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Rees CA, Kisenge R, Godfrey E, Ideh RC, Kamara J, Coleman-Nekar YJ, Samma A, Manji HK, Sudfeld CR, Westbrook A, Niescierenko M, Morris CR, Whitney CG, Breiman RF, Duggan CP, Manji KP. Derivation and Internal Validation of a Novel Risk Assessment Tool to Identify Infants and Young Children at Risk for Post-Discharge Mortality in Dar es Salaam, Tanzania and Monrovia, Liberia. J Pediatr 2024; 273:114147. [PMID: 38878962 DOI: 10.1016/j.jpeds.2024.114147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/23/2024] [Accepted: 06/11/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE To derive and validate internally a novel risk assessment tool to identify young children at risk for all-cause mortality ≤60 days of discharge from hospitals in sub-Saharan Africa. STUDY DESIGN We performed a prospective observational cohort study of children aged 1-59 months discharged from Muhimbili National Hospital in Dar es Salaam, Tanzania and John F. Kennedy Medical Center in Monrovia, Liberia (2019-2022). Caregivers received telephone calls up to 60 days after discharge to ascertain participant vital status. We collected socioeconomic, demographic, clinical, and anthropometric data during hospitalization. Candidate variables with P < .20 in bivariate analyses were included in a multivariable logistic regression model with best subset selection to identify risk factors for the outcome. We internally validated our tool using bootstrapping with 500 repetitions. RESULTS There were 1933 young children enrolled in the study. The median (IQR) age was 11 (4, 23) months and 58.7% were males. In total, 67 (3.5%) died during follow-up. Ten variables contributed to our tool (total possible score 82). Cancer (aOR 10.6, 95% CI 2.58, 34.6), pedal edema (aOR 6.94, 95% CI 1.69, 22.6), and leaving against medical advice (aOR 6.46, 95% CI 2.46, 15.3) were most predictive of post-discharge mortality. Our risk assessment tool demonstrated good discriminatory value (optimism corrected area under the receiver operating characteristic curve 0.77), high precision, and sufficient calibration. CONCLUSIONS After validation, this tool may be used to identify young children at risk for post-discharge mortality to direct resources for follow-up of high-risk children.
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Affiliation(s)
- Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Evance Godfrey
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Readon C Ideh
- Department of Pediatrics, John F. Kennedy Medical Center, Monrovia, Liberia
| | - Julia Kamara
- Department of Pediatrics, John F. Kennedy Medical Center, Monrovia, Liberia
| | | | - Abraham Samma
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Hussein K Manji
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Accident and Emergency Department, The Aga Khan Health Services, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Adrianna Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA
| | - Michelle Niescierenko
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA
| | - Claudia R Morris
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, GA; Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | | | - Robert F Breiman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Christopher P Duggan
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; Division of Gastroenterology, Hepatology, and Nutrition, Center for Nutrition, Boston Children's Hospital, Boston, MA
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Grover S, Court L, Amoo-Mitchual S, Longo J, Rodin D, Scott AA, Lievens Y, Yap ML, Abdel-Wahab M, Lee P, Harsdorf E, Khader J, Jia X, Dosanjh M, Elzawawy A, Ige T, Pomper M, Pistenmaa D, Hardenbergh P, Petereit DG, Sargent M, Cina K, Li B, Anacak Y, Mayo C, Prattipati S, Lasebikan N, Rendle K, O'Brien D, Wendling E, Coleman CN. Global Workforce and Access: Demand, Education, Quality. Semin Radiat Oncol 2024; 34:477-493. [PMID: 39271284 DOI: 10.1016/j.semradonc.2024.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
There has long existed a substantial disparity in access to radiotherapy globally. This issue has only been exacerbated as the growing disparity of cancer incidence between high-income countries (HIC) and low and middle-income countries (LMICs) widens, with a pronounced increase in cancer cases in LMICs. Even within HICs, iniquities within local communities may lead to a lack of access to care. Due to these trends, it is imperative to find solutions to narrow global disparities. This requires the engagement of a diverse cohort of stakeholders, including working professionals, non-governmental organizations, nonprofits, professional societies, academic and training institutions, and industry. This review brings together a diverse group of experts to highlight critical areas that could help reduce the current global disparities in radiation oncology. Advancements in technology and treatment, such as artificial intelligence, brachytherapy, hypofractionation, and digital networks, in combination with implementation science and novel funding mechanisms, offer means for increasing access to care and education globally. Common themes across sections reveal how utilizing these new innovations and strengthening collaborative efforts among stakeholders can help improve access to care globally while setting the framework for the next generation of innovations.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Botswana-University of Pennsylvania Partnership, Gaborone, Botswana.
| | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center
| | - Sheldon Amoo-Mitchual
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John Longo
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada; Global Cancer Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Belgium; Ghent University, Ghent, Belgium
| | - Mei Ling Yap
- Liverpool and Macarthur Cancer Therapy Centres, Western Sydney University, Campbelltown, New South Wales, Australia; The George Institute for Global Health, UNSW Sydney, Barangaroo, NSW, Australia; Collaboration for Cancer Outcomes, Research and Evaluation (CCORE), Ingham Institute, UNSW Sydney, Liverpool, NSW, Australia
| | - May Abdel-Wahab
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Peter Lee
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ekaterina Harsdorf
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jamal Khader
- Radiation Oncology Department, King Hussein Cancer Center, Amman, Jordan
| | - Xun Jia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD
| | - Manjit Dosanjh
- ICEC, CERN, Geneva, Switzerland; University of Oxford, Oxford, UK
| | - Ahmed Elzawawy
- Department of Clinical Oncology, Suez Canal University, Ismailia, Egypt; Alsoliman Clinical and Radiation Oncology Center, Port Said, Egypt
| | | | - Miles Pomper
- James Martin Center for Nonproliferation Studies, Washington, DC; ICEC, International Cancer Expert Corps, Washington, DC
| | | | | | - Daniel G Petereit
- Monument Health Cancer Care Institute Rapid City, South Dakota; Avera Research Institute, Sioux Falls, SD
| | | | | | - Benjamin Li
- University of Washington, Seattle, WA; Fred Hutch Cancer Center, Seattle, WA
| | - Yavuz Anacak
- Department of Radiation Oncology, Ege University, Faculty of Medicine, Izmir, Turkey
| | - Chuck Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Nwamaka Lasebikan
- Department of Radiation and Clinical Oncology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Katharine Rendle
- Department of Family Medicine & Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Donna O'Brien
- ICEC, International Cancer Expert Corps, Washington, DC
| | | | - C Norman Coleman
- ICEC, International Cancer Expert Corps, Washington, DC; Radiation Research Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Sun S, Simonsson O, McGarvey S, Torous J, Goldberg SB. Mobile phone interventions to improve health outcomes among patients with chronic diseases: an umbrella review and evidence synthesis from 34 meta-analyses. Lancet Digit Health 2024:S2589-7500(24)00119-5. [PMID: 39332937 DOI: 10.1016/s2589-7500(24)00119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/04/2024] [Accepted: 06/05/2024] [Indexed: 09/29/2024]
Abstract
This umbrella review of 34 meta-analyses, representing 235 randomised controlled trials done across 52 countries and 48 957 participants and ten chronic conditions, aimed to evaluate evidence on the efficacy of mobile phone interventions for populations with chronic diseases. We evaluated the strengths of evidence via the Fusar-Poli and Radua methodology. Compared with usual care, mobile apps had convincing effects on glycated haemoglobin reduction among adults with type 2 diabetes (d=0·44). Highly suggestive effects were found for both text messages and apps on various outcomes, including medication adherence (among patients with HIV in sub-Saharan Africa and people with cardiovascular disease), glucose management in type 2 diabetes, and blood pressure reduction in hypertension. Many effects (42%) were non-significant. Various gaps were identified, such as a scarcity of reporting on moderators and publication bias by meta-analyses, little research in low-income and lower-middle-income countries, and little reporting on adverse events.
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Affiliation(s)
- Shufang Sun
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, USA; International Health Institute, School of Public Health, Brown University, Providence, RI, USA; Mindfulness Center, School of Public Health, Brown University, Providence, RI, USA.
| | - Otto Simonsson
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Stephen McGarvey
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA; International Health Institute, School of Public Health, Brown University, Providence, RI, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Simon B Goldberg
- Department of Counseling Psychology, School of Education, University of Wisconsin-Madison, Madison, WI, USA; Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
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Walker RJ, Magro C, Amjad R, Hawks LC, Iregbu S, Egede LE. Material needs security and cardiovascular risk factors in rural South Africa. BMC Public Health 2024; 24:2170. [PMID: 39135025 PMCID: PMC11318146 DOI: 10.1186/s12889-024-19688-z] [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: 01/17/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The prevalence of cardiovascular disease is burgeoning in low- and middle-income countries (LMICs). In sub-Saharan Africa, the prevalence of cardiovascular risk factors is increasing, though rates of CVD diagnosis and management remain low. Awareness of the influence of social determinants of health (SDOH) on cardiovascular outcomes is growing, however, most work focuses on high-income countries. Material needs security is a measure of SDOH that may be particularly relevant for LMICs. This study investigated the relationship between material needs security and cardiovascular risk in older adults living in South Africa. METHODS The analysis included 5059 respondents age ≥ 40 in the Health and Aging in Africa survey, an observational cohort study administered in 2014 in Mpumalanga Province, South Africa. Linear regression models tested the association between material needs and eight cardiovascular risk factors (waist-to-hip ratio, body mass index, blood pressure, glucose, cholesterol, LDL, and triglycerides). Adjusted linear regression models controlled for sociodemographic confounders. RESULTS There were significant adjusted associations found between increased material needs security and four cardiovascular risk factors, including waist-to-hip ratio (β = 0.001; 95% CI [0.00002,0.002]), BMI (β = 0.19; 95%CI=[0.14,0.24]), glucose (β = 0.46; 95%CI=[0.02,0.90]), and triglycerides (β = 0.26; 95%CI=[0.02,0.49]). CONCLUSION Increased material needs security was associated with significantly increased cardiovascular risk in older adults in rural South Africa. These findings can inform the approach to treatment and management of cardiovascular disease in South Africa and similar LMICs. Future investigations should evaluate the implementation and efficacy of interventions that recognize the role of material needs security in cardiovascular risk.
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Affiliation(s)
- Rebekah J Walker
- Division of Population Health, Department of Medicine, Jacob's School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, D2-76, 14203, USA
| | - Caitlin Magro
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rabia Amjad
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura C Hawks
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sandra Iregbu
- Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Division of Population Health, Department of Medicine, Jacob's School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Buffalo, NY, D2-76, 14203, USA.
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Habtemichael M, Molla M, Tassew B. Catastrophic out-of-pocket payments related to non-communicable disease multimorbidity and associated factors, evidence from a public referral hospital in Addis Ababa Ethiopia. BMC Health Serv Res 2024; 24:896. [PMID: 39107740 PMCID: PMC11301858 DOI: 10.1186/s12913-024-11392-3] [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: 06/02/2023] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND In low and middle-income countries (LMICs), non-communicable diseases (NCDs) are on the rise and have become a significant cause of mortality. Unfortunately, accessing affordable healthcare services can prove to be challenging for individuals who are unable to bear the expenses out of their pockets. For NCDs, the treatment costs are already high, and being multimorbid further amplifies the economic burden on patients and their families. The present study seeks to bridge the gap in knowledge regarding the financial risks that come with NCD multimorbidity. It accomplishes this by examining the catastrophic out-of-pocket (OOP) expenditure levels and the factors that contribute to it at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia. METHODS A facility-based cross-sectional study was conducted at Tikur Anbesa Specialized Hospital between May 18 and July 22, 2020 and 392 multimorbid patients participated. The study participants were selected from the hospital's four NCD clinics using systematic random sampling. Patients' direct medical and non-medical out-of-pocket (OOP) expenditures were recorded, and the catastrophic OOP health expenditure for NCD care was estimated using various thresholds as cutoff points (5%, 10%, 15%, 20%, 25%, and 40% of both total household consumption expenditure and non-food expenditure). The collected data was entered into Epi Data version 3.1 and analyzed using STATA V 14. Descriptive statistics were utilized to present the study's findings, while logistic regression was used to examine the associations between variables. RESULTS A study was conducted on a sample of 392 patients who exhibited a range of socio-demographic and economic backgrounds. The annual out-of-pocket spending for the treatment of non-communicable disease multimorbidity was found to be $499.7 (95% CI: $440.9, $558.6) per patient. The majority of these expenses were allocated towards medical costs such as medication, diagnosis, and hospital beds. It was found that as the threshold for spending increased from 5 to 40% of total household consumption expenditure, the percentage of households facing catastrophic health expenditures (CHE) decreased from 77.55 to 10.46%. Similarly, the proportion of CHE as a percentage of non-food household expenditure decreased from 91.84 to 28.32% as the threshold increased from 5 to 40%. The study also revealed that patients who traveled to Addis Ababa for healthcare services (AOR = 7.45, 95% CI: 3.41-16.27), who were not enrolled in an insurance scheme (AOR = 4.97, 95% CI: 2.37, 10.4), who had more non-communicable diseases (AOR = 2.05, 95% CI: 1.40, 3.01), or who had more outpatient visits (AOR = 1.46, 95%CI: 1.31, 1.63) had a higher likelihood of incurring catastrophic out-of-pocket health expenditures at the 40% threshold. CONCLUSION AND RECOMMENDATION This study has revealed that patients with multiple non-communicable diseases (NCDs) frequently face substantial out-of-pocket health expenditures (CHE) due to both medical and non-medical costs. Various factors, including absence from an insurance scheme, medical follow-ups necessitating travel to Addis Ababa, multiple NCDs and outpatient visits, and utilization of both public and private facilities, increase the likelihood of incurring CHE. To mitigate the incidence of CHE for individuals with NCD multimorbidity, an integrated NCD care service delivery approach, access to affordable medications and diagnostic services in public facilities, expanded insurance coverage, and fee waiver or service exemption systems should be explored.
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Affiliation(s)
- Mizan Habtemichael
- School of Public Health, College of Heath Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Meseret Molla
- School of Public Health, College of Heath Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Berhan Tassew
- School of Public Health, College of Heath Science, Addis Ababa University, Addis Ababa, Ethiopia
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Kopinska J, Atella V, Bhattacharya J, Miller G. The changing relationship between bodyweight and longevity in high- and low-income countries. ECONOMICS AND HUMAN BIOLOGY 2024; 54:101392. [PMID: 38703461 DOI: 10.1016/j.ehb.2024.101392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 05/06/2024]
Abstract
Standard measures of bodyweight (overweight and obese, for example) fail to reflect differences across populations and technological progress over time. This paper builds on the pioneering work of Hans Waaler (1984) and Robert Fogel (1994) to empirically estimate how the relationship between body mass index (BMI) and longevity varies across high-, middle-, and low-income countries. Importantly, we show that these differences are so profound that the share of national populations above mortality-minimizing bodyweight is not clearly greater in countries with higher overweight and obesity rates (as traditionally defined)-and in fact, relative to current standards, a larger share of low-income countries' populations can be unhealthily heavy.
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Affiliation(s)
| | - Vincenzo Atella
- Department of Economics and Finance, University of Rome Tor Vergata, Italy.
| | - Jay Bhattacharya
- School of Medicine - Stanford University, Stanford, United States of America; NBER, United States of America
| | - Grant Miller
- School of Medicine - Stanford University, Stanford, United States of America; NBER, United States of America
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Pallangyo P, Komba MS, Mkojera ZS, Mfanga L, Mmari JE, Kailembo NV, Bhalia S, Aloyce M, Matemu GG, Faraji HY, Keria JS, Waane T, Kisenge PR. Perspectives for the Prevention of Noncommunicable Diseases in Tanzania: Is Knowledge Translated into Practice? Risk Manag Healthc Policy 2024; 17:1177-1186. [PMID: 38742139 PMCID: PMC11090195 DOI: 10.2147/rmhp.s460703] [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: 02/26/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024] Open
Abstract
Background In Tanzania, where over a third of the society is impoverished, the burden of NCDs which account for about two-fifths of all disability-adjusted life years (DALYs) and one-third of premature deaths has doubled in the past two decades. However, notwithstanding a wider realization of the escalating burden of NCDs across Tanzania, the link between NCD awareness and lifestyle practices at the population level is not well characterized. We aimed to establish the gap between NCD knowledge and healthy behaviors. Methods This multi-regional community-based cross-sectional study was conducted in 5 regions of Tanzania between September 2022 and June 2023. A 22-item standardized tool evaluating various NCD risk behaviors was used in knowledge assessment and a cut-off of ≥70% was used to denote good knowledge. Bivariate analyses were performed to compare knowledge of NCD risk factors across various NCD risk subgroups. All tests were two tailed, and the significance was set at p<0.05. Results A total of 5121 individuals were consecutively enrolled. The mean age was 47.2 years and females comprised over three-fifths (60.8%) of the participants. With regard to behavioral NCD risks, physical inactivity, unhealthy diet, smoking and alcohol consumption were present in 79.0%, 70.2%, 2.1% and 17.6% of participants, respectively. Moreover, biological risk factors, ie, excess body weight, hypertension, and diabetes were present in 68.4%, 55.8% and 13.0% of participants, respectively. The mean knowledge score was 77.1% and 70.3% of participants demonstrated good knowledge of NCD risk factors. Except for smoking, individuals who showed awareness of various NCD risk factors were found to have significant rates of risky behaviors. Conclusion Despite sufficient NCD risk knowledge, incongruent lifestyle practices persist, highlighting a crucial concern. This suggests that awareness of NCDs and their risks may influence motivation for change but may not necessarily result in lifestyle modification.
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Affiliation(s)
- Pédrö Pallangyo
- Department Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Makrina Sotel Komba
- Department Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Zabella Seif Mkojera
- Department Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Loveness Mfanga
- Department Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Janeth Elidaima Mmari
- Department Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Neema Victor Kailembo
- Department Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Mohamed Aloyce
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Genofeva Gerald Matemu
- Department of Public Relations, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Husna Yasin Faraji
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Jasmine Said Keria
- Department of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Tatizo Waane
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Peter R Kisenge
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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Tefera YD, Ali AC, Woldearegay AG. A Study on Communication Practices in Reducing Non-Communicable Diseases in Bahir Dar City, Ethiopia. Risk Manag Healthc Policy 2024; 17:827-841. [PMID: 38601884 PMCID: PMC11005850 DOI: 10.2147/rmhp.s452771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/23/2024] [Indexed: 04/12/2024] Open
Abstract
Background Non-communicable diseases (NCDs) pose special challenges in developing countries In Ethiopia, the growing NCD burden has raised a public health concern with significant social, economic, and developmental effects. Thus, the study sought to examine health communication practices in addressing the NCDs in Bahir Dar City of the Amhara Region of Ethiopia. Methods A qualitative case study was conducted from January to April 2023. The study employed in-depth interviews, focus group discussions, and observations to gather data from health extension workers, NCD experts, and NCD focal persons about their experiences and perspectives regarding NCD prevention and control. The participants were purposively selected, and a thematic analysis technique was employed to analyze the data. Results The study found that several health communication strategies, such as health promotion, training and creating model households, screening, referrals, follow-ups, rehabilitation services, and activities reporting were employed. Nevertheless, there was a lack of consistent, reliable, and long-lasting and professional health communication regarding NCD prevention and management. Some of the challenges contributing to such deficient practices were overloading HEWs with various tasks, allocating many households to a single HEW, shortage of screening tools, shortage of financial and human resources, weak interdisciplinary collaboration, COVID-19, and recurrent conflicts in the city and the region. Above all, lack of health communication skills affected the health interventions. Concerning communication methods, one-to-one communication was frequently employed, while mass media and social media were rare. Generally, NCD communication, in particular, and health communication, in general, did not receive priority as other health-related activities in the city. Conclusion The study found that there were poor health communication practices in preventing and controlling NCDs. Thus, professional practice of health communication about NCDs must be prioritized, and emphasis should be given to inter-sectoral collaborations. Prioritizing financial and human resources is also essential for effective NCD communication.
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Affiliation(s)
- Yekitie Dagne Tefera
- Department of Journalism and Communication, Bahir Dar University, Bahir Dar, Ethiopia
| | - Adem Chanie Ali
- Department of Journalism and Communication, Bahir Dar University, Bahir Dar, Ethiopia
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Huda MD, Rahman M, Mostofa MG, Sarkar P, Islam MJ, Adam IF, Duc NHC, Al-Sobaihi S. Health Facilities Readiness and Determinants to Manage Cardiovascular Disease in Afghanistan, Bangladesh, and Nepal: Evidence from the National Service Provision Assessment Survey. Glob Heart 2024; 19:31. [PMID: 38524910 PMCID: PMC10959132 DOI: 10.5334/gh.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Background In South Asia, cardiovascular diseases (CVDs) are an increasing public health concern. One strategy for dealing with the growing CVDs epidemic is to make health facilities more ready to provide CVDs services. The study's objectives were to: (1) assess healthcare facilities' readiness to offer CVDs services; and (2) identify the variables that influence such readiness. Methods This study employed data from the Afghanistan Service Provision Assessment Survey 2018-2019, Bangladesh Health Facility Survey 2017, and Nepal Health Facility Survey 2021 that were cross-sectional and nationally representative. In Afghanistan, Bangladesh, and Nepal, 117, 368, and 1,381 health facilities, respectively, were examined. A total of 10 items/indicators were used to measure a health facility's readiness to provide CVDs services across three domains. Results The mean readiness scores of managing CVDs were 6.7, 5.6, and 4.6 in Afghanistan, Bangladesh, and Nepal, respectively. Availability of trained staff for CVD services are not commonly accessible in Afghanistan (21.5%), Bangladesh (15.3%), or Nepal (12.9%), except from supplies and equipment. Afghanistan has the highest levels of medicine and other commodity availability. Among the common factors linked with readiness scores, we ought to expect a 0.02 unit rise in readiness scores for three nations for every unit increase in number of CVDs care providers. In Afghanistan, Bangladesh, and Nepal, availability of both diagnosis and treatment facilities was associated with increases in readiness scores of 27%, 9%, and 17%, respectively. Additionally, an association was observed between nation-specific facility types and the readiness scores. Conclusions Country-specific factors as well as universal factors present in all three nations must be addressed to improve a health facility's readiness to provide CVDs care. To create focused and efficient country-specific plans to raise the standard of CVD care in South Asia, more investigation is necessary to ascertain the reasons behind country-level variations in the availability of tracer items.
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Affiliation(s)
- Md. Durrul Huda
- Diabetic Hospital, Chapai Nawabganj, Bangladesh
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh
| | - Mosiur Rahman
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh
| | - Md. Golam Mostofa
- Department of Population Science and Human Resource Development University of Rajshahi, Rajshahi-6205, Bangladesh
| | - Prosannajid Sarkar
- Dr. Wazed Research and Training Institute, Begum Rokeya University, Rangpur, Bangladesh
| | - Md. Jahirul Islam
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD 4122, Australia
| | | | | | - Saber Al-Sobaihi
- Premium Research Institute for Human Metaverse Medicine (WPI-PRIMe) at Osaka University, Osaka, Japan
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Lkhagvasuren B, Batkhuyag E, Tumurbaatar E, Urtnasan T, Tsengel D, Tumur-Ochir G, Oka T. Psychometric properties of the Mongolian version of shitsu-taikan-sho (alexisomia) in young adults. Sci Prog 2024; 107:368504231225075. [PMID: 38262911 PMCID: PMC10807320 DOI: 10.1177/00368504231225075] [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] [Indexed: 01/25/2024]
Abstract
Objective: Alexisomia is characterized by difficulty in identifying and describing bodily feelings. Shitsu-taikan-sho scale (STSS) is a self-report tool that assesses alexisomia. This study aimed to validate the Mongolian version of STSS in a nonclinical student sample. Methods: A total of 593 undergraduate students (217 males, 376 females, 18-25 years), who were studying at medical universities, were recruited. Participants completed the Mongolian version of STSS, which was translated from Japanese to Mongolian, back-translated, and finalized by an expert committee. Construct validity was examined using exploratory and confirmatory factor analyses for a three-factor structure. Internal consistency and test-retest reliability were measured using Cronbach's α and the intraclass correlation coefficients (ICC), respectively. Results: The mean scores of STSS were 18.6 ± 5.7 for difficulty identifying bodily feelings (DIB), 18.8 ± 4.0 for overadaptation (OA), 23.7 ± 4.1 for lack of health management (LHM), and 61.1 ± 10.5 for the total score (possible range: 7-35 for DIB, OA, LHM, and 21-105 for the total score, respectively). Exploratory factor analysis indicated a three-factor structure consisting of 21 items that explained 40.3% of the variance (KMO = 0.916, RMSEA = 0.049, χ2 = 372, p < .001). Confirmatory factor analysis provided a good fit to the data (CFI = 0.876, TLI = 0.861, RMSEA = 0.068, χ2 = 703, p < .001). Cronbach's alpha for the STSS was 0.860, indicating good internal consistency. Test-retest reliability analysis demonstrated good reliability (ICC = 0.791). Conclusion: The 21-item Mongolian version of STSS demonstrated evidence of good reliability and validity for assessing alexisomia in a nonclinical population in Mongolia. This suggests that the Mongolian version of the STSS may allow for the comparison of alexisomia among adults in Mongolia with those in other countries.
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Affiliation(s)
- Battuvshin Lkhagvasuren
- Department of Psychosomatic Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
- Brain Science Institute, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - Enkhzaya Batkhuyag
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Enkhnaran Tumurbaatar
- Brain Science Institute, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | | | - Delgermaa Tsengel
- Dornogobi Medical School, Mongolian National University of Medical Sciences, Sainshand, Dornogobi, Mongolia
| | - Gantsetseg Tumur-Ochir
- Department of Mental Health Surveillance, National Center of Mental Health, Sharkhad, Ulaanbaatar, Mongolia
| | - Takakazu Oka
- Department of Psychosomatic Medicine, International University of Health and Welfare Narita Hospital, Narita, Chiba, Japan
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Serag H, Ghulmi L, Sallam HS, Ferguson M, Manakatt B. Addressing Chronic Conditions and Social Determinants of Health During the COVID-19 Pandemic. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1458:335-348. [PMID: 39102207 DOI: 10.1007/978-3-031-61943-4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Chronic conditions or diseases are defined as persistent conditions lasting ≥ 1 year requiring either ongoing medical attention or limiting daily living or both (Agency for Healthcare Research and Quality (AHRQ) in Programs: SHARE approach workshop, Agency for Healthcare Research and Quality (AHRQ) (2016) Programs: SHARE approach workshop 2016. https://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/workshop/index.html . Accessed 20 Jan 2017). Physical chronic conditions, including diabetes, hypertension, heart disease, arthritis, and stroke, are prevalent, especially in the older population. Over 90% of older adults have at least 1 and 77% have ≥ 2 chronic conditions (American Diabetes Association (ADA) in Statistics about diabetes, American Diabetes Association (ADA) (2023) Statistics about diabetes. https://diabetes.org/about-us/statistics/about-diabetes . Accessed 20 Apr 2023). Chronic conditions account for $4.1 trillion of the nation's annual healthcare expenditure (Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion in Health and economic costs of chronic conditions, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Health and Economic Costs of Chronic Conditions (2022). https://www.cdc.gov/chronicdisease/about/costs/index.htm . Accessed 7 Jan 2023). There are marked disparities based on age, color, and income, with older people, people of color, and lower-income people having higher treatment costs or even lost wages in response to having chronic conditions. Chronic conditions are the on-the-top leading causes for death with diabetes being the top 7th in the USA in 2019 (Ferguson in Metabolic Syndrome Related Dis, Ferguson et al., Metab Syndr Relat Disord 21:177-187, 2023).
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Affiliation(s)
- Hani Serag
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Lima Ghulmi
- School of Health Professions, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Hanaa S Sallam
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Monique Ferguson
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Bushra Manakatt
- School of Nursing, The University of Texas Medical Branch, Galveston, Texas, USA.
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Jere J, Ruark A, Bidwell JT, Butterfield RM, Neilands TB, Weiser SD, Mulauzi N, Mkandawire J, Conroy AA. "High blood pressure comes from thinking too much": Understandings of illness among couples living with cardiometabolic disorders and HIV in Malawi. PLoS One 2023; 18:e0296473. [PMID: 38153924 PMCID: PMC10754453 DOI: 10.1371/journal.pone.0296473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023] Open
Abstract
Cardiometabolic disorders (CMD) such as hypertension and diabetes are increasingly prevalent in sub-Saharan Africa, placing people living with HIV at risk for cardiovascular disease and threatening the success of HIV care. Spouses are often the primary caregivers for people living with CMD, and understanding patients' and partners' conceptions of CMD could inform care. We conducted semi-structured interviews with 25 couples having a partner living with HIV and either hypertension or diabetes. Couples were recruited from HIV clinics in Malawi and were interviewed on beliefs around symptoms, causation, prevention, and treatment for CMD. Data were analyzed at the individual and dyadic levels using framework analysis and Kleinman's theory of explanatory models as a lens. On average, participants were 51 years old and married for 21 years. Approximately 57%, 14%, and 80% had hypertension, diabetes, and HIV. Couples endorsed a combination of biomedical explanatory models (beliefs around physical and mental health) and traditional explanatory models (beliefs around religion and natural remedies), although tended to emphasize the biomedical model. Half of couples believed stress was the main cause of hypertension. For diabetes, diet was believed to be a common cause. In terms of prevention, dietary changes and physical activity were most frequently mentioned. For disease management, medication adherence and diet modifications were emphasized, with some couples also supporting herbal remedies, stress reduction, and faith in God as strategies. Participants were generally more concerned about CMD than HIV due to poor access to CMD medications and beliefs that CMD could lead to sudden death. Within couples, partners often held many of the same beliefs but diverged around which etiological or preventive factors were most important (e.g., stress versus diet) and the best diet for CMD. Health education programs should involve primary partners to build knowledge of CMD and address overlap with HIV, and reinforce accurate information on lifestyle factors for the prevention and treatment of CMD.
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Affiliation(s)
- Jane Jere
- School of Public Health, University of California Berkeley, Berkeley, California, United States of America
| | - Allison Ruark
- Wheaton College, Biological and Health Sciences, Wheaton, IL, United States of America
| | - Julie T. Bidwell
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, United States of America
| | - Rita M. Butterfield
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States of America
| | - Sheri D. Weiser
- Division of HIV, Infectious Disease and Global Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | | | | | - Amy A. Conroy
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, United States of America
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13
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Liang D, Cai X, Guan Q, Ou Y, Zheng X, Lin X. Burden of type 1 and type 2 diabetes and high fasting plasma glucose in Europe, 1990-2019: a comprehensive analysis from the global burden of disease study 2019. Front Endocrinol (Lausanne) 2023; 14:1307432. [PMID: 38152139 PMCID: PMC10752242 DOI: 10.3389/fendo.2023.1307432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/23/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction With population aging rampant globally, Europe faces unique challenges and achievements in chronic disease prevention. Despite this, comprehensive studies examining the diabetes burden remain absent. We investigated the burden of type 1 and type 2 diabetes, alongside high fasting plasma glucose (HFPG), in Europe from 1990-2019, to provide evidence for global diabetes strategies. Methods Disease burden estimates due to type 1 and type 2 diabetes and HFPG were extracted from the GBD 2019 across Eastern, Central, and Western Europe. We analyzed trends from 1990 to 2019 by Joinpoint regression, examined correlations between diabetes burden and Socio-demographic indices (SDI), healthcare access quality (HAQ), and prevalence using linear regression models. The Population Attributable Fraction (PAF) was used to described diabetes risks. Results In Europe, diabetes accounted for 596 age-standardized disability-adjusted life years (DALYs) per 100,000 people in 2019, lower than globally. The disease burden from type 1 and type 2 diabetes was markedly higher in males and escalated with increasing age. Most DALYs were due to type 2 diabetes, showing regional inconsistency, highest in Central Europe. From 1990-2019, age-standardized DALYs attributable to type 2 diabetes rose faster in Eastern and Central Europe, slower in Western Europe. HFPG led to 2794 crude DALYs per 100,000 people in 2019. Type 1 and type 2 diabetes burdens correlated positively with diabetes prevalence and negatively with SDI and HAQ. High BMI (PAF 60.1%) and dietary risks (PAF 34.6%) were significant risk factors. Conclusion Europe's diabetes burden was lower than the global average, but substantial from type 2 diabetes, reflecting regional heterogeneity. Altered DALYs composition suggested increased YLDs. Addressing the heavy burden of high fasting plasma glucose and the increasing burden of both types diabetes necessitate region-specific interventions to reduce type 2 diabetes risk, improve healthcare systems, and offer cost-effective care.
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Affiliation(s)
- Dong Liang
- The School of Health Management, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiuli Cai
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Qing Guan
- The School of Health Management, Fujian Medical University, Fuzhou, Fujian, China
| | - Yangjiang Ou
- “The 14th Five-Year Plan” Application Characteristic Discipline of Hunan Province (Clinical Medicine), Hunan Provincial Key Laboratory of the Traditional Chinese Medicine Agricultural Biogenomics, Changsha Medical University, Changsha, Hunan, China
| | - Xiaoxin Zheng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei, China
- Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Xiuquan Lin
- The School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
- Department for Chronic and Noncommunicable Disease Control and Prevention, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
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Hoang CT, Kohler IV, Amin V, Behrman JR, Kohler HP. Resilience, Accelerated Aging and Persistently Poor Health: Diverse Trajectories of Health in Malawi. POPULATION AND DEVELOPMENT REVIEW 2023; 49:771-800. [PMID: 38605849 PMCID: PMC11005366 DOI: 10.1111/padr.12590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Individuals age at vastly different rates resulting in significant within-population heterogeneity in health and aging outcomes. This diversity in health and aging trajectories has rarely been investigated among low-income aging populations that have experienced substantial hardships throughout their lifecourses. Utilizing 2006-2018 data from the Malawi Longitudinal Study of Families and Health (MLSFH) and estimating group-based trajectory models (GBTM), our analyses identified three distinct lifecourse health trajectories: (1) comparatively good initial mental and physical health that persisted throughout the lifecourse ("resilient aging"); (2) relatively good initial mental and physical health that started to deteriorate during mid-adulthood ("accelerated aging"); and (3) poor initial mental and physical health that further declined over the lifecourse ("aging with persistently poor health"). For both physical and mental health, men were more likely to enjoy resilient aging than women. Predictors other than gender of trajectory membership sometimes confirmed, and sometimes contradicted, hypotheses derived from high-income country studies. Our analyses highlight the long arm of early life conditions and gender in determining aging trajectories and show that a non-trivial sub-population is characterized by aging with persistently poor health. The study uncovers widening gaps in health outcomes between those who age with resilience and those who experience accelerated aging.
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Agarwal D, Bailie CR, Rana S, Balan L, Grills NJ, Mathias K. Scaling a group intervention to promote caregiver mental health in Uttarakhand, India: A mixed-methods implementation study. Glob Ment Health (Camb) 2023; 10:e85. [PMID: 38161744 PMCID: PMC10755371 DOI: 10.1017/gmh.2023.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/24/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024] Open
Abstract
Caregivers are integral to health and social care systems in South Asian countries yet are themselves at higher risk of mental illness. Interventions to support caregiver mental health developed in high-income contexts may be contextually inappropriate in the Global South. In this mixed-methods study, we evaluated the implementation and scaling of a locally developed mental health group intervention for caregivers and others in Uttarakhand, India. We describe factors influencing implementation using the updated Consolidated Framework for Implementation Research, and selected implementation outcomes. Key influencing factors we found in common with other programs included: an intervention that was relevant and adaptable; family support and stigma operating in the outer setting; training and support for lay health worker providers, shared goals, and relationships with the community and the process of engaging with organisational leaders and service users within the inner setting. We identified further factors including the group delivery format, competing responsibilities for caregivers and opportunities associated with the partnership delivery model as influencing outcomes. Implementation successfully reached target communities however attrition of 20% of participants highlights the potential for improving outcomes by harnessing enablers and addressing barriers. Findings will inform others implementing group mental health and caregiver interventions in South Asia.
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Affiliation(s)
- Disha Agarwal
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Christopher R. Bailie
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Samson Rana
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Laxman Balan
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
| | - Nathan J. Grills
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kaaren Mathias
- Project Burans, Herbertpur Christian Hospital, Atten Bagh, India
- Te Kaupeka Oranga, University of Canterbury, Christchurch, New Zealand
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Ngowi JE, Munishi C, Ndumwa HP, Njiro BJ, Amani DE, Mboya EA, Mloka D, Kikula AI, Balandya E, Ruggajo P, Kessy AT, Kitambala E, Kapologwe N, Kengia JT, Kiologwe J, Ubuguyu O, Salum B, Kamuhabwa A, Ramaiya K, Sunguya BF. Efforts to Address the Burden of Non-Communicable Diseases Need Local Evidence and Shared Lessons from High-Burden Countries. Ann Glob Health 2023; 89:78. [PMID: 38025922 PMCID: PMC10655753 DOI: 10.5334/aogh.4118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/09/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Jackline E. Ngowi
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Castory Munishi
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Harrieth P. Ndumwa
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Belinda J. Njiro
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Davis E. Amani
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Erick A. Mboya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Doreen Mloka
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Amani I. Kikula
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Paschal Ruggajo
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
- Ministry of Health, P O Box 743 Dodoma, Tanzania
| | - Anna T. Kessy
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Emilia Kitambala
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Ntuli Kapologwe
- President’s Office Regional Administration and Local Government, P O Box 1923 Dodoma, Tanzania
| | - James T. Kengia
- President’s Office Regional Administration and Local Government, P O Box 1923 Dodoma, Tanzania
| | | | | | - Bakari Salum
- President’s Office Regional Administration and Local Government, P O Box 1923 Dodoma, Tanzania
| | - Appolinary Kamuhabwa
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
| | - Kaushik Ramaiya
- Tanzania Non-Communicable Diseases Alliance, P O Box 65201 Dar es salaam, Tanzania
- Tanzania Diabetes Association, P O Box 65201 Dar es salaam, Tanzania
- Shree Hindu Mandal Hospital, P O Box 581 Dar es salaam, Tanzania
| | - Bruno F. Sunguya
- Muhimbili University of Health and Allied Sciences, 9 United Nations Road, Upanga West P O Box 65001, Dar es salaam, Tanzania
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Rine S, Lara ST, Bikomeye JC, Beltrán-Ponce S, Kibudde S, Niyonzima N, Lawal OO, Mulamira P, Beyer KMM. The impact of the COVID-19 pandemic on cancer care including innovations implemented in Sub-Saharan Africa: A systematic review. J Glob Health 2023; 13:06048. [PMID: 37976409 PMCID: PMC10656081 DOI: 10.7189/jogh.13.06048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background The coronavirus 2019 (COVID-19) pandemic has caused disruptions in the delivery and utilisation of cancer services. The impact of these interruptions is disproportionately borne by low- and middle-income countries in Sub-Saharan Africa (SSA). There are speculations of increased late-stage presentation and mortality as services are returning to the pre-pandemic state. This review aims to explore the extent to which the COVID-19 pandemic impacted cancer services across SSA and to identify innovations implemented across SSA to mitigate the impacts. Methods Using database-specific search strategies, a systematic literature search was conducted in PubMed, Ovid (MedLine), Web of Science, and African Index Medicus. Eligible studies included original research, reports, perspectives and summaries of national or regional outcomes published in the English language. The primary outcome was changes in the delivery and utilisation of cancer prevention and screening, diagnosis, treatment and follow-up services. The secondary outcome was to identify implemented innovations to mitigate the impact of the pandemic on service delivery. Results Out of the 167 articles identified in the literature search, 46 were included in the synthesis. A majority (95.7%) of the included articles described suspension and/or delay of screening, diagnosis, and treatment services, although two studies (4.3%) described the continuation of services despite the lockdown. Care was additionally impacted by transportation limitations, shortages of staff and personal protective equipment, disruption of the medication supply chain and patients' fears and stigma associated with contracting COVID-19. A major innovation was the use of telemedicine and virtual platforms for patient consultation and follow-up during the pandemic in SSA. Furthermore, drones and mobile applications were used for sample collection, medication delivery and scheduling of treatment. In some instances, medication routes and treatment protocols were changed. Conclusions The delivery and utilisation of cancer services decreased substantially during the pandemic. Cancer centres initiated innovative methods of care delivery, including telehealth and drone use, with long-term potential to mitigate the impact of the pandemic on service delivery. Cancer centres in SSA must explore sustainable, facility or country-specific innovations as services return to the pre-pandemic state. Registration The review was registered in PROSPERO with registration number CRD42022351455.
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Affiliation(s)
- Sarah Rine
- Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shana T Lara
- Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jean C Bikomeye
- Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sara Beltrán-Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Olatunji O Lawal
- Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Nigeria
| | | | - Kirsten MM Beyer
- Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Ejigu BA, Tiruneh FN. The Link between Overweight/Obesity and Noncommunicable Diseases in Ethiopia: Evidences from Nationwide WHO STEPS Survey 2015. Int J Hypertens 2023; 2023:2199853. [PMID: 38023617 PMCID: PMC10667048 DOI: 10.1155/2023/2199853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/28/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Noncommunicable diseases (NCDs) are the leading cause of death worldwide. Each year, 15 million adults die from NCDs; more than 85% of these premature deaths occur in low- and middle-income nations. Evidence indicates that overweight and obesity are the main risk factors for NCDs. Although the literature indicates that the burden of NCDs is increasing in Ethiopia, no research has been conducted to demonstrate a link between overweight/obesity and NCDs. Therefore, the aim of this study is to examine the association between overweight/obesity and the common NCDs while adjusting for other important factors. Methods We analysed data from the 2015 Ethiopia WHO STEPS survey, which was conducted in 2015. A total weighted sample of 9,800 participants (15-69 years) was included. The relationship between nutritional status and NCDs was assessed using bivariate and multivariable logistic regression models while adjusting for covariates. Results Among the 9,800 participants, 2053 (21% with (95% CI: 19.8-22.1) had hypertension and 1368 (14% with (95% CI: 13.1-15.0) had high cholesterol levels. According to the multivariable logistic regression analysis, being overweight/obese (AOR = 2.0; 95% CI: 1.7-2.3), alcohol consumption, received lifestyle advice, being female, living in urban areas, increased age, having government occupation, and living in SNNP region were positively associated with hypertension. While being underweight (AOR = 0.6; 95% CI: 0.5-0.7), living in the Afar, Somali, and Tigray regions were negatively associated with hypertension. Being overweight/obese (AOR = 1.4; 95% CI: 1.1-1.7), being female, having older age, and living in Somali region were positively associated with a high cholesterol level. Whereas being underweight (AOR = 0.7; 95% CI: 0.6-0.9), received lifestyle advice, reside in rural areas, being farmer, student, and housewife, and living in Gambela region were negatively associated with a high cholesterol level. Conclusion This study found a statistically positive association between the common NCDs, namely, overweight/obesity, hypertension, and high cholesterol levels. Our findings imply that there is a need for effective interventions to prevent overweight/obesity by encouraging people to increase physical activity, minimize sedentary behavior, and maintain a healthy dietary pattern in order to reduce the risk of hypertension and high cholesterol levels.
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Affiliation(s)
| | - Fentanesh Nibret Tiruneh
- Department of Applied Human Nutrition, Faculty of Chemical and Food Engineering, Bahir Dar Institute of Technology, Bahir Dar University, Bahir Dar, Ethiopia
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Terefa DR, Tesfaye E, Tolessa BE, Desisa AE, Olani W, Fetensa G, Chego M, Abdisa E, Turi E, Bekuma TT, Getachew M, Tesfaye L, Tilahun T. Impact of the COVID-19 pandemic on the cost of chronic diseases treatment and care at public hospitals in Wallaga zones, Oromia Regional State, Ethiopia: a hospital-based, cross-sectional study. BMJ Open 2023; 13:e070195. [PMID: 37931966 PMCID: PMC10632867 DOI: 10.1136/bmjopen-2022-070195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
OBJECTIVE Globally, around one-third of the population has at least one long-term health condition that could be affected by the COVID-19 pandemic. Despite the fact that studies have revealed the direct impact of COVID-19 on healthcare provision and utilisation, the impact of the pandemic on the cost of chronic disease treatment and care from a patient perspective was scanty. So, the study aimed to determine the impact of the COVID-19 pandemic on cost of chronic diseases treatment and care at public hospitals in Wallaga zones, Oromia Regional State, Ethiopia, from 1 August to 31 August 2020. METHODS An institutional-based cross-sectional study design was used, and the sample size for the study (n=642) was determined using a single population mean formula. Data were collected using interviews and analysed using SPSS V.25. Descriptive statistics were performed, and the cost of follow-up care before and after the pandemic was compared using a related-samples Wilcoxon signed-rank test, declaring the level of significance of the median cost difference at p<0.05. RESULTS A total of 642 patients were included in the study, of whom 605 (94.2%) responded to the interviews. There was a significant median cost difference (n=593, Z=5.05, p=0.001) between the cost of chronic diseases among follow-up patients during the pandemic and the costs incurred by these patients before the pandemic. CONCLUSION The cost of follow-up care among chronic disease patients during the COVID-19 pandemic was significantly higher compared with before the pandemic era. Therefore, healthcare providers should arrange special fee waiver mechanisms for chronic disease healthcare costs during such types of pandemics and provide the services at proximal health facilities.
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Affiliation(s)
- Dufera Rikitu Terefa
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Edosa Tesfaye
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Belachew Etana Tolessa
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Adisu Ewunetu Desisa
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Wolkite Olani
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Getahun Fetensa
- Schools of Nursing and Midwifery, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Melese Chego
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Eba Abdisa
- Schools of Nursing and Midwifery, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Ebisa Turi
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Tariku Tesfaye Bekuma
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Motuma Getachew
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Lensa Tesfaye
- Department of Public Health, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
| | - Temesgen Tilahun
- School of Medicine, Institute of Health Sciences, Wallaga University, Nekemte, Ethiopia
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Bat-Erdene E, Hiramoto T, Tumurbaatar E, Tumur-Ochir G, Jamiyandorj O, Yamamoto E, Hamajima N, Oka T, Jadamba T, Lkhagvasuren B. Quality of life in the general population of Mongolia: Normative data on WHOQOL-BREF. PLoS One 2023; 18:e0291427. [PMID: 37773966 PMCID: PMC10540971 DOI: 10.1371/journal.pone.0291427] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 08/30/2023] [Indexed: 10/01/2023] Open
Abstract
No data on the quality of life (QOL) of the general population are available for Mongolia. This study aimed to determine normative data on the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) in the general population of Mongolia. This nationwide, population-based, cross-sectional study was conducted in 48 sampling centers across Mongolia in 2020. We used the WHOQOL-BREF and the Hospital Anxiety and Depression Scale (HADS) in our study and evaluated their associations with vital signs, body measurements, and lifestyle determinants. A total of 714 participants (261 men and 453 women) with a mean (standard deviation) age of 40.7 (13.2) years were recruited. The mean scores of WHOQOL-BREF subscales were 61.5 for physical health, 73.5 for psychological health, 70.1 for social relationship, and 67.2 for environmental health domains. The prevalence of poor QOL was 16.9% among the participants. Participants living in an apartment in urban areas with high HADS scores had a low QOL. All domains of WHOQOL-BREF were inversely correlated with anxiety score (r = -0.353 - -0.206, p < 0.001) and depression scores (r = -0.335 - -0.156, p < 0.001). Physical health was predicted by residency location, anxiety, and depression (R2 = 0.200, p < 0.001); psychological health by anxiety and depression (R2 = 0.203, p < 0.001); social relationship by residency location, age group, anxiety and depression (R2 = 0.116, p < 0.001); and environmental health by employment, anxiety, and depression (R2 = 0.117, p < 0.001). This is the first report on normative data on the QOL in the general population of Mongolia. Physical health was low compared with that determined using international data. Poor QOL was observed among those with mental health issues living in the urban areas.
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Affiliation(s)
- Enkhjin Bat-Erdene
- Department of Neuroscience and Cell Biology, Child Health Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, United States of America
- Brain Science Institute, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - Tetsuya Hiramoto
- Department of Psychosomatic Medicine, Fukuoka National Hospital, National Hospital Organization, Fukuoka, Japan
| | - Enkhnaran Tumurbaatar
- Brain Science Institute, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - Gantsetseg Tumur-Ochir
- Department of Mental Health Surveillance, National Center for Mental Health, Ulaanbaatar, Mongolia
| | | | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Takakazu Oka
- Department of Psychosomatic Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Tsolmon Jadamba
- Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - Battuvshin Lkhagvasuren
- Brain Science Institute, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
- Department of Psychosomatic Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
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Bharati R, Kovach KA. Incorporating Lifestyle Medicine Into Primary Care Practice: Perceptions and Practices of Family Physicians. Am J Lifestyle Med 2023; 17:704-716. [PMID: 37711349 PMCID: PMC10498979 DOI: 10.1177/15598276211072506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Introduction: Lifestyle medicine (LM) uses therapeutic lifestyle behavior change to address the root causes of chronic diseases. The purpose of this study was to assess family physicians' perceptions and utilization of LM principles in their primary care practices, as well as identify reported barriers to implementation. Methods: A survey was administered to 5770 family physicians registered with the American Academy of Family Physicians (AAFP). The survey questions assessed the gap between perception and practice of LM core competencies and the 6 domains of LM. Results: The responses from 447 family physicians were included in the study. Respondents' perceived importance and reported practice was higher for clinical skills compared to the community partnerships and advocacy. There was a substantial gap in the reported comfort with and practice of certain LM domains, such as sleep (47%) and relationships (39.4%). However, LM board-certified physicians had a significantly higher frequency of practice in these domains. The majority of participants identified both difficulty with changing patient behavior (89%) and having limited time (81%) as major barriers to incorporate LM into their practice. Conclusion: Lifestyle medicine concepts resonate strongly with family physicians although gaps exist surrounding engaging in community partnerships, advocacy, and certain domains of LM. This study assesses family physicians' perceptions and utilization of LM principles in their primary care practices, and identifies reported barriers to implementation.
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Arovah NI, Thu DTA, Kurniawaty J, Haroen H. Physical activity and immunity in obese older adults: A systematic bibliographic analysis. SPORTS MEDICINE AND HEALTH SCIENCE 2023; 5:181-189. [PMID: 37753429 PMCID: PMC10518798 DOI: 10.1016/j.smhs.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 05/22/2023] [Accepted: 07/05/2023] [Indexed: 09/28/2023] Open
Abstract
Extensive research has been conducted on the roles of physical activity in immune functioning. However, reviews on the effect of physical activity on immune function among obese older adults are scarce. This study aimed to map the trend and development of the key terms and prominent sources to identify potential research opportunities through a systematic bibliographic analysis. A systematic search was conducted in the Scopus database on the following query: (sport∗ OR "physical activity" OR exercise) AND (elderly OR "older adult∗" OR aging) AND (immun∗) AND (obes∗) AND NOT (animal), in March 2023. Publication timing and citation were descriptively analyzed, followed by the bibliographic coupling and the term co-occurrence analyses for generating network and overlay visualization mapping using the VOSviewers software. The search resulted in 426 articles dating back from 1991 to the present and were dominated by authors from Western countries. Three thematic clusters of this research area were generated, covering (1) the impact of physical activity or inactivity on health, (2) physical activity assessments and the use of association and cross-sectional study as the primary type of research, and (3) the physical activity impacts at the population level. For future research, more intervention studies are needed to understand how exercise affects immune response in older obese adults and to explore optimal duration, type, and intensity of the exercise, using a multi-omics approach. Studies in non-Western populations and systematic reviews are recommended to complement this bibliographic analysis.
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Affiliation(s)
- Novita Intan Arovah
- Department of Sports Science, Faculty of Sports Science, Universitas Negeri Yogyakarta, Jalan Colombo No 1 Karangmalang, Yogyakarta, 55228, Indonesia
| | - Dang Thi Anh Thu
- School of Science, Faculty of Public Health, Hue University of Medicine and Pharmacy, 06 Ngo Quyen, Vinh Ninh Ward, Hue City, Viet Nam
| | - Juni Kurniawaty
- Department of Anaesthesiology, Faculty of Medicine, Universitas Gadjah Mada, Departemen Anestesiologi dan Terapi Intensif RSUP Dr. Sardjito, Jln. Kesehatan No.1, Sekip, Yogyakarta, 55231, Indonesia
| | - Hartiah Haroen
- Department of Nursing, Faculty of Nursing, Universitas Padjajaran, Hegarmanah, Kec. Jatinangor, Kabupaten Sumedang, Bandung, Jawa Barat, 45363, Indonesia
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Gelaw YA, Koye DN, Alene KA, Ahmed KY, Assefa Y, Erku DA, Tegegn HG, Tesema AG, Zeleke BM, Melaku YA. Socio-demographic correlates of unhealthy lifestyle in Ethiopia: a secondary analysis of a national survey. BMC Public Health 2023; 23:1528. [PMID: 37568091 PMCID: PMC10416504 DOI: 10.1186/s12889-023-16436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Multiple lifestyle risk factors exhibit a stronger association with non-communicable diseases (NCDs) compared to a single factor, emphasizing the necessity of considering them collectively. By integrating these major lifestyle risk factors, we can identify individuals with an overall unhealthy lifestyle, which facilitates the provision of targeted interventions for those at significant risk of NCDs. The aim of this study was to evaluate the socio-demographic correlates of unhealthy lifestyles among adolescents and adults in Ethiopia. METHODS A national cross-sectional survey, based on the World Health Organization's NCD STEPS instruments, was conducted in Ethiopia. The survey, carried out in 2015, involved a total of 9,800 participants aged between 15 and 69 years. Lifestyle health scores, ranging from 0 (most healthy) to 5 (most unhealthy), were derived considering factors such as daily fruit and vegetable consumption, smoking status, prevalence of overweight/obesity, alcohol intake, and levels of physical activity. An unhealthy lifestyle was defined as the co-occurrence of three or more unhealthy behaviors. To determine the association of socio-demographic factors with unhealthy lifestyles, multivariable logistic regression models were utilized, adjusting for metabolic factors, specifically diabetes and high blood pressure. RESULTS Approximately one in eight participants (16.7%) exhibited three or more unhealthy lifestyle behaviors, which included low fruit/vegetable consumption (98.2%), tobacco use (5.4%), excessive alcohol intake (15%), inadequate physical activity (66%), and obesity (2.3%). Factors such as male sex, urban residency, older age, being married or in a common-law relationship, and a higher income were associated with these unhealthy lifestyles. On the other hand, a higher educational status was associated with lower odds of these behaviors. CONCLUSION In our analysis, we observed a higher prevalence of concurrent unhealthy lifestyles. Socio-demographic characteristics, such as sex, age, marital status, residence, income, and education, were found to correlate with individuals' lifestyles. Consequently, tailored interventions are imperative to mitigate the burden of unhealthy lifestyles in Ethiopia.
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Affiliation(s)
- Yalemzewod Assefa Gelaw
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia.
- School of Population Health, Curtin University, Perth, WA, Australia.
| | - Digsu N Koye
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kefyalew Addis Alene
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Kedir Y Ahmed
- Rural Health Research Institute, Charles Sturt University, Orange, NSW, 2800, Australia
- Department of Public Health, Samara University, Samara, Afar, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Daniel Asfaw Erku
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Henok Getachew Tegegn
- School of Rural Medicine, University of New England, Armidale, 2351, Australia
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Azeb Gebresilassie Tesema
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Berihun Megabiaw Zeleke
- Planetary Health Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yohannes Adama Melaku
- FHMRI Sleep Health, Flinders University, Adelaide, SA, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
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Bailie CR, Pillai PS, Goodwin Singh A, Leishman J, Grills NJ, Mathias K. Does the Nae Umeed group intervention improve mental health and social participation? A pre-post study in Uttarakhand, India. Glob Ment Health (Camb) 2023; 10:e47. [PMID: 37854393 PMCID: PMC10579688 DOI: 10.1017/gmh.2023.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/21/2023] [Accepted: 07/19/2023] [Indexed: 10/20/2023] Open
Abstract
There are few evidence-based interventions to support caregiver mental health developed for low- and middle-income countries. Nae Umeed is a community-based group intervention developed with collaboratively with local community health workers in Uttarakhand, India primarily to promote mental wellbeing for caregivers and others. This pre-post study aimed to evaluate whether Nae Umeed improved mental health and social participation for people with mental distress, including caregivers. The intervention consisted of 14 structured group sessions facilitated by community health workers. Among 115 adult participants, 20% were caregivers and 80% were people with disability and other vulnerable community members; 62% had no formal education and 92% were female. Substantial and statistically significant improvements occurred in validated psychometric measures for mental health (12-Item General Health Questionnaire, Patient Health Questionnaire-9) and social participation (Participation Scale). Improvements occurred regardless of caregiver status. This intervention addressed mental health and social participation for marginalised groups that are typically without access to formal mental health care and findings suggest Nae Umeed improved mental health and social participation; however, a controlled community trial would be required to prove causation. Community-based group interventions are a promising approach to improving the mental health of vulnerable groups in South Asia.
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Affiliation(s)
- Christopher R. Bailie
- Nossal Institute for Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Pooja S. Pillai
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
| | - Atul Goodwin Singh
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
| | - Jed Leishman
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Nathan J. Grills
- Nossal Institute for Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Kaaren Mathias
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, India
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
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Krupp K, Rao AP, Pope B, Ravi K, Khan A, Srinivas V, Madhivanan P, Srinivas A. Prevalence and correlates of metabolic syndrome among women living in urban slums, Mysore, India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000846. [PMID: 37418350 DOI: 10.1371/journal.pgph.0000846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
Metabolic Syndrome (MetSyn) is a predictor of cardiovascular disease (CVD). About a third of urban Indians suffer from MetSyn. This study examined the prevalence of MetSyn among women living in urban slums. A cross-sectional survey was carried out between October 2017 and May 2018 among a non-probability sample of slum-dwelling women, 40-64 years of age, in six government-designated slums in Mysore, India. Data were collected on demographics, diet, behavioral risks, anthropometry, blood pressure, serum glucose, hemoglobin A1c, and serum lipids. The study used a definition of MetSyn from the International Diabetes Federation Task Force on Epidemiology and Prevention with an HbA1c measure for average blood glucose. About two-fifths of the 607 participants had MetSyn (41.5%; 95% CI: 37.7-45.5). Of those, 40.9% met three criteria, 38.1% four, and 25.0%, all five criteria. Elevated BP was the most prevalent MetSyn factor (79.6%), followed by increased waist circumference (54.5%), low HDL (50.1%), elevated Hb A1c (37.1%), and elevated triglycerides (36.1%). Odds for MetSyn were 1.52 times greater for those who were 50-59 years of age compared with those 40-49 years of age (adjusted odds ratio[AOR]:1.52; 95% CI:0.96-2.40). Women with mobility issues had 1.29 times higher odds of MetSyn than those without it (AOR: 0.76, 95% CI: 0.96, 1.75). Housewives had 1.29 times greater odds of MetSyn (AOR: 1.29, 95% CI: 1.00, 1.67). There is a high prevalence of MetSyn among urban slum-dwelling women in Mysore. There is a need for interventions aimed at reducing CVD risk factors in this population.
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Affiliation(s)
- Karl Krupp
- Division of Public Health Practice & Translational Research, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, United States of America
- Public Health Research Institute of India, Mysore, India
| | - Arathi P Rao
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Benjamin Pope
- Department of Epidemiology & Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Kavitha Ravi
- Public Health Research Institute of India, Mysore, India
| | - Anisa Khan
- Public Health Research Institute of India, Mysore, India
| | | | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, India
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Arizona, Tucson, United States of America
- Division of Infectious Diseases, College of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Arun Srinivas
- Department of Cardiology, Apollo Hospital, Mysore, India
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Chham S, Van Olmen J, Van Damme W, Chhim S, Buffel V, Wouters E, Ir P. Scaling-up integrated type-2 diabetes and hypertension care in Cambodia: what are the barriers to health system performance? Front Public Health 2023; 11:1136520. [PMID: 37333565 PMCID: PMC10272385 DOI: 10.3389/fpubh.2023.1136520] [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: 01/03/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Background Non-communicable diseases (NCDs) such as type-2 diabetes (T2D) and hypertension (HTN) pose a massive burden on health systems, especially in low- and middle-income countries. In Cambodia, to tackle this issue, the government and partners have introduced several limited interventions to ensure service availability. However, scaling-up these health system interventions is needed to ensure universal supply and access to NCDs care for Cambodians. This study aims to explore the macro-level barriers of the health system that have impeded the scaling-up of integrated T2D and HTN care in Cambodia. Methods Using qualitative research design comprised an articulation between (i) semi-structured interviews (33 key informant interviews and 14 focus group discussions), (ii) a review of the National Strategic Plan and policy documents related to NCD/T2D/HTN care using qualitative document analysis, and (iii) direct field observation to gain an overview into health system factors. We used a health system dynamic framework to map macro-level barriers to the health system elements in thematic content analysis. Results Scaling-up the T2D and HTN care was impeded by the major macro-level barriers of the health system including weak leadership and governance, resource constraints (dominantly financial resources), and poor arrangement of the current health service delivery. These were the result of the complex interaction of the health system elements including the absence of a roadmap as a strategic plan for the NCD approach in health service delivery, limited government investment in NCDs, lack of collaboration between key actors, limited competency of healthcare workers due to insufficient training and lack of supporting resources, mis-match the demand and supply of medicine, and absence of local data to generate evidence-based for the decision-making. Conclusion The health system plays a vital role in responding to the disease burden through the implementation and scale-up of health system interventions. To respond to barriers across the entire health system and the inter-relatedness of each element, and to gear toward the outcome and goals of the health system for a (cost-)effective scale-up of integrated T2D and HTN care, key strategic priorities are: (1) Cultivating leadership and governance, (2) Revitalizing the health service delivery, (3) Addressing resource constraints, and (4) Renovating the social protection schemes.
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Affiliation(s)
- Savina Chham
- National Institute of Public Health, Phnom Penh, Cambodia
- Centre for Population, Family and Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Josefien Van Olmen
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Gerontology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Srean Chhim
- National Institute of Public Health, Phnom Penh, Cambodia
| | - Veerle Buffel
- Centre for Population, Family and Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family and Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa
| | - Por Ir
- National Institute of Public Health, Phnom Penh, Cambodia
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Ambaw Kassie G, Alemu A, Yosef Gebrekidan A, Asmare Adella G, Eshetu K, Wolie Asres A, Sisay Asgedom Y. Undiagnosed hypertension and associated factors among adults in ethiopia: a systematic review and meta-analysis. BMC Cardiovasc Disord 2023; 23:278. [PMID: 37244992 PMCID: PMC10225092 DOI: 10.1186/s12872-023-03300-0] [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: 03/17/2023] [Accepted: 05/13/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND Hypertension is a major public health problem, resulting in 10 million deaths annually. Undiagnosed hypertension affects more people than ever before. It is more likely to be linked to severe hypertension, which can lead to stroke, cardiovascular disease, and ischemic heart disease. Thus, this systematic review and meta-analysis aimed to synthesize the prevalence of undiagnosed hypertension and its associated factors in Ethiopia. METHODS Databases, such as Medline/PubMed, Google Scholar, Science Direct, AJOL, and the Cochrane Library, were systematically searched to find potential studies published until December 2022. A Microsoft Excel spreadsheet was used to enter the extracted data. The pooled prevalence of undiagnosed hypertension and its associated factors was estimated using a random effect model. I2 statistics and the Cochrane Q-test were used to assess statistical heterogeneity across the studies. Begg's and Egger's tests were performed to identify possible publication bias. RESULTS A total of ten articles with 5,782 study participants were included in this meta-analysis. In the random effects model, the pooled prevalence of undiagnosed hypertension was 18.26% (95% CI = 14.94-21.58). Being older (OR = 3.8, 95% CI = 2.56, 5.66), having a body mass index > 25 kg/m2 (OR = 2.71, 95% CI = 2.1, 3.53), having a family history of hypertension (OR = 2.22, 95% CI = 1.47, 3.36), and having DM comorbidity (OR = 2.44, 95% CI = 1.38, 4.32) were significantly associated with undiagnosed hypertension. CONCLUSION In this meta-analysis, the pooled prevalence of undiagnosed hypertension was found to be high in Ethiopia. Being older, having a BMI > 25 kg/m2, having a family history of hypertension, and having DM comorbidity were found to be risk factors for undiagnosed hypertension.
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Affiliation(s)
- Gizachew Ambaw Kassie
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Afework Alemu
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amanuel Yosef Gebrekidan
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare Adella
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Eshetu
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Abiyot Wolie Asres
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Yordanos Sisay Asgedom
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Mukherjee PS, Ghosh S, Mukhopadhyay P, Das DK, Sarkar P, Majumdar S, Chatterjee K, Chowdhury A, Das K. Stepwise evaluation for the risk of metabolic unhealthiness and significant non-alcoholic fatty liver disease in India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 12:100142. [PMID: 37384057 PMCID: PMC10306046 DOI: 10.1016/j.lansea.2023.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 06/30/2023]
Abstract
Background Non-communicable diseases including metabolic health disorders are becoming area of concern for low/middle income countries with poor health-care resources. Present study was planned to assess the prevalence of metabolically unhealthy (MU) subjects in the community and proportion of the MU subjects having the risk of significant Non-alcoholic Fatty Liver Disease (NAFLD) using a step-wise evaluation strategy in a resource-poor setting. Methods Study was performed in 19 community development blocks of Birbhum district, West Bengal, India. Every fifth member in the electoral list was included for the first step evaluation (n = 79,957/1,019,365, 7.8%) to detect any metabolic risk. Subjects with any metabolic risk in the first step (n = 9819/41,095, 24%) were taken for second step evaluation with Fasting blood glucose (FBG) and ALT. Subjects with elevated FBG and/or ALT in the second step (n = 1403/5283, 27%) were taken into third step evaluation. Finding At least one risk factor was found in 51.4% (n = 41,095/79,957). 63% (n = 885/1403) of the subjects with metabolic abnormality (third step) had MU state making its overall prevalence of 1.1% (n = 885/79,957). 53% of MU subjects (n = 470/885) had 'persistently elevated ALT' suggesting the risk of having significant NAFLD. Interpretation Step-wise evaluation strategy could detect the subjects at risk, actually having MU state and proportion of MU subjects at risk of having 'persistently elevated ALT' (surrogate of significant NAFLD) in the community with minimum utilization of scarce resources. Funding This study was funded by Bristol Myers Squibb Foundation, USA, under the program 'Together on Diabetes Asia' (Project Number: 1205 - LFWB).
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Affiliation(s)
- Partha Sarathi Mukherjee
- John C Martin Centre for Liver Research and Innovations (jcmlri.edu.in), Indian Institute of Liver and Digestive Sciences (IILDS), Sitala (East), Jagadishpur, Sonarpur, 24 Pgs(S), Kolkata, PIN-700150, West Bengal, India
- Division of Hepatology, Indian Institute of Liver and Digestive Sciences, Sitala (East), Jagadishpur, Sonarpur, 24 Pgs(S), Kolkata, PIN-700150, West Bengal, India
- Liver Foundation, West Bengal, Chatterjee International Centre, 33 A J N Road, Kolkata, PIN-700071, West Bengal, India
| | - Sujoy Ghosh
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGME&R), 244, A. J. C. Bose Road, Kolkata, PIN-700020, West Bengal, India
| | - Pradip Mukhopadhyay
- Department of Endocrinology, Institute of Post Graduate Medical Education & Research (IPGME&R), 244, A. J. C. Bose Road, Kolkata, PIN-700020, West Bengal, India
| | - Dipesh Kumar Das
- Liver Foundation, West Bengal, Chatterjee International Centre, 33 A J N Road, Kolkata, PIN-700071, West Bengal, India
| | - Pabak Sarkar
- Liver Foundation, West Bengal, Chatterjee International Centre, 33 A J N Road, Kolkata, PIN-700071, West Bengal, India
| | - Saibal Majumdar
- Division of Clinical service, Suri Sadar Hospital, Birbhum, PIN-731101, West Bengal, India
| | - Kajal Chatterjee
- Division of Clinical service, Suri Sadar Hospital, Birbhum, PIN-731101, West Bengal, India
| | - Abhijit Chowdhury
- John C Martin Centre for Liver Research and Innovations (jcmlri.edu.in), Indian Institute of Liver and Digestive Sciences (IILDS), Sitala (East), Jagadishpur, Sonarpur, 24 Pgs(S), Kolkata, PIN-700150, West Bengal, India
- Division of Hepatology, Indian Institute of Liver and Digestive Sciences, Sitala (East), Jagadishpur, Sonarpur, 24 Pgs(S), Kolkata, PIN-700150, West Bengal, India
- Liver Foundation, West Bengal, Chatterjee International Centre, 33 A J N Road, Kolkata, PIN-700071, West Bengal, India
- Department of Hepatology, School of Digestive and Liver Disease, Institute of Post Graduate Medical Education & Research, 244, A. J. C. Bose Road, Kolkata, PIN-700020, West Bengal, India
| | - Kausik Das
- Department of Hepatology, School of Digestive and Liver Disease, Institute of Post Graduate Medical Education & Research, 244, A. J. C. Bose Road, Kolkata, PIN-700020, West Bengal, India
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Cahyaningsih I, Lambert M, Ochi T, Li F, Li X, Denig P, Taxis K. Community pharmacist-led interventions for patients with type 2 diabetes in low-income and middle-income countries: A scoping review. Res Social Adm Pharm 2023:S1551-7411(23)00238-3. [PMID: 37270326 DOI: 10.1016/j.sapharm.2023.04.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Studies assessing community pharmacist-led interventions conducted in high-income countries indicate that community pharmacists are successful in taking opportunities to support diabetes management. It is not yet clear as to what extent this is also true for low-income and middle-income countries. OBJECTIVES To provide an overview of the types of interventions performed by community pharmacists and available evidence about their effects on patients with type 2 diabetes mellitus in low-income and middle-income countries. METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for (non) randomized controlled, before-and-after, and interrupted time series design studies. There was no restriction on publication language. Interventions to be included had to be delivered by community pharmacists in a primary care or community setting. Study quality was assessed using the National Institute of Health tools, with results analyzed qualitatively, and the review itself was conducted in accordance with guidelines for scoping reviews. RESULTS Twenty-eight studies were included, representing 4,434 patients (mean age from 47.4 to 59.5 years, 55.4% female) from community pharmacies (16 studies), primary care centers (8 studies) or community setting (4 studies). Four studies were single-component and the remaining represented multi-component interventions. Face-to-face counseling of patients was the most common intervention, often combined with the provision of printed materials, remote consultations, or conducting medication reviews. Generally, studies showed improved outcomes in the intervention group, including clinical, patient-reported and medication safety outcomes. In most studies, at least one domain was judged to be of poor quality, with heterogeneity among studies. CONCLUSIONS Community pharmacist-led interventions on type 2 diabetes mellitus patients showed various positive effects but the quality of the evidence was poor. Face-to-face counseling of varying intensity, often combined with other strategies and representing a multi-component intervention, was the most common type. Although these findings support the expansion of the community pharmacist's role in diabetes care in low-income and middle-income countries, better quality studies are needed to evaluate the impact of specific interventions.
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Affiliation(s)
- Indriastuti Cahyaningsih
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands; Department of Pharmacist Profession Education, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Brawijaya, Geblagan, Tamantirto, Bantul, Daerah Istimewa Yogyakarta, 55183, Indonesia.
| | - Maarten Lambert
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Taichi Ochi
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Fang Li
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Xinyu Li
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Katja Taxis
- Department of PharmacoTherapy, -Epidemiology, and -Economics, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
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Mugamba S, Ziegel L, Bulamba RM, Kyasanku E, Johansson Århem K, Sjöland CF, Miller AP, Nakigozi G, Nalwoga GK, Watya S, Kiwanuka N, Kagaayi J, Kiwanuka D, Ddaaki W, Wagman JA, Kigozi G, Ekström AM, Nalugoda F. Cohort Profile: The Africa Medical and Behavioral Sciences Organization (AMBSO) Population Health Surveillance (APHS) in rural, semi-urban and urban Uganda. Int J Epidemiol 2023; 52:e116-e124. [PMID: 35962975 PMCID: PMC10114126 DOI: 10.1093/ije/dyac164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/02/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stephen Mugamba
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
- Makerere University Walter Reed Project, Kampala, Uganda
| | - Leo Ziegel
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Robert M Bulamba
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
| | | | - Katarina Johansson Århem
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Amanda P Miller
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Stephen Watya
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
| | - Noah Kiwanuka
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Joseph Kagaayi
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - William Ddaaki
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
| | - Jennifer A Wagman
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Godfrey Kigozi
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Södersjukhuset, Stockholm, Sweden
| | - Fred Nalugoda
- Africa Medical and Behavioral Sciences Organization, Wakiso, Uganda
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Tekle DY, Rosewarne E, Santos JA, Trieu K, Buse K, Palu A, Thow AM, Jan S, Webster J. Do Food and Nutrition Policies in Ethiopia Support the Prevention of Non-Communicable Diseases through Population-Level Salt Reduction Measures? A Policy Content Analysis. Nutrients 2023; 15:nu15071745. [PMID: 37049585 PMCID: PMC10096844 DOI: 10.3390/nu15071745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction: Despite the importance of salt reduction to health outcomes, relevant policy adoption in Ethiopia has been slow, and dietary consumption of sodium remains relatively high. Aim: This analysis aims to understand the content and context of existing food-related policy, strategy, and guideline documents to identify gaps and potential opportunities for salt reduction in Ethiopia in the wider context of global evidence-informed best practice nutrition policy. Methods: Policy documents relevant to food and noncommunicable diseases (NCDs), published between 2010 and December 2021, were identified through searches of government websites supplemented with experts’ advice. Documentary analysis was conducted drawing on the ‘policy cube’ which incorporates three dimensions: (i) comprehensiveness of policy measures, which for this study included the extent to which the policy addressed the food-related WHO “Best Buys” for the prevention of NCDs; (ii) policy salience and implementation potential; and (iii) equity (including gender) and human rights orientation. Results: Thirty-two policy documents were retrieved from government ministries, of which 18 were deemed eligible for inclusion. A quarter of these documents address diet-related “Best Buys” through the promotion of healthy nutrition and decreasing consumption of excess sodium, sugar, saturated fat, and trans-fats. The remainder focuses on maternal and child health and micronutrient deficiencies. All documents lack detail relating to budget, monitoring and evaluation, equity, and rights. Conclusions: This review demonstrates that the Government of Ethiopia has established policy frameworks highlighting its intention to address NCDs, but that there is an opportunity to strengthen these frameworks to improve the implementation of salt reduction programs. This includes a more holistic approach, enhanced clarification of implementation responsibilities, stipulation of budgetary allocations, and promoting a greater focus on inequities in exposure to nutrition interventions across population groups. While the analysis has identified gaps in the policy frameworks, further qualitative research is needed to understand why these gaps exist and to identify ways to fill these gaps.
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Affiliation(s)
- Dejen Yemane Tekle
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
- School of Public Health, Mekelle University, Mekelle 1871, Ethiopia
| | - Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Kent Buse
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
- The George Institute for Global Health, Imperial College London, London NW9 7PA, UK
| | - Aliyah Palu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Stephen Jan
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2042, Australia
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Bat-Erdene E, Tumurbaatar E, Tumur-Ochir G, Jamiyandorj O, Jadamba T, Yamamoto E, Hamajima N, Oka T, Lkhagvasuren B. Validation of the abbreviated version of the World Health Organization Quality of Life in Mongolia: a population-based cross-sectional study among adults in Ulaanbaatar. NAGOYA JOURNAL OF MEDICAL SCIENCE 2023; 85:79-92. [PMID: 36923633 PMCID: PMC10009621 DOI: 10.18999/nagjms.85.1.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/30/2022] [Indexed: 03/18/2023]
Abstract
There is currently no validated tool to measure the quality of life (QOL) in the Mongolian language. This study aimed to validate the Mongolian version of the World Health Organization Quality of Life - Brief (WHOQOL-BREF) questionnaire for the general population of Mongolia. The subjects were 301 adults aged 18-65 years selected randomly by a computer from 30 centers in 8 districts of Ulaanbaatar, Mongolia, in 2020. Reliability was measured using Cronbach's α and intraclass correlation coefficients. Convergent, discriminant, and construct validities were examined using exploratory and confirmatory factor analyses for a four-domain factor structure. Among the participants, 56.1% were women, 32.9% held a bachelor's degree or higher, 48.8% were employed, and 61.8% were married. The overall Cronbach's α coefficient of the WHOQOL-BREF questionnaire was 0.804. Correlations between the component scores of the WHOQOL-BREF ranged from 0.581-0.822. All items showed higher item-total correlations with their corresponding domains than with other domains, except the mobility item from the physical domain. Discriminative validity was evident in physical and psychological domains. Exploratory and confirmatory factor analyses revealed a four-factorial structure consisting of 24 items that provided an acceptable fit to the data (RMSEA=0.084; CFI=0.860). In conclusion, the Mongolian version of the WHOQOL-BREF demonstrated evidence of good reliability and validity for assessing QOL in the general population of Mongolia. These findings indicate that it allows the comparison of QOL of adults in Mongolia with those in other countries.
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Affiliation(s)
- Enkhjin Bat-Erdene
- Brain Science Institute, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - Enkhnaran Tumurbaatar
- Brain Science Institute, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - Gantsetseg Tumur-Ochir
- Department of Mental Health, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Tsolmon Jadamba
- Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takakazu Oka
- Department of Psychosomatic Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Battuvshin Lkhagvasuren
- Brain Science Institute, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,Brain and Mind Research Institute, Mongolian Academy of Sciences, Ulaanbaatar, Mongolia.,Department of Psychosomatic Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
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Bai J, Cui J, Shi F, Yu C. Global Epidemiological Patterns in the Burden of Main Non-Communicable Diseases, 1990-2019: Relationships With Socio-Demographic Index. Int J Public Health 2023; 68:1605502. [PMID: 36726528 PMCID: PMC9884670 DOI: 10.3389/ijph.2023.1605502] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Abstract
Objectives: This study aimed to analyze spatio-temporal patterns of the global burden caused by main NCDs along the socio-economic development. Methods: We extracted relevant data from GBD 2019. The estimated annual percentage changes, quantile regression and limited cubic splines were adopted to estimate temporal trends and relationships with socio-demographic index. Results: NCDs accounted for 74.36% of global all-cause deaths in 2019. The main NCDs diseases were estimated for cardiovascular diseases, neoplasms, and chronic respiratory diseases, with deaths of 18.56 (17.08-19.72) million, 10.08 (9.41-10.66) million and 3.97 (3.58-4.30) million, respectively. The death burden of three diseases gradually decreased globally over time. Regional and sex variations existed worldwide. Besides, the death burden of CVD showed the inverted U-shaped associations with SDI, while neoplasms were positively correlated with SDI, and CRD showed the negative association. Conclusion: NCDs remain a crucial public health issue worldwide, though several favorable trends of CVD, neoplasms and CRD were observed. Regional and sex disparities still existed. Public health managers should execute more targeted programs to lessen NCDs burden, predominantly among lower SDI countries.
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Affiliation(s)
- Jianjun Bai
- School of Public Health, Wuhan University, Wuhan, China
| | - Jiaxin Cui
- School of Nursing, Wuhan University, Wuhan, China
| | - Fang Shi
- School of Public Health, Wuhan University, Wuhan, China
| | - Chuanhua Yu
- School of Public Health, Wuhan University, Wuhan, China,*Correspondence: Chuanhua Yu,
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Kohler IV, Kämpfen F, Bandawe C, Kohler HP. Cognition and Cognitive Changes in a Low-Income Sub-Saharan African Aging Population. J Alzheimers Dis 2023; 95:195-212. [PMID: 37522209 PMCID: PMC10588811 DOI: 10.3233/jad-230271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND Cognition and its age-related changes remain vastly understudied in low-income countries (LICs), despite evidence suggesting that cognitive decline among aging low-income populations is a rapidly increasing disease burden often occurring at younger ages as compared to high-income countries (HICs). OBJECTIVE We examine patterns of cognition among men and women, 45 + years old, living in rural Malawi. We analyze how key socioeconomic characteristics predict levels of cognition and its changes as individuals get older. METHODS Utilizing the Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) collected during 2012-2017, we estimate standard regression models to analyze predictors of the age- and sex-specific levels and longitudinal changes in cognition. Cognition is assessed with a screening instrument that is adapted to this low-literacy context and measures different domains such as language, attention, or executive functioning. RESULTS Women have lower levels of cognition than men, a pattern in stark contrast to findings in HICs. Schooling and socioeconomic status increase the probability of having consistently high performance during the cognitive assessment. Cognitive decline accelerates with age and is detectable already at mid-adult ages (45-55 years). Despite lower levels of cognitive function observed among women, the pace of decline with age is similar for both genders. CONCLUSION Women are particularly affected by poor cognition in this context. The study emphasizes the importance of prioritizing cognitive health and research on cognition among older individuals in sub-Saharan Africa LICs, to which relatively little health care resources continue to be allocated.
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Affiliation(s)
- Iliana V Kohler
- Population Studies Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Chiwoza Bandawe
- Department of Psychiatry and Mental Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
| | - Hans-Peter Kohler
- Population Aging Research Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
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Soberano JID, Hernandez MA, Cacciata MC, Flores JLA, Leyva EWA, Tuazon JA, Evangelista LS. A Comparative Study on Health Risks, Lifestyle Behaviors, Health Perceptions, and Health Seeking Patterns between Older and Younger Filipinos in the Rural Areas. THE PHILIPPINE JOURNAL OF NURSING 2023; 93:3-12. [PMID: 38406642 PMCID: PMC10888510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Worldwide trends in health risks, lifestyle behaviors, health perceptions, and health-seeking patterns suggest alarming disparities among individuals from low- and middle-income countries. Such international comparisons are particularly troubling for older individuals (≥ 60 years). Objectives This study aims to compare health risks, lifestyle behaviors, health perceptions, and health-seeking patterns between younger (<60) and older (≥60) Filipinos from rural communities in the Philippines. Methods A comparative cross-sectional study was employed with 863 younger and 427 older Filipinos. Data were analyzed using frequencies, chi-squares, and T-tests. Results Older participants were more likely to be single/widowed, ≤ high school education and had higher rates of hypertension, high cholesterol, diabetes, and depression. They reported poorer health status and went to the village health center when sick. Furthermore, they were less likely to drink alcohol and see a physician. Conclusion There were significant differences in modifiable health risks and lifestyle behaviors and differences in health perceptions between younger and older cohorts of Filipinos living in rural areas in the Philippines. Our findings suggest the need to design separate health promotion interventions that target older and younger Filipinos' unique needs from rural communities.
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Affiliation(s)
| | | | | | - Jo Leah A. Flores
- Veteran’s Affairs Long Beach Healthcare System, Long Beach, California
| | | | - Josefina A. Tuazon
- University of the Philippines Manila College of Nursing, Manila, Philippines
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Malgaonkar N, Ramachandran M, Patel SD, Dsouza SA. Occupational Therapists' Perceptions of Home Program Provision for Stroke Survivors in a Lower- and Middle-Income Country: An Exploratory Study. Occup Ther Health Care 2023; 37:54-74. [PMID: 34253118 DOI: 10.1080/07380577.2021.1930326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This qualitative study aimed to understand occupational therapists' experiences of providing home programs to stroke survivors in India. Using an interpretative phenomenological approach, eight practicing occupational therapists were interviewed in depth about home programs for individuals recovering from stroke. Two broad themes with subthemes emerged describing the organizational factors, sociocultural and economic influences on home program provision as well as describing how the occupational therapists addressed the challenges to facilitate home program provision and adherence. The findings can inform occupational therapy practice in lower- and middle-income countries like India and other countries where existing practice recommendations for stroke rehabilitation and core professional tenets may be challenged.
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Affiliation(s)
- Neha Malgaonkar
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Physical Medicine and Rehabilitation Department, Kokilaben Dhirubhai Ambani Hospital and Research Institute, Mumbai, India
| | - Meena Ramachandran
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Bridgepoint Collaboratory for Research and Innovation, Sinai Health, Toronto, Canada
| | - Sefali Dushyant Patel
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Catholic Relief Services, Hanoi, Vietnam
| | - Sebestina Anita Dsouza
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Centre for Studies on Healthy Aging, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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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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Sathyanath S, Kundapur R, Deepthi R, Poojary SN, Rai S, Modi B, Saxena D. An economic evaluation of diabetes mellitus in India: A systematic review. Diabetes Metab Syndr 2022; 16:102641. [PMID: 36332443 DOI: 10.1016/j.dsx.2022.102641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Approximately 88 million people throughout Southeast Asia have diabetes, of which 77 million reside in India. India had an annual estimated diabetes treatment cost of Rs.10,000 to 12,000 crore in 2003, which is likely to rise to as high as Rs. 1,26,000 crores by 2025. AIM To assess the annual mean expenditure for an individual with diabetes mellitus. METHODS We used search terms and Boolean operators to identify studies on the economic burden of diabetes mellitus patients in India between 2015 and 2020. Thereafter, we used the checklists of STROBE, as well as the PRISMA, Drummonds and down, and Black criteria, to assess the quality of included studies. Then, Meta xl was used to calculate the weighted means and weighted proportion based on the quality assessment findings. RESULTS Mean expenditure with a maximum weightage of 100% was found in a community-based study, whereas the lowest weightage obtained was 20%. The mean expenditure on diabetes and its complications was calculated as INR 15,535/-(USD 209.3) per year, with a pooled mean of INR 17, 080(USD 230.1)per year. On average, the OPD charges were 3%-5% of the total annual income of the individual. However, when there were complications and hospitalization, the average expenditure was higher (21%) which averages to around 11,000 INR. CONCLUSIONS While patients spent 3% of their annual income on only OPD charges on average, complications substantially increased the total cost by more than 10%, which amounts to catastrophic health expenditure.
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Affiliation(s)
| | - Rashmi Kundapur
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bibinagara, Hyderabad, India.
| | - R Deepthi
- Department of Community Medicine ESIC-MC and PGIMSR, Rajajinagar, Bangalore, 560010, India.
| | - Santhosh N Poojary
- Nitte (Deemed to be University) KS Hegde Medical Academy, Department of Community Medicine, Deralakatte, Mangalore, Karnataka, India.
| | - Sathvik Rai
- Nitte (Deemed to be University) KS Hegde Medical Academy, Department of Community Medicine, Deralakatte, Mangalore, Karnataka, India.
| | - Bhavesh Modi
- Community and Family Medicine Department, All India Institute of Medical Sciences, Rajkot, Gujarat, India.
| | - Deepak Saxena
- Indian Institute of Public Health Gandhinagar, India.
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Rahman T, Gasbarro D, Alam K. Financial risk protection against noncommunicable diseases: trends and patterns in Bangladesh. BMC Public Health 2022; 22:1835. [PMID: 36175951 PMCID: PMC9524135 DOI: 10.1186/s12889-022-14243-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Demographic and epidemiological transitions are changing the disease burden from infectious to noncommunicable diseases (NCDs) in low- and middle-income countries, including Bangladesh. Given the rising NCD-related health burdens and growing share of household out-of-pocket (OOP) spending in total health expenditure in Bangladesh, we compared the country's trends and socioeconomic disparities in financial risk protection (FRP) among households with and without NCDs. METHODS We used data from three recent waves of the Bangladesh Household Income and Expenditure Survey (2005, 2010, and 2016) and employed the normative food, housing (rent), and utilities method to measure the levels and distributions of catastrophic health expenditure (CHE) and impoverishing effects of OOP health expenditure among households without NCDs (i.e. non-NCDs only) and with NCDs (i.e. NCDs only, and both NCDs and non-NCDs). Additionally, we examined the incidence of forgone care for financial reasons at the household and individual levels. RESULTS Between 2005 and 2016, OOP expenses increased by more than 50% across all households (NCD-only: USD 95.6 to 149.3; NCD-and-non-NCD: USD 89.5 to 167.7; non-NCD-only: USD 45.3 to 73.0), with NCD-affected families consistently spending over double that of non-affected households. Concurrently, CHE incidence grew among NCD-only families (13.5% to 14.4%) while declining (with fluctuations) among non-NCD-only (14.4% to 11.6%) and NCD-and-non-NCD households (12.9% to 12.2%). Additionally, OOP-induced impoverishment increased among NCD-only and non-NCD-only households from 1.4 to 2.0% and 1.1 to 1.5%, respectively, affecting the former more. Also, despite falling over time, NCD-affected individuals more frequently mentioned prohibiting treatment costs as the reason for forgoing care than the non-affected (37.9% vs. 13.0% in 2016). The lowest quintile households, particularly those with NCDs, consistently experienced many-fold higher CHE and impoverishment than the highest quintile. Notably, CHE and impoverishment effects were more pronounced among NCD-affected families if NCD-afflicted household members were female rather than male, older people, or children instead of working-age adults. CONCLUSIONS The lack of FRP is more pronounced among households with NCDs than those without NCDs. Concerted efforts are required to ensure FRP for all families, particularly those with NCDs.
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Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, WA 6150 Australia
- Institute of Health Economics, University of Dhaka, Dhaka, 1000 Bangladesh
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, WA 6150 Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA 6150 Australia
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Hlongwana SI, Gray AL. Barriers and facilitators to medicine collection through the CCMDD programme at a Durban Hospital. Health SA 2022; 27:1906. [PMID: 36262925 PMCID: PMC9575334 DOI: 10.4102/hsag.v27i0.1906] [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: 01/07/2022] [Accepted: 06/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background South Africa has rekindled health reform efforts through the implementation of the Centralised Chronic Medicine Dispensing and Distribution (CCMDD) programme, as a precursor towards achieving envisioned National Health Insurance (NHI). The CCMDD programme enables stable patients to collect chronic medicines dispensed centrally from designated pick-up-points (PuPs). Barriers and facilitators of chronic medicine collection exist at different levels. Aim To identify barriers and facilitators associated with patients’ characteristics and noncollection of CCMDD patient medicine parcels (PMPs). Setting The study was conducted at a regional public sector hospital which provides support for 19 primary facilities. Methods An observational cross-sectional comparative study was conducted. Results There was no statistically significant difference in collection status in terms of most of the variables compared. Patients who had been on treatment longer or who were receiving multiple items were more likely to collect medication, as were patients with arthritis, HIV and AIDS, but the association was no longer significant after adjusting for other confounders. Patients using internal PuPs were significantly more likely to collect their PMPs than patients using external PuPs, and this may have implications for achieving CCMDD objectives. Conclusion This study has revealed that recently diagnosed patients are enrolled onto the CCMDD programme whilst the chronic condition stability is not yet attained. Patients were also enrolled onto the programme at the referral facility instead of being down-referred. Contribution This study makes a case for evaluation research to further assess the CCMDD programme implementation, in order to improve uptake and cost-effectiveness.
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Affiliation(s)
- Simangele I. Hlongwana
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa,Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,King Edward VIII Hospital, Durban, South Africa
| | - Andrew L. Gray
- Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
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Tavolinejad H, Roshani S, Rezaei N, Ghasemi E, Yoosefi M, Rezaei N, Ghamari A, Shahin S, Azadnajafabad S, Malekpour MR, Rashidi MM, Farzadfar F. A machine learning approach to evaluate the state of hypertension care coverage: From 2016 STEPs survey in Iran. PLoS One 2022; 17:e0273560. [PMID: 36129936 PMCID: PMC9491523 DOI: 10.1371/journal.pone.0273560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 08/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background
The increasing burden of hypertension in low- to middle-income countries necessitates the assessment of care coverage to monitor progress and guide future policies. This study uses an ensemble learning approach to evaluate hypertension care coverage in a nationally representative Iranian survey.
Methods
The data source was the cross-sectional 2016 Iranian STEPwise approach to risk factor surveillance (STEPs). Hypertension was based on blood pressure ≥140/90 mmHg, reported use of anti-hypertensive medications, or a previous hypertension diagnosis. The four steps of care were screening (irrespective of blood pressure value), diagnosis, treatment, and control. The proportion of patients reaching each step was calculated, and a random forest model was used to identify features associated with progression to each step. After model optimization, the six most important variables at each step were considered to demonstrate population-based marginal effects.
Results
The total number of participants was 30541 (52.3% female, median age: 42 years). Overall, 9420 (30.8%) had hypertension, among which 89.7% had screening, 62.3% received diagnosis, 49.3% were treated, and 7.9% achieved control. The random forest model indicated that younger age, male sex, lower wealth, and being unmarried/divorced were consistently associated with a lower probability of receiving care in different levels. Dyslipidemia was associated with reaching diagnosis and treatment steps; however, patients with other cardiovascular comorbidities were not likely to receive more intensive blood pressure management.
Conclusion
Hypertension care was mostly missing the treatment and control stages. The random forest model identified features associated with receiving care, indicating opportunities to improve effective coverage.
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Affiliation(s)
- Hamed Tavolinejad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Roshani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Negar Rezaei
- 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
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Yoosefi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sarvenaz Shahin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mahdi Rashidi
- 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
- * E-mail: f–
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Burden of diabetes and hyperglycaemia in adults in the Americas, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Diabetes Endocrinol 2022; 10:655-667. [PMID: 35850129 PMCID: PMC9399220 DOI: 10.1016/s2213-8587(22)00186-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 05/19/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND High prevalence of diabetes has been reported in the Americas, but no comprehensive analysis of diabetes burden and related factors for the region is available. We aimed to describe the burden of type 1 and type 2 diabetes and that of hyperglycaemia in the Americas from 1990 to 2019. METHODS We used estimates from GBD 2019 to evaluate the burden of diabetes in adults aged 20 years or older and high fasting plasma glucose in adults aged 25 years or older in the 39 countries and territories of the six regions in the Americas from 1990 to 2019. The main source to estimate the mortality attributable to diabetes and to chronic kidney disease due to diabetes was vital registration. Mortality due to overall diabetes (ie, diabetes and diabetes due to chronic kidney disease) was estimated using the Cause of Death Ensemble model. Years of life lost (YLLs) were calculated as the number of deaths multiplied by standard life expectancy at the age that the death occurred, years lived with disability (YLDs) were estimated based on the prevalence and severity of complications of diabetes. Disability-adjusted life-years (DALYs) were estimated as a sum of YLDs and YLLs. We assessed the association of diabetes burden with the level of development of a country (according to the Socio-demographic Index), health-care access and quality (estimated with the Healthcare Access and Quality Index), and diabetes prevalence. We also calculated the population attributable fraction (PAF) of diabetes burden due to each of its risk factors. We report the 95% uncertainty intervals for all estimates. FINDINGS In 2019, an estimated total of 409 000 (95% uncertainty interval 373 000-443 000) adults aged 20 years or older in the Americas died from diabetes, which represented 5·9% of all deaths. Diabetes was responsible for 2266 (1930-2649) crude DALYs per 100 000 adults in the Americas, and high fasting plasma glucose for 4401 DALYs (3685-5265) per 100 000 adults, with large variation across regions. DALYs were mostly due to type 2 diabetes and distribution was heterogeneous, being highest in central Latin America and the Caribbean and lowest in high-income North America and southern Latin America. Between 1990 and 2019, age-standardised DALYs due to type 2 diabetes increased 27·4% (22·0-32·5). This increase was particularly high in Andean Latin America and high-income North America. Burden for both type 1 and type 2 diabetes across countries increased with higher diabetes prevalence and decreased with greater Socio-demographic and Healthcare Access and Quality Indices. Main risk factors for the burden were high BMI, with a PAF of 63·2% and dietary risks, with a PAF of 27·5%. The fraction of burden due to disability has increased since 1990 and now represents nearly half of the overall burden in 2019. INTERPRETATION The burden of diabetes in the Americas is large, increasing, heterogeneous, and expanding. To confront the rising burden, population-based interventions aimed to reduce type 2 diabetes risk and strengthening health systems to provide effective and cost-efficient care for those affected are mandatory. FUNDING Bill & Melinda Gates Foundation.
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Tekalegn Y, Solomon D, Sahiledengle B, Assefa T, Negash W, Tahir A, Regassa T, Mamo A, Gezahegn H, Bekele K, Zenbaba D, Tasew A, Desta F, Atlaw D, Regassa Z, Nugusu F, Engida ZT, Tesfaye DG, Kene C, Nigussie WS, Chala D, Abdi AG, Beressa G, Woldeyohannes D, Rogers HL, Mwanri L. Prevalence of central obesity and its associated risk factors among adults in Southeast Ethiopia: A community-based cross-sectional study. PLoS One 2022; 17:e0265107. [PMID: 35930540 PMCID: PMC9355191 DOI: 10.1371/journal.pone.0265107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obesity and overweight are known public health problems that affect populations across the world. These conditions have been associated with a wide range of chronic diseases including type 2 diabetes mellitus, cardiovascular disease, and cancers. In Ethiopia, the literature regarding the burden of central (abdominal) obesity is scarce. This study aimed to fill this gap by assessing the prevalence and risk factors associated with central obesity among adults in Ethiopia. METHODS From May to July 2021, a community-based cross-sectional survey was conducted on a sample of 694 adults aged ≥18 years in administrative towns of Bale zone, Southeast Ethiopia. Multi-stage sampling followed by systematic random sampling was employed to identify study participants. Waist and hip circumferences were measured using standard protocols. The World Health Organization STEPS wise tool was used to assess risk factors associated with central obesity. Bi-variable and multi-variable binary logistic regression were used to identify factors associated with central obesity. Adjusted odds ratios (AOR) and their corresponding 95% confidence intervals (CI) have been reported to estimate the strength of associations. RESULTS The overall prevalence of central obesity using waist circumference was 39.01% [(95% CI: 35.36-42.76; 15.44% for men and 53.12% for women)]. Multi-variable binary logistic regression analysis revealed that female sex (AOR = 12.93, 95% CI: 6.74-24.79), Age groups: 30-39 years old (AOR = 2.8, 95% CI: 1.59-4.94), 40-49 years (AOR = 7.66, 95% CI: 3.87-15.15), 50-59 years (AOR = 4.65, 95% CI: 2.19-9.89), ≥60 years (AOR = 12.67, 95% CI: 5.46-29.39), occupational status like: housewives (AOR = 5.21, 95% CI: 1.85-14.62), self-employed workers (AOR = 4.63, 95% CI: 1.62-13.24), government/private/non-government employees (AOR = 4.68, 95% CI: 1.47-14.88), and skipping breakfast (AOR = 0.46, 95% CI: 0.23-0.9) were significantly associated with central obesity. CONCLUSIONS Abdominal obesity has become an epidemic in Bale Zone's towns in Southeastern Ethiopia. Female sex, age, being employed were positively associated with central obesity, while skipping breakfast was a protective factor.
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Affiliation(s)
- Yohannes Tekalegn
- Public Health Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Damtew Solomon
- Biomedical Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Biniyam Sahiledengle
- Public Health Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Tesfaye Assefa
- Nursing Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Wogene Negash
- Nursing Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Anwar Tahir
- Nursing Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Tadele Regassa
- Biomedical Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Ayele Mamo
- Pharmacy Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Habtamu Gezahegn
- Biomedical Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Kebebe Bekele
- Surgery Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Demisu Zenbaba
- Public Health Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Alelign Tasew
- Public Health Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Fikreab Desta
- Public Health Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Daniel Atlaw
- Biomedical Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Zegeye Regassa
- Nursing Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Fikadu Nugusu
- Public Health Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Zinash Teferu Engida
- Public Health Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Degefa Gomora Tesfaye
- Midwifery Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Chala Kene
- Midwifery Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | | | - Dereje Chala
- Nursing Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Adisu Gemechu Abdi
- Nursing Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Girma Beressa
- Public Health Department, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Demelash Woldeyohannes
- School of Medicine and Health Science, Department of Public health, Wachemo University, Hosana, Ethiopia
| | - Heather L. Rogers
- Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Ikerbasque Basque Foundation for Science Bilbao, Bilbao, Bizkaia, Spain
| | - Lillian Mwanri
- Torrens University Australia, Adelaide, South Australia, Australia
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County Health Leadership Practices and Readiness for Noncommunicable Disease Services in Kenya. Ann Glob Health 2022; 88:58. [PMID: 35936230 PMCID: PMC9306762 DOI: 10.5334/aogh.2673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 06/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Premature mortality from noncommunicable diseases (NCDs) is a contemporary development challenge. Low-income and lower-middle-income countries are disproportionately affected, with the poorest in society considered the most vulnerable. A paucity of literature exists on how leadership practices at the implementation level relate to ensuring readiness for NCD services. Objective: This study investigated any relationship between leadership practices and readiness for NCD services. Methods: This correlational study investigated any relationship between leadership practices at the county level and readiness for NCD services in Kenya using secondary data from a 2013 Service Availability and Readiness Assessment survey. Correlation and multiple linear regression tests were used to determine the strength and direction of any relationship between leadership practices (annual work planning, therapeutic committees, and supportive supervision), and NCD readiness (county readiness score). Findings: The findings indicated a statistically significant relationship between therapeutic committee (p = .002) and supportive supervision practices (p = .023) and NCD readiness. Leadership practices also had a statistically significant predictive relationship with NCD readiness (p = .009). Conclusion: Health leaders should ensure that leadership practices that have a predictive relationship with NCD readiness, such as therapeutic committee activities and supportive supervision visits, are implemented appropriately. Further, county health leaders should pay particular attention to the implementation of these leadership practices at nonpublic and Tiers 2, 3, and 4 health facilities that had lower NCD readiness scores.
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Kohler IV, Sudharsanan N, Bandawe C, Kohler HP. Aging and hypertension among the global poor-Panel data evidence from Malawi. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000600. [PMID: 36962748 PMCID: PMC10022104 DOI: 10.1371/journal.pgph.0000600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/19/2022] [Indexed: 05/28/2023]
Abstract
Hypertension is a rapidly growing disease burden among older persons in low-income countries (LICs) that is often inadequately diagnosed and treated. Yet, most LIC research on hypertension is based on cross-sectional data that does not allow inferences about the onset or persistence of hypertension, its correlates, and changes in hypertension as individuals become older. The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) is used to provide among the first panel analyses of hypertension for older individuals in a sub-Saharan LIC using blood pressure measurements obtained in 2013 and 2017. We find that high blood pressure is very common among mature adults aged 45+, and hypertension is more prevalent among older as compared to middle-aged respondents. Yet, in panel analyses for 2013-17, we find no increase in the prevalence of hypertension as individuals become older. Hypertension often persists over time, and the onset of hypertension is predicted by factors such as being overweight/obese, or being in poor physical health. Otherwise, however, hypertension has few socioeconomic predictors. There is also no gender differences in the level, onset or persistence in hypertension. While hypertension is associated with several negative health or socioeconomic consequences in longitudinal analyses, cascade-of-care analyses document significant gaps in the diagnosis and treatment of hypertension. Overall, our findings indicate that hypertension and related high cardiovascular risks are widespread, persistent, and often not diagnosed or treated in this rural sub-Saharan population of older individuals. Prevalence, onset and persistence of hypertension are common across all subgroups-including, importantly, both women and men. While age is an important predictor of hypertension risk, even in middle ages 45-55 years, hypertension is already widespread. Hypertension among adults aged 45+ in Malawi is thus more similar to a "generalized epidemic" than in high-income countries where cardiovascular risk has strong socioeconomic gradients.
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Affiliation(s)
- Iliana V. Kohler
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Nikkil Sudharsanan
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Chiwoza Bandawe
- Department of Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Hans-Peter Kohler
- Population Aging Research Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, United States of America
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Qin C, Murali S, Lee E, Supramaniam V, Hausenloy DJ, Obungoloch J, Brecher J, Lin R, Ding H, Akudjedu TN, Anazodo UC, Jagannathan NR, Ntusi NAB, Simonetti OP, Campbell-Washburn AE, Niendorf T, Mammen R, Adeleke S. Sustainable low-field cardiovascular magnetic resonance in changing healthcare systems. Eur Heart J Cardiovasc Imaging 2022; 23:e246-e260. [PMID: 35157038 PMCID: PMC9159744 DOI: 10.1093/ehjci/jeab286] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular disease continues to be a major burden facing healthcare systems worldwide. In the developed world, cardiovascular magnetic resonance (CMR) is a well-established non-invasive imaging modality in the diagnosis of cardiovascular disease. However, there is significant global inequality in availability and access to CMR due to its high cost, technical demands as well as existing disparities in healthcare and technical infrastructures across high-income and low-income countries. Recent renewed interest in low-field CMR has been spurred by the clinical need to provide sustainable imaging technology capable of yielding diagnosticquality images whilst also being tailored to the local populations and healthcare ecosystems. This review aims to evaluate the technical, practical and cost considerations of low field CMR whilst also exploring the key barriers to implementing sustainable MRI in both the developing and developed world.
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Affiliation(s)
- Cathy Qin
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjana Murali
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Elsa Lee
- School of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | | | - Derek J Hausenloy
- Division of Medicine, University College London, London, UK
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
- Hatter Cardiovascular Institue, UCL Institute of Cardiovascular Sciences, University College London, London, UK
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Johnes Obungoloch
- Department of Biomedical Engineering, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rongyu Lin
- School of Medicine, University College London, London, UK
| | - Hao Ding
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Theophilus N Akudjedu
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Science, Bournemouth University, Poole, UK
| | | | - Naranamangalam R Jagannathan
- Department of Electrical Engineering, Indian Institute of Technology, Chennai, India
- Department of Radiology, Sri Ramachandra University Medical College, Chennai, India
- Department of Radiology, Chettinad Hospital and Research Institute, Kelambakkam, India
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Radiology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrück Centre for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Regina Mammen
- Department of Cardiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Sola Adeleke
- School of Cancer & Pharmaceutical Sciences, King’s College London, Queen Square, London WC1N 3BG, UK
- High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
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Tesema AG, Peiris D, Joshi R, Abimbola S, Fentaye FW, Teklu AM, Kinfu Y. Exploring complementary and competitive relations between non-communicable disease services and other health extension programme services in Ethiopia: a multilevel analysis. BMJ Glob Health 2022; 7:e009025. [PMID: 35738842 PMCID: PMC9226884 DOI: 10.1136/bmjgh-2022-009025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Ethiopia has recently revitalised its health extension programme (HEP) to address the rising burden of non-communicable diseases (NCDs). We examined the effects of existing essential HEP services on the uptake of NCD preventive services. METHODS We applied a mixed-effect non-linear model with a logit link function to identify factors associated with a community resident's probability of receiving NCD prevention services through the HEP. The data were drawn from the Ethiopian HEP assessment Survey conducted in all regions. The analysis included 9680 community residents, 261 health extension workers (HEWs), 153 health posts, 119 health centres, 55 districts and 9 regions, which we combined hierarchically into a single database. RESULTS In the 12 months before the survey, 22% of the sample population reported receiving NCD preventive service at least once. The probability of receiving NCD prevention service increased by up to 25% (OR=1.25, CI 1.01 to 1.53) if health centres routinely gathered NCD data from health posts and by up to 48% (OR=.48, CI 1.24 to 1.78) if they provided general (ie, non-NCD specific) training to HEWs. NCD preventive service uptake also increased if the HEW held level IV qualification (OR=1.32, CI 1.06 to 1.65) and lived in the community (OR=1.24, CI 1.03 to 1.49). Conversely, if facilities delayed general performance reviews of HEWs by a month, uptake of NCD prevention services decreased by 6% (OR=0.94, CI 0.91 to 0.97). We observed that better HIV/AIDS programme performance was associated with a lower uptake of NCD preventive services (OR=0.15, CI 0.03 to 0.85). CONCLUSION Despite efforts to improve NCD services through the HEP, the coverage remains limited. A strong HEP is good for the uptake of NCD preventive services. However, integration requires a careful balance, so that the success already recorded for some existing programmes is not lost.
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Affiliation(s)
- Azeb Gebresilassie Tesema
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
| | - Seye Abimbola
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Fasil Walelign Fentaye
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ), Ethiopia office, MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Alula M Teklu
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ), Ethiopia office, MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Yohannes Kinfu
- Department of Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Department of Health Science Metrics, University of Washington, Seattle, Washington, USA
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48
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Liwin LK. Shifting educational gradients in body mass index trajectories of Indonesians: an age period cohort analysis. BMC Public Health 2022; 22:1004. [PMID: 35585591 PMCID: PMC9115941 DOI: 10.1186/s12889-022-13379-3] [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: 02/15/2022] [Accepted: 05/05/2022] [Indexed: 12/13/2022] Open
Abstract
Background Globally, the number of obese adults has increased rapidly in many developing countries. The links between increased educational attainment and lower risks of overweight/obesity have been studied in a number of high-income contexts. However, educational attainment can have a different association with obesity at different levels of economic development and different stages of the nutritional transition, and these associations may vary by period and cohort. This study aims to provide evidence on the shifting of educational gradients in overweight/obesity in Indonesia, a low middle income country. Methods Using five waves of Indonesian Family Life Survey (IFLS), this study examines the Body Mass Index (BMI) trajectories of 14,810 individuals from 1993 to 2014. This study analyses how educational gradients in BMI have shifted over time and across cohorts using a hierarchical age-period-cohort (HAPC) model to account for the effects of age and the changes in historical periods (social and environmental contexts). Results In older generations, higher educational attainment is associated with higher BMI, but the gap between educational groups shrinks in more recently-born cohorts. The BMI of lower educational groups is catching up with that of the tertiary educated, leading to an increased risk of overweight/obesity among low educated individuals. Having tertiary education lowers the risk of weight gain (-0.04 point) among recently-born cohort of women, but it still increases the risk (+ 0.04 point) for men. Conclusion Changes in access to education and the ongoing nutritional transition in Indonesia are leading to a shifting of educational gradients in overweight/obesity over time. The rising trends in BMI among low-educated and younger individuals are of substantial concern for Indonesian public health due to their implications for the risk of communicable and non-communicable diseases in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13379-3.
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Affiliation(s)
- Lilipramawanty Kewok Liwin
- School of Demography, The Australian National University, Canberra, Australian Capital Territory, Australia.
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49
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Santra A, Mallick A. Prevalence of hypertension among individuals with diabetes and its determinants: Evidences from the National Family Health Survey 2015-16, India. Ann Hum Biol 2022; 49:133-144. [PMID: 35499256 DOI: 10.1080/03014460.2022.2072525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The incidence of Diabetes mellitus (DM) has escalated in recent decades, and the risk of diabetes-related mortality has increased dramatically due to the co-existence of hypertension (HTN). DM and HTN, having similar aetiology and disease mechanism, are influenced by lifestyle factors and greatly contribute to critical health complications. AIM The present study attempted to explore the co-existence of DM-HTN and the potential determinants considering rapid upsurge of both the diseases. SUBJECTS AND METHODS National Family Health Survey data were used, which included 7092 adult diabetic individuals, to find out the prevalence rate of HTN in diabetic persons in India. Appropriate statistical analyses were performed to accomplish the study objectives. RESULTS Prevalence rate of HTN in diabetic individuals was approximately 37%. Higher BMI was associated with DM-HTN co-existence. In males, increased age, higher BMI, alcohol consumption, poorest wealth index, and non-smoking (tobacco) were the significant determinants of the co-existence of DM-HTN, while in females, they were increased age, higher BMI, and geographical region. CONCLUSION This study unveiled the significance of healthy lifestyle maintenance and equitable health care services to prevent HTN among the diabetics, along with promotion of the awareness and management of DM and HTN through appropriate pharmacological treatments.
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Affiliation(s)
- Arpita Santra
- Biological Anthropology Unit, Indian Statistical Institute, 203, B.T. Road, Kolkata - 108
| | - Akash Mallick
- Biological Anthropology Unit, Indian Statistical Institute, 203, B.T. Road, Kolkata - 108
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50
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Sharma M, John R, Afrin S, Zhang X, Wang T, Tian M, Sahu KS, Mash R, Praveen D, Saif-Ur-Rahman KM. Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review. Front Public Health 2022; 10:820750. [PMID: 35345509 PMCID: PMC8957212 DOI: 10.3389/fpubh.2022.820750] [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: 11/23/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022] Open
Abstract
Almost all low- and middle-income countries (LMICs) have instated a program to control and manage non-communicable diseases (NCDs). Population screening is an integral component of this strategy and requires a substantial chunk of investment. Therefore, testing the screening program for economic along with clinical effectiveness is essential. There is significant proof of the benefits of incorporating economic evidence in health decision-making globally, although evidence from LMICs in NCD prevention is scanty. This systematic review aims to consolidate and synthesize economic evidence of screening programs for cardiovascular diseases (CVD) and diabetes from LMICs. The study protocol is registered on PROSPERO (CRD42021275806). The review includes articles from English and Chinese languages. An initial search retrieved a total of 2,644 potentially relevant publications. Finally, 15 articles (13 English and 2 Chinese reports) were included and scrutinized in detail. We found 6 economic evaluations of interventions targeting cardiovascular diseases, 5 evaluations of diabetes interventions, and 4 were combined interventions, i.e., screening of diabetes and cardiovascular diseases. The study showcases numerous innovative screening programs that have been piloted, such as using mobile technology for screening, integrating non-communicable disease screening with existing communicable disease screening programs, and using community health workers for screening. Our review reveals that context is of utmost importance while considering any intervention, i.e., depending on the available resources, cost-effectiveness may vary—screening programs can be made universal or targeted just for the high-risk population.
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Affiliation(s)
- Manushi Sharma
- The George Institute for Global Health, New Delhi, India
| | - Renu John
- The George Institute for Global Health, New Delhi, India
| | - Sadia Afrin
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh
| | - Xinyi Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Tengyi Wang
- School of Public Health, Harbin Medical University, Harbin, China
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, China.,Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kirti Sundar Sahu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Robert Mash
- Department of Family and Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Devarsetty Praveen
- The George Institute for Global Health, New Delhi, India.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - K M Saif-Ur-Rahman
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh.,Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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