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Ikram N, Lewandowski LB, Watt MH, Scott C. Barriers and facilitators to medical care retention for pediatric systemic lupus erythematosus in South Africa: a qualitative study. Pediatr Rheumatol Online J 2024; 22:59. [PMID: 38807125 PMCID: PMC11131184 DOI: 10.1186/s12969-024-00994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members). METHODS Caregivers (n = 22) were recruited through pediatric and adult rheumatology clinics. Individuals were eligible if they cared for youth (≤ 19 years) who were diagnosed with cSLE and satisfied at least four of the eleven ACR SLE classification criteria. Individual in-depth, semi-structured interviews were conducted between January 2014 and December 2014, and explored barriers to and facilitators of ongoing chronic care for cSLE. Data were analyzed using applied thematic analysis. RESULTS Four barriers to chronic care engagement and retention were identified: knowledge gap, financial burdens, social stigma of SLE, and complexity of the South African medical system. Additionally, we found three facilitators: patient and caregiver education, robust support system for the caregiver, and financial support for the caregiver and patient. CONCLUSION These findings highlight multiple, intersecting barriers to routine longitudinal care for cSLE in South Africa and suggest there might be a group of diagnosed children who don't receive follow-up care and are subject to loss to follow-up. cSLE requires ongoing treatment and care; thus, the different barriers may interact and compound over time with each follow-up visit. South African cSLE patients are at high risk for poor outcomes. South African care teams should work to overcome these barriers and place attention on the facilitators to improve care retention for these patients and create a model for other less resourced settings.
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Affiliation(s)
- Naira Ikram
- Harvard Medical School, 02115, Boston, MA, USA
| | - Laura B Lewandowski
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, DHHS, 9000 Rockville Pike, Building 10, 12N248 Room 28, Bethesda, MD, 20892-1102, USA.
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Melissa H Watt
- Department of Population Health Sciences, University of Utah, Utah, USA
| | - Christiaan Scott
- Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape, South Africa
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Ikram N, Lewandowski LB, Watt MH, Scott C. Barriers and facilitators to medical care retention for pediatric systemic lupus erythematosus in South Africa: a qualitative study. RESEARCH SQUARE 2024:rs.3.rs-3919073. [PMID: 38464004 PMCID: PMC10925452 DOI: 10.21203/rs.3.rs-3919073/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background: Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members). Methods: Caregivers (n=22) were recruited through pediatric and adult rheumatology clinics. Individuals were eligible if they cared for youth ( < 19 years) who were diagnosed with cSLE and satisfied at least four of the eleven ACR SLE classification criteria. Individual in-depth, semi-structured interviews were conducted between January 2014 and December 2014, and explored barriers to and facilitators of ongoing chronic care for cSLE. Data were analyzed using applied thematic analysis. Results: Four barriers to chronic care engagement and retention were identified: knowledge gap, financial burdens, social stigma of SLE, and complexity of the South African medical system. Additionally, we found three facilitators: patient and caregiver education, robust support system for the caregiver, and financial support for the caregiver and patient. Conclusion: These findings highlight multiple, intersecting barriers to routine longitudinal care for cSLE in South Africa and suggest there might be a group of diagnosed children who don't receive follow-up care and are subject to attrition. cSLE requires ongoing treatment and care; thus, the different barriers may interact and compound over time with each follow-up visit. South African cSLE patients are at high risk for poor outcomes. South African care teams should work to overcome these barriers and place attention on the facilitators to improve care retention for these patients and create a model for other less resourced settings.
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Khursheed T, Ovseiko P, Dyball S, Nakashima R, Gonzalez AMA, Babini A, Kalla AA, Hill C, Danda D, Dey D, Traboco L, Nikiphorou E, Harifi G, Badshah H, Hmamouchi I, Marie Von Feldt J, Farani JB, Andreoli L, Guimarães MP, Toro Gutiérrez CE, Sieiro Santos C, Duftner C, Alpizar Rodriguez D, Ziadé N, Palominos PE, Haq SA, Bautista-Molano W, Tanaka Y, Gossec L, Agarwal V, Wright GC, Coates L, Gupta L. Coalition for Health and Gender Equity (CHANGE)-a protocol for a global cross-sectional survey of health and gender equity in rheumatology. Rheumatol Adv Pract 2024; 8:rkae021. [PMID: 38560641 PMCID: PMC10980588 DOI: 10.1093/rap/rkae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/31/2023] [Indexed: 04/04/2024] Open
Abstract
Objectives The primary aim of the CHANGE survey is to determine the current state of gender equity within rheumatology, and secondarily, to review the physician perspective on bullying, harassment and equipoise of opportunities within rheumatology. Methods The CHANGE e-survey is a cross-sectional self-reported questionnaire adapted from EULAR's gender equity in academic rheumatology task force. The survey was launched in January 2023; it is available in six languages and distributed widely via rheumatology organizations and social media. Eligible participants include rheumatologist physicians and rheumatology health-care professionals. Survey responses will undergo descriptive analysis and inter-group comparison aiming to explore gender-based discrimination using logistic regression, with subgroup analyses for country/continent variations. Conclusion This e-survey represents a comprehensive global initiative led by an international consortium, aimed at exploring and investigating the gender-related disparities and obstacles encountered by rheumatologists and rheumatology health-care professionals across diverse communities and health-care environments. By pursuing this initiative, we aim to take the broader rheumatology community a step closer to understanding the underlying origins of inequities and their determinants. Such insights are pivotal in identifying viable interventions and strategies to foster gender equity within the field. Ultimately, our collective objective is to ensure equitable access to opportunities for every individual, irrespective of gender, thereby promoting inclusivity and fairness across the entire spectrum of professional practice and career development.
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Affiliation(s)
- Tayyeba Khursheed
- Department of Rheumatology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Pavel Ovseiko
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah Dyball
- Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ana Maria Arredondo Gonzalez
- Colombian Association of Rheumatology, Bogotá, Colombia
- Department of Rheumatology, Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
| | - Alejandra Babini
- Rheumatology Unit, Hospital Italiano de Cordoba, Cordoba, Argentina
| | - Asgar Ali Kalla
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Hill
- Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College, Vellore, India
| | - Dzifa Dey
- Rheumatology Unit Department of Medicine and Therapeutics, Korle bu Teaching Hospital, University of Ghana Medical School, Accra, Ghana
| | - Lisa Traboco
- Department of Medicine, Section of Rheumatology, St Luke’s Medical Center-Global City, Taguig, Philippines
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King’s College London, London, UK
- Rheumatology Department, King’s College Hospital, London, UK
| | - Ghita Harifi
- Department of Rheumatology, Mediclinic Parkview Hospital, Dubai, United Arab Emirates
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Humeira Badshah
- Dr Humeira Badsha Medical Center, Dubai, United Arab Emirates
| | - Ihsane Hmamouchi
- Clinical Epidemiology, Health Sciences College, International University of Rabat (UIR), Rabat, Morocco
- Department of Rheumatology, Provincial Hospital of Temara, Temara, Morocco
| | | | - Júlia Boechat Farani
- Division of Rheumatology, Hospital Santa Casa de Misericórdia de Juiz de Fora, Juiz de Fora, Brazil
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | | | - Carlos Enrique Toro Gutiérrez
- General Director, Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontifica Universidad Javeriana Cali, Cali, Colombia
| | | | - Christina Duftner
- Internal Medicine, Clinical Division of Internal Medicine II, Medizinische Universität Innsbruck, Innsbruck, Austria
| | | | - Nelly Ziadé
- Rheumatology Department, Hôtel-Dieu de France Hospital, Saint Joseph’s University, Beirut, Lebanon
| | | | | | - Wilson Bautista-Molano
- Rheumatology Division, University Hospital Fundación Santa Fé de Bogotá, Bogota, Colombia
- School of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Yoshiya Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Laure Gossec
- Sorbonne Université, INSERM, IPLESP, AP-HP, Pitié-Salpetrière Hospital, Paris, France
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Grace C Wright
- Association of Women in Rheumatology; United Rheumatology, New York, NY, USA
| | - Laura Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Latika Gupta
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Hmamouchi I, Adebajo A. Global excellence in rheumatology: Africa-The contribution of African women rheumatologists. Front Med (Lausanne) 2022; 9:1032122. [PMID: 36507499 PMCID: PMC9732090 DOI: 10.3389/fmed.2022.1032122] [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: 08/30/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
Over the last few decades, the development of Rheumatology on the African continent has made great strides. Alongside an increasing recognition of the prevalence and burden of disease from these conditions, has been a determination to raise awareness of these disorders in Africa together with an appreciation of the associated disease impact on individuals, families and society as a whole. Great improvements have also been made across the continent with regards to the education of medical students, trainee doctors and allied health professionals of these conditions. Furthermore, high quality rheumatological research is now emanating from Africa. Taken together, these actions mean that Africa is making a significant contribution to global excellence in Rheumatology. Although this achievement has been made possible by visionary, hardworking and inspirational men and women, we believe that it is vital to bring to light the extraordinary efforts of African female rheumatologists in this endeavor. Their contribution is all the more remarkable because of the barriers that women still face in medicine in general and in academia in particular. We showcase here, four women of distinction who in their own unique way, have exemplified the contribution of African female rheumatologists to global excellence in Africa. We pay tribute to them and to their ongoing efforts to act as beacons of excellence in rheumatology in Africa to men and especially to other women.
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Affiliation(s)
- Ihsane Hmamouchi
- Rheumatology Health Sciences College, International University of Rabat (UIR), Rabat, Morocco,Laboratory of Biostatistical, Clinical and Epidemiological Research (LBRCE), Faculty of Medicine and Pharmacy, Rabat, Morocco,*Correspondence: Ihsane Hmamouchi
| | - Adewale Adebajo
- Faculty of Medicine, Dentistry and Health University of Sheffield, Sheffield, United Kingdom
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