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Iravani M, Khadivi R. Intrahospital Mortality Rate after the Implementation of the Second Phase of the Health Sector Reform in Comparison with Before that in Iran. Int J Prev Med 2024; 15:33. [PMID: 39239299 PMCID: PMC11376495 DOI: 10.4103/ijpvm.ijpvm_288_23] [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: 10/24/2023] [Accepted: 04/04/2024] [Indexed: 09/07/2024] Open
Abstract
Background The second phase of the health sector reform, called the Health Sector Evolution Plan (HSEP), has been implemented in Iran since 2014, aims to improve the equity and quality of health services. In the present study, we aimed to measure the trend of hospitalization and the crude intrahospital mortality rate from 1 year before the HSEP implementation (2013) to 5 years after the HSEP implementation (2018) in public hospitals compared with profit, nonprofit, and charity hospitals, which are affiliated with the Isfahan University of Medical Sciences (MUI). Methods In a prospective, cross-sectional study, the data related to the frequency of hospitalized patients and intrahospital mortality during the time of hospitalization were collected through census sampling from 39 public hospitals as the exposed hospitals and 20 profit, nonprofit, and charity hospitals as the control hospitals. Results After HSEP implementation, the frequency of hospitalization increased in public hospitals by 50.45% compared with the previous period. Although the crude intrahospital mortality rate increased from 12.61 to 12.93 per 1000 hospitalized patients (an increase of 2.54%) in public hospitals, the raise was not significant (P value = 0.348). The frequency of hospitalization increased in Social Security Organization's (SSO) hospitals as well as charity hospitals. However, the percent of decrease in the intrahospital mortality rates were -42.96%, -34.76%, and -18.47% in the private, charity, and SSO hospitals, respectively, but was not significant (P value > 0.05). Conclusions The crude intrahospital mortality rates in public hospitals affiliated with MUI did not change significantly after the implementation of the HSEP.
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Affiliation(s)
- Mojtaba Iravani
- Community and Family Medicine Department, Medical Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Khadivi
- Community and Family Medicine Department, Medical Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
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Navuluri N, Lagat DK, Birgen E, Kitur S, Kussin PS, Murdoch DM, Thielman NM, Parish A, Green CL, MacIntyre N, Egger JR, Wools-Kaloustian K, Que LG. Prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya: a single-centre, prospective cohort study. BMJ Open 2023; 13:e072111. [PMID: 37723111 PMCID: PMC10510888 DOI: 10.1136/bmjopen-2023-072111] [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: 01/24/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE Global medical oxygen security is limited by knowledge gaps in hypoxaemia burden and oxygen access in low-income and middle-income countries. We examined the prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya, with a focus on chronic hypoxaemia. DESIGN Single-centre, prospective cohort study. SETTING National tertiary referral hospital in Eldoret, Kenya between September 2019 and April 2022. PARTICIPANTS Adults (age ≥18 years) admitted to general medicine wards. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was proportion of patients who were hypoxaemic (oxygen saturation, SpO2 ≤88%) on admission. Secondary outcomes were proportion of patients with hypoxaemia on admission who had hypoxaemia resolution, hospital discharge, transfer, or death among those with unresolved hypoxaemia or chronic hypoxaemia. Patients remaining hypoxaemic for ≤3 days after admission were enrolled into an additional cohort to determine chronic hypoxaemia. Chronic hypoxaemia was defined as an SpO2 ≤ 88% at either 1-month post-discharge follow-up or, for patients who died prior to follow-up, a documented SpO2 ≤88% during a previous hospital discharge or outpatient visit within the last 6 months. RESULTS We screened 4104 patients (48.5% female, mean age 49.4±19.4 years), of whom 23.8% were hypoxaemic on admission. Hypoxaemic patients were significantly older and more predominantly female than normoxaemic patients. Among those hypoxaemic on admission, 33.9% had resolution of their hypoxaemia as inpatients, 55.6% had unresolved hypoxaemia (31.0% died before hospital discharge, 13.3% were alive on discharge and 11.4% were transferred) and 10.4% were lost to follow-up. The prevalence of chronic hypoxaemia was 2.1% in the total screened population, representing 8.8% of patients who were hypoxaemic on admission. Chronic hypoxaemia was determined at 1-month post-discharge among 59/86 patients and based on prior documentation among 27/86 patients. CONCLUSION Hypoxaemia is highly prevalent among adults admitted to a general medicine ward at a national referral hospital in Kenya. Nearly 1 in 11 patients who are hypoxaemic on admission are chronically hypoxaemic.
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Affiliation(s)
- Neelima Navuluri
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - David K Lagat
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Elcy Birgen
- Duke Global Health Institute, Durham, North Carolina, USA
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Sylvia Kitur
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Peter S Kussin
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David M Murdoch
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nathan M Thielman
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Neil MacIntyre
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joseph R Egger
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Loretta G Que
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Starnes JR, Rogers A, Wamae J, Okoth V, Mudhune SA, Omondi A, Were V, Baraza Awino D, Lefebvre CH, Yap S, Otieno Odhong T, Vill B, Were L, Wamai R. Childhood mortality and associated factors in Migori County, Kenya: evidence from a cross-sectional survey. BMJ Open 2023; 13:e074056. [PMID: 37607788 PMCID: PMC10445361 DOI: 10.1136/bmjopen-2023-074056] [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: 03/29/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVES The under-five mortality (U5M) rate in Kenya (41 per 1000 live births) remains significantly above international goals (25 per 1000 live births). This is further exacerbated by regional inequalities in mortality. We aimed to describe U5M in Migori County, Kenya, and identify associated factors that can serve as programming targets. DESIGN Cross-sectional observational survey. SETTING Areas served by the Lwala Community Alliance and control areas in Migori County, Kenya. PARTICIPANTS This study included 15 199 children born to respondents during the 18 years preceding the survey. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was mortality in the first 5 years of life. The survey was powered to detect a 10% change in various health metrics over time with 80% power. RESULTS A total of 15 199 children were included in the primary analyses, and 230 (1.5%) were deceased before the fifth birthday. The U5M rate from 2016 to 2021 was 32.2 per 1000 live births. Factors associated with U5M included year of birth (HR 0.926, p<0.001), female sex (HR 0.702, p=0.01), parental marriage (HR 0.642, p=0.036), multiple gestation pregnancy (HR 2.776, p<0.001), birth spacing less than 18 months (HR 1.894, p=0.005), indoor smoke exposure (HR 1.916, p=0.027) and previous familial contribution to the National Hospital Insurance Fund (HR 0.553, p=0.009). The most common cause of death was malaria. CONCLUSIONS We describe factors associated with childhood mortality in a Kenyan community using survival analyses of complete birth histories. Mortality rates will serve as the baseline for future programme evaluation as a part of a 10-year study design. This provides both the hyperlocal information needed to improve programming and generalisable conclusions for other organisations working in similar environments.
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Affiliation(s)
- Joseph R Starnes
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Lwala Community Alliance, Rongo, Kenya
| | | | | | | | | | - Alyn Omondi
- Adaptive Model for Research and Empowerment of Communities in Africa, Kisumu, Kenya
| | - Vincent Were
- Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Christina Hope Lefebvre
- Department of Cultures, Societies, and Global Studies, Northeastern University, Boston, Massachusetts, USA
| | - Samantha Yap
- Department of Cultures, Societies, and Global Studies, Northeastern University, Boston, Massachusetts, USA
| | - Tom Otieno Odhong
- Department of Health Services, Migori County Government, Migori, Kenya
| | - Beffy Vill
- Department of Health Services, Migori County Government, Migori, Kenya
| | - Lawrence Were
- Department of Global Health, Boston University, Boston, Massachusetts, USA
| | - Richard Wamai
- Department of Cultures, Societies, and Global Studies, Northeastern University, Boston, Massachusetts, USA
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Mugo MG. The impact of health insurance enrollment on health outcomes in Kenya. HEALTH ECONOMICS REVIEW 2023; 13:42. [PMID: 37584819 PMCID: PMC10428604 DOI: 10.1186/s13561-023-00454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND The achievement of the global agenda on universal health coverage (UHC) is pivotal in ensuring healthy lives and promoting the well-being of all. However, achieving healthy lives and wellbeing of all has been hampered by the challenge of health care financing. As such, healthcare financing, through health insurance is gaining popularity in developing countries such as Kenya, in their pursuit to achieve universal health coverage. The primary purpose of health insurance and delivery is to improve health. However, there is a paucity of evidence on the effectiveness of health insurance in improving the health outcomes and health status of the Kenyan population. Therefore, this study aimed to analyze the impact of health insurance on health outcomes in Kenya. METHODS The study utilized the most recent nationally representative Kenya Integrated Household Budget Survey (KIHBS) 2015/16 dataset in order to analyze the impact of health insurance on health outcomes. The instrumental variable 2-stage least squares (IV 2SLS) and control function approach (CFA) estimation techniques were used to cater for potential endogeneity and heterogeneity biases present in ordinary least squares (OLS) estimators. RESULTS Health insurance enrolment leads to a reduction in mortality, thereby improving the health status of the Kenyan population, despite low levels of insurance uptake. However, the insured population experienced higher chronic illnesses and out-of-pocket (OOP) expenditures raising concerns about financial risk protection. The fact that health insurance is linked to chronic illnesses not only reinforces the reverse causality of health insurance and health status, but also that the effects of potential adverse selection strongly drive the strength and direction of this impact. CONCLUSIONS We conclude that health insurance enrolment reduces mortality and hence has a beneficial impact in promoting health. Health insurance coverage therefore, should be promoted through the restructuring of the National Hospital Insurance Fund (NHIF) fragmented schemes and by consolidating the different insurance schemes to serve different population groups more effectively and equitably. The government should revisit the implementation of a universal social health insurance scheme, as a necessary step towards UHC, while continuing to offer subsidies in the form of health insurance to the marginalized, vulnerable and poor populations.
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Affiliation(s)
- Mercy G Mugo
- Department of Economics & Development Studies, University of Nairobi, P.O. Box 30197, 00100, Nairobi, Kenya.
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Song L, Wang Y, Chen B, Yang T, Zhang W, Wang Y. The Association between Health Insurance and All-Cause, Cardiovascular Disease, Cancer and Cause-Specific Mortality: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1525. [PMID: 32120888 PMCID: PMC7084505 DOI: 10.3390/ijerph17051525] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to evaluate the association of insurance status with all-cause and cause-specific mortality. A total of 390,881 participants, aged 18-64 years and interviewed from 1997 to 2013 were eligible for a mortality follow-up in December 31, 2015. Cox proportional hazards models were used to calculate the hazards ratios (HR) and 95% confidence intervals (CI) to determine the association between insurance status and all-cause and cause-specific mortality. The sample group cumulatively aged 4.22 million years before their follow-ups, with a mean follow-up of 10.4 years, and a total of 22,852 all-cause deaths. In fully adjusted models, private insurance was significantly associated with a 17% decreased risk of mortality (HR = 0.83; 95% CI = 0.80-0.87), but public insurance was associated with a 21% increased risk of mortality (HR = 1.21; 95% CI = 1.15-1.27). Compared to noninsurance, private coverage was associated with about 21% lower CVD mortality risk (HR = 0.79, 95% CI = 0.70-0.89). In addition, public insurance was associated with increased mortality risk of kidney disease, diabetes and CLRD, compared with noninsurance, respectively. This study supports the current evidence for the relationship between private insurance and decreased mortality risk. In addition, our results show that public insurance is associated with an increased risk of mortality.
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Affiliation(s)
- Liying Song
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China;
| | - Yan Wang
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China;
- Mianyang Taxation Bureau of Sichuan Province, State Taxation Administration, Mianyang 621000, China
| | - Baodong Chen
- Department of Accounting, School of Management, Xi’an Polytechnic University, No.19, Jinhua South Road, Xincheng District, Xi’an 710048, China;
| | - Tan Yang
- School of Finance and Accounting, Xi’an University of Technology, No. 58, Yanxiang Road, Yanta District, Xi’an 710054, China;
| | - Weiliang Zhang
- School of Economics and Finance, Xi’an International Studies University, South Wenyuan Road, Chang’an District, Xi’an 710128, China;
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430071, China
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Intensive Care Outcomes and Mortality Prediction at a National Referral Hospital in Western Kenya. Ann Am Thorac Soc 2019; 15:1336-1343. [PMID: 30079751 DOI: 10.1513/annalsats.201801-051oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The burden of critical care is greatest in resource-limited settings. Intensive care unit (ICU) outcomes at public hospitals in Kenya are unknown. The present study is timely, given the Kenyan Ministry of Health initiative to expand ICU capacity. OBJECTIVES To identify factors associated with mortality at Moi Teaching and Referral Hospital and validate the Mortality Probability Admission Model II (MPM0-II). METHODS A retrospective cohort of 450 patients from January 1, 2013, to April 5, 2015, was evaluated using demographics, presenting diagnoses, interventions, mortality, and cost data. RESULTS ICU mortality was 53.6%, and 30-day mortality was 57.3%. Most patients were male (61%) and at least 18 years old (70%); the median age was 29 years. Factors associated with high adjusted odds of mortality were as follows: age younger than 10 years (adjusted odds ratio [aOR], 3.59; P ≤ 0.001), ages 35-49 years (aOR, 3.13; P = 0.002), and age above 50 years (aOR, 2.86; P = 0.004), with reference age range 10-24 years; sepsis (aOR, 3.39; P = 0.01); acute stroke (aOR, 8.14; P = 0.011); acute respiratory failure or mechanical ventilation (aOR, 6.37; P < 0.001); and vasopressor support (aOR, 7.98; P < 0.001). Drug/alcohol poisoning (aOR, 0.33; P = 0.005) was associated with lower adjusted odds of mortality. MPM0-II discrimination showed an area under the receiver operating characteristic curve of 0.78 (95% confidence interval, 0.72-0.82). The result of the Hosmer-Lemeshow test for calibration was significant (P < 0.001). CONCLUSIONS In a Kenyan public ICU, high mortality was noted despite the use of advanced therapies. MPM0-II has acceptable discrimination but poor calibration. Modification of MPM0-II or development of a new model using a prospective multicenter global collaboration is needed. Standardized triage and treatment protocols for high-risk diagnoses are needed to improve ICU outcomes.
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Olbara G, Martijn HA, Njuguna F, Langat S, Martin S, Skiles J, Vik T, Kaspers GJL, Mostert S. Influence of health insurance status on childhood cancer treatment outcomes in Kenya. Support Care Cancer 2019; 28:917-924. [DOI: 10.1007/s00520-019-04859-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
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Castro B, Ing L, Park Y, Abrams J, Ryan M. Addressing Noncommunicable Disease in Dominican Republic: Barriers to Hypertension and Diabetes Care. Ann Glob Health 2018; 84:625-629. [PMID: 30779509 DOI: 10.9204/aogh.2370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Noncommunicable diseases (NCDs) significantly contribute to morbidity and mortality worldwide. During medical brigades in Santo Domingo, the Dominican Aid Society of Virginia (DASV) collects data to help understand the dynamics of NCD management. This study presents findings regarding resources and barriers to NCD treatment. Methods: A cross-sectional survey study was conducted in two communities (Los Mina and Paraiso) during the 2014 DASV summer brigade. Descriptive statistics, associations, correlations as well as qualitative analyses were conducted to better understand resources and barriers to care in relation to health care coverage. RESULTS More than one third (n = 64) of 165 individuals had hypertension and/or diabetes. Thirty-seven percent (Paraiso) and 46% (Los Mina) of study participants did not have health insurance in the previous year. For those that did have insurance, 77% (P) and 89% (LM) visited a physician in the previous year. In this same group, 65% of individuals from Paraiso reported that their health insurance never covered the cost of medications while only a quarter of individuals from Los Mina indicated this. Health insurance and access to physicians and medication varied depending on the community of residence. Surveys indicated that access to affordable medications was an important issue for participants. Also, even though individuals in Los Mina were less likely to have health insurance than those in Paraiso, they were more likely to visit a physician. CONCLUSION This study contributes to a greater understanding of health care coverage and access for low-resource communities in the Dominican Republic. Health care access, insurance, and cost sharing differed between these communities, but barriers to care were common. Future investigations could focus on qualitative differences in communities' health insurance coverages and development of interventions to address obstacles to care.
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Affiliation(s)
| | | | - Yeri Park
- Virginia Commonwealth University, US
| | | | - Mark Ryan
- Virginia Commonwealth University, US
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Castro B, Ing L, Park Y, Abrams J, Ryan M. Addressing Noncommunicable Disease in Dominican Republic: Barriers to Hypertension and Diabetes Care. Ann Glob Health 2018. [PMID: 30779509 PMCID: PMC6748242 DOI: 10.29024/aogh.2370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Noncommunicable diseases (NCDs) significantly contribute to morbidity and mortality worldwide. During medical brigades in Santo Domingo, the Dominican Aid Society of Virginia (DASV) collects data to help understand the dynamics of NCD management. This study presents findings regarding resources and barriers to NCD treatment. Methods: A cross-sectional survey study was conducted in two communities (Los Mina and Paraiso) during the 2014 DASV summer brigade. Descriptive statistics, associations, correlations as well as qualitative analyses were conducted to better understand resources and barriers to care in relation to health care coverage. Results: More than one third (n = 64) of 165 individuals had hypertension and/or diabetes. Thirty-seven percent (Paraiso) and 46% (Los Mina) of study participants did not have health insurance in the previous year. For those that did have insurance, 77% (P) and 89% (LM) visited a physician in the previous year. In this same group, 65% of individuals from Paraiso reported that their health insurance never covered the cost of medications while only a quarter of individuals from Los Mina indicated this. Health insurance and access to physicians and medication varied depending on the community of residence. Surveys indicated that access to affordable medications was an important issue for participants. Also, even though individuals in Los Mina were less likely to have health insurance than those in Paraiso, they were more likely to visit a physician. Conclusion: This study contributes to a greater understanding of health care coverage and access for low-resource communities in the Dominican Republic. Health care access, insurance, and cost sharing differed between these communities, but barriers to care were common. Future investigations could focus on qualitative differences in communities' health insurance coverages and development of interventions to address obstacles to care.
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Affiliation(s)
| | | | - Yeri Park
- Virginia Commonwealth University, US
| | | | - Mark Ryan
- Virginia Commonwealth University, US
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Bloomfield GS, Wang TY, Boulware LE, Califf RM, Hernandez AF, Velazquez EJ, Peterson ED, Li JS. Implementation of management strategies for diabetes and hypertension: from local to global health in cardiovascular diseases. Glob Heart 2015; 10:31-8. [PMID: 25754564 DOI: 10.1016/j.gheart.2014.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Diabetes and hypertension are chronic conditions that are growing in prevalence as major causal factors of cardiovascular disease (CVD). The need for chronic-illness surveillance, population-risk management, and successful treatment interventions are crucial for reducing the burden of future CVD. Addressing these problems will require population-risk stratification, task-sharing and -shifting, and community-as well as network-based care. Information technology tools also provide new opportunities for identifying those at risk and for implementing comprehensive approaches to achieving the goal of improved health locally, regionally, nationally, and globally. This article discusses ongoing efforts at one university health center in the implementation of management strategies for diabetes and hypertension at the local, regional, national, and global levels.
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Affiliation(s)
- Gerald S Bloomfield
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC
| | - Tracy Y Wang
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC
| | - L Ebony Boulware
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC
| | - Robert M Califf
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC
| | - Adrian F Hernandez
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC
| | - Eric J Velazquez
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC
| | - Eric D Peterson
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC
| | - Jennifer S Li
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC.
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Bloomfield GS, Temu TM, Akwanalo CO, Chen PS, Emonyi W, Heckbert SR, Koech MM, Manji I, Shen C, Vatta M, Velazquez EJ, Wessel J, Kimaiyo S, Inui TS. Genetic mutations in African patients with atrial fibrillation: Rationale and design of the Study of Genetics of Atrial Fibrillation in an African Population (SIGNAL). Am Heart J 2015; 170:455-64.e5. [PMID: 26385028 DOI: 10.1016/j.ahj.2015.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/10/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is an urgent need to understand genetic associations with atrial fibrillation in ethnically diverse populations. There are no such data from sub-Saharan Africa, despite the fact that atrial fibrillation is one of the fastest growing diseases. Moreover, patients with valvular heart disease are underrepresented in studies of the genetics of atrial fibrillation. METHODS We designed a case-control study of patients with and without a history of atrial fibrillation in Kenya. Cases with atrial fibrillation included those with and without valvular heart disease. Patients underwent clinical phenotyping and will have laboratory analysis and genetic testing of >240 candidate genes associated with cardiovascular diseases. A 12-month follow-up assessment will determine the groups' morbidity and mortality. The primary analyses will describe genetic and phenotypic associations with atrial fibrillation. RESULTS We recruited 298 participants: 72 (24%) with nonvalvular atrial fibrillation, 78 (26%) with valvular atrial fibrillation, and 148 (50%) controls without atrial fibrillation. The mean age of cases and controls were 53 and 48 years, respectively. Most (69%) participants were female. Controls more often had hypertension (45%) than did those with valvular atrial fibrillation (27%). Diabetes and current tobacco smoking were uncommon. A history of stroke was present in 25% of cases and in 5% of controls. CONCLUSION This is the first study determining genetic associations in valvular and nonvalvular atrial fibrillation in sub-Saharan Africa with a control population. The results advance knowledge about atrial fibrillation and will enhance international efforts to decrease atrial fibrillation-related morbidity.
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Stone GS, Aruasa W, Tarus T, Shikanga M, Biwott B, Ngetich T, Andale T, Cheriro B. The relationship of weekend admission and mortality on the public medical wards at a Kenyan referral hospital. Int Health 2015; 7:433-7. [DOI: 10.1093/inthealth/ihu100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/29/2014] [Indexed: 11/14/2022] Open
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Katz I, Routh S, Bitran R, Hulme A, Avila C. Where will the money come from? Alternative mechanisms to HIV donor funding. BMC Public Health 2014; 14:956. [PMID: 25224636 PMCID: PMC4171544 DOI: 10.1186/1471-2458-14-956] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/02/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Donor funding for HIV programs has flattened out in recent years, which limits the ability of HIV programs worldwide to achieve universal access and sustain current progress. This study examines alternative mechanisms for resource mobilization. METHODS Potential non-donor funding sources for national HIV responses in low- and middle-income countries were explored through literature review and Global Fund documentation, including data from 17 countries. We identified the source, financing agent, magnitude of resources, frequency of availability, as well as enabling and risk factors. RESULTS Four non-donor funding sources for HIV programs were identified: earmarked levy for HIV from country budgets; risk-pooling schemes such as health insurance; debt conversion, in which the creditor country reduces the debt of the debtor country and allocates at least a part of that reduction to health; and concessionary loans from international development banks, which unlike grants, must be repaid. The first two are recurring sources of funding, while the latter two are usually one-time sources, and, if very large, might negatively affect the debtor country's economy. Insurance schemes in five African countries covered less than 6.1% of the HIV expenditure, while social health insurance in four Latin American countries covered 8-11% of the HIV expenditure; in Colombia and Chile, it covered 69% and 60%, respectively. Most low-income countries will find concessionary loans hard to repay, as their HIV programs cost 0.5-4% of GDP. Even in a middle-income country like India, a US$255 million concessionary loan to be repaid over 25 years provided only 7.8% of a 5-year HIV budget. Earmarked levies provided only 15% of the annual HIV funding needs in Zimbabwe and Kenya. Debt conversion provided the same share in Indonesia, but in Pakistan it was much higher - the equivalent of 45% of the annual cost of the national HIV program. CONCLUSIONS Domestic sources of funding are important alternatives to consider and might be able to replace donor HIV funding in specific country contexts, coupled with effective prioritization and efficiency measures. Successful resource mobilization design and implementation require close collaboration with other sectors, particularly with the Ministry of Finance, to make sure that the new financing mechanism is fully synchronized with economic growth and that HIV investments yield returns in the form of higher social benefits.
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Affiliation(s)
- Itamar Katz
- Abt Associates, 4550 Montgomery Ave, Suite 800 North, Bethesda, MD 20814, USA.
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