Predictors of health facility readiness for diabetes service delivery in low- and middle-income countries: The case of Bangladesh

Combined exposure to lead and microplastics increased risk of glucose metabolism in mice via the Nrf2/NF-κB pathway

The purpose of this study was to explore the effects of combined lead (Pb) and two types of microplastic (MP) (polyvinyl chloride [PVC] and polyethylene [PE]) exposure on glucose metabolism and investigate the role of the nuclear factor erythroid 2-related factor 2 (Nrf2)/nuclear factor-kappa B (NF-κB) signaling pathway in mediating these effects in mice. Adult C57BL/6J mice were randomly divided into four groups: control, Pb (100 mg/L), MPs (containing 10 mg/L PE and PVC), and Pb + MPs, each of which was treated with drinking water. Treatments were conducted for 6 weeks. Co-exposure to Pb + MPs exhibited increase glycosylated serum protein levels, insulin resistance, and damaged glucose tolerance compared with the control mice. Additionally, treatment with Pb + MPs caused more severe damage to hepatocytes than when exposed to them alone concomitantly, exposed to Pb + MPs exhibited improved the levels of interleukin-6, tumor necrosis factor-alpha, and malondialdehyde, but reduced superoxide dismutase, glutathione peroxidase, and catalase assay in livers. Furthermore, they increase the Kelch-like ECH-associated protein 1 (Keap1) and phosphorylated p-NF-κB protein levels but reduced the protein levels of heme oxygenase-1 and Nrf2, as well as increased Keap1 mRNA and Nrf2 mRNA. Co-exposure to Pb + MP impacts glucose metabolism via the Nrf2 /NF-κB pathway.

Assessing the accuracy of health facility typology in representing the availability of health services: a case study in Mali

INTRODUCTION

Using health facility types as a measure of service availability is a common approach in international standards for health system policy and planning. However, this proxy may not accurately reflect the actual availability of specific health services.

OBJECTIVE

This study aims to evaluate the reliability of health facility typology as an indicator of specific health service availability and explore whether certain facility types consistently provide particular services.

DESIGN

We analysed a comprehensive dataset containing information from 1725 health facilities in Mali. To uncover and visualise patterns within the dataset, we used two analytical techniques: Multiple Correspondence Analysis and Between-Class Analysis. These analyses allowed us to quantitatively measure the influence of health facility types on the variation in health service provisioning. Additionally, we developed and calculated a Consistency Index, which assesses the consistency of a health facility type in providing specific health services. By examining various health facilities and services, we sought to determine the accuracy of facility types as indicators of service availability.

SETTING

The study focused on the health system in Mali as a case study.

RESULTS

Our findings indicate that using health facility types as a proxy for service availability in Mali is not an accurate representation. We observed that most of the variation in service provision does not stem from differences between facility types but rather within facility types. This suggests that relying solely on health facility typology may lead to an incomplete understanding of health service availability.

CONCLUSIONS

These results have significant implications for health policy and planning. The reliance on health facility types as indicators for health system policy and planning should be reconsidered. A more nuanced and evidence-based understanding of health service availability is crucial for effective health policy and planning, as well as for the assessment and monitoring of health systems.

Health Facilities Readiness and Determinants to Manage Cardiovascular Disease in Afghanistan, Bangladesh, and Nepal: Evidence from the National Service Provision Assessment Survey

Background

In South Asia, cardiovascular diseases (CVDs) are an increasing public health concern. One strategy for dealing with the growing CVDs epidemic is to make health facilities more ready to provide CVDs services. The study's objectives were to: (1) assess healthcare facilities' readiness to offer CVDs services; and (2) identify the variables that influence such readiness.

Methods

This study employed data from the Afghanistan Service Provision Assessment Survey 2018-2019, Bangladesh Health Facility Survey 2017, and Nepal Health Facility Survey 2021 that were cross-sectional and nationally representative. In Afghanistan, Bangladesh, and Nepal, 117, 368, and 1,381 health facilities, respectively, were examined. A total of 10 items/indicators were used to measure a health facility's readiness to provide CVDs services across three domains.

Results

The mean readiness scores of managing CVDs were 6.7, 5.6, and 4.6 in Afghanistan, Bangladesh, and Nepal, respectively. Availability of trained staff for CVD services are not commonly accessible in Afghanistan (21.5%), Bangladesh (15.3%), or Nepal (12.9%), except from supplies and equipment. Afghanistan has the highest levels of medicine and other commodity availability. Among the common factors linked with readiness scores, we ought to expect a 0.02 unit rise in readiness scores for three nations for every unit increase in number of CVDs care providers. In Afghanistan, Bangladesh, and Nepal, availability of both diagnosis and treatment facilities was associated with increases in readiness scores of 27%, 9%, and 17%, respectively. Additionally, an association was observed between nation-specific facility types and the readiness scores.

Conclusions

Country-specific factors as well as universal factors present in all three nations must be addressed to improve a health facility's readiness to provide CVDs care. To create focused and efficient country-specific plans to raise the standard of CVD care in South Asia, more investigation is necessary to ascertain the reasons behind country-level variations in the availability of tracer items.

Cardiovascular disease risk profile and management among people 40 years of age and above in Bo, Sierra Leone: A cross-sectional study

Introduction

Access to care for cardiovascular disease risk factors (CVDRFs) in low- and middle-income countries is limited. We aimed to describe the need and access to care for people with CVDRF and the preparedness of the health system to treat these in Bo, Sierra Leone.

Methods

Data from a 2018 household survey conducted in Bo, Sierra Leone, was analysed. Demographic, anthropometric and clinical data on CVDRF (hypertension, diabetes mellitus or dyslipidaemia) from randomly sampled individuals 40 years of age and above were collected. Future risk of CVD was calculated using the World Health Organisation–International Society of Hypertension (WHO-ISH) calculator with high risk defined as >20% risk over 10 years. Requirement for treatment was based on WHO package of essential non-communicable (PEN) disease guidelines (which use a risk-based approach) or requiring treatment for individual CVDRF; whether participants were on treatment was used to determine whether care needs were met. Multivariable regression was used to test associations between individual characteristics and outcomes. Data from the most recent WHO Service Availability and Readiness Assessment (SARA) were used to create a score reflecting health system preparedness to treat CVDRF, and compared to that for HIV.

Results

2071 individual participants were included. Most participants (n = 1715 [94.0%]) had low CVD risk; 423 (20.6%) and 431 (52.3%) required treatment based upon WHO PEN guidelines or individual CVDRF, respectively. Sixty-eight (15.8%) had met-need for treatment determined by WHO guidelines, whilst 84 (19.3%) for individual CVDRF. Living in urban areas, having education, being older, single/widowed/divorced, or wealthy were independently associated with met need. Overall facility readiness scores for CVD/CVDRF care for all facilities in Bo district was 16.8%, compared to 41% for HIV.

Conclusion

The number of people who require treatment for CVDRF in Sierra Leone is substantially lower based on WHO guidelines compared to CVDRF. CVDRF care needs are not met equitably, and facility readiness to provide care is low.

The availability of essential medicines for diabetes at health facilities in Bangladesh: evidence from 2014 and 2017 national surveys

Background

Bangladesh ranks among the world’s top ten countries in the number of diabetic patients. The prevention of this disease requires treating patients with essential medicines, and the first crucial step in the uptake of these medicines is availability. We aimed to assess the availability of essential medicines for diabetes (EM-Diabetes) and to explore health facility characteristics associated with the availability of those medicines.

Methods

We performed the analysis using nationally representative data from the two waves of the cross-sectional Bangladesh Health Facility Survey (BHFS) in 2014 and 2017. Data are available for 1548 and 1524 health facilities in the 2014 and 2017 BHFS. Study samples of this study were 217 facilities (73 from 2014 and 144 from 2017) that offer diabetes diagnosis and treatment services. The outcome variable ‘EM-Diabetes availability’ was calculated as a counting score of the tracer medicines: metformin, glibenclamide, injectable insulin, and injectable glucose solution. A multivariable Poisson regression model was used to identify the health facility characteristics (such as, managing authority, location, external supervision, regular quality assurance activities, national guidelines for diagnosis and management of diabetes, etc.) associated with EM-Diabetes availability.

Results

Since 2014, there have been minimal increases in Bangladeshi health facilities that provide diabetes screening and treatment services (from 4.7% to 9.4%). Among facilities offering diabetes services, 64.5% (BHFS 2014) and 55.7% (BHFS 2017) facilities had no EM-Diabetes on-site at all. Between 2014 and 2017, the availability of metformin increased (from 27.5% to 40.1%), but there was a decrease in the availability of glibenclamide (from 16.5% to 9.1%), injectable insulin (from 20.4% to 11.4%), and injectable glucose solution (from 20.4% to 19.2%). Furthermore, publicly owned facilities [relative risk (RR) = 0.44, 95% confidence interval (CI): 0.25–0.78 for 2014 and RR= 0.54, 95% CI: 0.41–0.71 for 2017] and facilities in rural settings [RR= 0.26, 95% CI: 0.12–0.55 for 2014 and RR= 0.60, 95% CI: 0.44–0.81 for 2017] were significantly associated with decreased availability of EM-Diabetes in both survey years. Moreover, routine user fees [RR=3.70, 95% CI: 1.86–7.38] and regular quality assurance activities [RR= 1.62, 95% CI: 1.12–2.34] were also significantly associated with increased EM-Diabetes availability in 2017 only.

Conclusions

Overall, the health facilities in Bangladesh had insufficient essential medicines for treating diabetes. In general, the availability of EM-Diabetes declined from 2014 to 2017, except for metformin. Policymakers should consider a wide range of policy implications, focusing on the management of public facilities, rural facilities, routine user fees, and quality assurance activities to improve the availability of EM-Diabetes at health facilities in Bangladesh.