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Elsey H, Abboah-Offei M, Vidyasagaran AL, Anaseba D, Wallace L, Nwameme A, Gyasi A, Ayim A, Ansah-Ofei A, Amedzro N, Dovlo D, Agongo E, Awoonor-Williams K, Agyepong I. Implementation of the Community-based Health Planning and Services (CHPS) in rural and urban Ghana: a history and systematic review of what works, for whom and why. Front Public Health 2023; 11:1105495. [PMID: 37435526 PMCID: PMC10332345 DOI: 10.3389/fpubh.2023.1105495] [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: 11/22/2022] [Accepted: 05/11/2023] [Indexed: 07/13/2023] Open
Abstract
Background Despite renewed emphasis on strengthening primary health care globally, the sector remains under-resourced across sub-Saharan Africa. Community-based Health Planning and Services (CHPS) has been the foundation of Ghana's primary care system for over two decades using a combination of community-based health nurses, volunteers and community engagement to deliver universal access to basic curative care, health promotion and prevention. This review aimed to understand the impacts and implementation lessons of the CHPS programme. Methods We conducted a mixed-methods review in line with PRISMA guidance using a results-based convergent design where quantitative and qualitative findings are synthesized separately, then brought together in a final synthesis. Embase, Medline, PsycINFO, Scopus, and Web of Science were searched using pre-defined search terms. We included all primary studies of any design and used the RE-AIM framework to organize and present the findings to understand the different impacts and implementation lessons of the CHPS programme. Results N = 58 out of n = 117 full text studies retrieved met the inclusion criteria, of which n = 28 were quantitative, n = 27 were qualitative studies and n = 3 were mixed methods. The geographical spread of studies highlighted uneven distribution, with the majority conducted in the Upper East Region. The CHPS programme is built on a significant body of evidence and has been found effective in reducing under-5 mortality, particularly for the poorest and least educated, increasing use and acceptance of family planning and reduction in fertility. The presence of a CHPS zone in addition to a health facility resulted in increased odds of skilled birth attendant care by 56%. Factors influencing effective implementation included trust, community engagement and motivation of community nurses through salaries, career progression, training and respect. Particular challenges to implementation were found in remote rural and urban contexts. Conclusions The clear specification of CHPS combined with a conducive national policy environment has aided scale-up. Strengthened health financing strategies, review of service provision to prepare and respond to pandemics, prevalence of non-communicable diseases and adaptation to changing community contexts, particularly urbanization, are required for successful delivery and future scale-up of CHPS. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214006, identifier: CRD42020214006.
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Affiliation(s)
- Helen Elsey
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Mary Abboah-Offei
- School of Health and Life Sciences, University of the West of Scotland (London Campus), London, United Kingdom
| | | | - Dominic Anaseba
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Lauren Wallace
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Adanna Nwameme
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Akosua Gyasi
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Andrews Ayim
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Nina Amedzro
- Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Delanyo Dovlo
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Erasmus Agongo
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Irene Agyepong
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
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Baluku JB, Nabwana M, Nalunjogi J, Muttamba W, Mubangizi I, Nakiyingi L, Ssengooba W, Olum R, Bongomin F, Andia-Biraro I, Worodria W. Cardiovascular risk factors among people with drug-resistant tuberculosis in Uganda. BMC Cardiovasc Disord 2022; 22:464. [PMID: 36333654 PMCID: PMC9636825 DOI: 10.1186/s12872-022-02889-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) and its risk factors are independently associated with cardiovascular disease (CVD). We determined the prevalence and associations of CVD risk factors among people with drug-resistant tuberculosis (DRTB) in Uganda. METHODS In this cross-sectional study, we enrolled people with microbiologically confirmed DRTB at four treatment sites in Uganda between July to December 2021. The studied CVD risk factors were any history of cigarette smoking, diabetes mellitus (DM) hypertension, high body mass index (BMI), central obesity and dyslipidaemia. We used modified Poisson regression models with robust standard errors to determine factors independently associated with each of dyslipidaemia, hypertension, and central obesity. RESULTS Among 212 participants, 118 (55.7%) had HIV. Overall, 196 (92.5%, 95% confidence interval (CI) 88.0-95.3) had ≥ 1 CVD risk factor. The prevalence; 95% CI of individual CVD risk factors was: dyslipidaemia (62.5%; 55.4-69.1), hypertension (40.6%; 33.8-47.9), central obesity (39.3%; 32.9-46.1), smoking (36.3%; 30.1-43.1), high BMI (8.0%; 5.0-12.8) and DM (6.5%; 3.7-11.1). Dyslipidaemia was associated with an increase in glycated haemoglobin (adjusted prevalence ratio (aPR) 1.14, 95%CI 1.06-1.22). Hypertension was associated with rural residence (aPR 1.89, 95% CI 1.14-3.14) and previous history of smoking (aPR 0.46, 95% CI 0.21-0.98). Central obesity was associated with increasing age (aPR 1.02, 95%CI 1.00-1.03), and elevated diastolic blood pressure (aPR 1.03 95%CI 1.00-1.06). CONCLUSION There is a high prevalence of CVD risk factors among people with DRTB in Uganda, of which dyslipidaemia is the commonest. We recommend integrated services for identification and management of CVD risk factors in DRTB.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.
- Makerere University Lung Institute, Kampala, Uganda.
- Directorate of programs, Mildmay Uganda, Wakiso, Uganda.
| | - Martin Nabwana
- Makerere University-John Hopkin's University Collaboration, Kampala, Uganda
| | | | - Winters Muttamba
- Makerere University Lung Institute, Kampala, Uganda
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, UK
| | | | - Lydia Nakiyingi
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Willy Ssengooba
- Makerere University Lung Institute, Kampala, Uganda
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Ronald Olum
- Department of Internal Medicine, St. Francis Hospital, Nsambya, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Department of Internal Medicine, le mémorial Hospital, Kampala, Uganda
| | - Irene Andia-Biraro
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - William Worodria
- Makerere University Lung Institute, Kampala, Uganda
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Smith J, Togawa K, Dresler C, Hawari F, Zain ZM, Stewart B, Warren GW, Sitas F. Smoking cessation after a cancer diagnosis: Commentary on special supplement in Cancer Epidemiology. Cancer Epidemiol 2022; 79:102210. [PMID: 35785684 DOI: 10.1016/j.canep.2022.102210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/26/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Justin Smith
- Townsville University Hospital & College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Kayo Togawa
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer/World Health Organization, France; Division of Surveillance and Policy Evaluation, National Cancer Center Institute for Cancer Control, Japan
| | - Carolyn Dresler
- International Association for the Study of Lung Cancer, Montrose, CO, USA
| | | | | | - Bernard Stewart
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales - Sydney, Australia
| | - Graham W Warren
- Department of Radiation Oncology, Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC, USA
| | - Freddy Sitas
- Centre for Primary Health Care and Equity, School of Population Health, University of New South Wales-Sydney, Menzies Centre for Health Policy, School of Public Health, University of Sydney, and Cancer Epidemiology, Elsevier Press, Australia.
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Jarde A, Siqueira N, Afaq S, Naz F, Irfan M, Tufail P, Aslam F, Todowede O, Rakhshanda S, Khalid H, Lin Y, Bierman O, Elsony A, Elsey H, Siddiqi N, Siddiqi K. Addressing TB multimorbidity in policy and practice: An exploratory survey of TB providers in 27 high-TB burden countries. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001205. [PMID: 36962813 PMCID: PMC10022227 DOI: 10.1371/journal.pgph.0001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/29/2022] [Indexed: 12/12/2022]
Abstract
In people with TB, co-existence of long-term conditions (e.g., depression, diabetes and HIV) and risk factors (e.g.,alcohol misuse, malnutrition, and smoking) are associated with increased mortality and poor treatment outcomes including delayed recovery, TB treatment failure and relapse. However, it is unclear as to what extent these comorbidities are addressed in TB policy and practice. Between August and October 2021, we conducted an online cross-sectional survey in high-TB burden countries. We recruited a purposive sample of TB health workers, managers, policy makers, advisors and advocates from these countries. The survey enquired about the extent to which various comorbid conditions are: (a) mentioned in TB policies, plans, and guidelines; (b) screened, diagnosed, treated or referred to specialist services by TB healthcare workers. We summarised using descriptive analysis. Of the 1100 potential respondents contacted in 33 countries, 543 responded but only 446 (41%) from 27 countries provided sufficient data for inclusion in the study. We found no notable differences between these providing insufficient data and those completing the survey. HIV, diabetes mellitus, depression and tobacco and alcohol use disorders were identified as the most common and concerning comorbid conditions in TB. HIV was screened for and managed by TB services in most countries. Screening for diabetes and/or tobacco and alcohol use disorders was offered by almost half of all TB services but only a few offered relevant treatments. Depression was rarely screened for, almost never treated, and only infrequently referred to specialist services. Most respondents felt confident in screening/diagnosing these comorbid conditions but not in treating these conditions. With the exception of HIV, chronic comorbid conditions are only partially screened for and rarely managed within TB services. Mental health conditions are for the most part neglected. Given their adverse impact on TB outcomes, integrating screening and management of these comorbidities within TB programmes offers a significant opportunity to meet TB targets, address non-communicable diseases and improve patient well-being.
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Affiliation(s)
- Alexander Jarde
- Department of Health Sciences, University of York, York, United Kingdom
| | - Noemia Siqueira
- Department of Health Sciences, University of York, York, United Kingdom
| | - Saima Afaq
- Department of Health Sciences, University of York, York, United Kingdom
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Farah Naz
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Muhammad Irfan
- Department of Mental Health, Psychiatry & Behavioural Sciences, Peshawar Medical College, Peshawar, Pakistan
| | - Pervaiz Tufail
- National group of TB people, TB and Poverty Subgroup Core Team, Stoptb.org., Pakistan
| | - Faiza Aslam
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Olamide Todowede
- Department of Health Sciences, University of York, York, United Kingdom
| | - Shagoofa Rakhshanda
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Humaira Khalid
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Yan Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Olivia Bierman
- Department of Global Public Health, Karolinska Institute, Solna, Sweden
| | - Asma Elsony
- Epi-Lab: The Epidemiological Laboratory, Khartoum, Sudan
| | - Helen Elsey
- Department of Health Sciences, University of York, York, United Kingdom
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
- Bradford District Care NHS Foundation Trust, Shipley, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
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