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Nabukalu D, Calazans JA, Marston M, Calvert C, Nakawooya H, Nansereko B, Sekubugu R, Nakigozi G, Serwadda D, Sewankambo N, Kigozi G, Gray RH, Nalugoda F, Makumbi F, Lutalo T, Todd J. Estimation of cause-specific mortality in Rakai, Uganda, using verbal autopsy 1999-2019. Glob Health Action 2024; 17:2338635. [PMID: 38717826 PMCID: PMC11080674 DOI: 10.1080/16549716.2024.2338635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/31/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status. OBJECTIVES To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda. METHODOLOGY Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood. RESULTS Between 1999 and 2019, 63082 adults (15-60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33-5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61-12.28) to 3.27 (95% CI: 2.89-3.68) per 1000 pyo between 1999-2004 and 2015-2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively. CONCLUSION There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.
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Affiliation(s)
- Dorean Nabukalu
- Data management, Rakai Health Sciences Program, Rakai, Uganda
- Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Júlia Almeida Calazans
- Centre for Demographic Studies (CED), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Milly Marston
- Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clara Calvert
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Robert Sekubugu
- Data management, Rakai Health Sciences Program, Rakai, Uganda
| | | | - David Serwadda
- Data management, Rakai Health Sciences Program, Rakai, Uganda
- Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Nelson Sewankambo
- Data management, Rakai Health Sciences Program, Rakai, Uganda
- College of Health Sciences, Makerere University School of Medicine, Kampala, Uganda
| | - Godfrey Kigozi
- Data management, Rakai Health Sciences Program, Rakai, Uganda
| | - Ronald H Gray
- Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Fred Nalugoda
- Data management, Rakai Health Sciences Program, Rakai, Uganda
| | - Fredrick Makumbi
- Data management, Rakai Health Sciences Program, Rakai, Uganda
- Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Tom Lutalo
- Data management, Rakai Health Sciences Program, Rakai, Uganda
- Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Jim Todd
- Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Herce ME, Bosomprah S, Masiye F, Mweemba O, Edwards JK, Mandyata C, Siame M, Mwila C, Matenga T, Frimpong C, Mugala A, Mbewe P, Shankalala P, Sichone P, Kasenge B, Chunga L, Adams R, Banda B, Mwamba D, Nachalwe N, Agarwal M, Williams MJ, Tonwe V, Pry JM, Musheke M, Vinikoor M, Mutale W. Evaluating a multifaceted implementation strategy and package of evidence-based interventions based on WHO PEN for people living with HIV and cardiometabolic conditions in Lusaka, Zambia: protocol for the TASKPEN hybrid effectiveness-implementation stepped wedge cluster randomized trial. Implement Sci Commun 2024; 5:61. [PMID: 38844992 PMCID: PMC11155136 DOI: 10.1186/s43058-024-00601-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Despite increasing morbidity and mortality from non-communicable diseases (NCD) globally, health systems in low- and middle-income countries (LMICs) have limited capacity to address these chronic conditions, particularly in sub-Saharan Africa (SSA). There is an urgent need, therefore, to respond to NCDs in SSA, beginning by applying lessons learned from the first global response to any chronic disease-HIV-to tackle the leading cardiometabolic killers of people living with HIV (PLHIV). We have developed a feasible and acceptable package of evidence-based interventions and a multi-faceted implementation strategy, known as "TASKPEN," that has been adapted to the Zambian setting to address hypertension, diabetes, and dyslipidemia. The TASKPEN multifaceted implementation strategy focuses on reorganizing service delivery for integrated HIV-NCD care and features task-shifting, practice facilitation, and leveraging HIV platforms for NCD care. We propose a hybrid type II effectiveness-implementation stepped-wedge cluster randomized trial to evaluate the effects of TASKPEN on clinical and implementation outcomes, including dual control of HIV and cardiometabolic NCDs, as well as quality of life, intervention reach, and cost-effectiveness. METHODS The trial will be conducted in 12 urban health facilities in Lusaka, Zambia over a 30-month period. Clinical outcomes will be assessed via surveys with PLHIV accessing routine HIV services, and a prospective cohort of PLHIV with cardiometabolic comorbidities nested within the larger trial. We will also collect data using mixed methods, including in-depth interviews, questionnaires, focus group discussions, and structured observations, and estimate cost-effectiveness through time-and-motion studies and other costing methods, to understand implementation outcomes according to Proctor's Outcomes for Implementation Research, the Consolidated Framework for Implementation Research, and selected dimensions of RE-AIM. DISCUSSION Findings from this study will be used to make discrete, actionable, and context-specific recommendations in Zambia and the region for integrating cardiometabolic NCD care into national HIV treatment programs. While the TASKPEN study focuses on cardiometabolic NCDs in PLHIV, the multifaceted implementation strategy studied will be relevant to other NCDs and to people without HIV. It is expected that the trial will generate new insights that enable delivery of high-quality integrated HIV-NCD care, which may improve cardiovascular morbidity and viral suppression for PLHIV in SSA. This study was registered at ClinicalTrials.gov (NCT05950919).
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Affiliation(s)
- Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Felix Masiye
- Department of Health Economics, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Chomba Mandyata
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Mmamulatelo Siame
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Chilambwe Mwila
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Tulani Matenga
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | | | - Anchindika Mugala
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Medicine, Division of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia
| | - Peter Mbewe
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Perfect Shankalala
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Pendasambo Sichone
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Blessings Kasenge
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Luanaledi Chunga
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Rupert Adams
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Brian Banda
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Daniel Mwamba
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Namwinga Nachalwe
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Mansi Agarwal
- Institute of Public Health, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Makeda J Williams
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, U.S. National Institutes of Health, Bethesda, MD, USA
| | - Veronica Tonwe
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, U.S. National Institutes of Health, Bethesda, MD, USA
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Epidemiology, School of Medicine, University of California at Davis, Davis, CA, USA
| | - Maurice Musheke
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael Vinikoor
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Division of Infectious Diseases, Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Wilbroad Mutale
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
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Wandera SO, Golaz V, Kwagala B, Ntozi JPM, Ayuku DO. "These are just finishing our medicines": older persons' perceptions and experiences of access to healthcare in public and private health facilities in Uganda. BMC Health Serv Res 2024; 24:396. [PMID: 38553700 PMCID: PMC10979571 DOI: 10.1186/s12913-024-10741-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/18/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND There is limited research on the experiences of access to medicines for non-communicable diseases (NCDs) in health facilities among older persons in Uganda. This paper explores the perspectives of older persons and healthcare providers concerning older persons' access to essential medicines in Uganda. METHODS It is based on qualitative data from three districts of Hoima, Kiboga, and Busia in Uganda. Data collection methods included seven (07) focus group discussions (FGDs) and eighteen (18) in-depth interviews with older persons. Nine (9) key informant interviews with healthcare providers were conducted. Deductive and inductive thematic analysis (using Health Access Livelihood Framework) was used to analyze the barriers and facilitators of access to healthcare using QSR International NVivo software. RESULTS The key facilitators and barriers to access to healthcare included both health system and individual-level factors. The facilitators of access to essential medicines included family or social support, earning some income or Social Assistance Grants for Empowerment (SAGE) money, and knowing a healthcare provider at a health facility. The health system barriers included the unavailability of specialized personnel, equipment, and essential medicines for non-communicable diseases, frequent stock-outs, financial challenges, long waiting times, high costs for medicines for NCDs, and long distances to health facilities. CONCLUSION Access to essential medicines for NCDs is a critical challenge for older persons in Uganda. The Ministry of Health should make essential drugs for NCDS to be readily available and train geriatricians to provide specialized healthcare for older persons to reduce health inequities in old age. Social support systems need to be strengthened to enable older persons to access healthcare.
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Affiliation(s)
- Stephen Ojiambo Wandera
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda.
- Department of Mental Health and Behavioral Sciences and Mental Health, Moi University, Eldoret, Kenya.
| | - Valerie Golaz
- Institut National d'Etudes Demographiques (INED), Paris, Aubervilliers, France
| | - Betty Kwagala
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - James P M Ntozi
- Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, P. O. Box 7062, Kampala, Uganda
| | - David Otundo Ayuku
- Department of Mental Health and Behavioral Sciences and Mental Health, Moi University, Eldoret, Kenya
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Banturaki A, Munyambalu DK, Kajoba D, Onchoke VB, Peris A, Ryamugwiza P, Amandua J, Akaba K. Chronic obstructive pulmonary disease burden, grades and erythrocytosis at a tertiary hospital in western Uganda. BMC Pulm Med 2024; 24:119. [PMID: 38448860 PMCID: PMC10918867 DOI: 10.1186/s12890-024-02944-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/01/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide among people over 40 years of age, and erythrocytosis is one of the major complications associated with increased mortality among COPD patients. The study aimed to determine the proportion of COPD, associated factors, and the burden of erythrocytosis among COPD participants. METHODS AND MATERIALS A descriptive cross-sectional study design was used. A consecutive sampling technique was used to obtain study participants at the Fort Portal Regional Referral Hospital outpatient clinic. Focused history and physical examination were carried out to select eligible participants. Participants were screened using the COPD population screener for spirometry after consenting to participate. The study enrolled all adults at risk of having COPD based on the COPD population screener and able to undergo spirometry. Spirometry was carried out according to the Global Chronic Obstructive Lung Disease and European Respiratory Society guidelines, and haemoglobin concentration was measured. RESULTS One hundred eighty participants were enrolled in the study, most of whom were females. The modal and mean age of participants was 60 years with 139 (77.2%) females and primary as the highest education level 149(82.8%). The proportion of COPD was 25% (45) [95% CI 18.9 - 32] and highest among females (68.9%) and those aged 60 years and above (70%). The combined COPD assessment tool groups had a proportion of 55.6%, 37.8%, 4.4%, and 2.2% for groups A, B, C, and D, respectively. Age < 50 years was protective against COPD, while for every additional year of smoking, there was an associated 6.5% increased risk compared to the general population. Additionally, the proportion of erythrocytosis among COPD participants was 6.7%. CONCLUSIONS AND RECOMMENDATIONS There was a high proportion of COPD among study participants (25%), with a 6.7% proportion of erythrocytosis. We recommend a complete blood count for every patient in groups C and D of the ABCD COPD GOLD groups.
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Affiliation(s)
- Amon Banturaki
- Department of Internal Medicine, Kampala International University-Teaching Hospital, P.O. BOX 71, Ishaka- Bushenyi, Uganda.
| | - Dalton Kambale Munyambalu
- Department of Internal Medicine, Kampala International University-Teaching Hospital, P.O. BOX 71, Ishaka- Bushenyi, Uganda
| | - Dickson Kajoba
- Department of Paediatrics and Child Health, Kampala International University-Teaching Hospital, Ishaka- Bushenyi, Uganda
| | - Verah Bella Onchoke
- Department of Internal Medicine, Kampala International University-Teaching Hospital, P.O. BOX 71, Ishaka- Bushenyi, Uganda
| | - Alina Peris
- Department of Internal Medicine, Kampala International University-Teaching Hospital, P.O. BOX 71, Ishaka- Bushenyi, Uganda
| | - Prosper Ryamugwiza
- Department of Internal Medicine, Kampala International University-Teaching Hospital, P.O. BOX 71, Ishaka- Bushenyi, Uganda
| | - Jacinto Amandua
- Department of Internal Medicine, Kampala International University-Teaching Hospital, P.O. BOX 71, Ishaka- Bushenyi, Uganda
| | - Kingsley Akaba
- Department of Internal Medicine, Kampala International University-Teaching Hospital, P.O. BOX 71, Ishaka- Bushenyi, Uganda
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Defar A, Zeleke GT, Berhanu D, Lemango ET, Bekele A, Alemu K, Biadgilign S. Health system's availability and readiness of health facilities for chronic non-communicable diseases: Evidence from the Ethiopian national surveys. PLoS One 2024; 19:e0297622. [PMID: 38394315 PMCID: PMC10890768 DOI: 10.1371/journal.pone.0297622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 01/09/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) currently cause more deaths than all other causes of deaths. Cardiovascular disease, diabetes, cancer, and chronic respiratory diseases-threaten the health and economies of individuals and populations worldwide. This study aimed to assess the availability and readiness of health facilities for chronic non-communicable diseases (NCDs) and describe the changes of service availability for common NCDs in Ethiopia. Methods We used data from the 2014 Ethiopia Service Provision Assessment Plus (ESPA +) and 2016 and 2018 Service Availability and Readiness Assessment (SARA) surveys, which were cross-sectional health facility-based studies. A total of 873 health facilities in 2014, 547 in 2016, 632 in 2018 were included in the analysis. (ESPA+) and SARA surveys are conducted as a census or a nationally/sub-nationally representative sample of health facilities. Proportion of facilities that offered the service for diabetes, cardiovascular disease, chronic respiratory disease, cancer diseases, mental illness, and chronic renal diseases was calculated to measure health service availability. The health facility service readiness was measured using the mean availably of tracer items that are required to offer the service. Thus, 13 tracer items for diabetes disease, 12 for cardiovascular disease, 11 for chronic respiratory disease and 11 cervical cancer services were used. RESULTS The services available for diagnosis and management did not show improvement between 2014, 2016 and 2018 for diabetes (59%, 22% and 36%); for cardiovascular diseases (73%, 41% and 49%); chronic respiratory diseases (76%, 45% and 53%). Similarly, at the national level, the mean availability of tracer items between 2014, 2016 and 2018 for diabetes (37%, 53% and 48%); cardiovascular diseases (36%, 41% and 42%); chronic respiratory diseases (26%, 27% and 27%); and cancer diseases (6%, 72% and 51%). However, in 2014 survey year, the mean availability of tracer items was 7% each for mental illness and chronic renal diseases, respectively. CONCLUSIONS The majority of the health facilities have low and gradual decrement in the availability to provide NCDs services in Ethiopia. There is a need to increase NCD service availability and readiness at primary hospitals and health centers, and private and rural health facilities where majority of the population need the services.
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Affiliation(s)
- Atkure Defar
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | | | - Della Berhanu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ephrem Tekle Lemango
- Maternal, Child Health and Nutrition Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Abebe Bekele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kassahun Alemu
- College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Sibhatu Biadgilign
- Independent Public Health Analyst and Research Consultant, Addis Ababa, Ethiopia
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Olds PK, Nuwagaba G, Obwoya PS, Nuwagira E, Haberer JE, Okello S. Patient-provider experiences with chronic non-communicable disease care during COVID-19 lockdowns in rural Uganda: A qualitative analysis. PLoS One 2023; 18:e0295596. [PMID: 38096188 PMCID: PMC10721044 DOI: 10.1371/journal.pone.0295596] [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: 07/06/2023] [Accepted: 11/24/2023] [Indexed: 12/17/2023] Open
Abstract
Non-communicable diseases (NCDs) are a growing health burden in Sub-Saharan Africa and especially Uganda, where they account for over one third of all deaths. During the COVID-19 pandemic, public health control measures such as societal "lockdowns" had a significant impact on longitudinal NCD care though no studies have looked at the lived experience around NCD care during the pandemic. Our objective was to understand the experience of NCD care for both patients and providers in southwestern Uganda during the COVID-19 pandemic. We conducted in-depth, in-person qualitative interviews with 20 patients living with hypertension, diabetes, and/or cardiac disease purposefully selected from the outpatient clinics at Mbarara Regional Referral Hospital and 11 healthcare providers from public health facilities in Mbarara, southwestern Uganda. We analyzed transcripts according to conventional content analysis. We identified four major themes that emerged from the interviews; (1) difficulty accessing medication; (2) food insecurity; (3) barriers to the delivery of NCD clinical care and (4) alternative forms of care. Pre-existing challenges with NCD care were exacerbated during COVID-19 lockdown periods and care was severely disrupted, leading to worsened patient health and even death. The barriers to care were exacerbations of underlying systemic problems with NCD care delivery that require targeted interventions. Future work should leverage digital health interventions, de-centralizing NCD care, improving follow-up, providing social supports to NCD patients, and rectifying supply chain issues.
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Affiliation(s)
- Peter K. Olds
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | | | - Paul S. Obwoya
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edwin Nuwagira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jessica E. Haberer
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
- University of North Carolina, Chapel Hill, NC, United States of America
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Edward A, Kalyesubula R, Pariyo G, Kyazze AP, Hu X, Appel LJ, Matsushita K. Self-paced online learning to improve knowledge competencies for hypertension among medical students in Uganda: A pre-post study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001609. [PMID: 37459296 PMCID: PMC10351720 DOI: 10.1371/journal.pgph.0001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
The growing burden of hypertension (HT) is projected to reach 1.56 billion globally by 2025 and is an increasing public health concern, even for low- and middle-income countries (LMIC) like Uganda, where the prevalence of HT is 31.5%. The objective of this study was to test the effectiveness of a freely available HT online course on knowledge competencies for medical students in Uganda. The online course was developed by a multidisciplinary team at Johns Hopkins University to address HT control in resource-constrained healthcare settings. Students in the 3rd, 4th, and 5th years of medical school were randomly selected to participate in the online course. Pre and post knowledge tests were administered using an online survey system. Of the 201 invited students, 121 (60.2%) completed the study. Significant improvements in mean knowledge scores were evident following the online course completion for Module 1, Fundamentals of HT (21.9±2.5 to 23.7±2.5, p<0.001), and Module 2, Basics of HT Management (14.9±3.3 to 18.5±4.3, p<0.001). No statistically significant differences were evident by gender or school year. Students who took a shorter duration to complete the course had significantly higher mean score improvement between pre- and post-test (mean score improvement 7.0 if <4 weeks, 3.6 if 4-8 weeks, and 3.7 if >8 weeks, p<0.003). Students recognized information on blood pressure measurement (32.2%) and HT management (22.3%) as the most important concept addressed in the course. A self-paced online course, complementing medical school training, improved knowledge on HT burden and management in Uganda.
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Affiliation(s)
- Anbrasi Edward
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Robert Kalyesubula
- Departments of Medicine and Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - George Pariyo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Andrew Peter Kyazze
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Xiao Hu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lawrence J. Appel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins School of Nursing, Baltimore, Maryland, United States of America
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Cissé K, Samadoulougou S, Kaboré J, Somda P, Zongo A, Traoré S, Zabsonre P, Yombi JC, Kouanda S, Kirakoya-Samadoulougou F. Healthcare system's preparedness to provide cardiovascular and diabetes-specific care in the context of geopolitical crises in Burkina Faso: a trend analysis from 2012 to 2018. BMJ Open 2023; 13:e065912. [PMID: 37221029 DOI: 10.1136/bmjopen-2022-065912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the trends of the availability and readiness of the healthcare system to provide cardiometabolic (cardiovascular diseases (CVD) and diabetes) services in Burkina Faso in multiple political and insecurity crises context. DESIGN We performed a secondary analysis of repeated nationwide cross-sectional studies in Burkina Faso. DATA SOURCE Four national health facility survey data (using WHO Service Availability and Readiness Assessment (SARA) tool) conducted between 2012 and 2018 were used. PARTICIPANTS In 2012, 686 health facilities were surveyed, 766 in 2014, 677 in 2016 and 794 in 2018. PRIMARY AND SECONDARY OUTCOME MEASURES The main outcomes were the availability and readiness services indicators defined according to the SARA manual. RESULTS Between 2012 and 2018, the availability of CVD and diabetes services significantly increased (67.3% to 92.7% for CVD and 42.5% to 54.0% for diabetes). However, the mean readiness index of the healthcare system to manage CVD decreased from 26.8% to 24.1% (p for trend <0.001). This trend was observed mainly at the primary healthcare level (from 26.0% to 21.6%, p<0.001). For diabetes, the readiness index increased (from 35.4% to 41.1%, p for trend=0.07) during 2012-2018. However, during the crisis period (2014-2018), both CVD (27.9% to 24.1%, p<0.001) and diabetes (45.8% to 41.1%, p<0.001) service readiness decreased. At the subnational level, the readiness index for CVD significantly decreased in all regions but predominantly in the Sahel region, which is the main insecure region (from 32.2% to 22.6%, p<0.001). CONCLUSION In this first monitoring study, we found a low level and decreased trend of readiness of the healthcare system for delivering cardiometabolic care, particularly during the crisis period and in conflicted regions. Policymakers should pay more attention to the impact of crises on the healthcare system to mitigate the rising burden of cardiometabolic diseases.
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Affiliation(s)
- Kadari Cissé
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Institut de Recherche en Sciences de la santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Sékou Samadoulougou
- Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute Research Center, Quebec City, Quebec, Canada
- Centre for Research On Planning and Development (CRAD), Laval University, Quebec City, Quebec, Canada
| | - Jean Kaboré
- Institut de Recherche en Sciences de la santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
| | - Paulin Somda
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | | | | | - Patrice Zabsonre
- Unité de formation et de recherche en sciences de la santé, Université Joseph Ki-Zerbo Ouagadougou, Ouagadougou, Burkina Faso
| | - Jean Cyr Yombi
- Service de médecine interne et maladies infectieuses, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Seni Kouanda
- Institut de Recherche en Sciences de la santé, Centre National de la Recherche Scientifique et Technologique, Ouagadougou, Burkina Faso
- Institut Africain de Sante Publique, Ouagadougou, Burkina Faso
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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Nanono J, Neupane D, Ssekamatte T, Ahumuza E, Kasujja FX, Rutebemberwa E. Service Availability and Readiness of Primary Care Health Facilities Offering Hypertension Diagnosis Services in Wakiso District, Uganda, 2019. Prev Chronic Dis 2023; 20:E18. [PMID: 36996407 PMCID: PMC10109518 DOI: 10.5888/pcd20.220236] [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] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Hypertension is a growing burden in Uganda and other low- and middle-income countries. Appropriate diagnosis services are needed at primary care health facilities to identify, initiate treatment for, and manage hypertension. This study assessed service availability and readiness as well as facilitators and barriers in primary health care facilities for hypertension diagnosis services in Wakiso District, Uganda. METHODS In July and August 2019, we conducted structured interviews at 77 randomly selected primary care health facilities in Wakiso District. We used an interviewer-administered health facility checklist modified from the World Health Organization's service availability and readiness assessment tool. We also conducted 13 key informant interviews with health workers and district-level managers. Readiness was measured by availability of functional diagnostic equipment, related supplies and tools, and health provider attributes. Service availability was measured by assessing hypertension diagnosis services. RESULTS Most (86%; 66 of 77) health facilities offered hypertension diagnosis services and 84% (65 of 77) had digital blood pressure measuring devices; only 69% (53 of 77) had functional blood pressure measuring devices. Lower-level facilities lacked appropriate blood pressure cuffs for use across age groups: 92% (71 of 77) lacked pediatric cuffs and 52% (40 of 77) lacked alternative adult cuffs. Facilitators for diagnosing hypertension included partners that built health facility staff capacity and funds for purchasing hypertension diagnostic supplies; common barriers were nonfunctional equipment, delays in receiving training, and inadequate staffing. CONCLUSION The results highlight the need for an adequate supply of devices, routine replacements or repairs, and frequent refresher training for health workers.
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Affiliation(s)
- Jackline Nanono
- Makerere University School of Public Health, New Mulago Hospital Complex, Mulago Hill Road, PO Box 7072, Kampala, Uganda
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Francis Xavier Kasujja
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
- The Chronic Diseases and Cancer Theme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Research Unit, Entebbe, Uganda
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10
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Azmin M, Mohebi F, Yoosefi M, Ahmadi N, Shirazi S, Modirian M, Farzadfar F. The incremental cost of implementing the world health organization Package of essential non-communicable (PEN) diseases interventions in Iran. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000449. [PMID: 36962715 PMCID: PMC10021820 DOI: 10.1371/journal.pgph.0000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 12/15/2022] [Indexed: 02/11/2023]
Abstract
World-Health-Organization's PEN package proposes a minimum set of cost-effective interventions for early diagnosis and management of Non-Communicable-Disease (NCD). IraPEN (the PEN package implemented in Iran), adopted from PEN and Iran National Action Plans for NCDs, addresses challenges regarding NCD prevention and control. IraPEN was piloted in four districts of Iran. In this research, we estimate incremental per-capita cost of IraPEN program implementation in two of the pilot districts. We utilized a bottom-up, ingredient-based costing approach. Institutional expenditure data was collected via information forms. Information pertaining to personnel costs was gathered by performing task time measurements using Direct Observation Method. An individual-level survey was conducted in under-study districts to determine program coverage and its users' demographic information via systematic random cluster sampling. Sampling of districts was based on systematic random cluster sampling. In each district, 250 families in 25 clusters proportional to urban or rural populations were randomly selected by postal codes. All family members eligible for the program were interviewed. Interviews were organized and conducted in each district by NCD experts in provincial Universities of Medical Sciences. Costs were re-categorized into fixed and variable costs based on their dependency on the program's coverage. Fixed and variable costs were, respectively, divided by total eligible populations and covered populations in each district to calculate cost per-capita for each protocol. Total per-capita cost per-service was then calculated for each protocol and whole program by adding these figures. All costs are reported in US$ 2015-2016. The incremental costs of IraPEN implementation per user, with and without introduction cost, were US$24.90 and US$25.32, respectively. Total incremental cost per-capita for each protocol ranged between US$1.05 to US$7.45. The human resources and supplies had the highest contribution in total program cost (74.97% and 15.76%, respectively). The present study shows that IraPEN program implementation to be a high-cost package within Iranian context, that necessitates cautions in other similar contexts for implementation. It is, however, difficult to make decisions on implementation of NCD prevention and control programs purely based on their cost. Informed decision making requires assessment of a programs' effectiveness and justifications and alterations to the current package could reduce the costs, leading to increased efficiency of the program.
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Affiliation(s)
- Mehrdad Azmin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnam Mohebi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Haas School of Business, University of California, Berkeley, California, United States of America
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Shirazi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Modirian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Nyanchoka M, Mulaku M, Nyagol B, Owino EJ, Kariuki S, Ochodo E. Implementing essential diagnostics-learning from essential medicines: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000827. [PMID: 36962808 PMCID: PMC10121180 DOI: 10.1371/journal.pgph.0000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Abstract
The World Health Organization (WHO) model list of Essential In vitro Diagnostic (EDL) introduced in 2018 complements the established Essential Medicines List (EML) and improves its impact on advancing universal health coverage and better health outcomes. We conducted a scoping review of the literature on implementing the WHO essential lists in Africa to inform the implementation of the recently introduced EDL. We searched eight electronic databases for studies reporting on implementing the WHO EDL and EML in Africa. Two authors independently conducted study selection and data extraction, with disagreements resolved through discussion. We used the Supporting the Use of Research Evidence (SURE) framework to extract themes and synthesised findings using thematic content analysis. We used the Mixed Method Appraisal Tool (MMAT) version 2018 to assess the quality of included studies. We included 172 studies reporting on EDL and EML after screening 3,813 articles titles and abstracts and 1,545 full-text papers. Most (75%, n = 129) studies were purely quantitative in design, comprising descriptive cross-sectional designs (60%, n = 104), 15% (n = 26) were purely qualitative, and 10% (n = 17) had mixed-methods approaches. There were no qualitative or randomised experimental studies about EDL. The main barrier facing the EML and EDL was poorly equipped health facilities-including unavailability or stock-outs of essential in vitro diagnostics and medicines. Financial and non-financial incentives to health facilities and workers were key enablers in implementing the EML; however, their impact differed from one context to another. Only fifty-six (33%) of the included studies were of high quality. Poorly equipped and stocked health facilities remain an implementation barrier to essential diagnostics and medicines. Health system interventions such as financial and non-financial incentives to improve their availability can be applied in different contexts. More implementation study designs, such as experimental and qualitative studies, are required to evaluate the effectiveness of essential lists.
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Affiliation(s)
- Moriasi Nyanchoka
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Mercy Mulaku
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Pharmacology, Clinical Pharmacy, and Pharmacy Practice, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Bruce Nyagol
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eddy Johnson Owino
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eleanor Ochodo
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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12
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Mulugeta TK, Kassa DH. Readiness of the primary health care units and associated factors for the management of hypertension and type II diabetes mellitus in Sidama, Ethiopia. PeerJ 2022; 10:e13797. [PMID: 36042860 PMCID: PMC9420406 DOI: 10.7717/peerj.13797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023] Open
Abstract
Background In low-income nations such as Ethiopia, noncommunicable diseases (NCDs) are becoming more common. The Ethiopian Ministry of Health has prioritized NCD prevention, early diagnosis, and management. However, research on the readiness of public health facilities to address NCDs, particularly hypertension and type II diabetes mellitus, is limited. Methods The study used a multistage cluster sampling method and a health facility-based cross-sectional study design. A total of 83 health facilities were evaluated based on WHO's Service Availability and Readiness Assessment (SARA) tool to investigate the availability of services and the readiness of the primary health care unit (PHCU) to manage type II diabetes and Hypertension. Trained data collectors interviewed with PHCU head or NCD focal persons. The study tried to investigate (1) the availability of basic amenities and the four domains: staff and guidelines, basic equipment, diagnostic materials, and essential medicines used to manage DM and HPN, (2) the readiness of the PHCU to manage DM and HPN. The data were processed by using SPSS version 24. Descriptive statistics, including frequency and percentage, inferential statistics like the chi-square test, and logistic regression models were used to analyze the data. Results Of the 82 health facilities, only 29% and 28% of the PHCU identified as ready to manage HPN and DM. Facility type, facility location, presence of guidelines, trained staff, groups of antihypertensive and antidiabetic medicines had a significant impact (P < 0.05) on the readiness of the PHCU to manage HPN and DM at a 0.05 level of significance. Facilities located in urban were 8.2 times more likely to be ready to manage HPN cases than facilities located in rural (AOR = 8.2, 95% CI [2.4-28.5]) and P < 0.05. Conclusion and recommendation The results identified comparatively poor and deprived readiness to offer HPN and DM services at lower-level health facilities(health centers). Equipping the lower-level health facilities with screening and diagnostic materials, essential medicines, and provision of basic training for the health care providers and NCD guidelines should be available, especially in the lower health care facilities.
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Affiliation(s)
- Tigist Kebede Mulugeta
- School of Nutrition, Food Science and Technology, Department of Human Nutrition Hawassa University, Hawassa, Ethiopia
- School of Public Health, Department of Public Health Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu Kassa
- School of Public Health, Department of Public Health Hawassa University, Hawassa, Ethiopia
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Kazibwe A, Bisaso KR, Kyazze AP, Ninsiima S, Ssekamatte P, Bongomin F, Baluku JB, Kibirige D, Akabwai GP, Kamya MR, Mayanja-Kizza H, Byakika-Kibwika P, Kagimu M, Kalyesubula R, Andia-Biraro I. HIV, tuberculosis, diabetes mellitus and hypertension admissions and premature mortality among adults in Uganda from 2011 to 2019: is the tide turning? Trop Med Health 2022; 50:54. [PMID: 35948991 PMCID: PMC9458845 DOI: 10.1186/s41182-022-00447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/01/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The growing burden of diabetes mellitus (DM) and hypertension (HTN) on the background of endemic Human Immuno-deficiency Virus (HIV) and tuberculosis (TB) is a concern in low- and middle-income countries. We aimed to describe annual trends in admissions, mortality rates and premature mortality (years of potential life lost-YPLLs) due to HIV, tuberculosis (TB), diabetes mellitus (DM) and hypertension (HTN) in Uganda. METHODS We conducted a retrospective cohort study, retrieving electronic records of adults admitted to Mulago and Kiruddu national referral hospitals medical wards between 1st January 2011 and 31st December 2019. We used STATA BE 17.0 and GraphPad Prism 8.0.2 to compute total admissions, inpatient crude mortality rates, and YPLLs; and demonstrate trends using Mann-Kendall test. RESULTS Of 108,357 admissions, 55,620 (51.3%) were female, 15,300 (14.1%) were recorded in 2012, and 22,997 (21.2%) were aged 21-30 years. HIV, TB, DM and HTN accounted for 26,021 (24.0%); 9537 (8.8%); 13,708 (12.7) and 13,252 (12.2%) of all admissions, respectively. Overall inpatient mortality was 16.7% (18,099/108,357), 53.5% (9674/18,099) were male, 21.5% (3898) were aged 31-40 years and 2597 (14.4%) were registered in 2013. HIV, TB, DM and HTN accounted for 35.6% (6444), 14.6% (2646), 9.1% (1648) and 11.8% (2142) of all deaths, respectively. Total admissions (Kendall's tau-B = - 0.833, p < 0.001) and deaths declined (Kendall's tau-B = - 0.611, p = 0.029). A total of 355,514 (mean = 20.8 years, SD 30.0) YPLLs were recorded, of which 54.6% (191,869) were in males; 36.2% (128,755) were among those aged 21-30 years and were recorded in 2012 (54,717; 15.4%). HIV, TB, DM and HTN accounted for 46.5% (165,352); 19.5% (69,347); 4.8% (16,991) and 4.5% (16,167) of YPLLs, respectively. Proportionate contribution of HIV to deaths and YPLLs declined, remained stagnant for TB; and increased for both DM and HTN. CONCLUSION TB and HIV account for higher though declining, while DM and HTN account for lower albeit rising morbidity and premature mortality among adult medical patients in Uganda. TB prevention and treatment; and DM/HTN service integration in HIV care should be optimized and scaled up.
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Affiliation(s)
- Andrew Kazibwe
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda ,Directorate of Programs, The AIDS Support Organisation, P. O. Box 10443, Kampala, Uganda
| | | | - Andrew Peter Kyazze
- grid.11194.3c0000 0004 0620 0548Tuberculosis and Co-Morbidities (TAC) Research Group, Makerere University, Kampala, Uganda
| | - Sandra Ninsiima
- grid.11194.3c0000 0004 0620 0548Tuberculosis and Co-Morbidities (TAC) Research Group, Makerere University, Kampala, Uganda
| | - Phillip Ssekamatte
- grid.11194.3c0000 0004 0620 0548Tuberculosis and Co-Morbidities (TAC) Research Group, Makerere University, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Felix Bongomin
- grid.442626.00000 0001 0750 0866Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, P. O. Box 166, Gulu, Uganda
| | - Joseph Baruch Baluku
- grid.513250.0Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Davis Kibirige
- Uganda Martyrs Hospital, Lubaga, P. O. Box 14130, Kampala, Uganda
| | - George Patrick Akabwai
- grid.423308.e0000 0004 0397 2008Baylor College of Medicine, Children’s Foundation, Kampala, Uganda
| | - Moses R. Kamya
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Harriet Mayanja-Kizza
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Magid Kagimu
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda
| | - Robert Kalyesubula
- grid.11194.3c0000 0004 0620 0548Department of Physiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Irene Andia-Biraro
- grid.11194.3c0000 0004 0620 0548Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, P. O. Box 7072, Kampala, Uganda ,grid.415861.f0000 0004 1790 6116Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Ammoun R, Wami WM, Otieno P, Schultsz C, Kyobutungi C, Asiki G. Readiness of health facilities to deliver non-communicable diseases services in Kenya: a national cross-sectional survey. BMC Health Serv Res 2022; 22:985. [PMID: 35918710 PMCID: PMC9344761 DOI: 10.1186/s12913-022-08364-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Non-communicable diseases (NCDs) account for an estimated 71% of all global deaths annually and nearly 80% of these deaths occur in low- and middle-income countries. This study aimed to assess the readiness of existing healthcare systems at different levels of health care in delivering NCDs management and prevention services in Kenya. Methods A cross-sectional survey of 258 facilities was conducted between June 2019 and December 2020 using multistage sampling, examining facility readiness based on the availability of indicators such as equipment, diagnostic capacity, medicines and commodities, trained staff and guidelines for NCDs management. Readiness scores were calculated as the mean availability of tracer items expressed as a percentage and a cut-off threshold of ≥ 70% was used to classify facilities as “ready” to manage NCDs. Descriptive and bivariate analyses were performed to assess the readiness of facilities by type, level, and location settings. Logistic regressions were used to identify factors associated with the readiness of facilities to provide disease-specific services. Results Of the surveyed facilities, 93.8% offered chronic respiratory disease (CRD) diagnosis and/or management services, 82.2% diabetes mellitus, 65.1% cardiovascular disease (CVD), and only 24.4% cervical cancer screening services. The mean readiness scores for diabetes mellitus (71%; 95% CI: 67–74) and CVD (69%; 95% CI: 66–72) were relatively high. Although CRD services were reportedly the most widely available, its mean readiness score was low (48%; 95% CI: 45–50). The majority of facilities offering cervical cancer services had all the necessary tracer items available to provide these services. Modeling results revealed that private facilities were more likely to be “ready” to offer NCDs services than public facilities. Similarly, hospitals were more likely “ready” to provide NCDs services than primary health facilities. These disparities in service readiness extended to the regional and urban/rural divide. Conclusions Important gaps in the current readiness of facilities to manage NCDs in Kenya at different levels of health care were revealed, showing variations by disease and healthcare facility type. A collective approach is therefore needed to bridge the gap between resource availability and population healthcare needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08364-w.
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Affiliation(s)
- Rita Ammoun
- Faculty of Médicine, Limoges Université, 2 Rue du Docteur Marcland, 87025, LIMOGES CEDEX, France
| | - Welcome Mkhululi Wami
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya. .,Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands.
| | - Peter Otieno
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya
| | - Constance Schultsz
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Catherine Kyobutungi
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya.,Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya.,Department of Women's and Children's Health (KBH), Karolinka Institutet, Tomtebodavägen 18A, 171 77, Solna, Sweden
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Hennein R, Ggita J, Ssuna B, Shelley D, Akiteng AR, Davis JL, Katamba A, Armstrong-Hough M. Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption. Glob Public Health 2022; 17:1868-1882. [PMID: 34775913 PMCID: PMC10570963 DOI: 10.1080/17441692.2021.2003838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
Many implementation efforts experience interruptions, especially in settings with developing health systems. Approaches for evaluating interruptions are needed to inform re-implementation strategies. We sought to devise an approach for evaluating interruptions by exploring the sustainability of a programme that implemented diabetes mellitus (DM) screening within tuberculosis clinics in Uganda in 2017. In 2019, we conducted nine interviews with clinic staff and observed clinic visits to determine their views and practices on providing integrated care. We mapped themes to a social ecological model with three levels derived from the Consolidated Framework for Implementation Research (CFIR): outer setting (i.e. community), inner setting (i.e. clinic), and individuals (i.e. clinicians). Respondents explained that DM screening ceased due to disruptions in the national supply chain for glucose test strips, which had cascading effects on clinics and clinicians. Lack of screening supplies in clinics limited clinicians' opportunities to perform DM screening, which contributed to diminished self-efficacy. However, culture, compatibility and clinicians' beliefs about DM screening sustained throughout the interruption. We propose an approach for evaluating interruptions using the CFIR and social ecological model; other programmes can adapt this approach to identify cascading effects of interruptions and target them for re-implementation.
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Affiliation(s)
- Rachel Hennein
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States
- Yale School of Medicine, New Haven, Connecticut, United States
| | - Joseph Ggita
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Bashir Ssuna
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - Donna Shelley
- Department of Public Health Policy and Management, New York University, New York, New York, United States
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Upper Mulago Hill, Kampala, Uganda
| | - J. Lucian Davis
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, United States
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, United States
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Clinical Epidemiology and Biostatistics Unit, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mari Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
- Department of Social and Behavioral Sciences, New York University, New York, NY
- Department of Epidemiology, New York University, New York, New York, United States
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16
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Moor SE, Tusubira AK, Wood D, Akiteng AR, Galusha D, Tessier-Sherman B, Donroe EH, Ngaruiya C, Rabin TL, Hawley NL, Armstrong-Hough M, Nakirya BD, Nugent R, Kalyesubula R, Nalwadda C, Ssinabulya I, Schwartz JI. Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment. BMJ Open 2022; 12:e059949. [PMID: 35863829 PMCID: PMC9310153 DOI: 10.1136/bmjopen-2021-059949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To explore how respondents with common chronic conditions-hypertension (HTN) and diabetes mellitus (DM)-make healthcare-seeking decisions. SETTING Three health facilities in Nakaseke District, Uganda. DESIGN Discrete choice experiment (DCE). PARTICIPANTS 496 adults with HTN and/or DM. MAIN OUTCOME MEASURES Willingness to pay for changes in DCE attributes: getting to the facility, interactions with healthcare providers, availability of medicines for condition, patient peer-support groups; and education at the facility. RESULTS Respondents were willing to pay more to attend facilities that offer peer-support groups, friendly healthcare providers with low staff turnover and greater availabilities of medicines. Specifically, we found the average respondent was willing to pay an additional 77 121 Ugandan shillings (UGX) for facilities with peer-support groups over facilities with none; and 49 282 UGX for 1 month of medicine over none, all other things being equal. However, respondents would have to compensated to accept facilities that were further away or offered health education. Specifically, the average respondent would have to be paid 3929 UGX to be willing to accept each additional kilometre they would have to travel to the facilities, all other things being equal. Similarly, the average respondent would have to be paid 60 402 UGX to accept facilities with some health education, all other things being equal. CONCLUSIONS Our findings revealed significant preferences for health facilities based on the availability of medicines, costs of treatment and interactions with healthcare providers. Understanding patient preferences can inform intervention design to optimise healthcare service delivery for patients with HTN and DM in rural Uganda and other low-resource settings.
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Affiliation(s)
- Sarah Eg Moor
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew K Tusubira
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
| | - Dallas Wood
- Center for Applied Economics and Strategy, RTI International, Research Triangle Park, North Carolina, USA
| | - Ann R Akiteng
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Baylah Tessier-Sherman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Evelyn Hsieh Donroe
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
| | - Christine Ngaruiya
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tracy L Rabin
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
| | - Nicola L Hawley
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Mari Armstrong-Hough
- Department of Social and Behavioral Sciences and Department of Epidemiology, School of Global Public Health, New York University, New York, New York, USA
| | | | - Rachel Nugent
- Global Non-Communicable Diseases, RTI International, Seattle, Washington, USA
| | - Robert Kalyesubula
- African Community for Social Sustainability, Nakaseke, Uganda
- Department of Internal Medicine, Makerere University School of Medicine, Kampala, Uganda
| | - Christine Nalwadda
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Makerere University School of Medicine, Kampala, Uganda
| | - Jeremy I Schwartz
- Uganda Initiative for Integrated Management of Non-communicable Diseases, Kampala, Uganda
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Network for Global Non-communicable Diseases, Yale University, New Haven, Connecticut, USA
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Jackson-Morris AM, Mutungi G, Maree E, Waqanivalu T, Marten R, Nugent R. 'Implementability' matters: using implementation research steps to guide and support non-communicable disease national planning in low-income and middle-income countries. BMJ Glob Health 2022; 7:bmjgh-2021-008275. [PMID: 35418410 PMCID: PMC9014004 DOI: 10.1136/bmjgh-2021-008275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/20/2022] [Indexed: 11/03/2022] Open
Abstract
The 'implementation gap' between national plans and successful implementation is a central theme in addressing non-communicable diseases (NCDs). It is a factor that has undermined Sustainable Development Goal 3.4, which aims to achieve a one-third reduction in premature mortality from four major NCDs by 2030. Responding to the potential of implementation research to support low-income and middle-income countries to effectively advance their strategies, we describe ways to make NCD plans more robust by including implementation steps. These steps are (1) choosing some (but not all) effective and cost-effective options; (2) tailoring interventions and their scale-up to national capacity; and (3) making the priorities implementable. We illustrate with examples from several countries.
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Affiliation(s)
| | - Gerald Mutungi
- Noncommunicable Diseases, Republic of Uganda Ministry of Health, Kampala, Uganda
| | - Ephantus Maree
- Noncommunicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | - Temo Waqanivalu
- Department of Non-communicable Diseases, World Health Organisation, Suva, Fiji
| | - Robert Marten
- WHO Alliance for Health Policy and Systems Research, Geneva, Switzerland
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, North Carolina, USA
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18
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Ikhile D, Omodara D, Seymour-Smith S, Musoke D, Gibson L. “Some They Need Male, Some They Need Female”: A Gendered Approach for Breast Cancer Detection in Uganda. Front Glob Womens Health 2022; 3:746498. [PMID: 35400129 PMCID: PMC8989840 DOI: 10.3389/fgwh.2022.746498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction There are several challenges associated with breast cancer detection in Uganda and other low-and-middle-income countries. One of the identified challenges is attributed to the health workers' gender, which facilitates gender disparities in access to breast cancer detection services. Although this challenge is well acknowledged in existing literature, there are hardly any studies on how it can be addressed. Therefore, drawing on an intersectionality lens, our study examined how to address gender disparities facilitated by health workers' gender in accessing breast cancer detection services in Uganda. Materials and Methods We collected qualitative data through semi-structured interviews with twenty participants comprising community health workers, primary health care practitioners, non-governmental organizations, district health team, and the Ministry of Health. For the data analysis, thematic analysis was conducted on NVivo using Braun and Clarke's non-linear 6-step process to identify the themes presented in the results section. Results Four themes emerged from the data analysis: understanding a woman's gender constructions; health workers' approachability; focus on professionalism, not sex; and change in organizational culture. These themes revealed participants' perceptions regarding how to address gender disparities relating to the role health workers' gender play in breast cancer detection. Through the intersectionality lens, our findings showed how gender intersects with other social stratifiers such as religious beliefs, familial control, health worker's approachability, and professionalism within the health workforce. Conclusion Our findings show that the solutions to address gender disparities in breast cancer detection are individually and socially constructed. As such, we recommend a gendered approach to understand and redress the underlying power relations perpetuating such constructions. We conclude that taking a gendered approach will ensure that breast cancer detection programs are context-appropriate, cognizant of the prevailing cultural norms, and do not restrict women's access to breast cancer detection services.
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Affiliation(s)
- Deborah Ikhile
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
- *Correspondence: Deborah Ikhile
| | - Damilola Omodara
- Global Public Health, Institute of Population Health Science, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Sarah Seymour-Smith
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
| | - David Musoke
- School of Public Health, Makerere University, Kampala, Uganda
| | - Linda Gibson
- Public Health, Institute of Health and Allied Professions, School of Social Sciences, Nottingham Trent University, Nottingham, United Kingdom
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Chowdhury HA, Paromita P, Mayaboti CA, Rakhshanda S, Rahman FN, Abedin M, Rahman AKMF, Mashreky SR. Assessing service availability and readiness of healthcare facilities to manage diabetes mellitus in Bangladesh: Findings from a nationwide survey. PLoS One 2022; 17:e0263259. [PMID: 35171912 PMCID: PMC8849622 DOI: 10.1371/journal.pone.0263259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 01/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
Diabetes Mellitus (DM) is one of the most prevalent non-communicable diseases (NCDs)as well as a major cause of morbidity and mortality worldwide. Around 80% diabetic patients live in low- and middle-income countries. In Bangladesh, there is a scarcity of data on the quality of DM management within health facilities. This study aims to describe service availability and readiness for DM at all tiers of health facilities using the World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) standard tool.
Methods
This cross-sectional survey was conducted in 266 health facilities all across Bangladesh using the WHO SARA standard tool. Descriptive analyses for the availability of DM services was carried out. Composite scores for facility readiness index (RI) were calculated in four domains: staff and guideline, basic equipment, diagnostic capacity, and essential medicines. Indices were stratified by facility level and a cut off value of 70% was considered as ‘ready’ to manage diabetes at each facility level.
Results
The mean RI score of tertiary and specialized hospitals was above the cutoff value of 70% (RI: 79%), whereas for District Hospitals (DHs), Upazila Health Complexes (UHCs) and NGO and Private hospitals the RI scores were other levels of 65%, 51% and 62% respectively. This indicating that only the tertiary level of health facilities was ready to manage DM. However, it has been observed that the RI scores of the essential medicine domain was low at all levels of health facilities including tertiary-level.
Conclusions
The study revealed only tertiary level facilities were ready to manage DM. However, like other facilities, they require an adequate supply of essential medicines. Alongside the inadequate supply of medicines, shortage of trained staff and unavailability of guidelines on the diagnosis and treatment of DM also contributed to the low RI score for rest of the facilities.
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Affiliation(s)
- Hasina Akhter Chowdhury
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail:
| | - Progga Paromita
- Kirtipasha Health and Family Welfare Centre, Jhalokathi Sadar Upazila, Barishal, Bangladesh
| | | | - Shagoofa Rakhshanda
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Farah Naz Rahman
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Minhazul Abedin
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
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Majumdar U, Nanyonga Clarke R, Moran AE, Doupe P, Gadikota-Klumpers DD, Gidio A, Ssentamu D, Heller DJ. Hypertension screening, prevalence, treatment, and control at a large private hospital in Kampala, Uganda: A retrospective analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000386. [PMID: 36962239 PMCID: PMC10021338 DOI: 10.1371/journal.pgph.0000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022]
Abstract
Adult hypertension prevalence in Uganda is 27%, but only 8% are aware of their diagnosis, accordingly treatment and control levels are limited. The private sector provides at least half of care nationwide, but little is known about its effectiveness in hypertension control. We analyzed clinical data from 39 235 outpatient visits among 17 777 adult patients from July 2017 to August 2018 at Uganda's largest private hospital. We calculated blood pressure screening rate at every visit, and hypertension prevalence, medication treatment, and control rates among the 5 090 patients with two or more blood pressure checks who received any medications from the hospital's pharmacy. We defined hypertension in this group as 1) an average of two blood pressure measurements at separate consecutive visits, higher than 140 mm Hg systolic or 90 mm Hg diastolic, 2) receipt of any antihypertensive medication, or 3) the use of a hypertension electronic medical record code. We deemed hypertension control as normotensive at the most recent check. 12 821 (72.1%) of patients received at least 1 blood pressure check. Among the 5 090 patients above, 2 121 (41.6%) had hypertension (33.4% age-standardized to a world population standard): 1 915 (37.6%) with elevated blood pressure, and 170 (3.3%) were normotensive but receiving medication. 838 (39.4%) of patients with hypertension received medication at least once. Overall, 18.3% of patients achieved control (27% of treated patients, and 15% of untreated patients). Hypertension is common and incompletely controlled in this Ugandan private-sector population, suggesting several avenues for novel interventions.
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Affiliation(s)
- Usnish Majumdar
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | | | - Andrew E Moran
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | | | - Darinka D Gadikota-Klumpers
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Agaba Gidio
- Clarke International University, Kampala, Uganda
| | | | - David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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21
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Tusubira AK, Nalwadda CK, Akiteng AR, Hsieh E, Ngaruiya C, Rabin TL, Katahoire A, Hawley NL, Kalyesubula R, Ssinabulya I, Schwartz JI, Armstrong-Hough M. Social Support for Self-Care: Patient Strategies for Managing Diabetes and Hypertension in Rural Uganda. Ann Glob Health 2021; 87:86. [PMID: 34458110 PMCID: PMC8378074 DOI: 10.5334/aogh.3308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Low-income countries suffer a growing burden of non-communicable diseases (NCDs). Self-care practices are crucial for successfully managing NCDs to prevent complications. However, little is known about how patients practice self-care in resource-limited settings. Objective We sought to understand self-care efforts and their facilitators among patients with diabetes and hypertension in rural Uganda. Methods Between April and June 2019, we conducted a cross-sectional qualitative study among adult patients from outpatient NCD clinics at three health facilities in Uganda. We conducted in-depth interviews exploring self-care practices for hypertension and/or diabetes and used content analysis to identify emergent themes. Results Nineteen patients participated. Patients said they preferred conventional medicines as their first resort, but often used traditional medicines to mitigate the impact of inconsistent access to prescribed medicines or as a supplement to those medicines. Patients adopted a wide range of vernacular practices to supplement treatment or replace unavailable diagnostic tests, such as tasting urine to gauge blood-sugar level. Finally, patients sought and received both instrumental and emotional support for self-care activities from networks of family and peers. Patients saw their children as their most reliable source of support facilitating self-care, especially as a source of money for medicines, transport and home necessities. Conclusion Patients valued conventional medicines but engaged in varied self-care practices. They depended upon networks of social support from family and peers to facilitate self-care. Interventions to improve self-care may be more effective if they improve access to prescribed medicines and engage or enhance patients' social support networks.
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Affiliation(s)
- Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Christine K. Nalwadda
- Department of Community Health and Behavioural Sciences, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Evelyn Hsieh
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Christine Ngaruiya
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tracy L. Rabin
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Anne Katahoire
- Child Health and Development Centre, Makerere University, Kampala, Uganda
| | - Nicola L. Hawley
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Robert Kalyesubula
- Departments of Physiology and Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
- African Community Center for Social Sustainability (ACCESS), Nakaseke, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Department of Internal Medicine, Makerere College of Health Sciences, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Network for Global Non-Communicable Diseases, Yale University, New Haven, CT, USA
| | - Mari Armstrong-Hough
- Department of Social & Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY USA
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22
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Krishnan A, Mathur P, Kulothungan V, Salve HR, Leburu S, Amarchand R, Nongkynrih B, Chaturvedi HK, Ganeshkumar P, K S VU, Laxmaiah A, Boruah M, Kumar S, Patro BK, Raghav PR, Rajkumar P, Sarma PS, Sharma R, Tambe M, Arlappa N, Mahanta TG, Bhuyan PJ, Joshi RP, Pakhare AP, Galhotra A, Kumar D, Behera BK, Topno RK, Gupta MK, Rustagi N, Trivedi AV, Thankappan KR, Gupta S, Garg S, Shelke SC. Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS). BMC Health Serv Res 2021; 21:757. [PMID: 34332569 PMCID: PMC8325187 DOI: 10.1186/s12913-021-06530-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 05/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18). METHODS NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) - Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises. RESULTS Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3-3.3) in rural public to 9.0% (95% CI; 6.2-13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities. CONCLUSION Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Mathur
- Indian Council Medical Research - National Centre for Disease Informatics and Research, Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India.
| | - Vaitheeswaran Kulothungan
- Indian Council Medical Research - National Centre for Disease Informatics and Research, Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Harshal Ramesh Salve
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sravya Leburu
- Indian Council Medical Research - National Centre for Disease Informatics and Research, Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Baridalyne Nongkynrih
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - P Ganeshkumar
- Indian Council Medical Research - National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Vinay Urs K S
- Indian Council Medical Research - National Centre for Disease Informatics and Research, Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Avula Laxmaiah
- Division of Public Health Nutrition, Indian Council Medical Research - National Institute of Nutrition, Hyderabad, Telangana, India
| | - Manjit Boruah
- Department of Community Medicine, Assam Medical College, Dibrugarh, Assam, India
| | - Sanjeev Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Binod Kumar Patro
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Pankaja Ravi Raghav
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prabu Rajkumar
- Indian Council Medical Research - National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - P Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Rinku Sharma
- Centre for Noncommunicable Diseases, National Centre for Disease Control, Directorate General of Health Services, New Delhi, India
| | - Muralidhar Tambe
- Department of Community Medicine, B J Govt. Medical College, Pune, Maharashtra, India
| | - N Arlappa
- Division of Public Health Nutrition, Indian Council Medical Research - National Institute of Nutrition, Hyderabad, Telangana, India
| | - Tulika Goswami Mahanta
- Department of Community Medicine / Prevention & Social Medicine, Tezpur Medical College, Tezpur, Assam, India
| | - Pranab Jyoti Bhuyan
- Regional Director Office, Ministry of Health and Family Welfare, Guwahati, Assam, India
| | - Rajnish P Joshi
- Department of General Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Abhijit P Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Abhiruchi Galhotra
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Dewesh Kumar
- Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Binod Kumar Behera
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Roshan K Topno
- Department of Epidemiology, Indian Council Medical Research - Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - Manoj Kumar Gupta
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Neeti Rustagi
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Atulkumar V Trivedi
- Department of Community Medicine, Government Medical College, Bhavnagar, Gujarat, India
| | - K R Thankappan
- Department of Public Health and Community Medicine, Central University Kerala, Kasaragod, Kerala, India
| | - Sonia Gupta
- Centre for Noncommunicable Diseases, National Centre for Disease Control, Directorate General of Health Services, New Delhi, India
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
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Kiptoo J, Yadesa TM, Muzoora C, Namugambe JS, Tamukong R. Predictors of Medication-Related Emergency Department Admissions Among Patients with Cardiovascular Diseases at Mbarara Regional Referral Hospital, South-Western Uganda. Open Access Emerg Med 2021; 13:279-290. [PMID: 34234583 PMCID: PMC8254663 DOI: 10.2147/oaem.s309508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Medication-related emergency department admissions impose a huge and unnecessary burden on the healthcare system. We sought to determine the prevalence and predictors of medication-related emergency department admissions, among patients with cardiovascular diseases at Mbarara Regional Referral Hospital, Uganda. METHODS Institutional research ethics approval was secured to conduct a cross-sectional study at the Mbarara Regional Referral Hospital emergency department, between February and September, 2020. All eligible and consenting patients were enrolled in a consecutive manner after a preliminary diagnosis was made by the attending physician. Structured questionnaire interview and comprehensive medication history reviews were used to identify medication therapy problems, in collaboration with a resident physician present on duty. We used sequential categorization for medication therapy problem(s). Descriptive and logistic regression analyses were used to determine prevalence and predictors of medication-related emergency department admissions. RESULTS Out of the 128 patients interviewed, 105 (82%) patient admissions were associated with a medication therapy problem: ineffectiveness of drug therapy (53.3%, 56), medication non-adherence (42.9%, 45), and adverse drug reactions (3.8%, 4). Out of a total of 90 incidences of medication non-adherence, 34.4% (31/90) were due to lack of understanding of patient medication regimen, and 27.8% (25/90) due to unaffordable cost of medicines. Female gender (AOR = 4.31 [1.43, 13.03 at 95% CI]; P-value = 0.010]) and a history of tobacco use (AOR = 9.58 [1.14, 80.28 at 95% CI]; P-value = 0.037) were statistically significant predictors of medication-related emergency department admissions in adjusted analysis. CONCLUSION Four in five emergency department admissions were associated with medication-related causes, majorly due to ineffectiveness of drug therapy. Knowledge gap on patient medication regimens was the most prevalent cause for medication non-adherence. Female gender and previous or current tobacco use was an independent risk factor for medication-related admissions.
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Affiliation(s)
- Joshua Kiptoo
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Conrad Muzoora
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Juliet Sanyu Namugambe
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robert Tamukong
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
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Ahaibwe G, Abdool Karim S, Thow AM, Erzse A, Hofman K. Barriers to, and facilitators of, the adoption of a sugar sweetened beverage tax to prevent non-communicable diseases in Uganda: a policy landscape analysis. Glob Health Action 2021; 14:1892307. [PMID: 33874854 PMCID: PMC8078933 DOI: 10.1080/16549716.2021.1892307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Uganda is experiencing an increase in nutrition-related non-communicable diseases. Risk factors include overconsumption of sugar-sweetened beverages. Fiscal and taxation policies aim to make the consumption of healthier foods easier. However, the adoption and implementation of fiscal policies by countries are constrained by political and economic challenges. Objective We investigated the policy and political landscape related to the prevention of nutrition-related non-communicable diseases in Uganda to identify barriers to and facilitators of the adoption of sugar-sweetened beverage taxation in Uganda. Methods A desk-based policy analysis of policies related to nutrition-related non-communicable diseases and sugar-sweetened beverage taxation was conducted. Four key informant consultations (n = 4) were conducted to verify the policy review and to gain further insight into the policy and stakeholder contexts. Analysis was framed by Kingdon’s theory of agenda setting and policy change. Results Nutrition-related non-communicable diseases were recognised as an emerging problem in Uganda. The Government has adopted a comprehensive approach to improve diets, but implementation is slow. There is limited recognition of the consumption of sugar and sugar-sweetened beverages as a contributor to the nutrition-related non-communicable disease burden in policy documents. Existing taxes on soft drinks are lower than the World Health Organization’s recommended rate of 20% and do not target sugar content. The soft drink industry has been influential in framing the taxation debate, and the Ministry of Finance previously reduced taxation of sugar-sweetened beverages. Maintaining competitiveness in a regional market is an important business strategy. However, the Ministry of Health and other public health actors in civil society have been successful (albeit marginally) in countering reductions in taxation, which are supported by industry. Conclusions An established platform for sugar-sweetened beverage taxation advocacy exists in Uganda. Compelling local research that explicitly links soft drink taxes to health goals is essential to advance sugar-sweetened beverage taxation.
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Affiliation(s)
- Gemma Ahaibwe
- Economic Policy Research Centre (EPRC), Makerere University, Makerere, Uganda
| | - Safura Abdool Karim
- SAMRC Centre for Health Economic and Decision Science - Priority Cost Effective Lessons for Systems Strengthening (PRICELESS SA), University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, Australia
| | - Agnes Erzse
- SAMRC Centre for Health Economic and Decision Science - Priority Cost Effective Lessons for Systems Strengthening (PRICELESS SA), University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC Centre for Health Economic and Decision Science - Priority Cost Effective Lessons for Systems Strengthening (PRICELESS SA), University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
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Reorienting Primary Health Care Services for Non-Communicable Diseases: A Comparative Preparedness Assessment of Two Healthcare Networks in Malawi and Zambia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095044. [PMID: 34068818 PMCID: PMC8126199 DOI: 10.3390/ijerph18095044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/16/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
Despite positive NCD policies in recent years, majority of Sub-Saharan African (SSA) health systems are inadequately prepared to deliver comprehensive first-line care for NCDs. Primary health care (PHC) settings in countries like Malawi and Zambia could be a doorway to effectively manage NCDs by moving away from delivering only episodic care to providing an integrated approach over time. As part of a collaborative health system strengthening project, we assessed and compared the preparedness and operational capacity of two target networks of public PHC settings in Lilongwe (Malawi) and Lusaka (Zambia) to integrate NCD services within routine service delivery. Data was collected and analyzed using validated health facility survey tools. These baseline assessments conducted between August 2018 and March 2019, also included interviews with 20 on-site health personnel and focal persons, who described existing barriers in delivering NCD services. In both countries, policy directives to decentralize disease-specific NCD services to the primary care level were initiated to meet increased demand but lacked operational guidance. In general, the assessed PHC sites were inadequately prepared to integrate NCDs into various service delivery domains, thus requiring further support. In spite of existing multi-faceted limitations, there was motivation among healthcare staff to provide NCD services.
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Understanding the diagnostic delays and pathways for diabetes in eastern Uganda: A qualitative study. PLoS One 2021; 16:e0250421. [PMID: 33882116 PMCID: PMC8059813 DOI: 10.1371/journal.pone.0250421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/06/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Type 2 diabetes is rapidly becoming a significant challenge in Uganda and other low and middle-income countries. A large proportion of the population remains undiagnosed. To understand diagnostic delay, we explored the diagnostic pathways for diabetes among patients receiving care at a semi-urban district hospital in eastern Uganda. METHODS Eligible participants were patients aged 35-70 years receiving care at the diabetes clinic of Iganga district hospital between April and May 2019 and their healthcare providers. Patients were interviewed using an interview guide to collect information on patients' symptoms and their diagnostic experience. A separate interview guide was used to understand the organisation of the diabetes services and the diabetes diagnostic process at the hospital. Using maximum variation purposive sampling, we selected 17 diabetes patients aged 35-68 years, diagnosed within the previous three years, and the three health workers managing the diabetes clinic at Iganga hospital. The data was analysed using ATLAS.ti version 8 to code, organise and track the data segments. We conducted template analysis using a priori themes derived from the intervals of Walter's model of Pathways to Treatment to identify the factors influencing diagnostic delay. RESULTS We identified four typologies: a short diagnostic pathway, protracted appraisal pathway, protracted appraisal and diagnostic interval pathway, and delayed treatment pathway. The pathways of patients with protracted appraisal or diagnostic intervals demonstrated strong socio-cultural influences. There was a firm reliance on traditional healers both before and after diagnosis which deferred enrolment into care. Other health system barriers implicated in delayed diagnosis included stock-out of diagnostic supplies, misdiagnosis, and missed diagnosis. Denial of diagnosis was also found to lead to delayed initiation of care. CONCLUSION Reducing diagnostic delay requires addressing both negative socio-cultural influences and the adoption of system-wide interventions to address barriers to timely diagnosis.
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Albelbeisi AH, Albelbeisi A, El Bilbeisi AH, Taleb M, Takian A, Akbari-Sari A. Public Sector Capacity to Prevent and Control of Noncommunicable Diseases in Twelve Low- and Middle-Income Countries Based on WHO-PEN Standards: A Systematic Review. Health Serv Insights 2021; 14:1178632920986233. [PMID: 33597808 PMCID: PMC7863145 DOI: 10.1177/1178632920986233] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/11/2020] [Indexed: 10/29/2022] Open
Abstract
This review was conducted to assess the capacity of the public sector to prevent and control noncommunicable diseases (NCDs) in low-and middle-income countries (LMIC) based on WHO-PEN standards. A PRISMA systematic search appraisal of PubMed, Scopus, and Embase was conducted during May-2020 for original articles conducted in LMIC and reported the capacity of the public sector to prevent and control NCDs. The country readiness score was calculated as the mean score of items for each domain. The indices were compared to an agreed cutoff at 80% the WHO optimal target of availability of affordable essential medicines and basic technologies required to treat NCDs. The literature search yielded 5 original studies, conducted in twelve countries, and surveyed 304 public health facilities. All countries failed to reach the WHO optimal target of availability of affordable essential medicines and basic technologies. The readiness index score according to WHO-PEN standards among countries in terms of essential medicines, diagnostic investigations, and basic equipment were range from 13.5% to 51%, 0.0% to 59.4%, and 29.2% to 51.2% respectively. This review revealed critical gaps in the twelve LMIC public sector capacity to prevent and control of NCDs in terms of essential medicines, basic equipment, and diagnostic investigations.
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Affiliation(s)
- Ahmed Hassan Albelbeisi
- School of Public Health, Department of Health Management and Economics, Tehran University of Medical Sciences, International Campus (TUMS-IC), Iran
| | - Ali Albelbeisi
- In-service Health Education, European Gaza Hospital, Ministry of Health, Palestine
| | - Abdel Hamid El Bilbeisi
- Department of Clinical Nutrition, Faculty of Pharmacy, Al Azhar University of Gaza, Palestine
| | - Mahmoud Taleb
- Faculty of Pharmacy, Al Azhar University of Gaza, Palestine
| | - Amirhossein Takian
- School of Public Health, Department of Health Management and Economics, Tehran University of Medical Sciences, International Campus (TUMS-IC), Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Iran
| | - Ali Akbari-Sari
- School of Public Health, Department of Health Management and Economics, Tehran University of Medical Sciences, International Campus (TUMS-IC), Iran
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Musoke D, Atusingwize E, Ikhile D, Nalinya S, Ssemugabo C, Lubega GB, Omodara D, Ndejjo R, Gibson L. Community health workers' involvement in the prevention and control of non-communicable diseases in Wakiso District, Uganda. Global Health 2021; 17:7. [PMID: 33413500 PMCID: PMC7791672 DOI: 10.1186/s12992-020-00653-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background Community health workers (CHWs) are an important cadre of the global health workforce as they are involved in providing health services at the community level. However, evidence on the role of CHWs in delivering interventions for non-communicable diseases (NCDs) in Uganda is limited. This study, therefore, assessed the involvement of CHWs in the prevention and control of NCDs in Wakiso District, Uganda with a focus on their knowledge, attitudes and practices, as well as community perceptions. Methods A cross-sectional study using mixed methods was conducted which involved a structured questionnaire among 485 CHWs, and 6 focus group discussions (FGDs) among community members. The study assessed knowledge, perceptions including the importance of the various risk factors, and the current involvement of CHWs in NCDs, including the challenges they faced. Quantitative data were analysed in STATA version 13.0 while thematic analysis was used for the qualitative data. Results The majority of CHWs (75.3%) correctly defined what NCDs are. Among CHWs who knew examples of NCDs (87.4%), the majority mentioned high blood pressure (77.1%), diabetes (73.4%) and cancer (63.0%). Many CHWs said that healthy diet (86.2%), physical activity (77.7%), avoiding smoking/tobacco use (70.9%), and limiting alcohol consumption (63.7%) were very important to prevent NCDs. Although more than half of the CHWs (63.1%) reported being involved in NCDs activities, only 20.9 and 20.6% had participated in community mobilisation and referral of patients respectively. The majority of CHWs (80.1%) who were involved in NCDs prevention and control reported challenges including inadequate knowledge (58.4%), lack of training (37.6%), and negative community perception towards NCDs (35.1%). From the FGDs, community members were concerned that CHWs did not have enough training on NCDs hence lacked enough information. Therefore, the community did not have much confidence in them regarding NCDs, hence rarely consulted them concerning these diseases. Conclusions Despite CHWs having some knowledge on NCDs and their risk factors, their involvement in the prevention and control of the diseases was low. Through enhanced training and community engagement, CHWs can contribute to the prevention and control of NCDs, including health education and community mobilisation. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-020-00653-5.
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Affiliation(s)
- David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Edwinah Atusingwize
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Deborah Ikhile
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Sarah Nalinya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Ssemugabo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Grace Biyinzika Lubega
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Damilola Omodara
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Linda Gibson
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
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Cárdenas MK, Pérez-León S, Singh SB, Madede T, Munguambe S, Govo V, Jha N, Damasceno A, Miranda JJ, Beran D. Forty years after Alma-Ata: primary health-care preparedness for chronic diseases in Mozambique, Nepal and Peru. Glob Health Action 2021; 14:1975920. [PMID: 34569443 PMCID: PMC8477950 DOI: 10.1080/16549716.2021.1975920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Four decades after the Alma-Ata Declaration, strengthening primary health care (PHC) remains a priority for health systems, especially in low- and middle-income countries (LMICs). Given the prominence of chronic diseases as a global health issue, PHC must include a wide range of components in order to provide adequate care. Objective To assess PHC preparedness to provide chronic care in Mozambique, Nepal and Peru, we used, as ‘tracer conditions’, diabetes, hypertension and a country-specific neglected tropical disease with chronic sequelae in each country. Methods By implementing a health system assessment, we collected quantitative and qualitative data from primary and secondary sources, including interviews of key informants at three health-system levels (macro, meso and micro). The World Health Organization’s health-system building blocks provided the basis for content analysis. Results In total, we conducted 227 interviews. Our findings show that the ambitious policies targeting specific diseases lack the support of technical, administrative and financial resources. Data collection systems do not allow the monitoring of individual patients or provide the health system with the information it requires. Patients receive limited disease-specific information. Clinical guidelines and training are either non-existent or not adapted to local contexts. Availability of medicines and diagnostic tests at the PHC level is an issue. Although medicines available through the public health care system are affordable, some essential medicines suffer shortages or are not available to PHC providers. This need, along with a lack of clear referral procedures and available transportation, generates financial issues for individuals and affects access to health care. Conclusion PHC in these LMICs is not well prepared to provide adequate care for chronic diseases. Improving PHC to attain universal health coverage requires strengthening the identified weaknesses across health-system building blocks.
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Affiliation(s)
- Maria Kathia Cárdenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silvana Pérez-León
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Tavares Madede
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Savaiva Munguambe
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Valério Govo
- Research Unit, Department of Internal Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Nilambar Jha
- B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva, Geneva University Hospitals, Geneva, Switzerland
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Global Public Health Guidelines on Physical Activity and Sedentary Behavior for People Living With Chronic Conditions: A Call to Action. J Phys Act Health 2021; 18:76-85. [DOI: 10.1123/jpah.2020-0525] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022]
Abstract
Background: In 2020, the World Health Organization (WHO) released global guidelines on physical activity (PA) and sedentary behavior, for the first time providing population-based recommendations for people living with selected chronic conditions. This article briefly presents the guidelines, related processes and evidence, and, importantly, considers how they may be used to support research, practice, and policy. Methods: A brief overview of the scope, agreed methods, selected chronic conditions (adults living with cancer, hypertension, type 2 diabetes, and human immunodeficiency virus), and appraisal of systematic review evidence on PA/sedentary behavior is provided. Methods were consistent with World Health Organization protocols for developing guidelines. Results: Moderate to high certainty evidence (varying by chronic condition and outcome examined) supported that PA can reduce the risk of disease progression or premature mortality and improve physical function and quality of life in adults living with chronic conditions. Direct evidence on sedentary behavior was lacking; however, evidence extrapolated from adult populations was considered applicable, safe, and likely beneficial (low certainty due to indirectness). Conclusions: Clinical and public health professionals and policy makers should promote the World Health Organization 2020 global guidelines and develop and implement services and programs to increase PA and limit sedentary behavior in adults living with chronic conditions.
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Tesema A, Joshi R, Abimbola S, Ajisegiri WS, Narasimhan P, Peiris D. Addressing barriers to primary health-care services for noncommunicable diseases in the African Region. Bull World Health Organ 2020; 98:906-908. [PMID: 33293751 PMCID: PMC7716106 DOI: 10.2471/blt.20.271239] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/14/2020] [Accepted: 08/15/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Azeb Tesema
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, Australia
| | - Whenayon Simeon Ajisegiri
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
| | | | - David Peiris
- The George Institute for Global Health, University of New South Wales (UNSW), Level 5, 1 King Street Newtown NSW 2042, Sydney, Australia
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Chamie G, Hickey MD, Kwarisiima D, Ayieko J, Kamya MR, Havlir DV. Universal HIV Testing and Treatment (UTT) Integrated with Chronic Disease Screening and Treatment: the SEARCH study. Curr HIV/AIDS Rep 2020; 17:315-323. [PMID: 32507985 DOI: 10.1007/s11904-020-00500-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The growing burden of untreated chronic disease among persons with HIV (PWH) threatens to reverse heath gains from ART expansion. Universal test and treat (UTT)'s population-based approach provides opportunity to jointly identify and treat HIV and other chronic diseases. This review's purpose is to describe SEARCH UTT study's integrated disease strategy and related approaches in Sub-Saharan Africa. RECENT FINDINGS In SEARCH, 97% of adults were HIV tested, 85% were screened for hypertension, and 79% for diabetes at health fairs after 2 years, for an additional $1.16/person. After 3 years, population-level hypertension control was 26% higher in intervention versus control communities. Other mobile/home-based multi-disease screening approaches have proven successful, but data on multi-disease care delivery are extremely limited and show little effect on clinical outcomes. Integration of chronic disease into HIV in the UTT era is feasible and can achieve population level effects; however, optimization and implementation remain a huge unmet need.
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Affiliation(s)
- Gabriel Chamie
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA.
| | - Matthew D Hickey
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA
| | | | | | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda.,Makerere University College of Health Sciences, Kampala, Uganda
| | - Diane V Havlir
- Division of HIV, Infectious Diseases & Global Medicine, San Francisco General Hospital / University of California, San Francisco, UCSF Box 0874, San Francisco, CA, 94143-0874, USA
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Namale G, Kamacooko O, Makhoba A, Mugabi T, Ndagire M, Ssanyu P, Ddamulira JBM, Yperzeele L, Cras P, Ddumba E, Seeley J, Newton R. Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study. BMC Cardiovasc Disord 2020; 20:442. [PMID: 33032527 PMCID: PMC7545850 DOI: 10.1186/s12872-020-01724-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/04/2020] [Indexed: 12/17/2022] Open
Abstract
Background We report here on a prospective hospital-based cohort study that investigates predictors of 30-day and 90-day mortality and functional disability among Ugandan stroke patients. Methods Between December 2016 and March 2019, we enrolled consecutive hemorrhagic stroke and ischemic stroke patients at St Francis Hospital Nsambya, Kampala, Uganda. The primary outcome measure was mortality at 30 and 90 days. The modified Ranking Scale wasused to assess the level of disability and mortality after stroke. Stroke severity at admission was assessed using the National Institute of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS). Examination included clinical neurological evaluation, laboratory tests and brain computed tomography (CT) scan. Kaplan-Meier curves and multivariate Cox proportional hazard model were used for unadjusted and adjusted analysis to predict mortality. Results We enrolled 141 patients; 48 (34%) were male, mean age was 63.2 (+ 15.4) years old; 90 (64%) had ischemic and 51 (36%) had hemorrhagic stroke; 81 (57%) were elderly (≥ 60 years) patients. Overall mortality was 44 (31%); 31 (23%) patients died within the first 30 days post-stroke and, an additional 13 (14%) died within 90 days post-stroke. Mortality for hemorrhagic stroke was 19 (37.3%) and 25 (27.8%) for ischemic stroke. After adjusting for age and sex, a GCS score below < 9 (adjusted hazard ratio [aHR] =3.49, 95% CI: 1.39–8.75) was a significant predictor of 30-day mortality. GCS score < 9 (aHR =4.34 (95% CI: 1.85–10.2), stroke severity (NIHSS ≥21) (aHR = 2.63, 95% CI: (1.68–10.5) and haemorrhagic stroke type (aHR = 2.30, 95% CI: 1.13–4.66) were significant predictors of 90-day mortality. Shorter hospital stay of 7–13 days (aHR = 0.31, 95% CI: 0.11–0.93) and being married (aHR = 0.22 (95% CI: 0.06–0.84) had protective effects for 30 and 90-day mortality respectively. Conclusion Mortality is high in the acute and sub-acute phase of stroke. Low levels of consciousness at admission, stroke severity, and hemorrhagic stroke were associated with increased higher mortality in this cohort of Ugandan stroke patients. Being married provided a protective effect for 90-day mortality. Given the high mortality during the acute phase, critically ill stroke patients would benefit from early interventions established as the post-stroke- standard of care in the country.
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Affiliation(s)
- Gertrude Namale
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.
| | - Onesmus Kamacooko
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda
| | - Anthony Makhoba
- St. Francis Hospital Nsambya affiliated to Uganda Martyrs University, Kampala, Uganda
| | - Timothy Mugabi
- St. Francis Hospital Nsambya affiliated to Uganda Martyrs University, Kampala, Uganda
| | - Maria Ndagire
- St. Francis Hospital Nsambya affiliated to Uganda Martyrs University, Kampala, Uganda
| | - Proscovia Ssanyu
- St. Francis Hospital Nsambya affiliated to Uganda Martyrs University, Kampala, Uganda
| | - John Bosco M Ddamulira
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Laetitia Yperzeele
- Stroke unit and Antwerp Neuro-Vascular Center, department of Neurology, University Hospital Antwerp, Antwerp Belgium and Research group on Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Patrick Cras
- Born Bunge Institute, University of Antwerp and Antwerp University Hospital, Department of Neurology, Antwerp, Belgium
| | - Edward Ddumba
- St. Francis Hospital Nsambya affiliated to Uganda Martyrs University, Kampala, Uganda
| | - Janet Seeley
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.,London School of Hygiene &Tropical Medicine, London, UK
| | - Robert Newton
- MRC/UVRI and LSHTM Uganda Research Unit, P.O Box 49, Entebbe, Uganda.,University of York, York, UK
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Albelbeisi AH, Albelbeisi A, El Bilbeisi AH, Takian A, Akbari-Sari A. Capacity of Palestinian primary health care system to prevent and control of non-communicable diseases in Gaza Strip, Palestine: A capacity assessment analysis based on adapted WHO-PEN tool. Int J Health Plann Manage 2020; 35:1412-1425. [PMID: 32869319 DOI: 10.1002/hpm.3022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/21/2020] [Accepted: 06/15/2020] [Indexed: 12/29/2022] Open
Abstract
The prevalence of non-communicable diseases (NCDs) are increasing in low-income countries including Palestine. This study was conducted to assess the capacity of Palestinian primary health care system to prevent and control of NCDs. This cross-sectional study in which, the World Health Organization package of essential NCDs interventions (WHO-PEN) tool, was used to assess the capacity of primary health care centers (PHCs) to prevent and control of NCDs. All governmental PHCs (n = 52) in Gaza Strip, Palestine were included in the final analysis. The centers readiness score was calculated as the average of domains indices. Then, the indices were compared to an agreed cutoff at 70%. Statistical analysis was performed using SPSS version 22. Out of 52 PHCs, only 21 (40.4%) were considered ready to prevent and control of NCDs; the highest readiness score was 79.4% and the lowest score was 29.2%. Furthermore, all governorates were not ready to prevent and control of NCDs (The readiness scores were < 70%), distributed as follow: 68.6%, 68.1%, 67.7%, 62.5% and 56.4%, for Rafah, Gaza, Khan-Yunis, Deir Al Balah and North Gaza, respectively. The governorates were differed significantly in terms of availability of aneroid blood pressure measuring devices, electrocardiography devices, Glibenclamide and Salbutamol tablets, patients counseling for diabetes self-management, patients education for self-administration of insulin (P values <.05 for all). The current study demonstrated critical gaps in the governmental PHCs capacity to prevent and control of NCDs, as most of PHCs failed to reach the minimum threshold of the WHO-PEN standards.
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Affiliation(s)
- Ahmed Hassan Albelbeisi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran
| | - Ali Albelbeisi
- In-service Health Education, European Gaza Hospital, Ministry of Health, Gaza, Palestine
| | - Abdel Hamid El Bilbeisi
- Department of Clinical Nutrition, Faculty of Pharmacy, Al Azhar University of Gaza, Gaza, Palestine
| | - Amirhossein Takian
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari-Sari
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
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Tusubira AK, Akiteng AR, Nakirya BD, Nalwoga R, Ssinabulya I, Nalwadda CK, Schwartz JI. Accessing medicines for non-communicable diseases: Patients and health care workers' experiences at public and private health facilities in Uganda. PLoS One 2020; 15:e0235696. [PMID: 32634164 PMCID: PMC7340292 DOI: 10.1371/journal.pone.0235696] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are increasingly prevalent in low- and middle-income countries. Successful management requires consistent access to appropriate medicines. Availability of NCD medicines is generally low, especially in the public sector, however, little is known about other factors affecting access. We explored barriers and facilitators of access to medicines for diabetes and hypertension at public and private health facilities in Uganda. Methods We conducted a qualitative descriptive study at six public hospitals and five private health facilities in different regions of Uganda. Data collection included 36 in-depth interviews and 14 focus group discussions (n = 128) among purposively selected adult outpatients with diabetes and/or hypertension and 26 key informant interviews with healthcare workers and patient association leaders. Transcripts were coded and emerging themes identified using the Framework method. Results Four main themes emerged: Stocking of medicines and supplies, Financial factors, Individual behaviour and attitudes, and Service delivery at health facilities. Stocking of medicines and supplies mainly presented barriers to access at public facilities including frequent stockouts, failure to stock certain medicines and low quality brands often rejected by patients. Financial factors, especially high cost of medicines and limited insurance coverage, were barriers in private facilities. Free service provision was a facilitator at public facilities. Patients’ confusion resulting from mixed messages and their preference for herbal treatments were cross-sector barriers. While flexibility in NCD service provision was a facilitator at private facilities, provider burnout and limited operating hours were barriers in public facilities. Patient-driven associations exist at some public facilities and help mitigate inadequate medicine stock. Conclusion Access to NCD medicines in Uganda is influenced by both health system and patient factors. Some factors are sector-specific, while others cross-cutting between public and private sectors. Due to commonalities in barriers, potential strategies for overcoming them may include patient-driven associations, public-private partnerships, and multi-modal health education platforms.
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Affiliation(s)
- Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- * E-mail:
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Brenda D. Nakirya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Ritah Nalwoga
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Christine K. Nalwadda
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences Makerere University, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
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Assessing Providers' Approach to Hypertension Management at a Large, Private Hospital in Kampala, Uganda. Ann Glob Health 2020; 86:5. [PMID: 31976304 PMCID: PMC6966335 DOI: 10.5334/aogh.2513] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Hypertension is increasingly prevalent in Uganda and its clinical management remains suboptimal across the country. Prior research has elucidated some of the factors contributing to poor control, but little is known about providers’ approaches to hypertension management and perceptions of barriers to care. This is particularly true in private health care settings – despite the fact that the private sector provides a substantial and growing portion of health care in Uganda. Objective: Our exploratory, pragmatic qualitative study aimed to examine the factors affecting the quality of hypertension care from the perspective of providers working in an urban, private hospital in Uganda. We focused on the organizational and system-level factors influencing providers’ approaches to management in the outpatient setting. Methods: We conducted interviews with 19 health care providers working in the outpatient setting of a 110-bed, private urban hospital in Kampala, Uganda. We then coded the interviews for thematic analysis, using an inductive approach to generate the study’s findings. Findings: Several themes emerged around perceived barriers and facilitators to care. Providers cited patient beliefs and behaviors, driven in part by cultural norms, as a key challenge to hypertension control; however, most felt their own approach to hypertension treatment aligned with international guidelines. Providers struggled to collaborate with colleagues in coordinating the joint management of patients. Furthermore, they cited the high cost and limited availability of medication as barriers. Conclusions: These findings offer important strategic direction for intervention development specific to this Ugandan context: for example, regarding culturally-adapted patient education initiatives, or programs to improve access to essential medications. Other settings facing similar challenges scaling up management of hypertension may find the results useful for informing intervention development as well.
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Bawazir AA, Al-Surimi K, Suwaidan SD, AlShehri AM, AlFarhan AI, Aboulfotouh MA. Capacity and readiness of primary health care centers for implementation of the basic strategy for prevention and control of non-communicable diseases in Saudi Arabia. A case study from the Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia. Saudi Med J 2019; 40:614-618. [PMID: 31219498 PMCID: PMC6778751 DOI: 10.15537/smj.2019.6.24164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To assess the capacity and readiness of primary healthcare centers (PHC) for the implementation of basic strategies for the prevention and control of non-communicable diseases (NCDs) at the Ministry of National Guard-Health Affairs (MNG-HA) in Saudi Arabia. METHODS Facility-based face-to-face interviews were conducted in 41 PHCs included in this survey, using the World Health Organization (WHO) questionnaire. Main area survived were: availability of human resources, medical equipment, infrastructure, medicines, service utilization, referral systems, and community outreach. Results: Approximately 90% of the PHC centers were located in urban areas of the country. The level of staff training on NCD prevention and control strategies was reported to be inadequate, particularly for nurses and other healthcare providers. As for diagnostic equipment, diagnostic tests, essential medication, access to referral facilities and medical records most of them were available in all the PHCs among the different categories. CONCLUSIONS The MNG-HA PHCs appear to have the capacity to integrate strategies for the prevention and control of NCDs as part of their daily functions. However, improvements are required in some areas to facilitate the integration process and training the health care workers (HCWs) on prevention and control of NCDs as part of their daily practice.
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Affiliation(s)
- Amen Ahmed Bawazir
- Department of College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Gong E, Lu H, Shao S, Tao X, Peoples N, Kohrt BA, Xiong S, Kyobutungi C, Haregu TN, Khayeka-Wandabwa C, Van Minh H, Hanh TTD, Koirala S, Gautam K, Yan LL. Feasibility assessment of invigorating grassrooTs primary healthcare for prevention and management of cardiometabolic diseases in resource-limited settings in China, Kenya, Nepal, Vietnam (the FAITH study): rationale and design. Glob Health Res Policy 2019; 4:33. [PMID: 31742234 PMCID: PMC6849318 DOI: 10.1186/s41256-019-0124-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/10/2019] [Indexed: 01/27/2023] Open
Abstract
Background Cardiometabolic diseases are the leading cause of death and disability in many low- and middle-income countries. As the already severe burden from these conditions continues to increase in low- and middle-income countries, cardiometabolic diseases introduce new and salient public health challenges to primary health care systems. In this mixed-method study, we aim to assess the capacity of grassroots primary health care facilities to deliver essential services for the prevention and control of cardiometabolic diseases. Built on this information, our goal is to propose evidence-based recommendations to promote a stronger primary health care system in resource-limited settings. Methods The study will be conducted in resource-limited settings in China, Kenya, Nepal, and Vietnam using a mixed-method approach that incorporates a literature review, surveys, and in-depth interviews. The literature, statistics, and document review will extract secondary data on the burden of cardiometabolic diseases in each country, the existing policies and interventions related to strengthening primary health care services, and improving care related to non-communicable disease prevention and control. We will also conduct primary data collection. In each country, ten grassroots primary health care facilities across representative urban-rural regions will be selected. Health care professionals and patients recruited from these facilities will be invited to participate in the facility assessment questionnaire and patients’ survey. Stakeholders – including patients, health care professionals, policymakers at the local, regional, and national levels, and local authorities – will be invited to participate in in-depth interviews. A standard protocol will be designed to allow for adaption and localization in data collection instruments and procedures within each country. Discussion With a special focus on the capacity of primary health care facilities in resource-limited settings in low- and middle-income countries, this study has the potential to add new evidence for policymakers and academia by identifying the most common and significant barriers primary health care services face in managing and preventing cardiometabolic diseases. With these findings, we will generate evidence-based recommendations on potential strategies that are feasible for resource-limited settings in combating the increasing challenges of cardiometabolic diseases.
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Affiliation(s)
- Enying Gong
- 1Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu China
| | - Hongsheng Lu
- 1Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu China
| | - Shuai Shao
- 1Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu China
| | - Xuanchen Tao
- 1Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu China
| | - Nicholas Peoples
- 1Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu China
| | - Brandon A Kohrt
- 2Global Health Institute, Duke University, Durham, NC USA.,3Department of Psychiatry, George Washington University, Washington, DC USA
| | - Shangzhi Xiong
- 1Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu China
| | | | | | | | | | | | - Suraj Koirala
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Kamal Gautam
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Lijing L Yan
- 1Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316 Jiangsu China.,2Global Health Institute, Duke University, Durham, NC USA
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Birabwa C, Bwambale MF, Waiswa P, Mayega RW. Quality and barriers of outpatient diabetes care in rural health facilities in Uganda - a mixed methods study. BMC Health Serv Res 2019; 19:706. [PMID: 31619234 PMCID: PMC6796349 DOI: 10.1186/s12913-019-4535-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 09/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. Poor quality of care is a serious limitation to the control of diabetes and its complications. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda. METHODS This was a mixed methods cross-sectional study, conducted in six facilities. A randomly selected sample of 377 people with diabetes was interviewed using a pre-tested interviewer administered questionnaire. Key informant interviews were also conducted with diabetes care providers. Data was collected on health outcomes, processes of care and foundations for high quality health systems. The study included three health outcomes, six elements of competent care under processes and 16 elements of tools/resources and workforce under foundations. Descriptive statistics were computed to determine performance under each domain, and thematic content analysis was used for qualitative data. RESULTS The mean age of participants was 49 years (±11.7 years) with a median duration of diabetes of 4 years (inter-quartile range = 2.7 years). The overall facility readiness score was 73.9%. Inadequacies were found in health worker training in standard diabetes care, availability of medicines, and management systems for services. These were also the key barriers to provision and access to care in addition to lack of affordability. Screening of clients for blood cholesterol and microvascular complications was very low. Regarding outcomes; 56.8% of participants had controlled blood glucose, 49.3% had controlled blood pressure; and 84.0% reported having at least one complication. CONCLUSION The quality of T2DM care provided in these rural facilities is sub-optimal, especially the process of care. The consequences include sub-optimal blood glucose and blood pressure control. Improving availability of essential medicines and basic technologies and competence of health workers can improve the care process leading to better outcomes.
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Affiliation(s)
- Catherine Birabwa
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Mulekya F. Bwambale
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Roy W. Mayega
- Department of Epidemiology and Biostatistics, Makerere University Kampala – College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda
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Kalyesubula R, Mutyaba I, Rabin T, Andia-Biraro I, Alupo P, Kimuli I, Nabirye S, Kagimu M, Mayanja-Kizza H, Rastegar A, Kamya MR. Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda; A four-year retrospective study. PLoS One 2019; 14:e0216060. [PMID: 31086371 PMCID: PMC6516645 DOI: 10.1371/journal.pone.0216060] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/14/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa suffers from a dual burden of infectious and non-communicable diseases. There is limited data on causes and trends of admission and death among patients on the medical wards. Understanding the major drivers of morbidity and mortality would help inform health systems improvements. We determined the causes and trends of admission and mortality among patients admitted to Mulago Hospital, Kampala, Uganda. METHODS AND RESULTS The medical record data base of patients admitted to Mulago Hospital adult medical wards from January 2011 to December 2014 were queried. A detailed history, physical examination and investigations were completed to confirm the diagnosis and identify comorbidities. Any histopathologic diagnoses were made by hematoxylin and eosin tissue staining. We identified the 10 commonest causes of hospitalization, and used Poisson regression to generate annual percentage change to describe the trends in causes of hospitalization. Survival was calculated from the date of admission to the date of death or date of discharge. Cox survival analysis was used to identify factors associate with in-hospital mortality. We used a statistical significance level of p<0.05. A total of 50,624 patients were hospitalized with a median age of 38 (range 13-122) years and 51.7% females. Majority of patients (72%) had an NCD condition as the primary reason for admission. Specific leading causes of morbidity were HIV/AIDS in 30% patients, hypertension in 14%, tuberculosis (TB) in 12%), non-TB pneumonia in11%) and heart failure in 9.3%. There was decline in the proportion of hospitalization due to malaria, TB and pneumonia with an annual percentage change (apc) of -20% to -6% (all p<0.03) with an increase in proportions of admissions due to chronic kidney disease, hypertension, stroke and cancer, with apc 13.4% to 24%(p<0.001). Overall, 8,637(17.1%) died during hospitalization with the highest case fatality rates from non-TB pneumonia (28.8%), TB (27.1%), stroke (26.8%), cancer (26.1%) and HIV/AIDS (25%). HIV-status, age above 50yrs and being male were associated with increased risk of death among patients with infections. CONCLUSION Admissions and case fatality rates for both infectious and non-infectious diseases were high, with declining trends in infectious diseases and a rising trend in NCDs. Health care systems in sub-Saharan region need to prepare to deal with dual burden of disease.
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Affiliation(s)
- Robert Kalyesubula
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Innocent Mutyaba
- Department of Medicine, Uganda Cancer Institute, Kampala, Uganda
| | - Tracy Rabin
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Patricia Alupo
- Department of Medicine, Makerere Lung Institute, Kampala, Uganda
| | - Ivan Kimuli
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stella Nabirye
- Directorate of Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | - Magid Kagimu
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Harriet Mayanja-Kizza
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Asghar Rastegar
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Moses R. Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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