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Baatiema L, Strachan DL, Okoibhole LO, Kretchy IA, Kushitor M, Awuah RB, Sanuade OA, Korleki Danyki E, Amon S, Adjaye-Gbewonyo K, Yacobi H, Vaughan M, Blandford A, Antwi P, Jennings HM, Arhinful DK, de-Graft Aikins A, Fottrell E, Diabetes Team TCARE. Contextual awareness, response and evaluation (CARE) of diabetes in poor urban communities in Ghana: the CARE diabetes project qualitative study protocol. Glob Health Action 2024; 17:2364498. [PMID: 39011874 PMCID: PMC467110 DOI: 10.1080/16549716.2024.2364498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/19/2024] [Indexed: 07/17/2024] Open
Abstract
Diabetes remains a major, global clinical and public health threat with consistent rises in prevalence around the world over the past four decades. Two-thirds of the projected increases in global diabetes prevalence to 2045 are expected to come from low- and middle-income countries, including those in sub-Saharan Africa. Ghana is typical of this trend. However, there are gaps in evidence regarding the appropriate development of interventions and well-targeted policies for diabetes prevention and treatment that pay due attention to relevant local conditions and influences. Due consideration to community perspectives of environmental influences on the causes of diabetes, access to appropriate health services and care seeking for diabetes prevention and management is warranted, especially in urban settings. The 'Contextual Awareness, Response and Evaluation (CARE): Diabetes in Ghana' project is a mixed methods study in Ga Mashie, Accra. An epidemiological survey is described elsewhere. Six qualitative studies utilising a range of methodologies are proposed in this protocol to generate a contextual understanding of type 2 diabetes mellitus in an urban poor population. They focus on community, care provider, and policy stakeholder perspectives with a focus on food markets and environmental influences, the demand and supply of health services, and the history of the Ga Mashie community and its inhabitants. The results will be shared with the community in Ga Mashie and with health policy stakeholders in Ghana and other settings where the findings may be usefully transferable for the development of community-based interventions for diabetes prevention and control.
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Affiliation(s)
- Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
- Centre for Tropical Medicine and Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Irene Akwo Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, University of Ghana, Legon, Ghana
| | - Mawuli Kushitor
- Department of Health Policy Planning and Management, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Raphael Baffour Awuah
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
- Vital Strategies, New York, USA
| | - Olutobi Adekunle Sanuade
- Department of Population Health Sciences, Division of Health System Innovation and Research, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | | | - Samuel Amon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | | | - Haim Yacobi
- Bartlett Development Planning Unit, University College London, London, UK
| | - Megan Vaughan
- Institute of Advanced Studies, University College London, London, UK
| | - Ann Blandford
- Department of Computer Science, University College London, London, UK
| | - Publa Antwi
- Department of Health Sciences, University of York, York, UK
| | - Hannah Maria Jennings
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, Heslington, UK
| | - Daniel Kojo Arhinful
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | | | - Edward Fottrell
- Institute for Global Health, University College London, London, UK
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Melichova J, Sivco P, Rusnak M, Phuong Truc P, Majdan M. International evidence-based guidelines on hypertension and type 2 diabetes mellitus: A systematic review. J Public Health Res 2023; 12:22799036221146913. [PMID: 36744042 PMCID: PMC9893365 DOI: 10.1177/22799036221146913] [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: 09/02/2022] [Accepted: 12/05/2022] [Indexed: 02/02/2023] Open
Abstract
This systematic review provides a high-quality, comprehensive summary of recommendations on hypertension (HT) and type 2 diabetes mellitus (T2DM), accentuating patient blood pressure, HbA1c levels, patterns of drug treatment, management, and screening of these diseases. The overall objective of the review is to support adapting existing clinical practice guidelines in Indonesia, Vietnam, and Myanmar. The database PubMed and the web search engines Google and Google Scholar were searched from October to December 2019 for evidence-based guidelines covering the overall disease management in Europe, the United States of America, and low and middle-income countries (Indonesia, Vietnam, and Myanmar-IVM later on). Nine studies were selected for the review, seven concerning HT and five T2DM. Guidelines in IVM and Europe identified HT as increased blood pressure (BP; ≥140/90 mmHg). IVM guidelines also recommended commencing drug treatment if lifestyle interventions were not successful. Four international HT guidelines recommended monitoring BP every few months, and the other three guidelines gave recommendations based on the patient's current BP levels. All five T2DM guidelines recommended target HbA1c levels below 7%-6.5%, but only IVM guidelines included re-examination every 3-6 months. Metformin was recommended as the first choice of medical treatment, if not contraindicated. Amid the guidelines' recommendations, there were no major variations in the Class of recommendation and Level of evidence (except IVM guidelines where COR and LOE were missing). Revision and completion of IVM guidelines by this grading system would enhance evidence-based and informed decisions in clinical care.
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Affiliation(s)
- Juliana Melichova
- Juliana Melichova, Department of Public
Health, Faculty of Health Sciences and Social Work, Trnava University,
Univerzitne Namestie 1, Trnava 918 43, Slovakia.
| | | | - Martin Rusnak
- Department of Public Health, Faculty of Health
Sciences and Social Work, Trnava University, Trnava, Slovakia
| | - Pham Phuong Truc
- Department of Public Health, Faculty of Health
Sciences and Social Work, Trnava University, Trnava, Slovakia
| | - Marek Majdan
- Department of Public Health, Faculty of Health
Sciences and Social Work, Trnava University, Trnava, Slovakia
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Sheron VA, Shanmugathas S, Gooden TE, Guruparan M, Kumarendran B, Lip GYH, Manaseki-Holland S, Nirantharakumar K, Shribavan K, Subaschandren K, Haniffa R, Surenthirakumaran R, Thomas GN, Uruthirakumar P, Greenfield S, Lane DA, Beane A. Healthcare provider and patient perspectives on access to and management of atrial fibrillation in the Northern Province, Sri Lanka: a rapid evaluation of barriers and facilitators to care. BMC Health Serv Res 2022; 22:1078. [PMID: 35999563 PMCID: PMC9400248 DOI: 10.1186/s12913-022-08440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia that affects 60 million people worldwide. Limited evidence on AF management exists from low- and middle-income countries and none from Sri Lanka. We aimed to investigate the existing AF care pathway and patients’ perception on AF management to identify barriers and enablers for optimal AF care in Northern Province, Sri Lanka. Methods A rapid evaluation was undertaken with use of qualitative methods. Local healthcare providers (HCPs) mapped the intended pathway of care for AF patients which was then explored and annotated through 12 iterative sessions with additional HCPs. Topics of inefficiencies identified from the finalised map were used to guide focus group discussions (FGDs) with AF patients. AF patients who were attending the anticoagulation clinic at the only tertiary hospital in Northern Province were recruited and invited to participate using purposive sampling. The topic guide was developed in collaboration with local clinicians and qualitative experts. FGDs were conducted in the native Tamil language and all sessions were recorded, transcribed verbatim and thematically analysed using a deductive approach. Results The mapped pathway revealed inefficiencies in referral, diagnosis and ongoing management. These were explored through three FGDs conducted with 25 AF patients aged 25 to 70 years. Two key themes that contributed to and resulted in delays in accessing care and ongoing management were health seeking behaviours and atomistic healthcare structures. Four cross-cutting sub-themes identified were decision making, paternalistic approach to care, cost impacts and lifestyle impacts. These are discussed across 10 unique categories with consideration of the local context. Conclusions Strengthening primary healthcare services, improving public health literacy regarding AF and building patient autonomy whilst understanding the importance of their daily life and family involvement may be advantageous in tackling the inefficiencies in the current AF care pathway in Sri Lanka. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08440-1.
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Affiliation(s)
- Vethanayagam Antony Sheron
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Shivany Shanmugathas
- Department of Marketing, Faculty of Management Studies and Commerce, University of Jaffna, Jaffna, Sri Lanka
| | - Tiffany E Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Balachandran Kumarendran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka.
| | - Gregory Y H Lip
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Kaneshamoorthy Shribavan
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Kumaran Subaschandren
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Rajendra Surenthirakumaran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Powsiga Uruthirakumar
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
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Muthee TB, Kimathi D, Richards GC, Etyang A, Nunan D, Williams V, Heneghan C. Factors influencing the implementation of cardiovascular risk scoring in primary care: a mixed-method systematic review. Implement Sci 2020; 15:57. [PMID: 32690051 PMCID: PMC7370418 DOI: 10.1186/s13012-020-01022-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/08/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) such as ischemic heart disease and stroke is the leading causes of death and disability globally with a growing burden in low and middle-income countries. A credible way of managing the incidence and prevalence of cardiovascular diseases is by reducing risk factors. This understanding has led to the development and recommendation for the clinical use of cardiovascular risk stratification tools. These tools enhance clinical decision-making. However, there is a lag in the implementation of these tools in most countries. This systematic review seeks to synthesise the current knowledge of the factors influencing the implementation of cardiovascular risk scoring in primary care settings. METHODS We searched bibliographic databases and grey literature for studies of any design relating to the topic. Titles, abstracts and full texts were independently assessed for eligibility by two reviewers. This was followed by quality assessment and data extraction. We analysed data using an integrated and best fit framework synthesis approach to identify these factors. Quantitative and qualitative forms of data were combined into a single mixed-methods synthesis. The Consolidated Framework for Implementation Research was used as the guiding tool and template for this analysis. RESULTS Twenty-five studies (cross-sectional n = 12, qualitative n = 9 and mixed-methods n = 4) were included in this review. Twenty (80%) of these were conducted in high-income countries. Only four studies (16%) included patients as participants. This review reports on a total of eleven cardiovascular risk stratification tools. The factors influencing the implementation of cardiovascular risk scoring are related to clinical setting and healthcare system (resources, priorities, practice culture and organisation), users (attributes and interactions between users) and the specific cardiovascular risk tool (characteristics, perceived role and effectiveness). CONCLUSIONS While these findings bolster the understanding of implementation complexity, there exists limited research in the context of low and middle-income countries. Notwithstanding the need to direct resources in bridging this gap, it is also crucial that these efforts are in concert with providing high-quality evidence on the clinical effectiveness of using cardiovascular risk scoring to improve cardiovascular disease outcomes of mortality and morbidity. TRIAL REGISTRATION PROSPERO registration number: CRD42018092679.
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Affiliation(s)
- Tonny B. Muthee
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Derick Kimathi
- KEMRI-Wellcome Trust Research Programme, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Georgia C. Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Anthony Etyang
- Epidemiology and Demography Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - David Nunan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
| | - Veronika Williams
- Faculty of Education and Professional Studies, School of Nursing, Nipissing University, North Bay, Canada
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford, OX2 6GG UK
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Peters DH, Peters MA, Wickramasinghe K, Osewe PL, Davidson PM. Asking the right question: implementation research to accelerate national non-communicable disease responses. BMJ 2019; 365:l1868. [PMID: 31110030 PMCID: PMC6526393 DOI: 10.1136/bmj.l1868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- David H Peters
- Johns Hopkins University Bloomberg School of Public Health, USA
| | | | - Kremlin Wickramasinghe
- World Health Organization European Office for Prevention and Control of NCDs, Russian Federation
| | | | - Patricia M Davidson
- Johns Hopkins University School of Nursing, Secretariat, World Health Organization Collaborating Centres of Nursing and Midwifery, USA
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Mbui JM, Oluka MN, Guantai EM, Sinei KA, Achieng L, Baker A, Jande M, Massele A, Godman B. Prescription patterns and adequacy of blood pressure control among adult hypertensive patients in Kenya; findings and implications. Expert Rev Clin Pharmacol 2017; 10:1263-1271. [PMID: 28831829 DOI: 10.1080/17512433.2017.1371590] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hypertension is a major cause of global morbidity and mortality, with high prevalence rates in Africa including Kenya. Consequently, it is imperative to understand current treatment approaches and their effectiveness in practice. Currently, there is paucity of such data in Kenya, which is a concern. The aim is to describe prescribing patterns and adequacy of blood pressure (BP) control in adult hypertensive patients to guide future practice. METHOD Retrospective study of patients attending a sub-county outpatient clinic combined with qualitative interviews. RESULTS 247 hypertensive patients, predominantly female, mean age 55.8 years on antihypertensive therapy for 1-5 years, were analyzed. ACEIs and thiazide diuretics were the most commonly prescribed drugs, mainly as combination therapy. Treatment typically complied with guidelines, mainly for stage 2 hypertension (75%). BP control was observed in 46% of patients, with a significant reduction in mean systolic (155 to 144 mmHg) and diastolic (91 to 83 mmHg) BP (P < 0.001). Patients on ≥2 antihypertensive drugs were more likely to have uncontrolled BP (OR:1.9, p = 0.021). CONCLUSION Encouragingly good adherence to guidelines was helped by training. Poor blood pressure control in the majority needs to be addressed. Additional training of prescribers and follow-up of measures to improve BP control will be introduced and followed up.
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Affiliation(s)
- Jennifer M Mbui
- a Department of Pharmacology and Pharmacognosy, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Margaret N Oluka
- a Department of Pharmacology and Pharmacognosy, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Eric M Guantai
- a Department of Pharmacology and Pharmacognosy, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Kipruto A Sinei
- a Department of Pharmacology and Pharmacognosy, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Loice Achieng
- b Department of Clinical Medicine and Therapeutics, School of Medicine , University of Nairobi , Nairobi , Kenya
| | - Amanj Baker
- c Strathclyde Institute of Pharmacy and Biomedical Sciences , Strathclyde University , Glasgow , UK
| | - Mary Jande
- d School of Pharmacy , Catholic University of Health and Allied Science , Mwanza , Tanzania
| | - Amos Massele
- e Department of Clinical Pharmacology, School of Medicine , University of Botswana , Gaborone , Botswana
| | - Brian Godman
- c Strathclyde Institute of Pharmacy and Biomedical Sciences , Strathclyde University , Glasgow , UK.,f Department of Laboratory Medicine, Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden.,g Health Economics Centre , Liverpool University Management School, Liverpool University , Liverpool , UK
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