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Chowdhury HA, Joham AE, Kabir A, Rahman AKMF, Ali L, Harrison CL, Billah B. Exploring type 2 diabetes self-management practices in rural Bangladesh: facilitators, barriers and expectations-a qualitative study protocol. BMJ Open 2024; 14:e081385. [PMID: 38697759 PMCID: PMC11086285 DOI: 10.1136/bmjopen-2023-081385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a global public health crisis impacting low-income and middle-income countries such as Bangladesh. While self-management is encouraged for individuals with T2DM, there is a significant lack of knowledge regarding the factors of facilitators, barriers and expectations associated with T2DM self-management in Bangladesh. This research aims to investigate the potential elements that support, impede and are anticipated in the effective practice of self-management for T2DM in rural areas of Bangladesh. METHODS AND ANALYSIS This study will use an exploratory qualitative approach. 16 focus group discussions, 13 in-depth interviews and 9 key informant interviews will be conducted among multilevel stakeholders, including people with T2DM, their caregivers, healthcare providers, health managers/administrators and policy planners. Interviews will be audio-recorded, transcribed, translated and analysed using thematic analysis. ETHICS AND DISSEMINATION This research project has been approved by the Monash University Human Research Ethics Committee (project reference number: 39483) and the Ethical Review Committee of the Centre for Injury Prevention and Research, Bangladesh (Memo: CIPRB/ERC/2023/14). Research findings will be disseminated in peer-reviewed journals and conference presentations. Published reports will include group data. Individual data privacy will be strictly maintained.
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Affiliation(s)
- Hasina Akhter Chowdhury
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Anju E Joham
- Monash Centre for Health Research and Implementation-MCHRI, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
- Department of Diabetes, Monash University, Melbourne, Victoria, Australia
| | - Ashraful Kabir
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A K M Fazlur Rahman
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Liaquat Ali
- Pothikrit Institute of Health Studies (PIHS), Dhaka, Bangladesh
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation-MCHRI, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Baki Billah
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Xie W, Paul RR, Goon IY, Anan A, Rahim A, Hossain MM, Hersch F, Oldenburg B, Chambers J, Mridha MK. Enhancing care quality and accessibility through digital technology-supported decentralisation of hypertension and diabetes management: a proof-of-concept study in rural Bangladesh. BMJ Open 2023; 13:e073743. [PMID: 37984955 PMCID: PMC10660961 DOI: 10.1136/bmjopen-2023-073743] [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: 03/17/2023] [Accepted: 10/04/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE The critical shortage of healthcare workers, particularly in rural areas, is a major barrier to quality care for non-communicable diseases (NCD) in low-income and middle-income countries. In this proof-of-concept study, we aimed to test a decentralised model for integrated diabetes and hypertension management in rural Bangladesh to improve accessibility and quality of care. DESIGN AND SETTING The study is a single-cohort proof-of-concept study. The key interventions comprised shifting screening, routine monitoring and dispensing of medication refills from a doctor-managed subdistrict NCD clinic to non-physician health worker-managed village-level community clinics; a digital care coordination platform was developed for electronic health records, point-of-care support, referral and routine patient follow-up. The study was conducted in the Parbatipur subdistrict, Rangpur Division, Bangladesh. PARTICIPANTS A total of 624 participants were enrolled in the study (mean (SD) age, 59.5 (12.0); 65.1% female). OUTCOMES Changes in blood pressure and blood glucose control, patient retention and patient-visit volume at the NCD clinic and community clinics. RESULTS The proportion of patients with uncontrolled blood pressure reduced from 60% at baseline to 26% at the third month of follow-up, a 56% (incidence rate ratio 0.44; 95% CI 0.33 to 0.57) reduction after adjustment for covariates. The proportion of patients with uncontrolled blood glucose decreased from 74% to 43% at the third month of follow-up. Attrition rates immediately after baseline and during the entire study period were 29.1% and 36.2%, respectively. CONCLUSION The proof-of-concept study highlights the potential for involving lower-level primary care facilities and non-physician health workers to rapidly expand much-needed services to patients with hypertension and diabetes in Bangladesh and in similar global settings. Further investigations are needed to evaluate the effectiveness of decentralised hypertension and diabetes care.
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Affiliation(s)
- Wubin Xie
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Rina Rani Paul
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | - Ian Y Goon
- Tyree Foundation Institute of Health Engineering, UNSW, Sydney, New South Wales, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Sprightly Pte Ltd, Singapore
| | - Aysha Anan
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | | | - Md Mokbul Hossain
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
| | | | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - John Chambers
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Malay Kanti Mridha
- Centre for Non-communicable Diseases and Nutrition, BRAC University James P Grant School of Public Health, Dhaka, Bangladesh
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Onteri SN, Kariuki J, Mathu D, Wangui AM, Magige L, Mutai J, Chuchu V, Karanja S, Ahmed I, Mokua S, Otambo P, Bukania Z. Diabetes health care specific services readiness and availability in Kenya: Implications for Universal Health Coverage. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002292. [PMID: 37756286 PMCID: PMC10529624 DOI: 10.1371/journal.pgph.0002292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
Diabetes is a major cause of morbidity and mortality worldwide yet preventable. Complications of undetected and untreated diabetes result in serious human suffering and disability. It negatively impacts on individual's social economic status threatening economic prosperity. There is a scarcity of data on health system diabetes service readiness and availability in Kenya which necessitated an investigation into the specific availability and readiness of diabetes services. A cross sectional descriptive study was carried out using the Kenya service availability and readiness mapping tool in 598 randomly selected public health facilities in 12 purposively selected counties. Ethical standards outlined in the 1964 Declaration of Helsinki and its later amendments were upheld throughout the study. Health facilities were classified into primary and secondary level facilities prior to statistical analysis using IBM SPSS version 25. Exploratory data analysis techniques were employed to uncover the distribution structure of continuous study variables. For categorical variables, descriptive statistics in terms of proportions, frequency distributions and percentages were used. Of the 598 facilities visited, 83.3% were classified as primary while 16.6% as secondary. A variation in specific diabetes service availability and readiness was depicted in the 12 counties and between primary and secondary level facilities. Human resource for health reported a low mean availability (46%; 95% CI 44%-48%) with any NCDs specialist and nutritionist the least carder available. Basic equipment and diagnostic capacity reported a fairly high mean readiness (73%; 95% CI 71%-75%) and (64%; 95%CI 60%-68%) respectively. Generally, primary health facilities had low diabetic specific service availability and readiness compared to secondary facilities: capacity to cope with diabetes increased as the level of care ascended to higher levels. Significant gaps were identified in overall availability and readiness in both primary and secondary levels facilities particularly in terms of human resource for health specifically nutrition and laboratory profession.
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Affiliation(s)
- Stephen N. Onteri
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - James Kariuki
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - David Mathu
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Antony M. Wangui
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Lucy Magige
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Joseph Mutai
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Vyolah Chuchu
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Sarah Karanja
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Ismail Ahmed
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Sharon Mokua
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Priscah Otambo
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
| | - Zipporah Bukania
- Centre for Public Health Research, Kenya Medical Research Institute Kenya, Nairobi, Kenya
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Fassinou LC, Hien H, Yombi JC, Nagot N, Kirakoya-Samadoulougou F. Availability and readiness of the health facilities to provide HIV counseling and testing and prevention of mother-to-child transmission services in Burkina Faso: a trend analysis from 2012 to 2018. BMC Health Serv Res 2023; 23:757. [PMID: 37452422 PMCID: PMC10347843 DOI: 10.1186/s12913-023-09757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Provider-Initiated HIV Testing and Counseling (PITC) and Prevention of Mother-To-Child Transmission (PMTCT) are key services for achieving the goal of complete elimination of HIV. However, there is limited evidence on the ability of health facilities to provide these services in Burkina Faso. Therefore, we aimed to assess the trends and disparities in the availability and readiness of health facilities to provide PITC and PMTCT services in Burkina Faso between 2012 and 2018. METHODS We performed a secondary analysis of facility-level data from the World Health Organization's Service Availability and Readiness Assessment (SARA) surveys conducted in 2012, 2014, 2016, and 2018 in Burkina Faso. The availability and readiness of health facilities were assessed using SARA's manual, and linear regressions were used to examine trends. RESULTS Between 2012 and 2018, the mean proportion of health facilities providing PITC services increased, but not significantly, from 82.9% to 83.4% (p = 0.11), with the mean readiness index significantly decreasing from 71.5% to 65.4% (p < 0.001). This decrease concerned the staff and guidelines (73.8% to 50.5%; p < 0.001), equipment (79.0% to 77.4%; p < 0.001), and medicines and commodities (54.2% to 45.2%; p < 0.001) domains. Regarding the PMTCT services, the mean proportion of health facilities globally providing the service significantly decreased from 83.7% in 2012 to 67.7% (p = 0.030) in 2018, and the mean readiness significantly decreased from 53.2% in 2012 to 50.9% in 2018 (p = 0.004). This decreasing trend was related to the staff and training (80.3% to 57.6%; p < 0.001) and medicines and commodities (9.2% to 6.5%; p < 0.001) domains. The global significant negative trend of readiness was mainly observed at the primary level of healthcare (52.7% to 49.4%; p = 0.030). Four regions experienced a significant decrease in the readiness index of health facilities to provide PMTCT services: Cascades, Centre, Centre-Sud, and Sud-Ouest, while Haut-Bassins and Nord regions showed increasing trends. CONCLUSION Availability and readiness of health facilities to provide PITC and PMTCT remain suboptimal in Burkina Faso. Actions to strengthen the skills of professionals and enhance the availability of medicines and commodities while focusing more on health regions with significant decreasing trends are urgently needed to improve the quality of services for HIV.
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Affiliation(s)
- Lucresse Corine Fassinou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Hervé Hien
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Jean Cyr Yombi
- Department of Internal Medicine, Infectious and Tropical Diseases, AIDS Reference Centre, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Nagot
- Pathogenesis & Control of Chronic and Emerging Infections, University of Montpellier, INSERM, University of Antilles, Etablissement Français du Sang, Montpellier, France
| | - Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques Et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
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Adhikari B, Pandey AR, Lamichhane B, Kc SP, Joshi D, Regmi S, Giri S, Baral SC. Readiness of health facilities to provide services related to non-communicable diseases in Nepal: evidence from nationally representative Nepal Health Facility Survey 2021. BMJ Open 2023; 13:e072673. [PMID: 37423630 DOI: 10.1136/bmjopen-2023-072673] [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] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE To assess the readiness of public and private health facilities (HFs) in delivering services related to non-communicable diseases (NCDs) in Nepal. METHODS We analysed data from nationally representative Nepal Health Facility Survey 2021 to determine the readiness of HFs for cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic respiratory diseases (CRDs) and mental health (MH)-related services using Service Availability and Readiness Assessment Manual of the WHO. Readiness score was measured as the average availability of tracer items in per cent, and HFs were considered 'ready' for NCDs management if they scored ≥70 (out of 100). We performed weighted univariate and multivariable logistic regression to determine the association of HFs readiness with province, type of HFs, ecological region, quality assurance activities, external supervision, client's opinion review and frequency of meetings in HFs. RESULTS The overall mean readiness score of HFs offering CRDs, CVDs, DM and MH-related services was 32.6, 38.0, 38.4 and 24.0, respectively. Guidelines and staff training domain had the lowest readiness score, whereas essential equipment and supplies domain had the highest readiness score for each of the NCD-related services. A total of 2.3%, 3.8%, 3.6% and 3.3% HFs were ready to deliver CRDs, CVDs, DM and MH-related services, respectively. HFs managed by local level were less likely to be ready to provide all NCD-related services compared with federal/provincial hospitals. HFs with external supervision were more likely to be ready to provide CRDs and DM-related services and HFs reviewing client's opinions were more likely to be ready to provide CRDs, CVDs and DM-related services. CONCLUSION Readiness of the HFs managed by local level to provide CVDs, DM, CRDs and MH-related services was relatively poor compared with federal/provincial hospitals. Prioritisation of policies to reduce the gaps in readiness and capacity strengthening of the local HFs is essential for improving their overall readiness to provide NCD-related services.
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Affiliation(s)
- Bikram Adhikari
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Achyut Raj Pandey
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Bipul Lamichhane
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Saugat Pratap Kc
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Deepak Joshi
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Shophika Regmi
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Santosh Giri
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
| | - Sushil Chandra Baral
- Research, Evaluation and Innovation Department, HERD International, Kathmandu, Nepal
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Kabir A, Karim MN, Billah B. The capacity of primary healthcare facilities in Bangladesh to prevent and control non-communicable diseases. BMC PRIMARY CARE 2023; 24:60. [PMID: 36864391 PMCID: PMC9979470 DOI: 10.1186/s12875-023-02016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND The rapid rise of non-communicable diseases (NCDs) has become a significant public health concern in Bangladesh. This study assesses the readiness of primary healthcare facilities to manage the following NCDs: diabetes mellitus (DM), cervical cancer, chronic respiratory diseases (CRIs), and cardiovascular diseases (CVDs). METHODS A cross-sectional survey was conducted between May 2021 and October 2021 among 126 public and private primary healthcare facilities (nine Upazila health complexes (UHCs), 36 union-level facilities (ULFs), 53 community clinics (CCs), and 28 private hospitals/clinics). The NCD-specific service readiness was assessed using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) reference manual. The facilities' readiness was assessed using the following four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. The mean readiness index (RI) score for each domain was calculated. Facilities with RI scores of above 70% were considered 'ready' to manage NCDs. RESULTS The general services availability ranged between 47% for CCs and 83% for UHCs and the guidelines and staff accessibility were the highest for DM in the UHCs (72%); however, cervical cancer services were unavailable in the ULFs and CCs. The availability of basic equipment was the highest for cervical cancer (100%) in the UHCs and the lowest for DM (24%) in the ULFs. The essential medicine for CRI was 100% in both UHCs and ULFs compared to 25% in private facilities. The diagnostic capacity for CVD and essential medicine for cervical cancer was unavailable at all levels of public and private healthcare facilities. The overall mean RI for each of the four NCDs was below the cut-off value of 70%, with the highest (65%) for CRI in UHCs but unavailable for cervical cancer in CCs. CONCLUSION All levels of primary healthcare facilities are currently not ready to manage NCDs. The notable deficits were the shortage of trained staff and guidelines, diagnostic facilities, and essential medicine. This study recommends increasing service availability to address the rising burden of NCDs at primary healthcare levels in Bangladesh.
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Affiliation(s)
- Ashraful Kabir
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Md Nazmul Karim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Roystonn K, AshaRani PV, Siva Kumar FD, Wang P, Abdin E, Sum CF, Lee ES, Chong SA, Subramaniam M. Factor structure of the diabetes knowledge questionnaire and the assessment of the knowledge of risk factors, causes, complications, and management of diabetes mellitus: A national population-based study in Singapore. PLoS One 2022; 17:e0272745. [PMID: 35947580 PMCID: PMC9365176 DOI: 10.1371/journal.pone.0272745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/26/2022] [Indexed: 01/12/2023] Open
Abstract
This study evaluated the knowledge of diabetes mellitus and predictors of the level of diabetes knowledge among the general public of Singapore. Confirmatory factor analysis and exploratory factor analysis were used to evaluate the fit of different factor models for the diabetes knowledge questionnaire. Multiple linear regressions were performed to determine the sociodemographic characteristics associated with diabetes knowledge. The final factor model identified three domains for diabetes knowledge: general knowledge, diabetes specific knowledge and causes of diabetes, and complications of untreated diabetes. Overall knowledge scores were 23.8 ± 2.4 for general diabetes knowledge, 2.3 ± 0.8 for diabetes specific knowledge, 2.3 ± 1.2 for causes, and 5.2 ± 1.2 for complications of untreated diabetes. Patients with diabetes were more knowledgeable than adults without diabetes in the population. While the general public in Singapore has adequate knowledge of diabetes, misconceptions were identified in both groups which underscores the need to tailor specific educational initiatives to reduce these diabetes knowledge gaps.
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Affiliation(s)
- Kumarasan Roystonn
- Research Division, Institute of Mental Health, Singapore, Singapore
- * E-mail:
| | - P. V. AshaRani
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Chee Fang Sum
- Clinical Research Unit, Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
| | - Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore
- Saw Swee Hock School of Public Health and Department of Medicine, National University of Singapore, Singapore, Singapore
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