD prevention in middle-aged women.
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Affiliation(s)
- Younhee Kang
- Division of Nursing, College of Nursing, Ewha Womans University, Seoul, Korea
| | - Yujin Hur
- Division of Nursing, College of Nursing, Ewha Womans University, Seoul, Korea.,Graduate Program in System Health and Engineering, Ewha Womans University, Seoul, Korea
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Lumbandali N, Mocumbi A. Retention of patient-held medical records for chronic diseases in Mozambique. Pan Afr Med J 2021; 39:1. [PMID: 34178229 PMCID: PMC8197044 DOI: 10.11604/pamj.2021.39.1.22504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 10/01/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction Non-Communicable Diseases (NCD) are becoming a public health problem in Mozambique and wider sub-Saharan Africa, and are driving changes to guaranty lifelong follow up of patients within the health systems. Patient-Held Medical Records (PHMR) are an option for this follow-up in under-resourced health systems. We designed a study to assess the rate of retention and quality of conservation of the PHMR. Methods we conducted a prospective observational study from November 2016 to October 2018 in a peri-urban hospital from in Mozambique. Consecutive newly diagnosed patients with cardiovascular disease were given PHMR. Data was collected after their first consultation and one year after. The retention and quality of conservation were assessed after 12 months. Results overall 134 PHMR were given to patients (24;17.9% children and 77;57.5% female), of which 121 (90.3%) retained at 12 months (90.9% in good conservation state). Most patients had on average four visits to health facilities during the study, all registered in the PHMR. Retention could not be confirmed in 13 patients who did not return the PHMR. Conclusion PHMR retention rates were high in an urban low-income setting in Africa, with high quality of conservation, thus supporting its use to replace hospital paper-based medical files. Specific research is recommended on acceptability, quality of information registered and patient´s perception.
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Affiliation(s)
- Norberto Lumbandali
- Instituto Nacional de Saúde, Marracuene District, Mozambique.,Hospital Geral de Mavalane, Maputo, Mozambique
| | - Ana Mocumbi
- Instituto Nacional de Saúde, Marracuene District, Mozambique.,Universidade Eduardo Mondlane, 3453 Avenida Julius Nyerere, Maputo, Mozambique
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Sorato MM, Davari M, Kebriaeezadeh A, Sarrafzadegan N, Shibru T, Fatemi B. Reasons for poor blood pressure control in Eastern Sub-Saharan Africa: looking into 4P's (primary care, professional, patient, and public health policy) for improving blood pressure control: a scoping review. BMC Cardiovasc Disord 2021; 21:123. [PMID: 33663387 PMCID: PMC7971125 DOI: 10.1186/s12872-021-01934-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/23/2021] [Indexed: 01/06/2023] Open
Abstract
AIM Hypertension control in Sub-Saharan Africa (SSA) is the worst (less than one out of ten) when compared to the rest of the world. Therefore, this scoping review was conducted to identify and describe the possible reasons for poor blood pressure (BP) control based on 4Ps' (patient, professional, primary healthcare system, and public health policy) factors. METHODS PRISMA extension for scoping review protocol was used. We systematically searched articles written in the English language from January 2000 to May 2020 from the following databases: PubMed/Medline, Embase, Scopus, Web of Science, and Google scholar. RESULTS Sixty-eight articles were included in this scoping review. The mean prevalence of hypertension, BP control, and patient adherence to prescribed medicines were 20.95%, 11.5%, and 60%, respectively. Only Kenya, Malawi, and Zambia out of ten countries started annual screening of the high-risk population for hypertension. Reasons for nonadherence to prescribed medicines were lack of awareness, lack of access to medicines and health services, professional inertia to intensify drugs, lack of knowledge on evidence-based guidelines, insufficient government commitment, and specific health behaviors related laws. Lack of screening for high-risk patients, non-treatment adherence, weak political commitment, poverty, maternal and child malnutrition were reasons for the worst BP control. CONCLUSION In conclusion, the rate of BP treatment, control, and medication adherence was low in Eastern SSA. Screening for high-risk populations was inadequate. Therefore, it is crucial to improve government commitment, patient awareness, and access to medicines, design country-specific annual screening programs, and empower clinicians to follow individualized treatment and conduct medication adherence research using more robust tools.
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Affiliation(s)
- Mende Mensa Sorato
- Department of Pharmacy, Arba Minch University College of Medicine and Health Sciences, P.O. Box 21, Arba Minch, Ethiopia
| | - Majid Davari
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Kebriaeezadeh
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tamiru Shibru
- College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Behzad Fatemi
- Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Ciccacci F, Orlando S, Majid N, Marazzi C. Epidemiological transition and double burden of diseases in low-income countries: the case of Mozambique. Pan Afr Med J 2020; 37:49. [PMID: 33209176 PMCID: PMC7648489 DOI: 10.11604/pamj.2020.37.49.23310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/09/2020] [Indexed: 12/26/2022] Open
Abstract
Epidemiological transition theory aims to describe changes in epidemiological scenarios at the global and national level. The assumption is the shift from infectious diseases (IDs) to non-communicable diseases (NCDs). Some authors argue that this theory failed to describe epidemiology in sub-Saharan Africa. We considered the case of Mozambique, where is occurring a rapid demographic change, with dramatic growth of the population. According to the data, we concluded that NCDs are increasing in Mozambique, but due to the vast predominance of IDs, a double burden of disease model is more accurate to describe the actual epidemiological context of the country. Consequently, health funding focusing on IDs should take into account the concomitant epidemiological scenario and try to encompass other health challenges.
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Affiliation(s)
- Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Stefano Orlando
- Department of Biomedicine and Control, University of Rome Torvergata, Rome, Italy
| | - Noorjehan Majid
- DREAM Program Mozambique, Community of Sant'Egidio, Maputo, Mozambique
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Abstract
OBJECTIVE To assess the current prevalence, awareness, treatment and control of arterial hypertension in Mozambican population, including adolescents and young adults, and to appraise their trends over the past decade, for the 25-64 years old population. METHODS A cross-sectional study of a representative sample of the population aged 15-64 years (n = 2965) was conducted in 2014-2015, following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Data from a survey conducted in 2005 using the same methodological approach was used to assess trends in the age group of 25-64 years. RESULTS The prevalence of hypertension increased significantly, from 33.1 to 38.9% (P = 0.048), whereas awareness (2005 vs. 2014-2015: 14.8 vs. 14.5%, P = 0.914) and treatment among the aware (2005 vs. 2014-2015: 51.9 vs. 50.1%, P = 0.770) remained similar. Control among the treated increased (from 39.9 to 44.5%, P = 0.587), although not significantly. Mean blood pressure values increased (SBP: from 132.1 to 134.6 mmHg, P = 0.089; DBP: from 78.2 to 82.5 mmHg, P < 0.001). Among participants aged 15-24 years, in 2014-2015 the prevalence of hypertension was 13.1% (95% confidence interval: 9.8-16.4). CONCLUSION Our findings show that the prevalence of hypertension in Mozambique is among the highest in developing countries, both in adults and adolescents, portraying an ample margin for reduction of the morbidity and mortality burden because of high blood pressure.
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Agarwal D, Hanafi NS, Chippagiri S, Brakema EA, Pinnock H, Khoo EM, Sheikh A, Liew SM, Ng CW, Isaac R, Chinna K, Ping WL, Hussein NB, Juvekar S. Systematic scoping review protocol of methodologies of chronic respiratory disease surveys in low/middle-income countries. NPJ Prim Care Respir Med 2019; 29:17. [PMID: 31068586 PMCID: PMC6506487 DOI: 10.1038/s41533-019-0129-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/12/2019] [Indexed: 11/09/2022] Open
Abstract
This protocol describes a systematic scoping review of chronic respiratory disease surveys in low/middle-income countries (LMICs) undertaken as part of the Four Country ChrOnic Respiratory Disease (4CCORD) study within the National Institute for Health Research Global Health Research Unit on Respiratory Health (RESPIRE). Understanding the prevalence and burden of chronic respiratory disease (CRD) underpins healthcare planning. We will systematically scope the literature to identify existing strategies (definitions/questionnaires/diagnostics/outcomes) used in surveys of CRDs in adults in low-resource settings. We will search MEDLINE, EMBASE, ISI WoS, Global Health and WHO Global Health Library [search terms: prevalence AND CRD (COPD, asthma) AND LMICs, from 1995], and two reviewers will independently extract data from selected studies onto a piloted customised data extraction form. We will convene a workshop of the multidisciplinary 4CCORD research team with representatives from the RESPIRE partners (Bangladesh, India, Malaysia, Pakistan and Edinburgh) at which the findings of the scoping review will be presented, discussed and interpreted. The findings will inform a future RESPIRE 4CCORD study, which will estimate CRD burden in adults in Asian LMICs.
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Affiliation(s)
- Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Nik Sherina Hanafi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Evelyn A Brakema
- Department of Public Health and Primary care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Aziz Sheikh
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Su-May Liew
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chiu-Wan Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rita Isaac
- RUHSA Department, Christian Medical College, Vellore, India
| | - Karuthan Chinna
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wong Li Ping
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norita Binti Hussein
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India.
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Jessen N, Govo V, Calua E, Machava M, Fabula A, Novela C, Mbanze I, Muianga C, Banze R, Zandamela I, Oliveira A, Xia X, Beaney T, Poulter NR, Damasceno A. Blood pressure screening in Mozambique: the May Measurement Month 2017 project-Sub-Saharan Africa. Eur Heart J Suppl 2019; 21:D80-D82. [PMID: 31043886 PMCID: PMC6479432 DOI: 10.1093/eurheartj/suz062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. In Mozambique, two national surveys of risk factors for chronic diseases were done, using the WHO STEPWISE approach, the first in 2005 and the last in 2014/2015. In this period of 10 years, the prevalence of hypertension in the adult population increased from 33.1% to 38.9% and the extremely low levels of awareness, treatment, and control did not change significantly. May Measurement Month (MMM) is a global initiative of the International Society of Hypertension aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Screening was conducted by volunteers, mainly in work places, markets, and religious activities, in the capital city, in most of the provincial capitals and some rural districts. About 4454 individuals were screened with a mean age of 39 years, and, after multiple imputation, 1371 (31.1%) had hypertension. Of individuals not receiving anti-hypertensive medication, 1099 (26.6%) were hypertensive. Of individuals receiving antihypertensive medication, 166 (61.6%) had uncontrolled BP. MMM17 was the largest BP screening campaign undertaken in Mozambique. These results suggest that opportunistic screening is an important tool to identify significant numbers of patients with raised BP.
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Affiliation(s)
- Neusa Jessen
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Valério Govo
- Research Unit, Department of Internal Medicine, Maputo Central Hospital, Av. Eduardo Mondlane 1653, Maputo, Mozambique
| | - Eleutério Calua
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Moséstia Machava
- Research Unit, Department of Internal Medicine, Maputo Central Hospital, Av. Eduardo Mondlane 1653, Maputo, Mozambique
| | - Alima Fabula
- Research Unit, Department of Internal Medicine, Maputo Central Hospital, Av. Eduardo Mondlane 1653, Maputo, Mozambique
| | - Célia Novela
- Research Unit, Department of Internal Medicine, Maputo Central Hospital, Av. Eduardo Mondlane 1653, Maputo, Mozambique
| | - Irina Mbanze
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Catarina Muianga
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Reginaldo Banze
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Imphikaxane Zandamela
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Angelo Oliveira
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
| | - Albertino Damasceno
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Av. Salvador Allende 702, Maputo, Mozambique.,Research Unit, Department of Internal Medicine, Maputo Central Hospital, Av. Eduardo Mondlane 1653, Maputo, Mozambique
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13
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Mocumbi AO, Langa DC, Chicumbe S, Schumacher AE, Al-Delaimy WK. Incorporating selected non-communicable diseases into facility-based surveillance systems from a resource-limited setting in Africa. BMC Public Health 2019; 19:147. [PMID: 30717732 PMCID: PMC6360799 DOI: 10.1186/s12889-019-6473-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/23/2019] [Indexed: 11/18/2022] Open
Abstract
Background As Mozambique faces a double burden of diseases, with a rise of Non Communicable Diseases (NCD) superimposed to uncontrolled communicable diseases (CD), routine disease surveillance system does not include NCD. The objectives of our study were to i) upgrade of the current surveillance system by adapting the data collection tools to NCD; ii) describe the occurrence and profile of selected NCD using these data collection tools. Methods Workshops were implemented in a first referral urban hospital of Mozambique to train clinical staff, administrative workers and nurses on NCD surveillance, as well as select conditions to be prioritized. Based on the WHO Global Action Plan and Brazaville Declaration for NCD prevention and control, we selected arterial hypertension, diabetes, stroke, chronic respiratory diseases, mental illness and cancers. Data collection tools used for CD were changed to include age, gender, outcome and visit type. Between February/2014 and January/2015 we collected data at an urban hospital in Mozambique’s capital. Results Over 12 months 92,018 new patients were assisted in this hospital. Data was missing or diagnosis was unreadable in 2637 (2.9%) thus only 89,381 were used for analysis; of these 6423 (median age 27 years; 58.4% female) had at least one selected NCD as their primary diagnosis: arterial hypertension (2397;37.31%), mental illness (1497;23.30%), asthma (1495;23.28%), diabetes (628;9.78%), stroke (299;4.66%), chronic obstructive pulmonary disease 61 (0.95%) and cancers 46 (0.72%). Emergency transfers were needed for 76 patients (1.2%), mainly due to hypertensive emergencies (31; 40.8%) and stroke (18;23.7%). Twenty-four patients died at entry points (0.3%); 10 of them had hypertensive emergencies. Conclusion Changes in existing surveillance tools for communicable diseases provided important data on the burden and outcomes of the selected NCD helping to identify priority areas for training and health care improvement. This information can be used to design the local NCD clinics and to strengthen the health information system in resource-limited settings in a progressive and sustainable way. Electronic supplementary material The online version of this article (10.1186/s12889-019-6473-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A O Mocumbi
- Instituto Nacional de Saúde, 1008 Av. Eduardo Mondlane, Maputo, Moçambique. .,Universidade Eduardo Mondlane, Maputo, Moçambique. .,Hospital Geral de Mavalane, Maputo, Moçambique.
| | - D C Langa
- Instituto Nacional de Saúde, 1008 Av. Eduardo Mondlane, Maputo, Moçambique.,Hospital Geral de Mavalane, Maputo, Moçambique
| | - S Chicumbe
- Instituto Nacional de Saúde, 1008 Av. Eduardo Mondlane, Maputo, Moçambique
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14
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Bousquet J, Mohammad Y, Bedbrook A, To T, McGihon R, Bárbara C, Melo-Gomes E, Rosado-Pinto J, Simão P, George F, Punturieri A, Kiley JP, Nunes E, Cossa A, Camargos P, Stelmach R, Cruz AA, Rostan MV, Yañez A, González-Díaz SN, Urrutia-Pereira M, Calderon MA, Gómez RM, German Z, Kolek V, Špičák V, Lan LTT, Hurd S, Lenfant C, Yorgancioglu A, Gemicioğlu B, Ekinci B, Ozkan Z, Abou Al-Zahab B, Dmeirieh A, Shifa R, Faroun H, AlJaber A, Halloum R, Fatmeh Y, Alzein A, Aloush J, Dib G, Shaaban R, Arrais M, do Céu Teixeira M, Conceição C, Ferrinho P. Country activities of Global Alliance against Chronic Respiratory Diseases (GARD): focus presentations at the 11th GARD General Meeting, Brussels. J Thorac Dis 2018; 10:7064-7072. [PMID: 30746253 DOI: 10.21037/jtd.2018.12.84] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jean Bousquet
- WHO Collaborating Center for Rhinitis and Asthma, Montpellier, France.,MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.,INSERM, VIMA: Ageing and Chronic Diseases. Epidemiological and Public Health Approaches, U1168, Paris, France.,UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Yvelines, France.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Dermatology and Allergy, Berlin Institute of Health, Comprehensive Allergy Center, Berlin, Germany
| | - Yousser Mohammad
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria.,Department of Internal Medicine, Syrian Private University, Damascus, Syria
| | - Anna Bedbrook
- WHO Collaborating Center for Rhinitis and Asthma, Montpellier, France.,MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - Teresa To
- The Hospital for Sick Children, Research Institute, Toronto, Ontario, Canada
| | - Rachel McGihon
- The Hospital for Sick Children, Research Institute, Toronto, Ontario, Canada
| | - Cristina Bárbara
- Instituto de Saúde Ambiental, Faculty of Medicine, University of Lisbon, Portugal
| | | | - José Rosado-Pinto
- Global Alliance against Chronic Respiratory Diseases (GARD) Portugal Coordinator, Serviço de Imunoalergologia, Hospital da Luz, Lisboa, Portugal
| | - Paula Simão
- Directorate-General of Health, Lisbon, Portugal
| | | | - Antonello Punturieri
- Division of Lung Diseases, NHLBI/National Institutes of Health, Bethesda, Maryland, USA
| | - James P Kiley
- Division of Lung Diseases, NHLBI/National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabete Nunes
- Department of Pulmonology, Maputo Central Hospital, Maputo, Mozambique
| | - Anilsa Cossa
- Department of Pulmonology, Maputo Central Hospital, Maputo, Mozambique
| | - Paulo Camargos
- Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Anahí Yañez
- Investigaciones en Alergia y Enfermedades Respiratorias (INAER), Buenos Aires, Argentina
| | | | | | - Moïses A Calderon
- Imperial College London, London, U.K.Royal Brompton Hospital, London, UK.,Universidad de Costa Rica, San Jose, Costa Rica
| | - René Maximiliano Gómez
- Fundación Ayre, Salta, Argentina.,School of Health Sciences, Catholic University of Salta, Argentina.,Argentinean Association of Allergy & Clinical Immunology (AAAeIC), Salta, Argentina
| | - Zachary German
- Department of Ecology and Evolutionary Biology, Brown University, Providence, Rhode Island, USA
| | - Vítězslav Kolek
- Department of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Václav Špičák
- Department of Pediatrics, Hospital Na Bulovce, Prague, Czech Republic
| | - Le Thi Tuyet Lan
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Vietnam
| | - Suzanne Hurd
- Global Initiative for Asthma (GINA), the Global Initiative for Chronic Obstructive Lung Disease (GOLD), Vancouver, WA, USA
| | - Claude Lenfant
- Global Initiative on Obstructive Lung Disease (GOLD), Gaithersburg, MD, USA
| | | | - Bilun Gemicioğlu
- Department of Chest Diseases, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Banu Ekinci
- Department of Chronic Diseases and Elderly, Directorate General of Public Health, Ankara, Turkey
| | - Zubeyda Ozkan
- Department of Chronic Diseases and Elderly, Directorate General of Public Health, Ankara, Turkey
| | | | | | | | | | - Aicha AlJaber
- National Professional Officer at WHO office in Syria, Damascus, Syria
| | - Ramsa Halloum
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | - Yassine Fatmeh
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | | | | | - Ghazal Dib
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | - Rafea Shaaban
- National Center for Research on Chronic Respiratory Diseases, Tishreen University, Tishreen Hospital, Latakia, Syria
| | | | | | - Cláudia Conceição
- Instituto de Higiene Medicina Tropical, NOVA University of Lisbon, Lisbon, Portugal
| | - Paulo Ferrinho
- Instituto de Higiene Medicina Tropical, NOVA University of Lisbon, Lisbon, Portugal
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15
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Keates AK, Mocumbi AO, Ntsekhe M, Sliwa K, Stewart S. Cardiovascular disease in Africa: epidemiological profile and challenges. Nat Rev Cardiol 2017; 14:273-293. [PMID: 28230175 DOI: 10.1038/nrcardio.2017.19] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
From a global perspective, the large and diverse African population is disproportionately affected by cardiovascular disease (CVD). The historical balance between communicable and noncommunicable pathways to CVD in different African regions is dependent on external factors over the life course and at a societal level. The future risk of noncommunicable forms of CVD (predominantly driven by increased rates of hypertension, smoking, and obesity) is a growing public health concern. The incidence of previously rare forms of CVD such as coronary artery disease will increase, in concert with historically prevalent forms of disease, such as rheumatic heart disease, that are yet to be optimally prevented or treated. The success of any strategies designed to reduce the evolving and increasing burden of CVD across the heterogeneous communities living on the African continent will be dependent upon accurate and up-to-date epidemiological data on the cardiovascular profile of every major populace and region. In this Review, we provide a contemporary picture of the epidemiology of CVD in Africa, highlight key regional discrepancies among populations, and emphasize what is currently known and, more importantly, what is still unknown about the CVD burden among the >1 billion people living on the continent.
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Affiliation(s)
- Ashley K Keates
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia
| | - Ana O Mocumbi
- Instituto Nacional de Saúde, Ministério da Saúde, Av. Eduardo Mondlane/Salvador Allende Caixa Postal 264, Maputo, Moçambique
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town, Old Main Building, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa
| | - Karen Sliwa
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Centre, 4th floor Chris Barnard Building, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Centre, 4th floor Chris Barnard Building, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
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Mukanu MM, Zulu JM, Mweemba C, Mutale W. Responding to non-communicable diseases in Zambia: a policy analysis. Health Res Policy Syst 2017; 15:34. [PMID: 28438177 PMCID: PMC5402674 DOI: 10.1186/s12961-017-0195-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 04/05/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are an emerging global health concern. Reports have shown that, in Zambia, NCDs are also an emerging problem and the government has begun initiating a policy response. The present study explores the policy response to NCDs by the Ministry of Health in Zambia using the policy triangle framework of Walt and Gilson. METHODS A qualitative approach was used for the study. Data collected through key informant interviews with stakeholders who were involved in the NCD health policy development process as well as review of key planning and policy documents were analysed using thematic analysis. RESULTS The government's policy response was as a result of international strategies from WHO, evidence of increasing disease burden from NCDs and pressure from interest groups. The government developed the NCD strategic plan based on the WHO Global Action Plan for NCDs 2013-2030. Development of the NCD strategic plan was driven by the government through the Ministry of Health, who set the agenda and adopted the final document. Stakeholders participated in the fine tuning of the draft document from the Ministry of Health. The policy development process was lengthy and this affected consistency in composition of the stakeholders and policy development momentum. Lack of representative research evidence for some prioritised NCDs and use of generic targets and indicators resulted in the NCD strategic plan being inadequate for the Zambian context. The interventions in the strategic plan also underutilised the potential of preventing NCDs through health education. Recent government pronouncements were also seen to be conflicting the risk factor reduction strategies outlined in the NCD strategic plan. CONCLUSION The content of the NCD strategic plan inadequately covered all the major NCDs in Zambia. Although contextual factors like international strategies and commitments are crucial catalysts to policy development, there is need for domestication of international guidelines and frameworks to match the disease burden, resources and capacities in the local context if policy measures are to be comprehensive, relevant and measurable. Such domestication should be guided by representative local research evidence.
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Affiliation(s)
- Mulenga M. Mukanu
- The University of Zambia, School of Public Health, P.O. Box 50110, Lusaka, Zambia
| | - Joseph Mumba Zulu
- The University of Zambia, School of Public Health, P.O. Box 50110, Lusaka, Zambia
| | - Chrispin Mweemba
- The University of Zambia, School of Public Health, P.O. Box 50110, Lusaka, Zambia
| | - Wilbroad Mutale
- The University of Zambia, School of Public Health, P.O. Box 50110, Lusaka, Zambia
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17
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Tshuma N, Muloongo K, Nkwei ES, Alaba OA, Meera MS, Mokgobi MG, Nyasulu PS. The mediating role of self-efficacy in the relationship between premotivational cognitions and engagement in multiple health behaviors: a theory-based cross-sectional study among township residents in South Africa. J Multidiscip Healthc 2017; 10:29-39. [PMID: 28176923 PMCID: PMC5266094 DOI: 10.2147/jmdh.s112841] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs) are one of the major global health challenges in developed countries and are rapidly increasing globally. Perception of self-efficacy is important for complex activities and long-term changes in health behavior. This study aimed to determine whether self-efficacy mediates the effect of individual beliefs (perceived severity, susceptibility, benefits and barriers) among informal settlement residents' health behavior in relation to the prevention and management of NCDs. METHODS A cross-sectional survey was conducted using a closed-ended questionnaire among informal settlement residents in Diepsloot, Johannesburg. The proposed model was tested using structural equation modeling (AMOS software). RESULTS A total of 2,277 participants were interviewed during this survey, consisting of 1,236 (54.3%) females, with the majority of them aged between 20 and 29 years. All constructs in the questionnaire had a good reliability with a Cronbach's alpha of >0.7. Perceived benefits and perceived barriers were the strongest predictors of self-efficacy, with the highest beta values of 0.14 and 0.15, respectively. Once associated with perceived self-efficacy, the direct effect of perceived susceptibility and perceived benefits on health behavior was statistically nonsignificant (P=0.0894 and P=0.2839, respectively). Perceived benefits and perceived susceptibility were totally mediated by self-efficacy. The indirect effects of perceived severity and perceived barriers (through self-efficacy) on health behavior were significant. Thus, perceived severity and perceived barriers were partially mediated by self-efficacy. CONCLUSION Perceived susceptibility and perceived benefits did not affect health behavior unless associated with self-efficacy. In contrast, individual perception of the seriousness of NCDs and perceived barriers might still have a direct influence on health behavior even if the person does not feel able to prevent NCDs. However, this influence would be more significant when perceived severity and perceived barriers of NCDs are associated with self-efficacy.
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Affiliation(s)
- Ndumiso Tshuma
- Community AIDS Response, Norwood, Johannesburg
- Schoolof Health Sciences, Monash South Africa, Johannesburg
| | - Keith Muloongo
- Community AIDS Response, Norwood, Johannesburg
- Schoolof Health Sciences, Monash South Africa, Johannesburg
| | | | - Olufunke A Alaba
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Maheedhariah S Meera
- Department of Human Behaviour, College of Southern Nevada, Henderson, NV
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Peter S Nyasulu
- Schoolof Health Sciences, Monash South Africa, Johannesburg
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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18
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Letebo M, Shiferaw F. Adapting HIV patient and program monitoring tools for chronic non-communicable diseases in Ethiopia. Global Health 2016; 12:26. [PMID: 27255329 PMCID: PMC4890485 DOI: 10.1186/s12992-016-0163-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 05/09/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Chronic non-communicable diseases (NCDs) have become a huge public health concern in developing countries. Many resource-poor countries facing this growing epidemic, however, lack systems for an organized and comprehensive response to NCDs. Lack of NCD national policy, strategies, treatment guidelines and surveillance and monitoring systems are features of health systems in many developing countries. Successfully responding to the problem requires a number of actions by the countries, including developing context-appropriate chronic care models and programs and standardization of patient and program monitoring tools. METHODS In this cross-sectional qualitative study we assessed existing monitoring and evaluation (M&E) tools used for NCD services in Ethiopia. Since HIV care and treatment program is the only large-scale chronic care program in the country, we explored the M&E tools being used in the program and analyzed how these tools might be adapted to support NCD services in the country. Document review and in-depth interviews were the main data collection methods used. The interviews were held with health workers and staff involved in data management purposively selected from four health facilities with high HIV and NCD patient load. Thematic analysis was employed to make sense of the data. RESULTS Our findings indicate the apparent lack of information systems for NCD services, including the absence of standardized patient and program monitoring tools to support the services. We identified several HIV care and treatment patient and program monitoring tools currently being used to facilitate intake process, enrolment, follow up, cohort monitoring, appointment keeping, analysis and reporting. Analysis of how each tool being used for HIV patient and program monitoring can be adapted for supporting NCD services is presented. CONCLUSION Given the similarity between HIV care and treatment and NCD services and the huge investment already made to implement standardized tools for HIV care and treatment program, adaptation and use of HIV patient and program monitoring tools for NCD services can improve NCD response in Ethiopia through structuring services, standardizing patient care and treatment, supporting evidence-based planning and providing information on effectiveness of interventions.
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Affiliation(s)
- Mekitew Letebo
- Clinton Health Access Initiative, Addis Ababa, Ethiopia.
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19
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Tang S, Bishwajit G, Ji L, Feng D, Fang H, Fu H, Shao T, Shao P, Liu C, Feng Z, Luba TR. Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services: Evidence From China. Medicine (Baltimore) 2016; 95:e3233. [PMID: 27057859 PMCID: PMC4998775 DOI: 10.1097/md.0000000000003233] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Proactive attitude of hypertensive patients seeking follow-up services (FUS) lies at the core of self-efficacy. However, few evidence have shown the activeness of seeking FUS in the context of blood pressure control among hypertensive patients. Improvements in follow-up visits may not just by services itself cause better control of blood pressure among hypertensive patients, rather due to the patient's pro-active attitude of the patient in seeking FUS.A cross-sectional study was carried out in selected rural regions of China to explore the association between blood pressure control and sociodemographic and economic variables and activeness of hypertensive patients in seeking FUS. The primary clinical outcome for this study was blood pressure control (systolic blood pressure <140 mmHg or diastolic blood pressure <90 mmHg)Out of the total 2321 participants with hypertension aged 35 years or older participated in this survey. Number of proactive FUS seekers were 3.17 times greater than those of passive seekers (odds ratio [OR] = 3.17, 95% confidence interval [CI] = 2.56-3.93, P < 0.001). In all subgroups, hypertensive patients who were seeking FUS actively were more likely to control blood pressure better than those seeking FUS passively.Proactive attitude of seeking follow-up services can improve blood pressure control among hypertensive patients.
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Affiliation(s)
- Shangfeng Tang
- From the School of Medicine and Health Management (ST, GB, DF, HF, HF, TS, PS, CL, ZF, TRL), Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Cancer Center (LJ), Sun Yat-sen University, Guangzhou, Guangdong, China
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20
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Martin G, MacLachlan M, Labonté R, Larkan F, Vallières F, Bergin N. Globalization and Health: developing the journal to advance the field. Global Health 2016; 12:6. [PMID: 26961760 PMCID: PMC4785659 DOI: 10.1186/s12992-016-0143-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/10/2022] Open
Abstract
Founded in 2005, Globalization and Health was the first open access global health journal. The journal has since expanded the field, and its influence, with the number of downloaded papers rising 17-fold, to over 4 million. Its ground-breaking papers, leading authors -including a Nobel Prize winner- and an impact factor of 2.25 place it among the top global health journals in the world. To mark the ten years since the journal's founding, we, members of the current editorial board, undertook a review of the journal's progress over the last decade. Through the application of an inductive thematic analysis, we systematically identified themes of research published in the journal from 2005 to 2014. We identify key areas the journal has promoted and consider these in the context of an existing framework, identify current gaps in global health research and highlight areas we, as a journal, would like to see strengthened.
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Affiliation(s)
- Greg Martin
- Centre for Global Health, Trinity College, University of Dublin, Dublin, Ireland.
| | - Malcolm MacLachlan
- Centre for Global Health, Trinity College, University of Dublin, Dublin, Ireland. .,School of Psychology, Trinity College, University of Dublin, Dublin, Ireland. .,Centre for Rehabilitation Studies, Stellenbosch University, Stellenbosch, South Africa. .,Palacky University, Olomouc, Czech Republic.
| | - Ronald Labonté
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Fiona Larkan
- Centre for Global Health, Trinity College, University of Dublin, Dublin, Ireland.,School of Medicine, Trinity College, University of Dublin, Dublin, Ireland
| | - Frédérique Vallières
- Centre for Global Health, Trinity College, University of Dublin, Dublin, Ireland.,School of Psychology, Trinity College, University of Dublin, Dublin, Ireland
| | - Niamh Bergin
- Masters in Global Mental Health Programme, University of Glasgow, Glasgow, Scotland
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21
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Abstract
This review will highlight the current challenges and barriers to diabetes management in low and lower middle income countries using the World Health Organization's 6 Building Blocks for Health Systems (service delivery; healthcare workforce; information; medical products, vaccines and technologies; financing; and leadership and governance). Low and lower middle income countries are characterized by low levels of income and insufficient health expenditure. These countries face a shift in disease burden from communicable to non-communicable diseases including diabetes. Many argue that health systems in these countries do not have the capacity to meet the needs of people with chronic conditions such as diabetes. A variety of barriers exist in terms of organization of health systems and care, human resources, sufficient information for decision-making, availability and affordability of medicines, policies, and alleviating the financial burden of care. These health system barriers need to be addressed, taking into account the need to have diabetes included in the global development agenda and also tailoring the response to local contexts including the needs of people with diabetes.
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Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 6, CH-1211, Geneva 14, Switzerland,
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22
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Metta E, Msambichaka B, Mwangome M, Nyato DJ, Dieleman M, Haisma H, Klatser P, Geubbels E. Public policy, health system, and community actions against illness as platforms for response to NCDs in Tanzania: a narrative review. Glob Health Action 2014; 7:23439. [PMID: 24848655 PMCID: PMC4028932 DOI: 10.3402/gha.v7.23439] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most low- and middle- income countries are facing a rise of the burden of non-communicable diseases (NCDs) alongside the persistent burden of infectious diseases. This narrative review aims to provide an inventory of how the existing policy environment, health system, and communities are addressing the NCDs situation in Tanzania and identify gaps for advancing the NCD research and policy agenda. METHODOLOGY A literature search was performed on PubMed and Google scholar with full text retrieval from HINARI of English language articles published between 2000 and 2012. Documents were read to extract information on what Tanzanian actors were doing that contributed to NCDs prevention, treatment, and control, and a narration was written out of these. Reference lists of all retrieved articles were searched for additional relevant articles. Websites of organizations active in the field of NCDs including the Government of Tanzania and WHO were searched for reports and grey literature. RESULTS Lack of a specific and overarching NCD policy has slowed and fragmented the implementation of existing strategies to prevent and control NCDs and their determinants. The health system is not prepared to deal with the rising NCD burden although there are random initiatives to improve this situation. How the community is responding to these emerging conditions is still unknown, and the current health-seeking behavior and perceptions on the risk factors may not favor control of NCDs and their risk factors. CONCLUSION AND RECOMMENDATION There is limited information on the burden and determinants of NCDs to inform the design of an integrative and multisectorial policy. Evidence on effective interventions for NCD services in primary care levels and on community perceptions on NCDs and their care seeking is virtually absent. Research and public health interventions must be anchored in the policy, health system, and community platforms for a holistic response.
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Affiliation(s)
- Emmy Metta
- Ifakara Health Institute, Dar es Salaam, Tanzania; ;
| | | | | | | | | | - Hinke Haisma
- Faculty of Spatial Sciences, Population Research Centre, University of Groningen, Groningen, The Netherlands
| | - Paul Klatser
- Royal Tropical Institute, Amsterdam, The Netherlands
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