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Gudlavalleti AG, Babu GR, Kamalakannan S, Murthy GVS, Schaper NC, van Schayck OCP. Training of Community Health Workers in Diabetes Lead to Improved Outcomes for Diabetes Screening and Management in Low- and Middle-Income Countries: Protocol for a Systematic Review. JMIR Res Protoc 2024; 13:e57313. [PMID: 39167436 PMCID: PMC11375384 DOI: 10.2196/57313] [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: 02/13/2024] [Revised: 05/01/2024] [Accepted: 06/05/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Diabetes is a growing concern worldwide, particularly in low- and middle-income countries (LMICs). Type 2 diabetes mellitus constitutes a significant proportion of cases and is associated with debilitating microvascular complications. Type 2 diabetes mellitus is steadily increasing among the LMICs where many barriers to health care exist. Thus, task shifting to community health workers (CHWs) has been proposed as a solution to improve diabetes management in these settings. However, CHWs often lack the necessary training to manage diabetes effectively. Thus, a systematic review is required to present evidence of the highest degree for this intervention. OBJECTIVE This study aims to establish the protocols for a systemic review. METHODS Using the Participants Intervention Comparator Outcome Time Study Design (PICOTS) framework, this study outlines a systematic review aiming to evaluate the impact of training programs for CHWs in diabetes management in LMICs. Quantitative studies focusing on CHWs, diabetes training, focusing on diabetes management outcomes like hemoglobin A1c levels and fasting blood glucose levels, between January 2000 and December 2023 and found on databases such as PubMed, Ovid MEDLINE, Evidence Based Medicine Reviews, BASE, Google Scholar, and Web of Science will be included. We will include randomized controlled trials but will also include observational studies if we find less than 5 randomized controlled trials. An author committee consisting of 3 reviewers will be formed, where 2 reviewers will conduct the review independently while the third will resolve all disputes. The Cochrane Methods Risk of Bias Tool 2 will be used for assessing the risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation approach for the meta-analysis and narrative synthesis analysis will be used. The results will be presented in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram. RESULTS The review will begin in May 2024 and conclude in 3 months. CONCLUSIONS The review will synthesize existing evidence and provide insights into the effectiveness of such programs, informing future research and practice in diabetes care in LMICs. TRIAL REGISTRATION PROSPERO CRD42022341717; https://tinyurl.com/jva2hpdr. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/57313.
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Affiliation(s)
- Anirudh Gaurang Gudlavalleti
- Pragyaan Sustainable Health Outcomes Foundation, Hyderabad, India
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Sureshkumar Kamalakannan
- Department of social work, education and community wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - G V S Murthy
- Pragyaan Sustainable Health Outcomes Foundation, Hyderabad, India
| | - Nicolaas C Schaper
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Herce ME, Bosomprah S, Masiye F, Mweemba O, Edwards JK, Mandyata C, Siame M, Mwila C, Matenga T, Frimpong C, Mugala A, Mbewe P, Shankalala P, Sichone P, Kasenge B, Chunga L, Adams R, Banda B, Mwamba D, Nachalwe N, Agarwal M, Williams MJ, Tonwe V, Pry JM, Musheke M, Vinikoor M, Mutale W. Evaluating a multifaceted implementation strategy and package of evidence-based interventions based on WHO PEN for people living with HIV and cardiometabolic conditions in Lusaka, Zambia: protocol for the TASKPEN hybrid effectiveness-implementation stepped wedge cluster randomized trial. Implement Sci Commun 2024; 5:61. [PMID: 38844992 PMCID: PMC11155136 DOI: 10.1186/s43058-024-00601-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/28/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Despite increasing morbidity and mortality from non-communicable diseases (NCD) globally, health systems in low- and middle-income countries (LMICs) have limited capacity to address these chronic conditions, particularly in sub-Saharan Africa (SSA). There is an urgent need, therefore, to respond to NCDs in SSA, beginning by applying lessons learned from the first global response to any chronic disease-HIV-to tackle the leading cardiometabolic killers of people living with HIV (PLHIV). We have developed a feasible and acceptable package of evidence-based interventions and a multi-faceted implementation strategy, known as "TASKPEN," that has been adapted to the Zambian setting to address hypertension, diabetes, and dyslipidemia. The TASKPEN multifaceted implementation strategy focuses on reorganizing service delivery for integrated HIV-NCD care and features task-shifting, practice facilitation, and leveraging HIV platforms for NCD care. We propose a hybrid type II effectiveness-implementation stepped-wedge cluster randomized trial to evaluate the effects of TASKPEN on clinical and implementation outcomes, including dual control of HIV and cardiometabolic NCDs, as well as quality of life, intervention reach, and cost-effectiveness. METHODS The trial will be conducted in 12 urban health facilities in Lusaka, Zambia over a 30-month period. Clinical outcomes will be assessed via surveys with PLHIV accessing routine HIV services, and a prospective cohort of PLHIV with cardiometabolic comorbidities nested within the larger trial. We will also collect data using mixed methods, including in-depth interviews, questionnaires, focus group discussions, and structured observations, and estimate cost-effectiveness through time-and-motion studies and other costing methods, to understand implementation outcomes according to Proctor's Outcomes for Implementation Research, the Consolidated Framework for Implementation Research, and selected dimensions of RE-AIM. DISCUSSION Findings from this study will be used to make discrete, actionable, and context-specific recommendations in Zambia and the region for integrating cardiometabolic NCD care into national HIV treatment programs. While the TASKPEN study focuses on cardiometabolic NCDs in PLHIV, the multifaceted implementation strategy studied will be relevant to other NCDs and to people without HIV. It is expected that the trial will generate new insights that enable delivery of high-quality integrated HIV-NCD care, which may improve cardiovascular morbidity and viral suppression for PLHIV in SSA. This study was registered at ClinicalTrials.gov (NCT05950919).
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Affiliation(s)
- Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.
| | - Samuel Bosomprah
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Felix Masiye
- Department of Health Economics, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Chomba Mandyata
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Mmamulatelo Siame
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Chilambwe Mwila
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Tulani Matenga
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Ridgeway Campus, Lusaka, Zambia
| | | | - Anchindika Mugala
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Medicine, Division of Infectious Diseases, University Teaching Hospital, Lusaka, Zambia
| | - Peter Mbewe
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Perfect Shankalala
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Pendasambo Sichone
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Blessings Kasenge
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Luanaledi Chunga
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Rupert Adams
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Brian Banda
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Daniel Mwamba
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Namwinga Nachalwe
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Mansi Agarwal
- Institute of Public Health, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Makeda J Williams
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, U.S. National Institutes of Health, Bethesda, MD, USA
| | - Veronica Tonwe
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, U.S. National Institutes of Health, Bethesda, MD, USA
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Epidemiology, School of Medicine, University of California at Davis, Davis, CA, USA
| | - Maurice Musheke
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael Vinikoor
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Division of Infectious Diseases, Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Wilbroad Mutale
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
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Lumu W, Bahendeka S, Kibirige D, Wesonga R, Mutebi RK. Effectiveness of a nurse-led management intervention on systolic blood pressure among type 2 diabetes patients in Uganda: a cluster randomized trial. Clin Diabetes Endocrinol 2024; 10:16. [PMID: 38764058 PMCID: PMC11103986 DOI: 10.1186/s40842-024-00173-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 01/31/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Hypertension (HT) is an orchestrator of atherosclerotic cardiovascular disease (ASCVD) in people living with type 2 diabetes (T2D). Control of systolic blood pressure (SBP) and HT as a whole is suboptimal in diabetes, partly due to the scarcity of doctors. While nurse-led interventions are pragmatic and cost-effective in the control of HT in primary health care, their effectiveness on SBP control among patients with T2D in Uganda is scantly known. AIM We evaluated the effectiveness of a nurse-led management intervention on SBP among T2D patients with a high ASCVD risk in Uganda. METHODS A two-armed cluster randomized controlled trial compared the nurse-led management intervention with usual doctor-led care. The intervention involved training nurses to provide structured health education, protocol-based HT/CVD management, 24-h phone calls, and 2-monthly text messages for 6 months. The primary outcome was the mean difference in SBP change among patients with T2D with a high ASCVD risk in the intervention and control groups after 6 months. The secondary outcome was the absolute difference in the number of patients at target for SBP, total cholesterol (TC), fasting blood glucose (FBG), glycated hemoglobin (HbA1C), low-density lipoprotein (LDL), triglycerides (TG), and body mass index (BMI) after the intervention. The study was analyzed according to the intention-to-treat principle. Generalized estimating equations were used to assess intra-cluster effect modifiers. Statistical significance was set at 0.05 for all analyses. RESULTS Eight clinics (n = 388 patients) were included (intervention 4 clinics; n = 192; control 4 clinics; n = 196). A nurse-led intervention reduced SBP by -11.21 ± 16.02 mmHg with a mean difference between the groups of -13.75 mmHg (95% CI -16.48 to -11.02, p < 0.001). An increase in SBP of 2.54 ± 10.95 mmHg was observed in the control group. Diastolic blood pressure was reduced by -6.80 ± 9.48 mmHg with a mean difference between groups of -7.20 mmHg (95% C1 -8.87 to -5.48, p < 0.001). The mean differences in the change in ASCVD score and glycated hemoglobin were -4.73% (95% CI -5.95 to -3.51, p = 0.006) and -0.82% (95% CI -1.30 to -0.35, p = 0.001), respectively. There were significant absolute differences in the number of patients at target in SBP (p = 0.001), DBP (p = 0.003), and TC (p = 0.008). CONCLUSION A nurse-led management intervention reduces SBP and ASCVD risk among patients with T2D. Such an intervention may be pragmatic in the screening and management of HT/ASCVD in Uganda. TRIAL REGISTRATION Pan African Clinical Trial Registry, PACTR202001916873358, registered on 6th October 2019.
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Affiliation(s)
- William Lumu
- Department of Internal Medicine, Mengo Hospital, P.O Box 7161, Kampala, Uganda.
| | - Silver Bahendeka
- Mother Kevin Post Graduate Medical School-Uganda Martyrs University, Kampala, Uganda
| | | | - Ronald Wesonga
- School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Ronald Kasoma Mutebi
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
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Gudlavalleti AG, Babu GR, Agiwal V, Murthy GVS, Schaper NC, van Schayck OCP. Undesirable Levels of Practice Behaviours and Associated Knowledge amongst Community Health Workers in Rural South India Responsible for Type 2 Diabetes Screening and Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:562. [PMID: 38791775 PMCID: PMC11121515 DOI: 10.3390/ijerph21050562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Type 2 diabetes (T2DM) poses an enormous global health care challenge, especially among rural communities. Healthcare in these areas can be inadequate and inaccessible due to socio-demographic barriers. To overcome this situation, many low- and middle-income countries are resorting to task shifting, using community health workers (CHWs) for diabetes management. However, its successful implementation depends on the practice behaviours and knowledge of these workers. OBJECTIVE This cross-sectional study aimed to evaluate the proficiency of CHWs involved in diabetes screening and management in rural South India by identifying the existing practice behaviours and knowledge gaps. METHODS Employing a customised questionnaire, developed through inputs from experts and government officials, we assessed practice behaviours and the corresponding knowledge base of 275 CHWs. Analytical methodologies consisted of descriptive statistics, logistic regression, and mosaic plots for comprehensive data interpretation. RESULTS The study showcased significant deficiencies in both practice behaviours (97%) and knowledge (95%) with current mean levels ranging from 48 to 50%, respectively, among the participants. The identified areas of insufficiency were broadly representative of the core competencies required for effective diabetes management, encompassing diabetes diagnosis and referral, HbA1c testing, diabetes diet, diabetes type and self-management, microvascular complications and their screening, peripheral neuropathy management, and diabetes risk assessment. In several areas, correct practice behaviour was reported by a relatively large number of CHWs despite incorrect answers to the related knowledge questions such as referral to the health centres, self-management, and calculation of diabetes risk assessment. CONCLUSION This study highlights widespread deficiencies (97% CHWs) in diabetes management practices and knowledge (95% CHWs). To overcome these deficiencies, a thorough needs assessments is vital for effective CHW training. Training of CHWs should not only identify prior knowledge and/or behaviour but also their interrelationship to help create a robust and flexible set of practice behaviours.
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Affiliation(s)
- Anirudh G. Gudlavalleti
- Pragyaan Sustainable Health Outcomes Foundation, World Trade Centre, Nanakramguda, Hyderabad 500032, Telangana, India;
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (N.C.S.); (O.C.P.v.S.)
| | - Giridhara R. Babu
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar;
| | - Varun Agiwal
- Indian Institute of Public Health Hyderabad, Rajendranagar, Hyderabad 500030, Telangana, India;
| | - G. V. S. Murthy
- Pragyaan Sustainable Health Outcomes Foundation, World Trade Centre, Nanakramguda, Hyderabad 500032, Telangana, India;
| | - Nicolaas C. Schaper
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (N.C.S.); (O.C.P.v.S.)
| | - Onno C. P. van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; (N.C.S.); (O.C.P.v.S.)
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Prattipati S, Tarimo TG, Kweka GL, Mlangi JJ, Samuel D, Sakita FM, Tupetz A, Bettger JP, Thielman NM, Temu G, Hertz JT. Patient and provider perspectives on barriers to myocardial infarction care among persons with human immunodeficiency virus in Tanzania: A qualitative study. Int J STD AIDS 2024; 35:18-24. [PMID: 37703080 PMCID: PMC11139408 DOI: 10.1177/09564624231199507] [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: 09/14/2023]
Abstract
INTRODUCTION People with HIV (PLWH) have an increased risk myocardial infarction (MI), and evidence suggests that MI is under-diagnosed in Tanzania. However, little is known about barriers to MI care among PLWH in the region. METHODS In this qualitative study grounded in phenomenology, semi-structured interviews were conducted in northern Tanzania. Purposive sampling was used to recruit a diverse group of providers who care for PLWH and patients with HIV and electrocardiographic evidence of prior MI. Emergent themes were identified via inductive thematic analysis. RESULTS 24 physician and patient participants were interviewed. Most participants explained MI as caused by emotional shock and were unaware of the association between HIV and increased MI risk. Providers described poor provider training regarding MI, high out-of-pocket costs, and lack of diagnostic equipment and medications. Patients reported little engagement with and limited knowledge of cardiovascular care, despite high engagement with HIV care. Most provider and patient participants indicated that they would prefer to integrate cardiovascular care with routine HIV care. CONCLUSIONS PLWH face many barriers to MI care in Tanzania. There is a need for multifaceted interventions to educate providers and patients, improve access to MI diagnosis, and increase engagement with cardiovascular care among this population.
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Affiliation(s)
| | | | | | | | | | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Janet P Bettger
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA, USA
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gloria Temu
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
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Chukwu OA, Nnogo CC, Essue B. Task shifting to nonphysician health workers for improving access to care and treatment for cancer in low- and middle-income countries- a systematic review. Res Social Adm Pharm 2023; 19:1511-1519. [PMID: 37659923 DOI: 10.1016/j.sapharm.2023.08.010] [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: 12/30/2022] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Cancer is a complex global health issue overburdening health systems especially in low- and middle-income countries (LMICs). This burden is becoming more severe and complex as the global shortage of cancer care workforce persists. Since task shifting offers an alternative to address workforce shortages, a systematic review with the following research question was carried out: What is the scope of roles and tasks shifted to nonphysician health workers in improving access to cancer control services? The aim of this review is to critically identify, appraise and present evidence on how task shifting could be integrated and scaled to expand access to quality cancer control services in LMICs. OBJECTIVE The aim of this review is to critically identify, appraise and present evidence on how task shifting could be integrated and scaled to expand access to quality cancer control services in LMICs. METHODS Four databases were searched - CINAHL, EMBASE, MEDLINE and SCOPUS from inception to October 15, 2022, and included all studies that reported task shifting of cancer control services to nonphysician health workers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines was followed to report the review process. Risk of bias was assessed using the National Heart, Lung, and Blood Institute quality assessment scale. The studies were summarized using narrative synthesis. A meta-analysis could not be carried out because the review only assessed the scope of roles that were shifted to nonphysician health workers and because of the heterogeneity in the characteristics of the studies included in the review. RESULTS The search identified 170 articles out of which 16 were included in the review. Three studies were randomized controlled trials, four were cluster randomized trials, while 9 were cross-sectional. Tasks were shifted to primary healthcare workers, nurses, and community health workers. Tasks shifted included screening, patient education, and diagnostic procedures. Evidence from the studies showed that the quality and effectiveness of tasks performed were comparable, and in some cases, better than usual care. CONCLUSIONS Findings showed that tasks in certain areas of cancer control services such as screening, education, and diagnosis can be shifted to nonphysician health workers and that it could be effective in improving access to certain cancer control services. Therefore, this review has shown that task shifting could be an effective strategy in addressing current workforce shortages in cancer care and that there is a need to examine the care required along the cancer continuum to better understand which interventions can most effectively be shifted to more advanced health professionals such as pharmacists to improve access to cancer control services in LMICs.
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Affiliation(s)
- Otuto Amarauche Chukwu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada.
| | | | - Beverley Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada
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Akintunde AA, Mutagaywa R, Manmak M, Oguntade AS, Adejumo OA, Isiguzo G, Beheiry H, Doku A, Dzudie A, Damasceno A, Onwubere BJC, Odili A, Adeoye A, Mbulaje L, Lamin ES, Akumiah F, Avorkliya L, Ogola E, Ayoola Y, Marwa S, Exon A, Amaechi UM, Okereke CJ, Nwude IE. Task sharing in the management of hypertension: highlights of the African hypertension school for nonphysicians health workers. J Hypertens 2023; 41:1544-1550. [PMID: 37642589 DOI: 10.1097/hjh.0000000000003463] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Abiodun A Akintunde
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Reuben Mutagaywa
- Muhimbili Orthopedic Institute & Muhimbili University of Health and Allied Sciences
| | - Manven Manmak
- Department of Medicine, University of Abuja, Nigeria
| | - Ayodipupo S Oguntade
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Big Data Institute
| | - Oluseyi A Adejumo
- Department of Internal Medicine University of Medical Sciences, Ondo State
| | - Godsent Isiguzo
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital
| | - Hind Beheiry
- Department of Physiology, Director of Educational Development and Research Centre
| | - Alfred Doku
- University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Anaestase Dzudie
- Department of Internal Medicine and Subspecialties, Douala General Hospital, Douala
| | | | | | - Augustine Odili
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, Main Campus, University of Abuja, off Airport Road, Abuja
| | - Abiodun Adeoye
- Cardiovascular Genomic Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lucia Mbulaje
- Queen Elizabeth Central Hospital, Box 95, Blantyre Malawi
| | - E S Lamin
- Department of Internal Medicine, Edward Francis Small Teaching Hospital/School of Medicine & Allied Health Sciences, University of the Gambia Banjul, The Gambia
| | - Florence Akumiah
- National Cardiothoracic Centre
- Dept of Medicine and Therapeutics, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | - Loius Avorkliya
- Dept of Medicine and Therapeutics, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | - Elijah Ogola
- Department of Medicine, University of Nairobi, Kenya
| | - Yekeen Ayoola
- Federal Teaching Hospital Gombe /Gombe State University, Gombe, Nigeria
| | | | - A Exon
- Muhumuliza Healthcare Polyclinic, Dar Es Salaam, Tanzania
| | - Uzochukwu M Amaechi
- Department of Human Resources, Society for Public Health and Social Development, Lugbe
| | | | - Ifeanyi E Nwude
- Department of Business Development and Communication, Society for Public Health and Social Development, Lugbe, Abuja, Nigeria
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Sundararajan R, Ponticiello M, Birch G, Nuwagaba G, Alaiku R, Nansera D, Mwanga-Amumpaire J, Muyindike W. Adaption and pilot testing of a lay HIV supporter program for traditional healers: a mixed methods study in rural Uganda. Implement Sci Commun 2023; 4:87. [PMID: 37501077 PMCID: PMC10373386 DOI: 10.1186/s43058-023-00469-5] [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] [Received: 01/12/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Half of people living with HIV (PLWH) in sub-Saharan Africa default from care within two years. In Uganda, and across sub-Saharan Africa, traditional healers (TH) are ubiquitous and often serve as the first line of health care. We hypothesized that with lay support training, TH could support relinkage to HIV care and ART adherence among rural Ugandan PLWH who have defaulted from HIV care. METHODS Following the ADAPT-ITT framework, we adapted an evidence-based layperson HIV support program from South Africa for delivery by Ugandan TH. The ADAPT-ITT framework consists of (1) Assessment of needs; (2) Deciding which evidence-based interventions to adapt; (3) Adaptation of interventions; (4) Production of drafted adapted interventions; (5) Topical expert feedback; (6) Integration of expert feedback; (7) Training personnel; and (8) Testing the adapted intervention. The Testing phase was completed via a pilot mixed methods prospective cohort study. The study population included 12 TH practicing in Mbarara Township and 20 adult PLWH with suboptimal ART adherence (CASE adherence index score < 10) who received care from a participating TH and who resided in Mbarara Township. Primary outcome was re-linkage to HIV care within 14 days. Secondary outcomes were ART re-initiation, ART adherence, retention in care after 9 months, and implementation measures. Qualitative interviews were conducted with all participants. RESULTS Data from the Assessment phase indicated that logistical challenges played an important role in disengagement from care among PLWH who receive care from TH, notably geographical distance to clinics and transportation costs. Additionally, HIV-related stigma and lack of social support were identified as barriers to entering and remaining in HIV care. Two core elements of the intervention were identified during the Production phase: (1) TH facilitating rapid re-linkage to HIV care and (2) TH provision of psychosocial support. In the pilot study phase, baseline median CASE adherence score was 3; only 5% of PLWH were adherent to ART via 4-day recall. The TH-delivered support achieved 100% linkage and ART initiation within 14 days, 95% ART adherence, and 100% of PLWH were retained in HIV care after 9 months. CONCLUSIONS The ADAPT-ITT framework successfully guided the adaption of a community health worker-delivered intervention for delivery by TH. TH successfully facilitated re-linkage to HIV care, support ART adherence, and retention in care for PLWH when trained as part of a lay support person program. Future studies are needed to evaluate scale-up and long-term impact.
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Affiliation(s)
- Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
| | | | | | | | - Rinu Alaiku
- Weill Cornell Medical College, Weill Cornell Medicine, New York, USA
| | - Denis Nansera
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Juliet Mwanga-Amumpaire
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Winnie Muyindike
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
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9
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Presswala B, De Souza LR. The diagnostic experience of polycystic ovary syndrome: A scoping review of patient perspectives. PATIENT EDUCATION AND COUNSELING 2023; 113:107771. [PMID: 37141692 DOI: 10.1016/j.pec.2023.107771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/02/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Polycystic Ovary Syndrome (PCOS) is a common endocrine condition with a complex diagnostic process. The present study aims to understand patient perceptions of the process of PCOS diagnosis, and how challenges during diagnosis can influence patient understanding of PCOS and trust in healthcare providers (HCPs). METHODS A scoping review framework was followed. Six databases were searched for patient experiences of PCOS diagnosis, between January 2006 - July 2021. Data extraction and thematic analyses were conducted. RESULTS Of the 338 studies screened, 21 studies fulfilled the inclusion criteria. Patient experiences of the diagnostic process were stratified into three themes: emotional, negotiating, and incomplete. As a result of these experiences, patients begin to perceive their HCPs as lacking knowledge and empathy. CONCLUSION There are prevailing gaps in how PCOS diagnostic criteria are understood and applied in the clinical setting, leading to a lengthy diagnostic process. Additionally, poor HCP communication negatively affects patient trust in HCPs. PRACTICE IMPLICATIONS Practicing patient-centered care and empowering patients by addressing their specific information needs are essential to improving the diagnostic experience and care of individuals living with PCOS. These recommendations may also apply to the diagnosis of other complex chronic conditions.
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Affiliation(s)
- Batul Presswala
- Faculty of Health Sciences, McMaster University, 1280 Main St. West, MDCL 3500, Hamilton, ON L8S 4K1, Canada; Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON K1A 0K9, Canada.
| | - Leanne R De Souza
- Human Biology Program, Health Studies Program, University College, University of Toronto, Room 281, 15 King's College Circle, Toronto, ON M5S 3H7, Canada
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10
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Rakotondramanana DA, Razafindrakoto ZR, Donno D, Tombozara N, Nalimanana NR, Andrianajara C, Beccaro GL, Ramanitrahasimbola D, Nicoletti M. Bio-guided isolation of androsta-1,4-dien-3,16-dione as a vasodilator active principle from the inflorescence of Ravenala madagascariensis Sonn. (Strelitziaceae). Nat Prod Res 2023; 37:809-818. [PMID: 35724374 DOI: 10.1080/14786419.2022.2089668] [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: 10/18/2022]
Abstract
Androsta-1,4-dien-3,16-dione was isolated for the first time from the plant kingdom of the ethanolic extract of the Ravenala madagascariensis' inflorescence by the bio-guided method. Its structure was elucidated by NMR and MS spectroscopic data analysis. The vascular effects of ethanol extracts, fractions and androsta-1,4-dien-3,16-dione were assessed on the phenylephrine pre-contracted isolated rat aorta. The isolated compound exerted the most potent vaso-relaxing effect (EC50 = 109.32 ± 15.82 µM) than the ethanol extract and fractions. The pharmacological mechanism of its vaso-relaxing action was analysed on isolated rat aorta using free-endothelial vascular tissue, specific contracting reagents (CaCl2 and KCl), antagonist (propranolol), enzyme inhibitors (L-NAME, methylene blue) and channel blocker (glibenclamide). Its vaso-relaxing activity could be due, at least partly, to the non-specific inhibition of the calcic influx.
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Affiliation(s)
| | | | - Dario Donno
- Dipartimento di Scienze Agrarie, Forestali e Alimentari, Università degli Studi di Torino, Turin, Italy
| | - Nantenaina Tombozara
- Applied Pharmacognosy Laboratory, Institut Malgache de Recherches Appliquées, Antananarivo, Madagascar
| | - Nina Robertina Nalimanana
- Applied Pharmacognosy Laboratory, Institut Malgache de Recherches Appliquées, Antananarivo, Madagascar
| | - Charles Andrianajara
- Applied Pharmacognosy Laboratory, Institut Malgache de Recherches Appliquées, Antananarivo, Madagascar
| | - Gabriele Loris Beccaro
- Dipartimento di Scienze Agrarie, Forestali e Alimentari, Università degli Studi di Torino, Turin, Italy
| | - David Ramanitrahasimbola
- Pharmacy Department, Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar.,Applied Pharmacognosy Laboratory, Institut Malgache de Recherches Appliquées, Antananarivo, Madagascar
| | - Marcello Nicoletti
- Department of Environmental Biology, Sapienza University of Roma, Rome, Italy
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Obubu M, Chuku N, Ananaba A, Sadiq FU, Sambo E, Kolade O, Oyekanmi T, Olaosebikan K, Serrano O. Evaluation of healthcare facilities and personnel distribution in Lagos State: implications on universal health coverage. Hosp Pract (1995) 2023; 51:64-75. [PMID: 36729124 DOI: 10.1080/21548331.2023.2170651] [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: 02/03/2023]
Abstract
BACKGROUND Nigeria is considering making Universal Health Coverage (UHC) a common policy goal to ensure that citizens have access to high-quality healthcare services without crippling debt. Globally, there is an acute shortage of human resources for Health (HRH), and the most significant burden is borne by low-income countries, especially in sub-Saharan Africa. This shortage has considerably constrained the achievement of health-related development goals and impeded accelerated progress toward universal health coverage. We examine the existing human resource capacity and the distribution of health facilities in Lagos state in this study, discussing the implications of our findings. METHODS The study is descriptive using secondary data analysis. We leverage census-based primary data collected by NOIPoll on health facility assessments in Lagos state. The collected data was analyzed using counts, ratios, rates, and percentages. RESULTS We observe a ratio of 5,014 people to 1 general medical doctor, 2,942 people to 1 specialist, 2,165 people to 1 nurse, and 5,117 people to 1 midwife, which are far higher than the WHO recommendation. We also observe that the ratio of nurses to general medical practitioners is 2.2:1 in urban areas and 2.7:1 in rural. In contrast, the ratio of nurses to specialist medical doctors is 1.3:1 in the urban area and 1.5:1 in the rural areas of Lagos state. The overall nurse per general medical practitioner ratio is 2.3:1 and 1.4:1 for specialist medical doctors. 77.2% of the health facilities surveyed were in the urban areas, with private-for-profit facilities accounting for 82.9%, government facilities accounting for 15.4%, and NGOs/faith clinics accounting for 1.7%. Primary healthcare facilities account for 75.3% of the facilities surveyed, secondary and tertiary facilities account for 24.6% and 0.08%, respectively. Alimosho LGA has the most health facilities (77.38% PHCs, and 22.62% SHCs) and staff strength specifically for general medical practitioners, specialists, nurses, and midwives (16.9%, 19.9%, 16.7%, 17.1%, respectively). Eti-Osa LGA has the best density ratio for generalist doctors, specialist doctors, and nurses per 10,000 (4.42, 12.96, and 11.34 respectively), while Ikeja has the best midwife population density ratio 5.46 per 10,000 population. CONCLUSION The distribution of health personnel and facilities in Lagos State is not equitable, with evident variation between rural and urban areas. This inequitable distribution could affect the physical distance of health facilities to residents, leading to decreased utilization, ultimately poor health outcomes, and impaired access. Much like child mortality, maternal mortality also exhibits a correlation with healthcare worker density. As the physician density increases linearly, the maternal mortality rate decreases exponentially. However, due to the low number of healthcare workers in Lagos state, doctors, nurses, and midwives are frequently unavailable during childbirth, resulting in increasing infant, neonatal, and maternal death. As such, the government should adopt the UHC strategy in its distribution of facilities and personnel in the state for adequate coverage and optimal performance of the facilities. Also, additional investments are needed in some parts of the state to improve access to tertiary health facilities and leverage private sector capacity.
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Affiliation(s)
- Maxwell Obubu
- Technical Unit, Health Systems Consult Limited (HSCL), Abuja, Nigeria
| | - Nkata Chuku
- Technical Unit, Health Systems Consult Limited (HSCL), Abuja, Nigeria
| | - Alozie Ananaba
- Technical Unit, Health Systems Consult Limited (HSCL), Abuja, Nigeria
| | | | - Emmanuel Sambo
- Technical Unit, Health Systems Consult Limited (HSCL), Abuja, Nigeria
| | - Oluwatosin Kolade
- Technical Unit, Health Systems Consult Limited (HSCL), Abuja, Nigeria
| | - Tolulope Oyekanmi
- Technical Unit, Health Systems Consult Limited (HSCL), Abuja, Nigeria
| | | | - Oluwafemi Serrano
- Operations, Head of Operations, Lagos State Health Management Agency (LASHMA), Nigeria
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Sarfo FS, Commeh ME, Tandoh IO, Agbogbatey M, Ankrah O, Akpalu A, Ovbiagele B. Nationwide rates of outpatient clinic attendance by stroke survivors in Ghana: Analysis by region and facility. J Neurol Sci 2022; 437:120250. [DOI: 10.1016/j.jns.2022.120250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/12/2022] [Accepted: 04/02/2022] [Indexed: 01/30/2023]
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13
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Lutala P, Muula A. Brief behaviour change counselling in non-communicable diseases in Mangochi, Southern Malawi: a hypothetical acceptability study. Pilot Feasibility Stud 2022; 8:69. [PMID: 35331326 PMCID: PMC8944110 DOI: 10.1186/s40814-022-01032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Brief behaviour change counselling (BBCC) approaches have shown some potential in reversing and/or decreasing the effects of behavioural risk factors (harmful alcohol, smoking, physical inactivity and unhealthy diets). However, BBCC is new in Malawi. Thus, we explored the acceptability of brief behaviour change counselling using 5 As and a guiding style from motivational interviewing (BBCC + 5 As + GS) among health providers, policy-makers and patients living with noncommunicable diseases (NCDs) in the Mangochi district located in Malawi. METHODS An exploratory qualitative cross-sectional study used purposive sampling to select 44 respondents. We conducted group discussions with five focus groups that included patients. We also carried out nine key-informant interviews with healthcare providers and policy-makers. Data were managed and organized with Atlas.ti. cloud and analysed using the thematic framework approach. FINDINGS Several themes, categories, and their subcategories emerged from the interviews. Participants perceived the introduction and delivery of BBCC + 5As + GS in Mangochi as smooth. However, they predicted a few challenges such as time and space to conduct the intervention, cultural bottlenecks caused by low education level, age differences between healthcare providers and patients, low provider- to- patient ratio and high provider turnover. For this method to be adopted, a simplified format is deemed necessary to improve effectiveness with patients. This technique can only be sustained if training opportunities are provided and if positive testimonies are given by beneficiaries. Incorporation of a continuous quality improvement cycle targeting challenges must be part of the intervention. Participants perceived that BBCC will contribute to developing the listening ability of healthcare providers. This would help in providing personalized and cost-effective care relevant to Mangochi. The participants also perceived that BBCC + 5As + GS will be affordable, credible and useful. CONCLUSION We found a high acceptability rate of BBCC among stakeholders in NCDs clinics in Mangochi. There are a number of areas where BBCC + 5As + GS could be improved to increase the acceptability. Accordingly, a study of feasibility and preliminary efficacy is warranted to determine other prerequisites for the implementation of a large-scale trial using this BBCC+ 5 As + GS, and to fully understand the implementation requirements of a full trial in Mangochi.
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Affiliation(s)
- Prosper Lutala
- School of Public Health & Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi.
- NCDs-Brite Consortium, College of Medicine, University of Malawi, Zomba, Malawi.
- Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM), Zomba, Malawi.
- College of Medicine Mangochi Campus, P.O. Box 431, Mangochi, Malawi.
| | - Adamson Muula
- School of Public Health & Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi
- Africa Centre of Excellence in Public Health and Herbal Medicine (ACEPHEM), Zomba, Malawi
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14
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Aifah AA, Odubela O, Rakhra A, Onakomaiya D, Hu J, Nwaozuru U, Oladele DA, Odusola AO, Idigbe I, Musa AZ, Akere A, Tayo B, Ogedegbe G, Iwelunmor J, Ezechi O. Integration of a task strengthening strategy for hypertension management into HIV care in Nigeria: a cluster randomized controlled trial study protocol. Implement Sci 2021; 16:96. [PMID: 34789277 PMCID: PMC8597211 DOI: 10.1186/s13012-021-01167-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In regions with weak healthcare systems, critical shortages of the healthcare workforce, and increasing prevalence of dual disease burdens, there is an urgent need for the implementation of proven effective interventions and strategies to address these challenges. Our mixed-methods hybrid type II effectiveness-implementation study is designed to fill this evidence-to-practice gap. This study protocol describes a cluster randomized controlled trial which evaluates the effectiveness of an implementation strategy, practice facilitation (PF), on the integration, adoption, and sustainability of a task-strengthening strategy for hypertension control (TASSH) intervention within primary healthcare centers (PHCs) in Lagos State, Nigeria. DESIGN Guided by the Consolidated Framework for Implementation Research (CFIR) and the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM), this study tests the impact of a proven effective implementation strategy to integrate hypertension management into the HIV care cascade, across 30 PHCs. The study will be conducted in three phases: (1) a pre-implementation phase that will use CFIR to develop a tailored PF intervention for integrating TASSH into HIV clinics; (2) an implementation phase that will use RE-AIM to compare the clinical effectiveness of PF vs. a self-directed condition (receipt of information on TASSH without PF) on BP reduction; and (3) a post-implementation phase that will use RE-AIM to evaluate the effect of PF vs. self-directed condition on adoption and sustainability of TASSH. The PF intervention components comprise (a) an advisory board to provide leadership support for implementing TASSH in PHCs; (b) training of the HIV nurses on TASSH protocol; and (c) training of practice facilitators, who will serve as coaches, provide support, and performance feedback to the HIV nurses. DISCUSSION This study is one of few, if any trials, to evaluate the impact of an implementation strategy for integrating hypertension management into HIV care, on clinical and implementation outcomes. Findings from this study will advance implementation science research on the effectiveness of tailoring an implementation strategy for the integration of an evidence-based, system-level hypertension control intervention into HIV care and treatment. TRIAL REGISTRATION ClinicalTrials.gov ( NCT04704336 ). Registered on 11 January 2021.
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Affiliation(s)
| | | | | | | | - Jiyuan Hu
- NYU Grossman School of Medicine, New York City, USA
| | | | | | | | - Ifeoma Idigbe
- Nigerian Institute of Medical Research, Lagos, Nigeria
| | | | | | - Bamidele Tayo
- Loyola University Parkinson School of Health Sciences and Public Health, Maywood, USA
| | - Gbenga Ogedegbe
- Institute for Excellence in Health Equity (IEHE), NYU Langone Health, New York City, USA.
| | | | - Oliver Ezechi
- Nigerian Institute of Medical Research, Lagos, Nigeria
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15
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Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957-980. [PMID: 34450083 PMCID: PMC8446938 DOI: 10.1016/s0140-6736(21)01330-1] [Citation(s) in RCA: 1076] [Impact Index Per Article: 358.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING WHO.
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16
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Bossman IF, Dare S, Oduro BA, Baffour PK, Hinneh TK, Nally JE. Patients' knowledge of diabetes foot complications and self-management practices in Ghana: A phenomenological study. PLoS One 2021; 16:e0256417. [PMID: 34432838 PMCID: PMC8386847 DOI: 10.1371/journal.pone.0256417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 08/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background The prevalence of diabetes is increasing in low and middle-income countries (LMICs) and over two-thirds of these are not diagnosed. Consequently, diabetes complications usually exist at the time of diagnosis. Foot ulcers is a leading cause of disability and mortality among diabetes patients. Purpose To assess the knowledge and experiences of adult patients with Diabetes on diabetes complications and self-management practices with emphasis on foot care. Methodology This applied phenomenological study design. Twenty patients attending Diabetes clinics were purposively sampled from two hospitals in Ghana. Face-to-face semi-structured interviews were conducted to evaluate patient’s understanding of diabetes and self-management practices. The interviews were audio-taped, transcribed, and analysed to generate themes using the constant comparison method. Results Three-quarters of the participants in the study correctly defined diabetes as high blood glucose levels, but few knew the risk factors and complications of diabetes. Stroke and Hypertension were the most popular complications known, whiles diabetes foot complications were the least known. Almost all participants showed awareness of dietary self-management practices, but few had limited knowledge in foot care practices. Conclusion Diabetes education in LMICs should promote self-management practices, especially foot care and clear dietary guidelines. There is also opportunity to invest in specialist diabetes training for healthcare providers and increase community-based care for people living with diabetes in Ghana.
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Affiliation(s)
- Irene Fosuhemaa Bossman
- East Sussex NHS Trust, Eastbourne District General Hospital, Eastbourne, United Kingdom
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
- * E-mail:
| | - Shadrach Dare
- Mother and Infant Research Unit, University of Dundee, Dundee, United Kingdom
| | - Bright Anyimah Oduro
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Prince Kyei Baffour
- East Sussex NHS Trust, Conquest Hospital, St Leonards-on-Sea, United Kingdom
| | | | - Jane Elizabeth Nally
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
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Peer N, Baatiema L, Kengne AP. Ischaemic heart disease, stroke, and their cardiometabolic risk factors in Africa: current challenges and outlook for the future. Expert Rev Cardiovasc Ther 2020; 19:129-140. [PMID: 33305637 DOI: 10.1080/14779072.2021.1855975] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Although cardiovascular diseases (CVDs) are among the leading causes of death in Sub-Saharan Africa (SSA), prevention is not a priority and effective treatments are not widely available. This perspective discusses the burden, challenges, and potential opportunities for improvement of CVD prevention and control efforts in SSA. AREAS COVERED This paper focuses on ischemic heart disease and stroke, and their key contributors of obesity, hypertension, diabetes and dyslipidaemia which are well-established, rapidly rising, and significant contributors to disease burden in SSA. However, their prevention, detection, treatment and control of are currently disorganized, inconsistent, unreliable, and insufficient with most SSA countries not geared to respond to this growing problem. National policies are frequently lacking or, if available, remain poorly implemented, for the control of these conditions. Primary healthcare systems have not adapted to cope with these rising CVD burdens and remain weak, underfunded and under resourced. Numerous barriers at the healthcare service, healthcare provider, and patient levels prevent optimal CVD risk factor care. EXPERT OPINION Innovative approaches such as task-shifting with the reallocation of care to lower-level healthcare workers and the potential use of inexpensive technological options should be encouraged to provide equitable CVD preventive and curative solutions to SSA's poor.
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Affiliation(s)
- Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Leonard Baatiema
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Andre-Pascal Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
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Bukhsh A, Goh BH, Zimbudzi E, Lo C, Zoungas S, Chan KG, Khan TM. Type 2 Diabetes Patients' Perspectives, Experiences, and Barriers Toward Diabetes-Related Self-Care: A Qualitative Study From Pakistan. Front Endocrinol (Lausanne) 2020; 11:534873. [PMID: 33329377 PMCID: PMC7729167 DOI: 10.3389/fendo.2020.534873] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/25/2020] [Indexed: 01/03/2023] Open
Abstract
Objective: This study aimed to qualitatively explore perspectives, practices, and barriers to self-care practices (eating habits, physical activity, self-monitoring of blood glucose, and medicine intake behavior) in urban Pakistani adults with type 2 diabetes mellitus (T2DM). Methods: Pakistani adults with T2DM were recruited from the outpatient departments of two hospitals in Lahore. Semistructured interviews were conducted and audiorecorded until thematic saturation was reached. Two researchers thematically analyzed the data independently using NVivo® software with differences resolved by a third researcher. Results: Thirty-two Pakistani adults (aged 35-75 years, 62% female) participated in the study. Six themes were identified from qualitative analysis: role of family and friends, role of doctors and healthcare, patients' understanding about diabetes, complication of diabetes and other comorbidities, burden of self care, and life circumstances. A variable experience was observed with education and healthcare. Counseling by healthcare providers, family support, and fear of diabetes-associated complications are the key enablers that encourage study participants to adhere to diabetes-related self-care practices. Major barriers to self care are financial constraints, physical limitations, extreme weather conditions, social gatherings, loving food, forgetfulness, needle phobia, and a hectic job. Conclusion: Respondents identified many barriers to diabetes self care, particularly related to life situations and diabetes knowledge. Family support and education by healthcare providers were key influencers to self-care practices among Pakistani people with diabetes.
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Affiliation(s)
- Allah Bukhsh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Bey-Hing Goh
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, China
- Biofunctional Molecule Exploratory Research Group, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Malaysia School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Nephrology, Monash Health, Melbourne, VIC, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Monash Diabetes, Monash Health, Melbourne, VIC, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kok-Gan Chan
- Division of Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Guangdong Provincial Key Laboratory of Marine Biology, Institute of Marine Sciences, Shantou University, Shantou, China
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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Gudlavalleti AG, Babu GR, van Schayck OC, Schaper NC, Lewis MG, Murthy G. Evaluation of competence training for the minimally trained health worker in type 2 diabetes: A cluster randomized controlled trial. Medicine (Baltimore) 2020; 99:e22959. [PMID: 33126364 PMCID: PMC7598789 DOI: 10.1097/md.0000000000022959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Type 2 diabetes mellitus is responsible for high mortality and morbidity globally and in India. India has high prevalence of the condition and the burden is set to increase exponentially in the next decade. Indians traditionally reside in rural or semi-urban areas with limited access to healthcare facilities. To overcome this, the government has introduced a cadre of health workers called Accredited Social Health Activists (ASHA) for such areas. These workers were initially trained to provide maternal & infant care but now need improved competence training to improve type 2 diabetes screening & management in these locations. The objective of the study is to assess the competence training provided to ASHA workers at the chosen study sites. METHODOLOGY A cluster randomized control trial has been designed. It will be conducted across 8 centers in Hyderabad & Rangareddy districts of Telangana, India. The training will be provided to ASHA workers. The tool used for training will be developed from existing sources with an emphasis on topics which require training. The training will be delivered across 6 months at each center as a classroom training. Each participant's baseline competence will be recorded using a questionnaire tool and a practical evaluation by trained public health experts. The same experts will use the same tools to assess the training post the intervention. DISCUSSION This trial will evaluate the use of health worker training as a tool for improving the clinical competence in relation to type 2 diabetes mellitus. We anticipate that the module will provide a greater understanding of type 2 diabetes mellitus, the importance of screening of both disease and complications and improved skills for the same. The study has received the ethical approval form the Institutional Ethics Committee of the Indian Institute of Public Health Hyderabad. The registration number is: IIPHH/TRCIEC/218/2020. The trial has also been registered under the Clinical trial registry of India (CTRI) on 27 July 2020. The registration number of the trial is: CTRI/2020/07/026828. The URL of the registry trial is: http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=45342&EncHid=&userName=CTRI/2020/07/026828.
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Affiliation(s)
- Anirudh Gaurang Gudlavalleti
- Indian Institute of Public Health Hyderabad, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, India –
- CAPHRI CaRE and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Giridhara R. Babu
- Indian Institute of Public Health Hyderabad, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, India –
| | - Onno C.P. van Schayck
- CAPHRI CaRE and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Nicolaas C. Schaper
- CAPHRI CaRE and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Melissa Glenda Lewis
- Indian Institute of Public Health Hyderabad, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, India –
| | - G.V.S. Murthy
- Indian Institute of Public Health Hyderabad, Public Health Foundation of India, ANV Arcade, 1 Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, India –
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Suglo JN, Evans C. Factors influencing self-management in relation to type 2 diabetes in Africa: A qualitative systematic review. PLoS One 2020; 15:e0240938. [PMID: 33091039 PMCID: PMC7580976 DOI: 10.1371/journal.pone.0240938] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/05/2020] [Indexed: 12/30/2022] Open
Abstract
AIM Effective control of type 2 diabetes is predicated upon the ability of a person with diabetes to adhere to self-management activities. In order to develop and implement services that are locally relevant and culturally acceptable, it is critical to understand people's experiences of living with the disease. We synthesized qualitative research evidence describing the views and experiences of persons with type 2 diabetes in Africa regarding diabetes self-management. METHODS Five data bases (MEDLINE, EMBASE, PsychINFO, SCOPUS and CINAHL) were searched for qualitative studies published between the year 2000 and December 2019. After study selection, the included papers were critically appraised using an established tool. The data were extracted, and findings were coded and analysed to identify descriptive and analytical themes using a thematic synthesis approach. This review was registered in the international prospective register of systematic reviews (PROSPERO) with registration number CRD42018102255. RESULTS Sixteen studies were included in this review, representing a total of 426 participants across seven countries. Synthesis of findings produced six analytical themes. The diagnosis of diabetes triggered a range of emotions and revealed culturally specific understandings of the condition that negatively affected self-management practices. People with diabetes seeking health care at hospitals encountered several challenges including long waiting times and costly diabetes treatment. Family support and a state of acceptance of the condition were identified as facilitators to diabetes self-management. CONCLUSION Effective self-management of type 2 diabetes is a challenge for most persons with diabetes in Africa. There is an urgent need for culturally appropriate education strategies and restructuring of the health system to facilitate self-management of diabetes.
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Affiliation(s)
| | - Catrin Evans
- School of Health Sciences, The University of Nottingham, Nottingham, United Kingdom
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21
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Asante KP, Iwelunmor J, Apusiga K, Gyamfi J, Nyame S, Adjei KGA, Aifah A, Adjei K, Onakomaiya D, Chaplin WF, Ogedegbe G, Plange-Rhule J. Uptake of Task-Strengthening Strategy for Hypertension (TASSH) control within Community-Based Health Planning Services in Ghana: study protocol for a cluster randomized controlled trial. Trials 2020; 21:825. [PMID: 33008455 PMCID: PMC7530961 DOI: 10.1186/s13063-020-04667-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/09/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Physician shortage is a major barrier to hypertension (HTN) control in Ghana, with only one physician to 10,000 patients in 2015, thus limiting its capacity for HTN control at the primary care level such as the Community Health Planning and Services (CHPS) compounds, where most Ghanaians receive care. A Task-Shifting Strategy for HTN control (TASSH) based on the WHO Cardiovascular (CV) Risk Package is an evidence-based strategy for mitigating provider- and systems-level barriers to optimal HTN control. Despite its effectiveness, TASSH remains untested in CHPS zones. Additionally, primary care practices in low- and middle-income countries (LMICs) lack resources and expertise needed to coordinate multilevel system changes without assistance. The proposed study will evaluate the effectiveness of practice facilitation (PF) as a quality improvement strategy for implementing TASSH within CHPS zones in Ghana. METHODS Guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we will evaluate, in a hybrid clinical effectiveness-implementation design, the effect of PF on the uptake of an evidence-based TASSH, among 700 adults who present to 70 CHPS zones with uncontrolled HTN. Components of the PF strategy include (a) an advisory board that provides leadership support for implementing the intervention within the CHPS zones and (b) trained task-strengthening facilitators (TSFs) who serve as practice coaches to provide training, and performance feedback to community health officers (CHOs) who will deliver TASSH at the CHPS zones. For this purpose, the TSFs are trained to identify, counsel, and refer adults with uncontrolled HTN to community health centers in Bono East Region of Ghana. DISCUSSION Uptake of community-based evidence-supported interventions for hypertension control in Ghana is urgently needed to address the CVD epidemic and its associated morbidity, mortality, and societal costs. Findings from this study will provide policymakers and other stakeholders the "how to do it" empirical literature on the uptake of evidence-based task-strengthening interventions for HTN control in Ghana and will serve as a model for similar action in other low, middle-income countries. TRIAL REGISTRATION ClinicalTrials.gov, NCT03490695 . Registered on 6 April 2018. PROTOCOL VERSION AND DATE Version 1, date: 21 August, 2019.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo, Ghana.
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Kingsley Apusiga
- Department of Physiology, School of Medical Science, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Joyce Gyamfi
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Solomon Nyame
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo, Ghana
| | - Kezia Gladys Amaning Adjei
- Department of Physiology, School of Medical Science, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Angela Aifah
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Kwame Adjei
- Kintampo Health Research Centre, Ghana Health Service, P.O. Box 200, Kintampo, Ghana
| | | | | | - Gbenga Ogedegbe
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Jacob Plange-Rhule
- Department of Physiology, School of Medical Science, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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Baatiema L, Abimbola S, de-Graft Aikins A, Damasceno A, Kengne AP, Sarfo FS, Charway-Felli A, Somerset S. Towards evidence-based policies to strengthen acute stroke care in low-middle-income countries. J Neurol Sci 2020; 418:117117. [PMID: 32919367 DOI: 10.1016/j.jns.2020.117117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022]
Abstract
Stroke is a major public health issue in many low- and middle-income countries (LMICs). Despite the emergence of new effective interventions for acute stroke care, uptake remains slow and largely inaccessible to patients in LMICs, where health systems response has been inadequate. In this paper, we propose a policy framework to optimise access to acute stroke care in LMICs. We draw on evidence from relevant primary studies, such as availability of evidence-based acute stroke care interventions, barriers to uptake of interventions for stroke care and insights on stroke mortality and morbidity burden in LMICs. Insights from review of secondary studies, principally systematic reviews on evidence-based acute stroke care; and the accounts and experiences of some regional experts on stroke and other NCDs have been taken into consideration. In LMICs, there is limited availability and access to emergency medical transport services, brain imaging services and best practice interventions for acute stroke care. Availability of specialist acute stroke workforce and low awareness of early stroke signs and symptoms are also major challenges impeding the delivery of quality stroke care services. As a result, stroke care in LMICs is patchy, fragmented and often results in poor patient outcomes. Reconfiguration of LMIC health systems is thus required to optimise access to quality acute stroke care. We therefore propose a ten-point framework to be adapted to country-specific health system capacity, needs and resources: Emergency medical transport and treatment services, scaling-up interventions and services for acute stroke care, clinical guidelines for acute stroke treatment and management, access to brain imaging services, human resource capacity development strategies, centralisation of stroke services, tele-stroke care, public awareness campaigns on early stroke symptoms, establish stroke registers and financing of stroke care in LMICs. While we recognise the challenges of implementing the recommendations in low resource settings, this list can provide a platform as well serve as the starting point for advocacy and prioritisation of interventions depending on context.
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Affiliation(s)
- Leonard Baatiema
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
| | - Seye Abimbola
- School of Public Health, University of Sydney, Australia.
| | | | | | - Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Fred S Sarfo
- Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Komfo Anokye Teaching Hospital, Department of Medicine, Kumasi, Ghana.
| | | | - Shawn Somerset
- Faculty of Health, University of Canberra, Canberra, Australia.
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Utz B, Assarag B, Lekhal T, Van Damme W, De Brouwere V. Implementation of a new program of gestational diabetes screening and management in Morocco: a qualitative exploration of health workers' perceptions. BMC Pregnancy Childbirth 2020; 20:315. [PMID: 32448233 PMCID: PMC7245901 DOI: 10.1186/s12884-020-02979-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 04/30/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with an increased risk for a future type 2 diabetes mellitus in women and their children. As linkage between maternal health and non-communicable diseases, antenatal care plays a key role in the primary and secondary prevention of GDM associated adverse outcomes. While implementing a locally adapted GDM screening and management approach through antenatal care services at the primary level of care, we assessed its acceptability by the implementing health care providers. METHODS As part of a larger implementation effectiveness study assessing a decentralized gestational diabetes screening and management approach in the prefecture of Marrakech and the rural district of Al Haouz in Morocco, we conducted four focus group discussions with 29 primary health care providers and seven in-depth interviews with national and regional key informants. After transcription of data, we thematically analyzed the data using a combined deductive and inductive approach. RESULTS The intervention of screening and managing women with gestational diabetes added value to existing antenatal care services but presented an additional workload for first line health care providers. An existing lack of knowledge about gestational diabetes in the community and among private health care physicians required of public providers to spend more time on counselling women. Nurses had to adapt recommendations on diet to the socio-economic context of patients. Despite the additional task, especially nurses and midwives felt motivated by their gained capacity to detect and manage gestational diabetes, and to take decisions on treatment and follow-up. CONCLUSIONS Detection and initial management of gestational diabetes is an acceptable strategy to extend the antenatal care service offer in Morocco and to facilitate service access for affected pregnant women. Despite its additional workload, gestational diabetes management can contribute to the professional motivation of primary level health care providers. TRIAL REGISTRATION clinicaltrials.gov; NCT02979756.
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Affiliation(s)
- Bettina Utz
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | | | - Touria Lekhal
- Service des Réseaux des Etablissements de Santé, Ministry of Health, Marrakech, Morocco
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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Mustapha FI, Aagaard-Hansen J, Lim SC, Nasir NH, Aris T, Bjerre-Christensen U. Variations in the Delivery of Primary Diabetes Care in Malaysia: Lessons to Be Learnt and Potential for Improvement. Health Serv Res Manag Epidemiol 2020; 7:2333392820918744. [PMID: 32313820 PMCID: PMC7160766 DOI: 10.1177/2333392820918744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The article describes variations in the organization of clinical services for diabetes
patients in 10 public primary health clinics in Malaysia with the view to learn from
current innovations and improve diabetes service provision. Methods: This study combined the use of secondary data and a qualitative multicase study
approach applying observations in 10 randomly selected Ministry of Health (MOH) health
clinics in Kuala Lumpur and Selangor and semistructured interviews of the family
medicine specialists from the same clinics. Results: Although there are specific MOH guidelines for diabetes care, some clinics had
introduced innovations for diabetes care such as the novel ‘personalized care’,
‘one-stop-centre’ and utilization of patients’ waiting time for health education.
Analysis showed that there was room for improvement in terms of task shifting to free
precious time of staff with specialized functions, streamlining appointments for various
examinations, increasing continuity of consultations with same doctors, and monitoring
of performance. Conclusion: We contend that there is a potential for increased effectiveness and efficiency of
primary diabetes care in Malaysia without increasing the resources – a potential that
may be tapped into by systematic learning from ongoing innovation.
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Affiliation(s)
- Feisul Idzwan Mustapha
- Ministry of Health Malaysia Disease Control Division, Wilayah Persekutuan, Putrajaya, Malaysia
| | - Jens Aagaard-Hansen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | | | | | - Tahir Aris
- Institute for Public Health, Kuala Lumpur, Malaysia
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Integration of Chronic Oncology Services in Noncommunicable Disease Clinic in Rural Rwanda. Ann Glob Health 2020; 86:33. [PMID: 32257833 PMCID: PMC7101006 DOI: 10.5334/aogh.2697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: In rural sub-Saharan Africa, access to care for severe non-communicable diseases (NCDs) is limited due to myriad delivery challenges. We describe the implementation, patient characteristics, and retention rate of an integrated NCD clinic inclusive of cancer services at a district hospital in rural Rwanda. Methods: In 2006, the Rwandan Ministry of Health at Rwinkwavu District Hospital (RDH) and Partners In Health established an integrated NCD clinic focused on nurse-led care of severe NCDs, within a single delivery platform. Implementation modifications were made in 2011 to include cancer services. For this descriptive study, we abstracted medical record data for 15 months after first clinic visit for all patients who enrolled in the NCD clinic between 1 July 2012 and 30 June 2014. We report descriptive statistics of patient characteristics and retention. Results: Three hundred forty-seven patients enrolled during the study period: oncology – 71.8%, hypertension – 10.4%, heart failure – 11.0%, diabetes – 5.5%, and chronic respiratory disease (CRD) – 1.4%. Twelve-month retention rates were: oncology – 81.6%, CRD – 60.0%, hypertension – 75.0%, diabetes – 73.7%, and heart failure – 47.4%. Conclusions: The integrated NCD clinic filled a gap in accessible care for severe NCDs, including cancer, at rural district hospitals. This novel approach has illustrated good retention rates.
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Gyamfi J, Allegrante JP, Iwelunmor J, Williams O, Plange-Rhule J, Blackstone S, Ntim M, Apusiga K, Peprah E, Ogedegbe G. Application of the Consolidated Framework for Implementation Research to examine nurses' perception of the task shifting strategy for hypertension control trial in Ghana. BMC Health Serv Res 2020; 20:65. [PMID: 31996195 PMCID: PMC6990487 DOI: 10.1186/s12913-020-4912-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The burden of hypertension in many low-and middle-income countries is alarming and requires effective evidence-based preventative strategies that is carefully appraised and accepted by key stakeholders to ensure successful implementation and sustainability. We assessed nurses' perceptions of a recently completed Task Shifting Strategy for Hypertension control (TASSH) trial in Ghana, and facilitators and challenges to TASSH implementation. METHODS Focus group sessions and in-depth interviews were conducted with 27 community health nurses from participating health centers and district hospitals involved in the TASSH trial implemented in the Ashanti Region, Ghana, West Africa from 2012 to 2017. TASSH evaluated the comparative effectiveness of the WHO-PEN program versus provision of health insurance for blood pressure reduction in hypertensive adults. Qualitative data were analyzed using open and axial coding techniques with emerging themes mapped onto the Consolidated Framework for Implementation Research (CFIR). RESULTS Three themes emerged following deductive analysis using CFIR, including: (1) Patient health goal setting- relative priority and positive feedback from nurses, which motivated patients to make healthy behavior changes as a result of their health being a priority; (2) Leadership engagement (i.e., medical directors) which influenced the extent to which nurses were able to successfully implement TASSH in their various facilities, with most directors being very supportive; and (3) Availability of resources making it possible to implement the TASSH protocol, with limited space and personnel time to carry out TASSH duties, limited blood pressure (BP) monitoring equipment, and transportation, listed as barriers to effective implementation. CONCLUSION Assessing stakeholders' perception of the TASSH implementation process guided by CFIR is crucial as it provides a platform for the nurses to thoroughly evaluate the task shifting program, while considering the local context in which the program is implemented. The feedback from the nurses informed barriers and facilitators to implementation of TASSH within the current healthcare system, and suggested system level changes needed prior to scale-up of TASSH to other regions in Ghana with potential for long-term sustainment of the task shifting intervention. TRIAL REGISTRATION Trial registration for parent TASSH study: NCT01802372. Registered February 27, 2013.
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Affiliation(s)
- Joyce Gyamfi
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120 Street, New York, NY 10027 USA
| | - John P. Allegrante
- Department of Health and Behavior Studies, Teachers College, Columbia University, 525 West 120 Street, New York, NY 10027 USA
| | - Juliet Iwelunmor
- Behavioral Science and Health Education, College for Public Health and Social Justice, Salus Center, Saint Louis University, 3545 Lafayette Ave., Saint Louis, MO 63103 USA
| | - Olajide Williams
- Columbia University Medical Center, 710 West 168th Street, New York, NY 10032 USA
| | - Jacob Plange-Rhule
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
| | - Sarah Blackstone
- Health and Behavioral Studies Building, James Madison University, MSC 4301,235 Martin Luther King Jr Way, Harrisonburg, VA 22807 USA
| | - Michael Ntim
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
| | - Kingsley Apusiga
- Department of Physiology, Kwame Nkrumah University of Science and Technology, Private Mail Bag University Post Office KNUST, Kumasi, Ghana
- College of Global Public Health, New York University, 726 Broadway, New York, NY 10012 USA
| | - Emmanuel Peprah
- College of Global Public Health, New York University, 726 Broadway, New York, NY 10012 USA
| | - Gbenga Ogedegbe
- Department of Population Health/ Section for Global Health, NYU School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
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Agokeng Kemnang BD, Bita'a LB, Yomi SHS, Djidjou BT, Mboumo RM, Douanla CD, Wouafack-Kenfack V, Tsakeng FCN, Homla Megaptche OT, Ateudjieu J. Distribution et itinéraire thérapeutique des patients reçus pour accident vasculaire cérébral à l'Hôpital Régional de Bafoussam, Cameroun. Pan Afr Med J 2019; 34:174. [PMID: 32153714 PMCID: PMC7046109 DOI: 10.11604/pamj.2019.34.174.19928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/05/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Méthodes Résultats Conclusion
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Affiliation(s)
- Brice-Donald Agokeng Kemnang
- Département de Santé Publique, Faculté de Médecine et des Sciences Pharmaceutiques, Université de Dschang, Dschang, Cameroun
- Meilleur Accès aux Soins de Santé (M.A. SANTE), Mogode, Cameroun
| | | | - Styve Hermane Simo Yomi
- Département de Santé Publique, Faculté de Médecine et des Sciences Pharmaceutiques, Université de Dschang, Dschang, Cameroun
| | - Brice Tajo Djidjou
- Département de Santé Publique, Faculté de Médecine et des Sciences Pharmaceutiques, Université de Dschang, Dschang, Cameroun
| | - Romarique Medjou Mboumo
- Département de Santé Publique, Faculté de Médecine et des Sciences Pharmaceutiques, Université de Dschang, Dschang, Cameroun
- Meilleur Accès aux Soins de Santé (M.A. SANTE), Yaoundé, Cameroun
| | - Cyrielle Djouda Douanla
- Département de Santé Publique, Faculté de Médecine et des Sciences Pharmaceutiques, Université de Dschang, Dschang, Cameroun
| | - Victorien Wouafack-Kenfack
- Département de Santé Publique, Faculté de Médecine et des Sciences Pharmaceutiques, Université de Dschang, Dschang, Cameroun
| | - Franck-Carrel Nguetsa Tsakeng
- Département de Santé Publique, Faculté de Médecine et des Sciences Pharmaceutiques, Université de Dschang, Dschang, Cameroun
- Department of Medicine, Faculty of Health Science, University of Buea, Buea, Cameroon
| | - Olivia Tania Homla Megaptche
- Département de Santé Publique, Faculté de Médecine et des Sciences Pharmaceutiques, Université de Dschang, Dschang, Cameroun
| | - Jérôme Ateudjieu
- Département de Santé Publique, Faculté de Médecine et des Sciences Pharmaceutiques, Université de Dschang, Dschang, Cameroun
- Meilleur Accès aux Soins de Santé (M.A. SANTE), Yaoundé, Cameroun
- Division de la Recherche Opérationnelle en Santé, Ministère de la Santé Publique, Yaoundé, Cameroun
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Mercer T, Chang AC, Fischer L, Gardner A, Kerubo I, Tran DN, Laktabai J, Pastakia S. Mitigating The Burden Of Diabetes In Sub-Saharan Africa Through An Integrated Diagonal Health Systems Approach. Diabetes Metab Syndr Obes 2019; 12:2261-2272. [PMID: 31802925 PMCID: PMC6827510 DOI: 10.2147/dmso.s207427] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 07/16/2019] [Indexed: 12/14/2022] Open
Abstract
Diabetes is a chronic non-communicable disease (NCD) presenting growing health and economic burdens in sub-Saharan Africa (SSA). Diabetes is unique due to its cross-cutting nature, impacting multiple organ systems and increasing the risk for other communicable and non-communicable diseases. Unfortunately, the quality of care for diabetes in SSA is poor, largely due to a weak disease management framework and fragmented health systems in most sub-Saharan African countries. We argue that by synergizing disease-specific vertical programs with system-specific horizontal programs through an integrated disease-system diagonal approach, we can improve access, quality, and safety of diabetes care programs while also supporting other chronic diseases. We recommend utilizing the six World Health Organization (WHO) health system building blocks - 1) leadership and governance, 2) financing, 3) health workforce, 4) health information systems, 5) supply chains, and 6) service delivery - as a framework to design a diagonal approach with a focus on health system strengthening and integration to implement and scale quality diabetes care. We discuss the successes and challenges of this approach, outline opportunities for future care programming and research, and highlight how this approach can lead to the improvement in the quality of care for diabetes and other chronic diseases across SSA.
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Affiliation(s)
- Tim Mercer
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX78712, USA
| | | | - Lydia Fischer
- Department of Child Psychiatry, Indiana University School of Medicine, Indianapolis, IN46202, USA
| | - Adrian Gardner
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN46202, USA
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
- Indiana Institute for Global Health, Indianapolis, IN46202, USA
| | - Immaculate Kerubo
- Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya
- National Spinal Injury Referral Hospital, Nairobi, Kenya
| | - Dan N Tran
- Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Purdue Kenya Partnership P.O. Box 5760, Eldoret 30100, Kenya
| | - Jeremiah Laktabai
- Department of Family Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Sonak Pastakia
- Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Purdue Kenya Partnership P.O. Box 5760, Eldoret 30100, Kenya
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Systemic lupus erythematosus in Native sub-Saharan Africans: A systematic review and meta-analysis. J Autoimmun 2019; 106:102348. [PMID: 31668352 DOI: 10.1016/j.jaut.2019.102348] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The prevalence and phenotype of systemic lupus erythematosus (SLE) have not been thoroughly investigated in Native sub-Saharan Africans despite knowledge that the highest burden of SLE occurs in people with an African trait. Through this systematic review of literature and meta-analysis, we wished to fill this gap. METHODS PubMed, EMBASE, Web of Science, African Journals Online, and Global Index Medicus as well as references of retrieved papers were searched to select studies addressing SLE in Native sub-Saharan Africans and published between January 1, 2008 and October 7, 2018. The prevalence of SLE and its characteristics were pooled through narrative review and random-effects model. Heterogeneity (I2) was assessed via the χ2 test. Pooled estimates are expressed with 95% confidence intervals. This study is registered with PROSPERO: registration number CRD42019139226. RESULTS Out of 1502 papers, 15 hospital-based studies were included. The pooled prevalence of SLE among 28,575 participants was 1.7% (0.8-2.9), with substantial heterogeneity between studies (I2 = 96.9% [94.8%; 98.1%], τ2 = 0.0020, p < 0.0001). The mean age at diagnosis ranged from 28.8 to 39.2 years. The female proportion varied from 88% to 100%. Rheumatological (5.1%-99.9%), dermatological (4.3%-100%) and hematological (1.4-86.9%) manifestations were the commonest clinical features of SLE. Patients had a high seroprevalence for anti-ribonucleoprotein 57.9% (36.4-77.9), anti-Smith 53.5% (40.4-66.2), anti-Sjogren syndrome antigen A 45.6% (19.2-73.4) and anti-Sjogren syndrome antigen B 33.7% (13.6-57.6) autoantibodies. The most used treatments were corticosteroids 99% (94.9-100) and antimalarials 62. 8% (23.3-94.1). The pooled mortality rate was 10.3% (3.3-20.6) and death was mainly due to infections, kidney disease and neurological involvement. CONCLUSION Over the last 30 years, SLE was not rare among Native sub-Saharan Africans and its featured characteristics were earlier onset, female predominance, and high seropositivity for extractable nuclear antigen autoantibodies. Corticosteroids and antimalarials were the standard treatments. The mortality rate was high. Population prevalence and incidence as well as full description of SLE characteristics in Native sub-Saharan Africans are needed.
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Laar AK, Adler AJ, Kotoh AM, Legido-Quigley H, Lange IL, Perel P, Lamptey P. Health system challenges to hypertension and related non-communicable diseases prevention and treatment: perspectives from Ghanaian stakeholders. BMC Health Serv Res 2019; 19:693. [PMID: 31615529 PMCID: PMC6792211 DOI: 10.1186/s12913-019-4571-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognized as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. METHODS A total of 55 informants - comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policymakers - were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after giving informed consent. RESULTS Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, and the benefits, as well as drawbacks, of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers - increasing providers' knowledge on hypertension and patients' awareness of same- there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence and the phenomenon of medical pluralism in Ghana were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and similarly designed programmes. CONCLUSIONS This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.
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Affiliation(s)
- Amos K Laar
- Department of Population, Family, & Reproductive Health, School of Public Health, University of Ghana, LG 13, Legon, Accra, Ghana.
| | - Alma J Adler
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Agnes M Kotoh
- Department of Population, Family, & Reproductive Health, School of Public Health, University of Ghana, LG 13, Legon, Accra, Ghana
| | - Helena Legido-Quigley
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK.,Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Pulau Ujong, Singapore
| | - Isabelle L Lange
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK
| | - Peter Lamptey
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK.,Family Health International 360, DC, Washington, WA, USA
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Mogre V, Johnson NA, Tzelepis F, Shaw JE, Paul C. A systematic review of adherence to diabetes self‐care behaviours: Evidence from low‐ and middle‐income countries. J Adv Nurs 2019; 75:3374-3389. [DOI: 10.1111/jan.14190] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/20/2019] [Accepted: 08/05/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Victor Mogre
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Department of Health Professions Education School of Medicine and Health Sciences University for Development Studies Tamale Ghana
| | - Natalie A. Johnson
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
| | - Flora Tzelepis
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
- Hunter New England Population Health Hunter New England Local Health District Wallsend New South Wales Australia
| | | | - Christine Paul
- School of Medicine and Public Health University of Newcastle Callaghan New South Wales Australia
- Hunter Medical Research Institute New Lambton New South Wales Australia
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Pfaff C, Singano V, Akello H, Amberbir A, Berman J, Kwekwesa A, Banda V, Speight C, Allain T, van Oosterhout JJ. Early experiences integrating hypertension and diabetes screening and treatment in a human immunodeficiency virus clinic in Malawi. Int Health 2019; 10:495-501. [PMID: 30052987 DOI: 10.1093/inthealth/ihy049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/07/2018] [Indexed: 12/13/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) programmes can be leveraged to manage the growing burden of non-communicable diseases (NCDs). Methods In October 2015, a model of integrated HIV-NCD care was developed at a large HIV clinic in southeast Malawi. Blood pressure was measured in adults at every visit and random blood glucose was determined every 2 y. Uncomplicated antiretroviral therapy (ART)-only care was provided by nurses, integrated HIV-NCD management was provided by clinical officers. Waiting times were assessed using the electronic medical record system. The team met monthly to identify bottlenecks. Results All (n=6036) adult HIV patients were screened and 765 were diagnosed with hypertension (prevalence 12.7% [95% confidence interval {CI} 11.9-13.5). A total of 2979 adult HIV patients were screened and 25 were diagnosed with diabetes mellitus (prevalence 0.8% [95% CI 0.6-1.2]). The mean duration of ART visits by clinical officers increased from 80.5 to 90 min during the first quarter following HIV-NCD integration but returned to 75 min the following quarter. The mean number of patients seen per day by clinical officers increased from 6 to 11 and for nurses decreased from 92 to 82 in that time period. The robust vertical HIV system made the design of integrated tools demanding. Challenges of integrated HIV-NCD care were related to patient flow, waiting times, NCD drug availability, data collection, clinic workload and the timing of diabetes and hypertension screening. Conclusions Integrated HIV-NCD services provision was feasible in our clinic.
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Affiliation(s)
- Colin Pfaff
- Dignitas International, Zomba, Malawi.,College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | | | | | | | | | | | | | - Colin Speight
- Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Theresa Allain
- College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Joep J van Oosterhout
- Dignitas International, Zomba, Malawi.,College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
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Blackstone S, Iwelunmor J, Plange-Rhule J, Gyamfi J, Quakyi NK, Ntim M, Addison A, Ogedegbe G. 'I believe high blood pressure can kill me:' using the PEN-3 Cultural Model to understand patients' perceptions of an intervention to control hypertension in Ghana. ETHNICITY & HEALTH 2019; 24:257-270. [PMID: 28675047 DOI: 10.1080/13557858.2017.1346178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Currently in Ghana, there is an on-going task-shifting strategy in which nurses are trained in hypertension management. While this study will provide useful information on the viability of this approach, it is not clear how patients in the intervention perceive hypertension, the task-shifting strategy, and its effects on blood pressure management. The objective of this paper is to examine patients' perceptions of hypertension and hypertension management in the context of an on-going task-shifting intervention to manage blood pressure control in Ghana. DESIGN Forty-two patients participating in the Task Shifting Strategy for Hypertension program (23 males, 19 females, and mean age 61. 7 years) completed in-depth, qualitative interviews. Interviews were transcribed, and key words and phrases were extracted and coded using the PEN-3 Cultural Model as a guide through open and axial coding techniques, thus allowing rich exploration of the data. RESULTS Emergent themes included patients' perceptions of hypertension, which encompassed misperceptions of hypertension and blood pressure control. Additional themes included enablers and barriers to hypertension management, and how the intervention nurtured lifestyle change associated with blood pressure control. Primary enabling factors included the supportive nature of TASSH nurses, while notable barriers were financial constraints and difficulty accessing medication. Nurturing factors included the motivational interviewing and patient counseling which instilled confidence in the patients that they could make lasting behavior changes. CONCLUSIONS This study offers a unique perspective of blood pressure control by examining how patients view an on-going task-shifting initiative for hypertension management. The results of this study shed light on factors that can help and hinder individuals in low-resource settings with long-term blood pressure management.
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Affiliation(s)
- Sarah Blackstone
- a Department of Kinesiology and Community Health , University of Illinois Urbana-Champaign , Champaign , IL , USA
| | - Juliet Iwelunmor
- a Department of Kinesiology and Community Health , University of Illinois Urbana-Champaign , Champaign , IL , USA
| | - Jacob Plange-Rhule
- b Department of Physiology , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Joyce Gyamfi
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
| | - Nana Kofi Quakyi
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
| | - Micheal Ntim
- b Department of Physiology , Kwame Nkrumah University of Science and Technology , Kumasi , Ghana
| | - Abigail Addison
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
| | - Gbenga Ogedegbe
- c Department of Population Health, School of Medicine , New York University , New York , NY , USA
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Owolabi M, Sarfo FS, Akinyemi R, Gebreyohanns M, Ovbiagele B. The Sub-Saharan Africa Conference on Stroke (SSACS): An idea whose time has come. J Neurol Sci 2019; 400:194-198. [PMID: 30991160 DOI: 10.1016/j.jns.2019.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/28/2019] [Indexed: 12/19/2022]
Abstract
Stroke is a leading cause of global morbidity and mortality. Sub-Saharan Africa (SSA), where an unprecedented rise in stroke burden is currently raging, has the highest age-standardized stroke incidence, stroke prevalence, and stroke mortality rates. This is in sharp contrast to the relative decline in stroke incidence in high-income countries over the past four decades through better awareness and control of vascular risk factors. Compared to other groups, Africans tend to have a higher risk of stroke, higher percentage of the hemorrhagic type and much poorer outcomes. Indeed, stroke levies a heavy toll on the developing SSA economy by affecting a relatively younger age group. In this commentary, we examine the disproportionately high burden of stroke in the setting of grossly inadequate resources and evidence-based interventions. We propose an annual pan-regional stroke conference (starting in 2020) to harness global resources and local talent with the goal of galvanizing action to tackle this escalating burden. We anticipate that a successful conference series could become a rallying point for the eventual establishment of an African Stroke Organization.
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Affiliation(s)
- Mayowa Owolabi
- Department of Medicine, University of Ibadan, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University of Ibadan, Ibadan, Nigeria.
| | | | - Rufus Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
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Mogre V, Johnson NA, Tzelepis F, Paul C. Barriers to diabetic self-care: A qualitative study of patients' and healthcare providers' perspectives. J Clin Nurs 2019; 28:2296-2308. [PMID: 30791160 DOI: 10.1111/jocn.14835] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/15/2019] [Accepted: 02/12/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore patient and healthcare provider (HCP) perspectives about patients' barriers to the performance of diabetic self-care behaviours in Ghana. BACKGROUND Sub-Saharan African urban populations are increasingly affected by type 2 diabetes due to nutrition transition, sedentary lifestyles and ageing. Diabetic self-care is critical to improving clinical outcomes. However, little is known about barriers to diabetic self-care (diet, exercise, medication taking, self-monitoring of blood glucose and foot care) in sub-Saharan Africa. DESIGN Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. METHODS Semi-structured interviews were conducted among 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. Interviews were audiotaped and transcribed verbatim. The constant comparative method of data analysis was used and identified themes classified according to constructs of the theory of planned behaviour (TPB): attitudes/behavioural beliefs, subjective norms and perceived behavioural control. RESULTS Barriers relating to attitudes included misconceptions that diabetes was caused by spiritual forces or curses, use of herbal medicines, intentional nonadherence, difficulty changing old habits, and feeling or lacking motivation to exercise. Barriers relating to subjective norms were inadequate family support, social stigma (usually by spouses and other members of the community) and cultural beliefs. Perceived behavioural control barriers were poor income levels, lack of glucometers, busy work schedules, long distance to the hospital and inadequate access to variety of foods due to erratic supply of foods or seasonality. CONCLUSIONS Both patients and HCPs discussed similar barriers and those relating to attitude and behavioural control were commonly discussed. RELEVANCE TO CLINICAL PRACTICE Interventions to improve adherence to diabetic self-care should focus on helping persons with diabetes develop favourable attitudes and how to overcome behavioural control barriers. Such interventions should have both individualised and community-wide approaches.
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Affiliation(s)
- Victor Mogre
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Natalie A Johnson
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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Prevalence of dyslipidaemia among adults in Africa: a systematic review and meta-analysis. LANCET GLOBAL HEALTH 2019; 6:e998-e1007. [PMID: 30103999 DOI: 10.1016/s2214-109x(18)30275-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The burden of dyslipidaemia in Africa remains inadequately characterised. We aimed to estimate the prevalence of dyslipidaemia in African adults from hospital-based and community-based studies. METHODS In this systematic review and meta-analysis, we searched MEDLINE via PubMed, Embase, African Journals Online, and African Index Medicus for studies published between Jan 1, 1980, and July 31, 2017, without language restriction. We assessed methodological quality of all cross-sectional studies reporting on the prevalence of elevated concentrations of total cholesterol, LDL cholesterol, or triglycerides, or low concentrations of HDL cholesterol in adults residing in African countries. We excluded reports on Africans living outside Africa, studies of individuals selected on the basis of existing dyslipidaemia or those including children and adolescents, and case series with a small sample size. The most frequently used cutoffs in the included studies were chosen for the subgroup analysis. We used random-effect model meta-analysis to derive the pooled prevalence of elevated total cholesterol, low HDL cholesterol, elevated LDL cholesterol, and elevated triglyceride concentrations. This study is registered with PROSPERO, number CRD42014015376. FINDINGS 181 studies (309 207 participants) were included in the meta-analysis. The pooled prevalence of dyslipidaemia in the general population from population-based studies was 23·6% (95% CI 18·4-29·2) for elevated concentrations of total cholesterol with a cutoff of at least 5·2 mmol/L, 41·1% (33·0-49·4) for low concentrations of HDL cholesterol with a cutoff of less than 1·0 mmol/L, 25·7% (16·2-36·6) for elevated concentrations of LDL cholesterol with a cutoff of at least 3·3 mmol/L, and 16·5% (11·8-21·6) for elevated concentrations of triglycerides with a cutoff of at least 1·7 mmol/L. INTERPRETATION The prevalence of dyslipidaemia is high in the general adult population in Africa. Ongoing efforts to reduce cardiovascular diseases in Africa should integrate effective detection and treatment of dyslipidaemia. FUNDING None.
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Mikhael EM, Hassali MA, Hussain SA, Shawky N. Self-management knowledge and practice of type 2 diabetes mellitus patients in Baghdad, Iraq: a qualitative study. Diabetes Metab Syndr Obes 2018; 12:1-17. [PMID: 30588052 PMCID: PMC6301727 DOI: 10.2147/dmso.s183776] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and aim: Diabetes self-management behaviors are necessary to ensure optimum glycemic control. However, limited data were available regarding the practice of self-management by the Iraqi diabetic patients. This study aims to understand the knowledge, behaviors, and barriers of diabetes self-management among Iraqi type 2 diabetes mellitus (T2DM) patients in addition to their opinions and views toward the diabetes self-management educational program. METHODS A qualitative method approach was used to obtain the data from T2DM patients recruited from the National Diabetes Center, Baghdad, Iraq. Data were collected using a semi-structured interview guide, and a thematic analysis approach was used to process the data. RESULTS Most participants agreed to the importance of self-management practices especially healthy eating, exercise, taking medications, and healthy coping with stress to control DM and prevent its complications. Healthy eating and physical activity recommendations were inadequately practiced by most of the participants. Most participants reported irregular self-monitoring of blood glucose. Most of the participants properly adhered to the anti-diabetic medications. They generally lack proper information/knowledge about the importance of self-management practices of foot care and managing diabetes during sick days and how such practices should be implemented. Most participants have positive attitudes toward diabetes self-management practices. Face-to-face educational sessions are preferred by most patients. CONCLUSION The Iraqi diabetic patients have inadequate self-management behaviors. The main barrier to self-management practices was the lack of knowledge due to the absence of diabetes self-management educational programs in Iraq.
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Affiliation(s)
- Ehab Mudher Mikhael
- Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq,
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia,
| | - Mohamed Azmi Hassali
- Department of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia,
| | - Saad Abdulrahman Hussain
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Rafidain University College, Baghdad, Iraq
| | - Nizar Shawky
- Internal Medicine Department, National Diabetes Center, Al-Mustansiriyah University, Baghdad, Iraq
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Nelissen HE, Cremers AL, Okwor TJ, Kool S, van Leth F, Brewster L, Makinde O, Gerrets R, Hendriks ME, Schultsz C, Osibogun A, van’t Hoog AH. Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria - a mixed methods feasibility study. BMC Health Serv Res 2018; 18:934. [PMID: 30514376 PMCID: PMC6277995 DOI: 10.1186/s12913-018-3740-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/20/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Access to quality hypertension care is often poor in sub-Saharan Africa. Some community pharmacies offer hypertension monitoring services, with and without involvement of medical doctors. To directly connect pharmacy staff and cardiologists a care model including a mobile application (mHealth) for remote patient monitoring was implemented and pilot tested in Lagos, Nigeria. Pharmacists provided blood pressure measurements and counselling. Cardiologists enrolled patients in the pilot program and remotely monitored them, for which patients paid a monthly fee. We evaluated the feasibility of this care model at five private community pharmacies. Outcome measures were retention in care, blood pressure change, quality of care, and patients' and healthcare providers' satisfaction with the care model. METHODS Patients participated in the care model's pilot at one of the five pharmacies for approximately 6-8 months from February 2016. We conducted structured patient interviews and blood pressure measurements at pilot entry and exit, and used exports of the mHealth-application, in-depth interviews and focus group discussions with patients, pharmacists and cardiologists. RESULTS Of 336 enrolled patients, 236 (72%) were interviewed at pilot entry and exit. According to the mHealth data 71% returned to the pharmacy after enrollment, with 3.3 months (IQR: 2.2-5.4) median duration of activity in the mHealth-application. Patients self-reported more visits than recorded in the mHealth data. Pharmacists mentioned use of paper records, understaffing, the application not being user-friendly, and patients' unwillingness to pay as reasons for underreporting. Mean systolic blood pressure decreased 9.9 mmHg (SD: 18). Blood pressure on target increased from 24 to 56% and an additional 10% had an improved blood pressure at endline, however this was not associated with duration of mHealth activity. Patients were satisfied because of accessibility, attention, adherence and information provision. CONCLUSION Patients, pharmacists and cardiologists adopted the care model, albeit with gaps in mHealth data. Most patients were satisfied, and their mean blood pressure significantly reduced. Usage of the mHealth application, pharmacy incentives, and a modified financing model are opportunities for improvement. In addition, costs of implementation and availability of involved healthcare providers need to be investigated before such a care model can be further implemented.
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Affiliation(s)
- Heleen E. Nelissen
- Department of Global Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, Amsterdam, The Netherlands
| | - Anne L. Cremers
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, Amsterdam, The Netherlands
- Department of Anthropology, University of Amsterdam, Nieuwe Achtergracht 166, Amsterdam, The Netherlands
- Department of Infectious Diseases, Division of Internal Medicine, Amsterdam UMC, University of Amsterdam, Center of Tropical Medicine and Travel Medicine, Meibergdreef 9, Amsterdam, The Netherlands
| | - Tochi J. Okwor
- Centre for Epidemiology and Health Development, Ibeju, Lekki, Lagos Nigeria
- Department of Community Health, University of Nigeria Teaching Hospital Enugu, P.M.B, Enugu, 01129 Nigeria
| | - Sam Kool
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, Amsterdam, The Netherlands
| | - Lizzy Brewster
- Department of Global Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, Amsterdam, The Netherlands
| | - Olalekan Makinde
- Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - René Gerrets
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, Amsterdam, The Netherlands
- Department of Anthropology, University of Amsterdam, Nieuwe Achtergracht 166, Amsterdam, The Netherlands
| | | | - Constance Schultsz
- Department of Global Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, Amsterdam, The Netherlands
| | - Akin Osibogun
- Centre for Epidemiology and Health Development, Ibeju, Lekki, Lagos Nigeria
- Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Anja H. van’t Hoog
- Department of Global Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Paasheuvelweg 25, Amsterdam, The Netherlands
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Passchier RV, Abas MA, Ebuenyi ID, Pariante CM. Effectiveness of depression interventions for people living with HIV in Sub-Saharan Africa: A systematic review & meta-analysis of psychological & immunological outcomes. Brain Behav Immun 2018; 73:261-273. [PMID: 29768184 DOI: 10.1016/j.bbi.2018.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 12/20/2022] Open
Abstract
This meta-analytic review evaluated the effectiveness of depression interventions on the psychological and immunological outcomes of people living with HIV in sub-Saharan Africa. 14 studies, yielding 932 participants were eligible. A random-effects models indicated that depression interventions were followed by large reductions in depression scores (effect size = 1.86, 95% CI = 1.71, 2.01, p < 0.01). No significant effect on immune outcome was observed, however there was a trend toward immune improvement of medium effect size (effect size on CD4 count and/or viral suppression = 0.57, 95% CI = -0.06, 1.20, p = 0.08). Pharmacological interventions appeared to have a significantly larger improvement in depression scores than psychological interventions. The greatest improvement in immune status was demonstrated in psychological treatments which incorporated a component to enhance HIV medication adherence, however these results did not reach significance. Small sample sizes and highly heterogeneous analysis necessitate caution in interpretation. The results of this meta-analysis should thus be treated as preliminary evidence and used to encourage further studies of immunopsychiatry in HIV in sub-Saharan Africa.
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Affiliation(s)
- Ruth Verity Passchier
- University of Cape Town, Department of Psychiatry and Mental Health, Anzio Road, Observatory, Cape Town, South Africa.
| | - Melanie Amna Abas
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London SE5 8AF, United Kingdom
| | - Ikenna D Ebuenyi
- Vrije Universiteit Amsterdam, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Netherlands
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London SE5 9RT, United Kingdom
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Awolude OA, Oyerinde SO, Akinyemi JO. Screen and Triage by Community Extension Workers to Facilitate Screen and Treat: Task-Sharing Strategy to Achieve Universal Coverage for Cervical Cancer Screening in Nigeria. J Glob Oncol 2018; 4:1-10. [PMID: 30085882 PMCID: PMC6223525 DOI: 10.1200/jgo.18.00023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Universal coverage of cervical cancer screening remains elusive in most low- and middle-income countries (LMICs), home to the greatest burden of this preventable disease. Implementation of a cytology-based screening strategy in these countries is challenging. Also, there is shortage of health care workers (HCWs) to implement the low-technology, cheaper, but equally effective, methods like visual inspection with acetic acid. However, the implementation of HIV programs in LMICs has introduced the innovation of task shifting and task sharing, using the community health extension workers (CHEWs) and community health officers (CHOs) to complement clinical HCWs, especially at the primary health care, level with good outcome. Hence, this study leveraged this strategy. Methods We piloted a study to improve knowledge and practice skills of CHEWs and CHOs in a rural community of Oyo state, Nigeria, through training and participatory supervision to screen for cervical cancer using visual inspection with acetic acid and link positive cases for treatment with cryotherapy. Results A total of 51 HCWs, including doctors, nurses, CHEWs, and CHOs, were trained during the study to provide cervical cancer screening services. After the training, cervical cancer and its prevention knowledge improved from 52.4% before training to 91.5% immediate after training. Over 12 months, 950 eligible women were screened, of whom 848 (89.3%) were screened by CHEWs and CHOs. Of the 63 rescreened by CHEWs and CHOs (data grouped), and nurses, 88.1% and 92.3%, respectively, agreed with expert team review, with κ statistics of 0.76 and 0.84, respectively. Conclusion This pilot project showed the ability of CHEWs and CHOs to identify cervical dysplasia was good and that of nurses was very good with appropriate competency training to achieve universal coverage of cervical cancer screening in LMICs.
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Affiliation(s)
- Olutosin A Awolude
- Olutosin A. Awolude, Joshua O. Akinyemi, College of Medicine, University of Ibadan; Olutosin A. Awolude and Sunday O. Oyerinde, University College Hospital, Ibadan, Nigeria
| | - Sunday O Oyerinde
- Olutosin A. Awolude, Joshua O. Akinyemi, College of Medicine, University of Ibadan; Olutosin A. Awolude and Sunday O. Oyerinde, University College Hospital, Ibadan, Nigeria
| | - Joshua O Akinyemi
- Olutosin A. Awolude, Joshua O. Akinyemi, College of Medicine, University of Ibadan; Olutosin A. Awolude and Sunday O. Oyerinde, University College Hospital, Ibadan, Nigeria
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Bollyky TJ, Templin T, Cohen M, Dieleman JL. Lower-Income Countries That Face The Most Rapid Shift In Noncommunicable Disease Burden Are Also The Least Prepared. Health Aff (Millwood) 2018; 36:1866-1875. [PMID: 29137514 PMCID: PMC7705176 DOI: 10.1377/hlthaff.2017.0708] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Demographic and epidemiological changes are shifting the disease burden from communicable to noncommunicable diseases in lower-income countries. Within a generation, the share of disease burden attributed to noncommunicable diseases in some poor countries will exceed 80 percent, rivaling that of rich countries, but this burden is likely to affect much younger people in poorer countries. The health systems of lower-income countries are unprepared for this change. We examined the shift to noncommunicable diseases and estimated preparedness for the shift by ranking 172 nations using a health system capacity index for noncommunicable disease. We project that the countries with the greatest increases in the share of disease burden attributable to noncommunicable disease over the next twenty-five years will also be the least prepared for the change, as they ranked low on our capacity index and are expected to have the smallest increases in national health spending. National governments and donors must invest more in preparing the health systems of lower-income countries for the dramatic shift to noncommunicable diseases and in reducing modifiable noncommunicable disease risks.
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Affiliation(s)
- Thomas J Bollyky
- Thomas J. Bollyky is a senior fellow for global health, economics, and development at the Council on Foreign Relations, in Washington, D.C
| | - Tara Templin
- Tara Templin is a graduate student in the Department of Health Research and Policy, Stanford University, in Palo Alto, California
| | - Matthew Cohen
- Matthew Cohen is a research associate for global health, economics, and development at the Council on Foreign Relations
| | - Joseph L Dieleman
- Joseph L. Dieleman ( ) is an assistant professor at the Institute for Health Metrics and Evaluation, University of Washington, in Seattle
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Strengthening the health workforce to support integration of HIV and noncommunicable disease services in sub-Saharan Africa. AIDS 2018; 32 Suppl 1:S47-S54. [PMID: 29952790 DOI: 10.1097/qad.0000000000001895] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The successful expansion of HIV services in sub-Saharan Africa has been a signature achievement of global public health. This article explores health workforce-related lessons from HIV scale-up, their implications for integrating noncommunicable disease (NCD) services into HIV programs, ways to ensure that healthcare workers have the knowledge, skills, resources, and enabling environment they need to provide comprehensive integrated HIV/NCD services, and discussion of a priority research agenda. DESIGN AND METHODS We conducted a scoping review of the published and 'gray' literature and drew upon our cumulative experience designing, implementing and evaluating HIV and NCD programs in low-resource settings. RESULTS AND CONCLUSION Lessons learned from HIV programs include the role of task shifting and the optimal use of multidisciplinary teams. A responsible and adaptable policy environment is also imperative; norms and regulations must keep pace with the growing evidence base for task sharing, and early engagement of regulatory authorities will be needed for successful HIV/NCD integration. Ex-ante consideration of work culture will also be vital, given its impact on the quality of service delivery. Finally, capacity building of a robust interdisciplinary workforce is essential to foster integrated patient-centered care. To succeed, close collaboration between the health and higher education sectors is needed and comprehensive competency-based capacity building plans for various health worker cadres along the education and training continuum are required. We also outline research priorities for HIV/NCD integration in three key domains: governance and policy; education, training, and management; and service delivery.
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Spies LA, Bader SG, Opollo JG, Gray J. Nurse-Led Interventions for Hypertension: A Scoping Review With Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2018; 15:247-256. [DOI: 10.1111/wvn.12297] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Lori A. Spies
- Assistant Professor, Baylor University; Louise Herrington School of Nursing; Dallas TX USA
| | - Susan Gerding Bader
- Medical Librarian, Baylor University; Louise Herrington School of Nursing; Dallas TX USA
| | - Jackline G. Opollo
- Director, Professional Practice & Nursing Research; Parkland Health and Hospital Systems; Dallas TX USA
| | - Jennifer Gray
- Associate Dean, College of Natural and Health Sciences; Oklahoma Christian University; Edmond OK USA
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Fuhs AK, LaGrone LN, Moscoso Porras MG, Rodríguez Castro MJ, Ecos Quispe RL, Mock CN. Assessment of Rehabilitation Infrastructure in Peru. Arch Phys Med Rehabil 2018; 99:1116-1123. [PMID: 29162468 PMCID: PMC5962371 DOI: 10.1016/j.apmr.2017.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 10/19/2017] [Accepted: 10/21/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess rehabilitation infrastructure in Peru in terms of the World Health Organization (WHO) health systems building blocks. DESIGN Anonymous quantitative survey; questions were based on the WHO's Guidelines for Essential Trauma Care and rehabilitation professionals' input. SETTING Large public hospitals and referral centers and an online survey platform. PARTICIPANTS Convenience sample of hospital personnel working in rehabilitation and neurology (N=239), recruited through existing contacts and professional societies. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Outcome measures were for 4 WHO domains: health workforce, health service delivery, essential medical products and technologies, and health information systems. RESULTS Regarding the domain of health workforce, 47% of physical therapists, 50% of occupational therapists, and 22% of physiatrists never see inpatients. Few reported rehabilitative nurses (15%) or prosthetist/orthotists (14%) at their hospitals. Even at the largest hospitals, most reported ≤3 occupational therapists (54%) and speech-language pathologists (70%). At hospitals without speech-language pathologists, physical therapists (49%) or nobody (34%) perform speech-language pathology roles. At hospitals without occupational therapists, physical therapists most commonly (59%) perform occupational therapy tasks. Alternate prosthetist/orthotist task performers are occupational therapists (26%), physical therapists (19%), and physicians (16%). Forty-four percent reported interdisciplinary collaboration. Regarding the domain of health services, the most frequent inpatient and outpatient rehabilitation barriers were referral delays (50%) and distance/transportation (39%), respectively. Regarding the domain of health information systems, 28% reported rehabilitation service data collection. Regarding the domain of essential medical products and technologies, electrophysical agents (88%), gyms (81%), and electromyography (76%) were most common; thickened liquids (19%), swallow studies (24%), and cognitive training tools (28%) were least frequent. CONCLUSIONS Rehabilitation emphasis is on outpatient services, and there are comparatively adequate numbers of physical therapists and physiatrists relative to rehabilitation personnel. Financial barriers seem low for accessing existing services. There appear to be shortages of inpatient rehabilitation, specialized services, and interdisciplinary collaboration. These may be addressed by redistributing personnel and investing in education and equipment for specialized services. Further examination of task sharing's role in Peru's rehabilitation services is necessary to evaluate its potential to address deficiencies.
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Affiliation(s)
| | | | - Miguel G Moscoso Porras
- School of Physical Therapy, Peruvian University of Applied Sciences, Lima, Peru; Association for the Development of Student Research in Health Sciences, San Marcos Major National University, Lima, Peru
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Tianyi FL, Agbor VN, Njamnshi AK. Prevalence, awareness, treatment, and control of hypertension in Cameroonians aged 50 years and older: A community-based study. Health Sci Rep 2018; 1:e44. [PMID: 30623073 PMCID: PMC6266375 DOI: 10.1002/hsr2.44] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/18/2018] [Accepted: 04/02/2018] [Indexed: 01/11/2023] Open
Abstract
AIMS To assess the prevalence of hypertension (HTN) in a rural elderly population (50 y and older) in Cameroon; evaluate the rates of awareness, treatment, and control of HTN in this population; and describe factors associated with HTN in this population. METHODS AND RESULTS A total of 501 participants aged 50 years and older were randomly recruited from May to July 2013 in a house-to-house survey of the Batibo Health District. Data were measured using standardized methods modelled after the World Health Organization STEPwise approach to Surveillance. The Statistical Package for the Social Sciences version 20.0 was used for statistical analysis. Chi-square, Fisher's exact or Student T test were used to compare variables. A multivariable logistic regression analysis was used to identify factors associated with HTN in this population. In our study population, 31% of the participants were men, with a mean age of 65.4 ± 8 years; women had a mean age of 61.4 ± 9 years. The prevalence of HTN was 57.3% (95% CI, 52.9-61.6). The awareness rate was 63.4%, treatment rate 96.7%, and control rate 32.4%. Being overweight/obese was independently associated with HTN in this group (odds ratio = 3.46; 95% CI, 2.38-5.03; P < .001). CONCLUSION The prevalence of HTN amongst the elderly in the Batibo Health District is high. Emphasis should be on patient education to improve the rates of blood pressure control amongst patients on treatment for HTN. Healthy lifestyle measures such as reduction in salt intake and increase in physical exercise should be encouraged amongst the elderly.
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Affiliation(s)
- Frank L. Tianyi
- Mayo‐Darlé Sub‐divisional HospitalBanyoAdamawa RegionCameroon
| | | | - Alfred K. Njamnshi
- Faculty of Medicine and Biomedical SciencesThe University of Yaoundé IYaoundéCameroon
- Brain Research Africa Initiative (BRAIN)YaoundeCameroon
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Ogedegbe G, Plange-Rhule J, Gyamfi J, Chaplin W, Ntim M, Apusiga K, Iwelunmor J, Awudzi KY, Quakyi KN, Mogaverro J, Khurshid K, Tayo B, Cooper R. Health insurance coverage with or without a nurse-led task shifting strategy for hypertension control: A pragmatic cluster randomized trial in Ghana. PLoS Med 2018; 15:e1002561. [PMID: 29715303 PMCID: PMC5929500 DOI: 10.1371/journal.pmed.1002561] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/26/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Poor access to care and physician shortage are major barriers to hypertension control in sub-Saharan Africa. Implementation of evidence-based systems-level strategies targeted at these barriers are lacking. We conducted a study to evaluate the comparative effectiveness of provision of health insurance coverage (HIC) alone versus a nurse-led task shifting strategy for hypertension control (TASSH) plus HIC on systolic blood pressure (SBP) reduction among patients with uncontrolled hypertension in Ghana. METHODS AND FINDINGS Using a pragmatic cluster randomized trial, 32 community health centers within Ghana's public healthcare system were randomly assigned to either HIC alone or TASSH + HIC. A total of 757 patients with uncontrolled hypertension were recruited between November 28, 2012, and June 11, 2014, and followed up to October 7, 2016. Both intervention groups received health insurance coverage plus scheduled nurse visits, while TASSH + HIC comprised cardiovascular risk assessment, lifestyle counseling, and initiation/titration of antihypertensive medications for 12 months, delivered by trained nurses within the healthcare system. The primary outcome was change in SBP from baseline to 12 months. Secondary outcomes included lifestyle behaviors and blood pressure control at 12 months and sustainability of SBP reduction at 24 months. Of the 757 patients (389 in the HIC group and 368 in the TASSH + HIC group), 85% had 12-month data available (60% women, mean BP 155.9/89.6 mm Hg). In intention-to-treat analyses adjusted for clustering, the TASSH + HIC group had a greater SBP reduction (-20.4 mm Hg; 95% CI -25.2 to -15.6) than the HIC group (-16.8 mm Hg; 95% CI -19.2 to -15.6), with a statistically significant between-group difference of -3.6 mm Hg (95% CI -6.1 to -0.5; p = 0.021). Blood pressure control improved significantly in both groups (55.2%, 95% CI 50.0% to 60.3%, for the TASSH + HIC group versus 49.9%, 95% CI 44.9% to 54.9%, for the HIC group), with a non-significant between-group difference of 5.2% (95% CI -1.8% to 12.4%; p = 0.29). Lifestyle behaviors did not change appreciably in either group. Twenty-one adverse events were reported (9 and 12 in the TASSH + HIC and HIC groups, respectively). The main study limitation is the lack of cost-effectiveness analysis to determine the additional costs and benefits, if any, of the TASSH + HIC group. CONCLUSIONS Provision of health insurance coverage plus a nurse-led task shifting strategy was associated with a greater reduction in SBP than provision of health insurance coverage alone, among patients with uncontrolled hypertension in Ghana. Future scale-up of these systems-level strategies for hypertension control in sub-Saharan Africa requires a cost-benefit analysis. TRIAL REGISTRATION ClinicalTrials.gov NCT01802372.
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Affiliation(s)
- Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
- * E-mail:
| | - Jacob Plange-Rhule
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joyce Gyamfi
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
| | - William Chaplin
- Department of Psychology, St. John’s University, Queens, New York, United States of America
| | - Michael Ntim
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kingsley Apusiga
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, United States of America
| | | | - Kofi Nana Quakyi
- College of Global Public Health, New York Unversity, New York, New York, United States of America
| | - Jazmin Mogaverro
- Department of Psychology, St. John’s University, Queens, New York, United States of America
| | - Kiran Khurshid
- Department of Psychology, St. John’s University, Queens, New York, United States of America
| | - Bamidele Tayo
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, United States of America
| | - Richard Cooper
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, United States of America
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Kushitor MK, Boatemaa S. The double burden of disease and the challenge of health access: Evidence from Access, Bottlenecks, Cost and Equity facility survey in Ghana. PLoS One 2018; 13:e0194677. [PMID: 29570720 PMCID: PMC5865721 DOI: 10.1371/journal.pone.0194677] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 03/07/2018] [Indexed: 11/18/2022] Open
Abstract
Despite the double burden of infectious and chronic non-communicable diseases in Africa, health care expenditure disproportionately favours infectious diseases. In this paper, we examine quantitatively the extent of this disproportionate access to diagnoses and treatment of diabetes, hypertension and malaria in Ghana. A total of 220 health facilities was surveyed across the country in 2011. Findings indicate that diagnoses and treatment of infectious diseases were more accessible than NCDs. In terms of treatment, 78% and 87% of health facilities had two of the recommended malaria drugs while less than 35% had essential diabetes and hypertension drugs. There is a significant unmet need for diagnoses and treatment of NCDs in Ghana. These inequities have implications for high morbidity and mortality from NCDs. We recommend the use of task shifting as a model to increase the delivery of NCD services.
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Affiliation(s)
| | - Sandra Boatemaa
- Regional Institute for Population Studies, University of Ghana, Legon, Accra, Ghana
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McDonald CL, Fuhs AK, Kartin D. An examination of current stroke rehabilitation practice in Peru: Implications for interprofessional education. J Interprof Care 2018; 32:329-338. [PMID: 29364739 DOI: 10.1080/13561820.2018.1425290] [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: 10/18/2022]
Abstract
This study aimed to better understand current clinical practice of rehabilitation professionals in Lima, Peru, and to explore the existence of and potential for interprofessional collaboration. A secondary purpose was to assess rehabilitation professionals' agreement with evidence-based stroke rehabilitation statements and confidence performing stroke rehabilitation tasks prior to and following an interprofessional stroke rehabilitation training. Current clinical practice for rehabilitation professionals in Peru differs from high-income counties like the United States, as physical therapists work with dysphagia and feeding, prosthetist orthotists serve a strictly technical role, and nurses have a limited role in rehabilitation. Additionally, while opportunity for future interprofessional collaboration within stroke rehabilitation exists, it appears to be discouraged by current health system policies. Pre- and post-training surveys were conducted with a convenience sample of 107 rehabilitation professionals in Peru. Survey response options included endorsement of professionals for rehabilitation tasks and a Likert scale of agreement and confidence. Training participants largely agreed with evidence-based stroke rehabilitation statements. Differences in opinion remained regarding the prevalence of dysphagia and optimal frequency of therapy post-stroke. Substantially increased agreement post-training was seen in favour of early initiation of stroke rehabilitation and ankle foot orthosis use. Participants were generally confident performing traditional profession-specific interventions and educating patients and families. Substantial increases were seen in respondents' confidence to safely and independently conduct bed to chair transfers and determine physiological stability. Identification of key differences in rehabilitation professionals' clinical practice in Peru is a first step toward strengthening the development of sustainable rehabilitation systems and interprofessional collaboration.
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Affiliation(s)
- Cody L McDonald
- a Department of Rehabilitation Medicine , University of Washington , Seattle , USA.,b Department of Global Health , University of Washington , Seattle , USA
| | - Amy K Fuhs
- a Department of Rehabilitation Medicine , University of Washington , Seattle , USA
| | - Deborah Kartin
- a Department of Rehabilitation Medicine , University of Washington , Seattle , USA
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Lulebo AM, Kaba DK, Atake SEH, Mapatano MA, Mafuta EM, Mampunza JM, Coppieters Y. Task shifting in the management of hypertension in Kinshasa, Democratic Republic of Congo: a cross-sectional study. BMC Health Serv Res 2017; 17:698. [PMID: 29219082 PMCID: PMC5773873 DOI: 10.1186/s12913-017-2645-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background The Democratic Republic of the Congo (DRC) is characterized by a high prevalence of hypertension (HTN) and a high proportion of uncontrolled HTN, which is indicative of poor HTN management. Effective management of HTN in the African region is challenging due to limited resources, particularly human resources for health. To address the shortage of health workers, the World Health Organization (WHO) recommends task shifting for better disease management and treatment. Although task shifting from doctors to nurses is being implemented in the DRC, there are no studies, to the best of our knowledge, that document the association between task shifting and HTN control. The aim of this study was to investigate the association between task shifting and HTN control in Kinshasa, DRC. Methods We conducted a cross-sectional study in Kinshasa from December 2015 to January 2016 in five general referral hospitals (GRHs) and nine health centers (HCs). A total of 260 hypertensive patients participated in the study. Sociodemographic, clinical, health care costs and perceived health care quality assessment data were collected using a structured questionnaire. To examine the association between task shifting and HTN control, we assessed differences between GRH and HC patients using bivariate and multivariate analyses. Results Almost half the patients were female (53.1%), patients’ mean age was 59.5 ± 11.4 years. Over three-fourths of patients had uncontrolled HTN. There was no significant difference in the proportion of GRH and HC patients with uncontrolled HTN (76.2% vs 77.7%, p = 0.771). Uncontrolled HTN was associated with co-morbidity (OR = 10.3; 95% CI: 3.8–28.3) and the type of antihypertensive drug used (OR = 4.6; 95% CI: 1.3–16.1). The mean healthcare costs in the GRHs were significantly higher than costs in the HCs (US$ 34.2 ± US$3.34 versus US$ 7.7 ± US$ 0.6, respectively). Conclusion Uncontrolled HTN was not associated with the type of health facility. This finding suggests that the management of HTN at primary healthcare level might be just as effective as at secondary level. However, the high proportion of patients with uncontrolled HTN underscores the need for HTN management guidelines at all healthcare levels.
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Affiliation(s)
- Aimée M Lulebo
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
| | - Didine K Kaba
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Mala A Mapatano
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Eric M Mafuta
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Julien M Mampunza
- Programme de santé en milieu rural (SANRU), Kongo-central, Matadi, Democratic Republic of the Congo
| | - Yves Coppieters
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
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Ndayisaba A, Harerimana E, Borg R, Miller AC, Kirk CM, Hann K, Hirschhorn LR, Manzi A, Ngoga G, Dusabeyezu S, Mutumbira C, Mpunga T, Ngamije P, Nkikabahizi F, Mubiligi J, Niyonsenga SP, Bavuma C, Park PH. A Clinical Mentorship and Quality Improvement Program to Support Health Center Nurses Manage Type 2 Diabetes in Rural Rwanda. J Diabetes Res 2017; 2017:2657820. [PMID: 29362719 PMCID: PMC5738565 DOI: 10.1155/2017/2657820] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/08/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The prevalence of diabetes mellitus is rapidly rising in SSA. Interventions are needed to support the decentralization of services to improve and expand access to care. We describe a clinical mentorship and quality improvement program that connected nurse mentors with nurse mentees to support the decentralization of type 2 diabetes care in rural Rwanda. METHODS This is a descriptive study. Routinely collected data from patients with type 2 diabetes cared for at rural health center NCD clinics between January 1, 2013 and December 31, 2015, were extracted from EMR system. Data collected as part of the clinical mentorship program were extracted from an electronic database. Summary statistics are reported. RESULTS The patient population reflects the rural settings, with low rates of traditional NCD risk factors: 5.6% of patients were current smokers, 11.0% were current consumers of alcohol, and 11.9% were obese. Of 263 observed nurse mentee-patient encounters, mentor and mentee agreed on diagnosis 94.4% of the time. Similarly, agreement levels were high for medication, laboratory exam, and follow-up plans, at 86.3%, 87.1%, and 92.4%, respectively. CONCLUSION Nurses that receive mentorship can adhere to a type 2 diabetes treatment protocol in rural Rwanda primary health care settings.
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Affiliation(s)
| | | | - Ryan Borg
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | | | | | | | - Gedeon Ngoga
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | | | | | | | - Joel Mubiligi
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Charlotte Bavuma
- Ministry of Health, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Paul H. Park
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
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