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Defar A, Zeleke GT, Berhanu D, Lemango ET, Bekele A, Alemu K, Biadgilign S. Health system's availability and readiness of health facilities for chronic non-communicable diseases: Evidence from the Ethiopian national surveys. PLoS One 2024; 19:e0297622. [PMID: 38394315 PMCID: PMC10890768 DOI: 10.1371/journal.pone.0297622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 01/09/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) currently cause more deaths than all other causes of deaths. Cardiovascular disease, diabetes, cancer, and chronic respiratory diseases-threaten the health and economies of individuals and populations worldwide. This study aimed to assess the availability and readiness of health facilities for chronic non-communicable diseases (NCDs) and describe the changes of service availability for common NCDs in Ethiopia. Methods We used data from the 2014 Ethiopia Service Provision Assessment Plus (ESPA +) and 2016 and 2018 Service Availability and Readiness Assessment (SARA) surveys, which were cross-sectional health facility-based studies. A total of 873 health facilities in 2014, 547 in 2016, 632 in 2018 were included in the analysis. (ESPA+) and SARA surveys are conducted as a census or a nationally/sub-nationally representative sample of health facilities. Proportion of facilities that offered the service for diabetes, cardiovascular disease, chronic respiratory disease, cancer diseases, mental illness, and chronic renal diseases was calculated to measure health service availability. The health facility service readiness was measured using the mean availably of tracer items that are required to offer the service. Thus, 13 tracer items for diabetes disease, 12 for cardiovascular disease, 11 for chronic respiratory disease and 11 cervical cancer services were used. RESULTS The services available for diagnosis and management did not show improvement between 2014, 2016 and 2018 for diabetes (59%, 22% and 36%); for cardiovascular diseases (73%, 41% and 49%); chronic respiratory diseases (76%, 45% and 53%). Similarly, at the national level, the mean availability of tracer items between 2014, 2016 and 2018 for diabetes (37%, 53% and 48%); cardiovascular diseases (36%, 41% and 42%); chronic respiratory diseases (26%, 27% and 27%); and cancer diseases (6%, 72% and 51%). However, in 2014 survey year, the mean availability of tracer items was 7% each for mental illness and chronic renal diseases, respectively. CONCLUSIONS The majority of the health facilities have low and gradual decrement in the availability to provide NCDs services in Ethiopia. There is a need to increase NCD service availability and readiness at primary hospitals and health centers, and private and rural health facilities where majority of the population need the services.
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Affiliation(s)
- Atkure Defar
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | | | - Della Berhanu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ephrem Tekle Lemango
- Maternal, Child Health and Nutrition Directorate, Ministry of Health, Addis Ababa, Ethiopia
| | - Abebe Bekele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kassahun Alemu
- College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Sibhatu Biadgilign
- Independent Public Health Analyst and Research Consultant, Addis Ababa, Ethiopia
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Prattipati S, Tarimo TG, Kweka GL, Mlangi JJ, Samuel D, Sakita FM, Tupetz A, Bettger JP, Thielman NM, Temu G, Hertz JT. Patient and provider perspectives on barriers to myocardial infarction care among persons with human immunodeficiency virus in Tanzania: A qualitative study. Int J STD AIDS 2024; 35:18-24. [PMID: 37703080 DOI: 10.1177/09564624231199507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION People with HIV (PLWH) have an increased risk myocardial infarction (MI), and evidence suggests that MI is under-diagnosed in Tanzania. However, little is known about barriers to MI care among PLWH in the region. METHODS In this qualitative study grounded in phenomenology, semi-structured interviews were conducted in northern Tanzania. Purposive sampling was used to recruit a diverse group of providers who care for PLWH and patients with HIV and electrocardiographic evidence of prior MI. Emergent themes were identified via inductive thematic analysis. RESULTS 24 physician and patient participants were interviewed. Most participants explained MI as caused by emotional shock and were unaware of the association between HIV and increased MI risk. Providers described poor provider training regarding MI, high out-of-pocket costs, and lack of diagnostic equipment and medications. Patients reported little engagement with and limited knowledge of cardiovascular care, despite high engagement with HIV care. Most provider and patient participants indicated that they would prefer to integrate cardiovascular care with routine HIV care. CONCLUSIONS PLWH face many barriers to MI care in Tanzania. There is a need for multifaceted interventions to educate providers and patients, improve access to MI diagnosis, and increase engagement with cardiovascular care among this population.
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Affiliation(s)
| | | | | | | | | | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Janet P Bettger
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA, USA
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gloria Temu
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
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Müller SA, Isaaka L, Mumm R, Scheidt-Nave C, Heldt K, Schuster A, Abdulaziz M, El Bcheraoui C, Hanefeld J, Agweyu A. Prevalence and risk factors for long COVID and post-COVID-19 condition in Africa: a systematic review. Lancet Glob Health 2023; 11:e1713-e1724. [PMID: 37858583 DOI: 10.1016/s2214-109x(23)00384-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND An improved estimation of the clinical sequelae of SARS-CoV-2 infection is crucial in African countries, where the subject has received little attention despite more than 12 million reported cases and evidence that many more people were infected. We reviewed the evidence on prevalence, associated risk factors for long COVID, and systemic or sociocultural determinants of reporting long COVID. METHODS We conducted a systematic review, searching PubMed, the Living OVerview of Evidence platform, and grey literature sources for publications from Dec 1, 2019, to Nov 23, 2022. We included articles published in English, French, Spanish, or Portuguese that reported on any study type in Africa with participants of any age who had symptoms for 4 weeks or more after an acute SARS-CoV-2 infection. We excluded secondary research, comments, and correspondence. Screening and data extraction were performed by two reviewers. Summary estimates were extracted, including sociodemographic factors, medical history, prevalence of persistent symptoms, and symptoms and associated factors. Results were analysed descriptively. The study was registered on the Open Science Framework platform. FINDINGS Our search yielded 294 articles, of which 24 peer-reviewed manuscripts were included, reporting on 9712 patients from eight African countries. Only one study exclusively recruited children, and one other study included children as part of their study population. Studies indicated moderate to low risk of bias. Prevalence of long COVID varied widely, from 2% in Ghana to 86% in Egypt. Long COVID was positively associated with female sex, older age, non-Black ethnicity, low level of education, and the severity of acute infection and underlying comorbidity. HIV and tuberculosis were not identified as risk factors. Factors influencing reporting included absence of awareness, inadequate clinical data and diagnostics, and little access to health-care services. INTERPRETATION In Africa, research on long COVID is scarce, particularly among children, who represent the majority of the population. However, existing studies show a substantial prevalence across settings, emphasising the importance of vaccination and other prevention strategies to avert the effects of long COVID on individual wellbeing, the increased strain on health systems, and the potential negative effects on economically vulnerable populations. At a global level, including African countries, tools for research on long COVID need to be harmonised to maximise the usefulness of the data collected. FUNDING None.
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Affiliation(s)
- Sophie Alice Müller
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany.
| | - Lynda Isaaka
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Rebekka Mumm
- Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Katharina Heldt
- Methods Development, Research Infrastructure and Information Technology, Robert Koch Institute, Berlin, Germany
| | - Angela Schuster
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany; Institute of General Practice and Family Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mohammed Abdulaziz
- Division of Disease Control and Prevention, Africa CDC, Addis Ababa, Ethiopia
| | - Charbel El Bcheraoui
- Evidence-based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Ambrose Agweyu
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; London School of Hygiene and Tropical Medicine, London, UK
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Akintunde AA, Mutagaywa R, Manmak M, Oguntade AS, Adejumo OA, Isiguzo G, Beheiry H, Doku A, Dzudie A, Damasceno A, Onwubere BJC, Odili A, Adeoye A, Mbulaje L, Lamin ES, Akumiah F, Avorkliya L, Ogola E, Ayoola Y, Marwa S, Exon A, Amaechi UM, Okereke CJ, Nwude IE. Task sharing in the management of hypertension: highlights of the African hypertension school for nonphysicians health workers. J Hypertens 2023; 41:1544-1550. [PMID: 37642589 DOI: 10.1097/hjh.0000000000003463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Abiodun A Akintunde
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Reuben Mutagaywa
- Muhimbili Orthopedic Institute & Muhimbili University of Health and Allied Sciences
| | - Manven Manmak
- Department of Medicine, University of Abuja, Nigeria
| | - Ayodipupo S Oguntade
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Big Data Institute
| | - Oluseyi A Adejumo
- Department of Internal Medicine University of Medical Sciences, Ondo State
| | - Godsent Isiguzo
- Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital
| | - Hind Beheiry
- Department of Physiology, Director of Educational Development and Research Centre
| | - Alfred Doku
- University of Ghana Medical School, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Anaestase Dzudie
- Department of Internal Medicine and Subspecialties, Douala General Hospital, Douala
| | | | | | - Augustine Odili
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, Main Campus, University of Abuja, off Airport Road, Abuja
| | - Abiodun Adeoye
- Cardiovascular Genomic Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lucia Mbulaje
- Queen Elizabeth Central Hospital, Box 95, Blantyre Malawi
| | - E S Lamin
- Department of Internal Medicine, Edward Francis Small Teaching Hospital/School of Medicine & Allied Health Sciences, University of the Gambia Banjul, The Gambia
| | - Florence Akumiah
- National Cardiothoracic Centre
- Dept of Medicine and Therapeutics, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | - Loius Avorkliya
- Dept of Medicine and Therapeutics, Korle Bu Teaching Hospital, Korle Bu, Accra, Ghana
| | - Elijah Ogola
- Department of Medicine, University of Nairobi, Kenya
| | - Yekeen Ayoola
- Federal Teaching Hospital Gombe /Gombe State University, Gombe, Nigeria
| | | | - A Exon
- Muhumuliza Healthcare Polyclinic, Dar Es Salaam, Tanzania
| | - Uzochukwu M Amaechi
- Department of Human Resources, Society for Public Health and Social Development, Lugbe
| | | | - Ifeanyi E Nwude
- Department of Business Development and Communication, Society for Public Health and Social Development, Lugbe, Abuja, Nigeria
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Mulupi S, Ayakaka I, Tolhurst R, Kozak N, Shayo EH, Abdalla E, Osman R, Egere U, Mpagama SG, Chinouya M, Chikaphupha KR, ElSony A, Meme H, Oronje R, Ntinginya NE, Obasi A, Taegtmeyer M. What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries. BMJ Open 2022; 12:e052105. [PMID: 35906045 PMCID: PMC9345041 DOI: 10.1136/bmjopen-2021-052105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Chronic respiratory diseases (CRD) are among the top four non-communicable diseases globally. They are associated with poor health and approximately 4 million deaths every year. The rising burden of CRD in low/middle-income countries will strain already weak health systems. This study aimed to explore the perspectives of healthcare workers and other health policy stakeholders on the barriers to effective diagnosis and management of CRD in Kenya, Malawi, Sudan, Tanzania and Uganda. STUDY DESIGN Qualitative descriptive study. SETTINGS Primary, secondary and tertiary health facilities, government agencies and civil society organisations in five sub-Saharan African countries. PARTICIPANTS We purposively selected 60 national and district-level policy stakeholders, and 49 healthcare workers, based on their roles in policy decision-making or health provision, and conducted key informant interviews and in-depth interviews, respectively, between 2018 and 2019. Data were analysed through framework approach. RESULTS We identified intersecting vicious cycles of neglect of CRD at strategic policy and healthcare facility levels. Lack of reliable data on burden of disease, due to weak information systems and diagnostic capacity, negatively affected inclusion in policy; this, in turn, was reflected by low budgetary allocations for diagnostic equipment, training and medicines. At the healthcare facility level, inadequate budgetary allocations constrained diagnostic capacity, quality of service delivery and collection of appropriate data, compounding the lack of routine data on burden of disease. CONCLUSION Health systems in the five countries are ill-equipped to respond to CRD, an issue that has been brought into sharp focus as countries plan for post-COVID-19 lung diseases. CRD are underdiagnosed, under-reported and underfunded, leading to a vicious cycle of invisibility and neglect. Appropriate diagnosis and management require health systems strengthening, particularly at the primary healthcare level.
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Affiliation(s)
- Stephen Mulupi
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Irene Ayakaka
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Lung Institute, Makerere University, Kampala, Uganda
| | - Rachel Tolhurst
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nicole Kozak
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Health Systems and Policy Research Unit, REACH Trust Malawi, Lilongwe, Malawi
| | - Elizabeth Henry Shayo
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- National Institute of Medical Research, Mbeya, United Republic of Tanzania
| | | | - Rashid Osman
- Lung Health Department, Epi-Lab, Khartoum, Sudan
| | - Uzochukwu Egere
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stellah G Mpagama
- Medical Department, Kibong'oto Infectious Diseases Hospital/Kilimanjaro Christian Medical University, Kilimanjaro, United Republic of Tanzania
| | - Martha Chinouya
- Education Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Asma ElSony
- Lung Health Department, Epi-Lab, Khartoum, Sudan
| | - Helen Meme
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Rose Oronje
- African Institute for Development Policy (AFIDEP), Nairobi, Kenya
| | - Nyanda Elias Ntinginya
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre, Mbeya, Tanzania, United Republic of
| | - Angela Obasi
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- AXESS Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Miriam Taegtmeyer
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Ansbro É, Garry S, Karir V, Reddy A, Jobanputra K, Fardous T, Sadique Z. Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study. Health Policy Plan 2021; 35:931-940. [PMID: 32621490 PMCID: PMC8312704 DOI: 10.1093/heapol/czaa050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The Syrian conflict has caused enormous displacement of a population with a high
non-communicable disease (NCD) burden into surrounding countries, overwhelming health
systems’ NCD care capacity. Médecins sans Frontières (MSF) developed a primary-level NCD
programme, serving Syrian refugees and the host population in Irbid, Jordan, to assist the
response. Cost data, which are currently lacking, may support programme adaptation and
system scale up of such NCD services. This descriptive costing study from the provider
perspective explored financial costs of the MSF NCD programme. We estimated annual total,
per patient and per consultation costs for 2015–17 using a combined ingredients-based and
step-down allocation approach. Data were collected via programme budgets, facility
records, direct observation and informal interviews. Scenario analyses explored the impact
of varying procurement processes, consultation frequency and task sharing. Total annual
programme cost ranged from 4 to 6 million International Dollars (INT$), increasing
annually from INT$4 206 481 (2015) to INT$6 739 438 (2017), with costs driven mainly by
human resources and drugs. Per patient per year cost increased 23% from INT$1424 (2015) to
1751 (2016), and by 9% to 1904 (2017), while cost per consultation increased from INT$209
to 253 (2015–17). Annual cost increases reflected growing patient load and increasing
service complexity throughout 2015–17. A scenario importing all medications cut total
costs by 31%, while negotiating importation of high-cost items offered 13% savings.
Leveraging pooled procurement for local purchasing could save 20%. Staff costs were more
sensitive to reducing clinical review frequency than to task sharing review to nurses.
Over 1000 extra patients could be enrolled without additional staffing cost if care
delivery was restructured. Total costs significantly exceeded costs reported for NCD care
in low-income humanitarian contexts. Efficiencies gained by revising procurement and/or
restructuring consultation models could confer cost savings or facilitate cohort
expansion. Cost effectiveness studies of adapted models are recommended.
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Affiliation(s)
- Éimhín Ansbro
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Sylvia Garry
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Veena Karir
- Médecins sans Frontières, Plantage Middenlaan 14 1018 DD Amsterdam, The Netherlands
| | - Amulya Reddy
- Médecins Sans Frontières, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London EC4A 1AB, UK
| | - Kiran Jobanputra
- Médecins Sans Frontières, Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London EC4A 1AB, UK
| | - Taissir Fardous
- Health Economy Directorate, Ministry of Health, Pr. Hamzah St., Amman, Jordan
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Aekplakorn W, Suriyawongpaisal P, Srithamrongsawadi S, Kaewkamjonchai P. Assessing a national policy on strengthening chronic care in primary care settings of a middle-income country using patients' perspectives. BMC Health Serv Res 2021; 21:223. [PMID: 33711999 PMCID: PMC7953793 DOI: 10.1186/s12913-021-06220-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background To improve care for patients with chronic diseases, a recent policy initiative in Thailand focused on strengthening primary care based on the concept of Chronic Care Model (CCM). This study aimed to assess the perception of patients about the health care services after the implementation. Methods We conducted a cross-sectional survey of 4071 patients with hypertension and/or diabetes registered with 27 primary care units and 11 hospital non-communicable diseases (NCDs) clinics in 11 provinces. The patients were interviewed using a validated questionnaire of the Patient Assessment of Chronic Illness Care. Upgraded primary care units (PCUs) were ordinary PCUs with the multi-professional team including a physician. Trained upgraded PCUs were upgraded PCUs with the training input. Structural equation modeling was used to create subscale scores for CCM and 5 A model characteristics. Mixed effect logistic models were employed to examine the association of subscales (high vs low score) of patient perception of the care quality with type of PCUs. Results Compared to hospital NCD clinics, ordinary PCUs were the best in the odds of receiving high score for every CCM subscale (ORs: 1.46–1.85; p < 0.05), whereas the trained upgraded PCUs were better in terms of follow-up (ORs:1.37; p < 0.05), and the upgraded PCU did not differ in all domains. According to the 5 A model subscales, patient assessment also revealed better performance of ordinary PCUs in all domains compared to hospital NCD clinics whereas upgraded PCUs and trained upgraded PCUs did so in some domains. Seeing the same doctor on repeated visits (ORs: 1.82–2.17; p < 0.05) or having phone contacts with the providers (ORs:1.53–1.99; p < 0.05) were found beneficial using CCM subscales and the 5A model subscales. However, patient assessment by both subscales did not demonstrate a statistically significant association across health insurance status. Conclusions The policy implementation might not satisfy the patients’ perception on quality of chronic care according to the CCM and the 5A model subscale. However, the arrangement of chronic care with patients seeing the same doctors or patients having telephone contact with healthcare providers may satisfy the patients’ perceived needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06220-x.
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Affiliation(s)
- Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand
| | - Paibul Suriyawongpaisal
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand
| | - Samrit Srithamrongsawadi
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand
| | - Phanuwich Kaewkamjonchai
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, 10400, Thailand.
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Naville R, Subtil F, Sy M, Marquis M, Costes P, Letrilliart L. Scope of health problems managed by general practitioners in Mali and France: awaiting practice transition in sub-Saharan Africa? Fam Pract 2020; 37:668-674. [PMID: 32531028 DOI: 10.1093/fampra/cmaa035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Minimal data are available on the clinical activity of general practitioners (GPs) in Africa. OBJECTIVE To describe the health problems managed by GPs in Mali as compared with France where epidemiological transition is already advanced. METHODS A retrospective, multicenter study, conducted in five Malian Community Health Centers. We compared their consultation data to those of the ECOGEN (Eléments de la COnsultation en médecine GENérale) study conducted in 128 French general practices, after data standardization for age and sex. RESULTS Malian and French databases included 19 068 and 19 341 consultations, respectively. Patients had an average of 1.2 health problems managed per consultation in Mali, versus 2.2 in France. They were dominated by infections (51.3%) in Mali, including malaria (24.9%), pneumonia (9.0%) and gastrointestinal infections (5.0%). In comparison with French GPs, Malian GPs more frequently managed cardiovascular (20.2% versus 13.5%), respiratory (15.0% versus 12.4%) and digestive (13.3% versus 7.8%) problems, and less frequently musculoskeletal (3.1% versus 12.6%), endocrine/metabolic (1.5% versus 10.7%) and psychological (0.2% versus 8.2%) problems. The main activity performed by French GPs was prevention (11.0%), which was nominal in Mali. Apart from hypertension, which accounted for 18.9% of the health problems managed in Mali, chronic conditions were less often managed by Malian GPs than by French GPs (12.3% versus 39.6%). CONCLUSIONS Africa is currently at the crossroads where chronic conditions carried with the epidemiological transition are progressing, while the burden of communicable diseases is still overwhelming. Along with the enhancing medicalization of primary care in Mali, the transition of practices is just emerging.
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Affiliation(s)
- Raphaël Naville
- Collège universitaire de médecine générale, Université Claude Bernard Lyon 1, Univ. Lyon, Lyon, France
| | - Fabien Subtil
- Service de Biostatistique-Bioinformatique, Hospices Civils de Lyon, Lyon, France
| | | | - Michel Marquis
- Agence régionale de santé Auvergne-Rhône-Alpes, Direction de la Santé Publique, Lyon, France
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Gbeasor-Komlanvi FA, Zida-Compaore WIC, Dare IH, Diallo A, Darre TP, Potchoo Y, Belo M, Ekouevi DK. Medication Consumption Patterns and Polypharmacy among Community-Dwelling Elderly in Lomé (Togo) in 2017. Curr Gerontol Geriatr Res 2020; 2020:4346035. [PMID: 32351556 PMCID: PMC7178761 DOI: 10.1155/2020/4346035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/05/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In the sub-Saharan African, region of the world with a fast growing aging population and where the use of herbal products is very common, there is a paucity of data on medication consumption patterns among elderly people. The objective of this study was to assess the prevalence of polypharmacy and its associated factors among community-dwelling elderly in Lomé, Togo, in 2017. METHODS A cross-sectional study was conducted from March to June 2017 in Lomé, Togo among people aged 60 years and older. The Respondent Driven Sampling method was used to recruit participants. Data on socio-demographic characteristics and medication consumption patterns, including the use of medicinal plants and dietary supplements, were collected using a standardized questionnaire during a face-to-face interview at participants' home. Descriptive and binary logistic regression analyses were performed. RESULTS A total of 370 participants with median age 65 years, (IQR: 62-71) were enrolled in the study. Almost three elderly in five (57.6%) were multimorbid (had two or more chronic diseases). Conventional drugs (78.4%), medicinal plants (14.3%) and other dietary supplements (9.5%) were used by participants. The prevalence of polypharmacy was 22.7% (95% CI: 18.5-27.3%). Concurrent use of conventional drugs and medicinal plants or other dietary supplements was observed among 17.0% of participants and 67.3% reported self-medication. Multimorbidity (aOR = 4.55; 95% CI: [2.42-8.54]) and female sex (aOR = 1.86; 95% CI: [1.00-3.47]) were associated with polypharmacy. CONCLUSION One elderly in five uses five or more medications in Togo. Further studies are needed to assess drug-drug interactions and herb-drug interactions among this population.
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Affiliation(s)
- Fifonsi A. Gbeasor-Komlanvi
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, BP 4089, Togo
| | | | - Ikpindi H. Dare
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | | | - Tchin P. Darre
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | - Yao Potchoo
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | - Mofou Belo
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
| | - Didier K. Ekouevi
- Faculté des Sciences de la Santé, Université de Lomé, Lomé, BP 1515, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique, Lomé, BP 4089, Togo
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10
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Kuuire VZ, Bisung E, Were JM. Examining the connection between residential histories and obesity among Ghanaians: evidence from a national survey. J Public Health (Oxf) 2019; 27:569-79. [DOI: 10.1007/s10389-018-0983-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Mayega RW, Rutebemberwa E. Clinical presentation of newly diagnosed diabetes patients in a rural district hospital in Eastern Uganda. Afr Health Sci 2018; 18:707-719. [PMID: 30603004 PMCID: PMC6307025 DOI: 10.4314/ahs.v18i3.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Our objective was to describe the clinical presentation of new diabetes patients in a rural hospital, to enhance clinical detection in low resource settings. Methods A case series assessment of 103 new diabetes patients consecutively enrolled at Iganga Hospital in rural Eastern Uganda was conducted. All underwent a basic clinical assessment through the clinic's routine procedures. Following diagnosis, variables pertinent to the study (symptoms, blood pressure, anthropometry, and blood glucose) were secondarily abstracted from their clinical records. Results Fiftty two percent of new diabetes patients were female. The mean age was 49 years (SD=14.4). Two clinical symptoms were present in almost all new patients: Frequent urination (100%) and frequent thirst (79%). Moderately occurring symptoms (i.e. 25–50% of patients) included blurred vision, frequent eating and frequent sweating. The mean duration of symptoms was 1.4 years; 48% had high blood pressure while 46% were overweight. Random blood sugar was normal for 25% of patients. The majority (71%) were classified as having ‘moderate illness' at diagnosis. Severe illness was significantly lower among patients aged 40 or older compared to younger patients (OR 0.1; 95% CI 0.03–0.35). Conclusion Out-patients aged 40–65 years should be prioritised for early diabetes diagnosis and associated risk factors in this setting.
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van Gemert FA, Kirenga BJ, Gebremariam TH, Nyale G, de Jong C, van der Molen T. The complications of treating chronic obstructive pulmonary disease in low income countries of sub-Saharan Africa. Expert Rev Respir Med 2018; 12:227-237. [PMID: 29298106 DOI: 10.1080/17476348.2018.1423964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In most low and middle-income countries, chronic obstructive pulmonary disease (COPD) is on the rise. Areas covered: Unfortunately, COPD is a neglected disease in these countries. Taking sub-Saharan Africa as an example, in rural areas, COPD is even unknown regarding public awareness and public health planning. Programs for the management of COPD are poorly developed, and the quality of care is often of a low standard. Inhaled medication is often not available or not affordable. Tobacco smoking is the most common encountered risk factor for COPD. However, in sub-Saharan Africa, household air pollution is another major risk factor for the development of COPD. Communities are also exposed to a variety of other risk factors, such as low birth weight, malnutrition, severe childhood respiratory infections, occupational exposures, outdoor pollution, human-immunodeficiency virus and tuberculosis. All these factors contribute to the high burden of poor respiratory health in sub-Saharan Africa. Expert commentary: A silent growing epidemic of COPD seems to be unravelling. Therefore, prevention and intervention programs must involve all the stakeholders and start as early as possible. More research is needed to describe, define and inform treatment approaches, and natural history of biomass-related COPD.
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Affiliation(s)
- Frederik A van Gemert
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda
| | - Bruce J Kirenga
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda.,c Department of Medicine , Makerere University , Kampala , Uganda
| | - Tewodros Haile Gebremariam
- d Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine , Addis Ababa University, College of Health Science , Addis Ababa , Ethiopia
| | - George Nyale
- e Respiratory and Infectious Disease Unit , Kenyatta National Referral & Teaching Hospital , Nairobi , Kenya.,f Kenya Association of Physicians for Tuberculosis and other Lung Disease (KAPTLD) , Nairobi , Kenya
| | - Corina de Jong
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Thys van der Molen
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda
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13
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Kane J, Landes M, Carroll C, Nolen A, Sodhi S. A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa. BMC Fam Pract 2017; 18:46. [PMID: 28330453 PMCID: PMC5363051 DOI: 10.1186/s12875-017-0613-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 03/07/2017] [Indexed: 12/21/2022]
Abstract
Background Chronic diseases, primarily cardiovascular disease, respiratory disease, diabetes and cancer, are the leading cause of death and disability worldwide. In sub-Saharan Africa (SSA), where communicable disease prevalence still outweighs that of non-communicable disease (NCDs), rates of NCDs are rapidly rising and evidence for primary healthcare approaches for these emerging NCDs is needed. Methods A systematic review and evidence synthesis of primary care approaches for chronic disease in SSA. Quantitative and qualitative primary research studies were included that focused on priority NCDs interventions. The method used was best-fit framework synthesis. Results Three conceptual models of care for NCDs in low- and middle-income countries were identified and used to develop an a priori framework for the synthesis. The literature search for relevant primary research studies generated 3759 unique citations of which 12 satisfied the inclusion criteria. Eleven studies were quantitative and one used mixed methods. Three higher-level themes of screening, prevention and management of disease were derived. This synthesis permitted the development of a new evidence-based conceptual model of care for priority NCDs in SSA. Conclusions For this review there was a near-consensus that passive rather than active case-finding approaches are suitable in resource-poor settings. Modifying risk factors among existing patients through advice on diet and lifestyle was a common element of healthcare approaches. The priorities for disease management in primary care were identified as: availability of essential diagnostic tools and medications at local primary healthcare clinics and the use of standardized protocols for diagnosis, treatment, monitoring and referral to specialist care. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0613-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Kane
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Megan Landes
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Dignitas International, 2 Adelaide Street West, Suite 200, Toronto, M5H 1L6, Canada
| | - Christopher Carroll
- Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield Regent Court, Regent Street, Sheffield, S1 4DA, UK
| | - Amy Nolen
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sumeet Sodhi
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Dignitas International, 2 Adelaide Street West, Suite 200, Toronto, M5H 1L6, Canada
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Pfaff C, Scott V, Hoffman R, Mwagomba B. You can treat my HIV - But can you treat my blood pressure? Availability of integrated HIV and non-communicable disease care in northern Malawi. Afr J Prim Health Care Fam Med 2017; 9:e1-e8. [PMID: 28235324 PMCID: PMC5320467 DOI: 10.4102/phcfm.v9i1.1151] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 08/24/2016] [Accepted: 07/21/2016] [Indexed: 11/29/2022] Open
Abstract
Background Many patients on antiretroviral therapy (ART) in Malawi have or will develop non-communicable diseases (NCDs). The current capacity of ART sites to provide care for NCDs is not known. Aim This study aimed to assess the capacity of ART sites to provide care for hypertension and diabetes in rural Malawi. Setting Twenty-five health centres and five hospitals in two rural districts in northern Malawi. Methods A cross-sectional survey was performed between March and May 2014 at all facilities. Qualitative interviews were held with three NCD coordinators. Results Treatment of hypertension and diabetes was predominantly hospital-based. Sixty percent of hospitals had at least one clinician and one nurse trained in NCD care, whereas 5% of health centres had a clinician and 8% had a nurse trained in NCD care. Hundred percent of hospitals and 92% of health centres had uninterrupted supply of hydrochlorothiazide in the previous 6 months, but only 40% of hospitals and no health centres had uninterrupted supply of metformin. Hundred percent of hospitals and 80% of health centres had at least one blood pressure machine, and 80% of hospitals and 32% of health centres had one glucometer. Screening for hypertension amongst ART patients was only conducted at one hospital and no health centres. At health centres, integrated NCD and ART care was more common, with 48% (12/25) providing ART and NCD treatment in the same consultation. Conclusions The results reflect the status of the initial stages of the Malawi NCD programme at sites currently providing ART care.
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Musinguzi G, Bastiaens H, Wanyenze RK, Mukose A, Van geertruyden JP, Nuwaha F. Capacity of Health Facilities to Manage Hypertension in Mukono and Buikwe Districts in Uganda: Challenges and Recommendations. PLoS One 2015; 10:e0142312. [PMID: 26560131 PMCID: PMC4641641 DOI: 10.1371/journal.pone.0142312] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 10/20/2015] [Indexed: 01/12/2023] Open
Abstract
Background The burden of chronic diseases is increasing in both low- and middle-income countries. However, healthcare systems in low-income countries are inadequately equipped to deal with the growing disease burden, which requires chronic care for patients. The aim of this study was to assess the capacity of health facilities to manage hypertension in two districts in Uganda. Methods In a cross-sectional study conducted between June and October 2012, we surveyed 126 health facilities (6 hospitals, 4 Health Center IV (HCIV), 23 Health Center III (HCIII), 41 Health Center II (HCII) and 52 private clinics/dispensaries) in Mukono and Buikwe districts in Uganda. We assessed records, conducted structured interviews with heads of facilities, and administered questionnaires to 271 health workers. The study assessed service provision for hypertension, availability of supplies such as medicines, guidelines and equipment, in-service training for hypertension, knowledge of hypertension management, challenges and recommendations. Results Of the 126 health facilities, 92.9% reported managing (diagnosing/treating) patients with hypertension, and most (80.2%) were run by non-medical doctors or non-physician health workers (NPHW). Less than half (46%) of the facilities had guidelines for managing hypertension. A 10th of the facilities lacked functioning blood pressure devices and 28% did not have stethoscopes. No facilities ever calibrated their BP devices except one. About a half of the facilities had anti-hypertensive medicines in stock; mainly thiazide diuretics (46%), beta blockers (56%) and calcium channel blockers (48.4%). Alpha blockers, mixed alpha & beta blockers and angiotensin II receptor antagonists were only stocked by private clinics/dispensaries. Most HCIIs lacked anti-hypertensive medicines, including the first line thiazide diuretics. Significant knowledge gaps in classification of patients as hypertensive were noted among respondents. All health workers (except 5, 1.9%) indicated that they needed additional training in hypertension management. Several provider and patient related challenges were also observed in this study. Conclusions Health facilities in this setting are inadequately equipped to provide services for management of hypertension. Diagnostic equipment, anti-hypertensive drugs and personnel present great challenges. To address the increasing burden of hypertension and other chronic diseases, measures are needed to substantially strengthen the healthcare facilities, including training of personnel in management of hypertension and other chronic diseases, and improving diagnostic and treatment supplies.
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Affiliation(s)
- Geofrey Musinguzi
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- International Health, Department of Epidemiology and Biostatistics, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Hilde Bastiaens
- Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Aggrey Mukose
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- International Health, Department of Epidemiology and Biostatistics, University of Antwerp, Antwerp, Belgium
| | | | - Fred Nuwaha
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Xiao Y. The "expert patient" approach for non-communicable disease management in low and middle income settings: When the reality confronts the rhetoric. Chronic Dis Transl Med 2015; 1:145-151. [PMID: 29063000 PMCID: PMC5643575 DOI: 10.1016/j.cdtm.2015.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Indexed: 11/05/2022] Open
Abstract
This paper seeks to explore the relevance between the Western “expert patient” rhetoric and the reality of non-communicable diseases (NCDs) control and management in low and middle income settings from the health sociological perspective. It firstly sets up a conceptual framework of the “expert patient” or the patient self-management approach, showing the rhetoric of the initiative in the developed countries. Then by examining the situation of NCDs control and management in low income settings, the paper tries to evaluate the possibilities of implementing the “expert patient” approach in these countries. Kober and Van Damme's study on the relevance of the “expert patient” for an HIV/AIDS program in low income settings is critically studied to show the relevance of the developed countries' rhetoric of the “expert patient” approach for the reality of developing countries. In addition, the MoPoTsyo diabetes peer educator program is analyzed to show the challenges faced by the low income countries in implementing patient self-management programs. Finally, applications of the expert patient approach in China are discussed as well, to remind us of the possible difficulties in introducing it into rural settings.
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Affiliation(s)
- Yue Xiao
- The Center for Health Policy Evaluation and Technology Assessment, The China National Health Development Research Center, Beijing 100910, China
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Kapongo RY, Lulebo AM, Mafuta EM, Mutombo PB, Dimbelolo JCM, Bieleli IE. Assessment of health service delivery capacities, health providers' knowledge and practices related to type 2 diabetes care in Kinshasa primary healthcare network facilities, Democratic Republic of the Congo. BMC Health Serv Res 2015; 15:9. [PMID: 25609206 PMCID: PMC4308827 DOI: 10.1186/s12913-015-0679-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 01/05/2015] [Indexed: 12/05/2022] Open
Abstract
Background Democratic Republic of the Congo (DRC) is experiencing an increase in the morbi-mortality related to Non Communicable Diseases (NCD). The reform of DRC health system, based on Health District model, is needed in order to tackle this public issue. This article used 2006 International Diabetes Federation (IDF)’s guidelines to assess the capacities of health facilities belonging to Kinshasa Primary Health Care Network (KPHCN) in terms of equipments, as well as the knowledge, and the practice of their health providers related to type 2 diabetes care. Methods A multicentric cross-sectional study was carried in 18 Health Facilities (HF) of KPHCN in charge of the follow-up of diabetic patients. The presence of IDF recommended materials and equipment was checked and 28 health providers were interviewed about their theoretical knowledge about patients’ management and therapeutic objectives during recommended visits. Chi square test or Fisher exact test was used to compare proportions and the Student t-test to compare means. Results The integration of NCD healthcare in the KPHC network is feasible. The majority of HF possessed IDF recommended materials except for the clinical practice guidelines, urinary test strips, and monofilament, available in only one, two and four HF, respectively. KPHCN referral facilities had required materials for biochemical analyses, the ECG and for the fundus oculi test. Patients’ management is characterized by a lack of attention on the impairment of renal function during the first visits and a poor respect of recommended practices during quarterly and annual visits. A poor knowledge of the reduction of cardiovascular risk factors-related therapeutic objectives has been also reported. Conclusion The capacities, knowledge, and practice of T2D care were poor among HF of KPHCN. The lack of equipment and training of healthcare professionals should be supplied even to those who are not medical doctors. Special attention must to be put on the clinical practice guidelines formulation and sensitization and on supervision.
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Affiliation(s)
- Remy Y Kapongo
- Internal Medicine Service, Friendship Sino-Congolese hospital, Kinshasa, Democratic Republic of Congo. .,Department of Internal Medicine, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Aimée M Lulebo
- Kinshasa School of Public Health, School Public Health, Faculty of Medicine, University of Kinshasa, Po Box 11850, Kinshasa 1, DR, Congo.
| | - Eric M Mafuta
- Kinshasa School of Public Health, School Public Health, Faculty of Medicine, University of Kinshasa, Po Box 11850, Kinshasa 1, DR, Congo.
| | - Paulin B Mutombo
- Kinshasa School of Public Health, School Public Health, Faculty of Medicine, University of Kinshasa, Po Box 11850, Kinshasa 1, DR, Congo.
| | | | - Isidore E Bieleli
- Department of Internal Medicine, University Clinics of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
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Mayega RW, Etajak S, Rutebemberwa E, Tomson G, Kiguli J. 'Change means sacrificing a good life': perceptions about severity of type 2 diabetes and preventive lifestyles among people afflicted or at high risk of type 2 diabetes in Iganga Uganda. BMC Public Health 2014; 14:864. [PMID: 25146387 PMCID: PMC4148963 DOI: 10.1186/1471-2458-14-864] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 08/15/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Interventions for prevention of type 2 diabetes ought to be acceptable to target communities. We assessed perceptions about type 2 diabetes and lifestyle change among people afflicted or at high risk of this disease in a low income setting in Iganga Uganda. METHODS Twelve focus group discussions (FGDs) of eight participants each were conducted, balancing rural and peri-urban (near the Municipality) residence and gender. The FGDs involved people with suspected type 2 diabetes (based on fasting plasma glucose (FPG), people with suspected pre-diabetes and obese people with normal FPG. Content analysis was conducted. RESULTS Diabetes was perceived to be a very severe disease. Its severity was attributed to its incurability and its numerous health effects. Men were also concerned about reduced sexual performance. However, participants' strong concerns about the severity of diabetes were not reflected in their perceptions about the risk factors and lifestyles associated with it. While people with diabetes perceive obesity as 'sickness', those without diabetes perceive it as a sign of 'success'. Although participants are willing to change their diet, they mention numerous barriers including poverty, family size, and access to some foods. Because of their good taste, reduction of high risk foods like sugar and fried food is perceived as 'sacrificing a good life'. Increments in physical activity were said to be feasible, but only in familiar forms like domestic work. An over-arching theme emerged that 'lifestyle changes are viewed as sacrificing a good life'. CONCLUSIONS Health promotion should target both community norms and individual awareness regarding obesity, physical activity and diet, and should address the notion that obesity and unhealthy foods represent a good life. Health educators should plan with clients on how to overcome barriers and misconceptions to lifestyle change, leveraging the pervasive perception of type 2 diabetes as a severe disease to motivate change.
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Affiliation(s)
- Roy W Mayega
- Makerere University School of Public Health, P,O, Box 7072, Kampala, Uganda.
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Mayega RW, Guwatudde D, Makumbi FE, Nakwagala FN, Peterson S, Tomson G, Ostenson CG. Comparison of fasting plasma glucose and haemoglobin A1c point-of-care tests in screening for diabetes and abnormal glucose regulation in a rural low income setting. Diabetes Res Clin Pract 2014; 104:112-20. [PMID: 24456993 DOI: 10.1016/j.diabres.2013.12.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/01/2013] [Accepted: 12/21/2013] [Indexed: 01/17/2023]
Abstract
AIMS Glycated haemoglobin (HbA1C) has been suggested to replace glucose tests in identifying diabetes and pre-diabetes. We assessed agreement between fasting plasma glucose (FPG) and HbA1C rapid tests in classifying abnormal glucose regulation (AGR), and their utility for preventive screening in rural Africa. METHODS A population-based survey of 795 people aged 35-60 years was conducted in a mainly rural district in Uganda. FPG was measured using On-Call® Plus glucometers, and classified using World Health Organization (WHO) and American Diabetes Association (ADA) criteria. HbA1C was measured using A1cNow® kits and classified using ADA criteria. Body mass index and blood pressure were measured. Percentage agreement between the two tests was computed. RESULTS Using HbA1C, 11.3% of participants had diabetes compared with 4.8% for FPG. Prevalence of HbA1C-defined pre-diabetes (26.4%) was 1.2 times and 2.5 times higher than FPG-defined pre-diabetes using ADA (21.8%) and WHO (10.1%) criteria, respectively. With FPG as the reference, agreement between FPG and HbA1C in classifying diabetes status was moderate (Kappa=22.9; Area Under the Curve (AUC)=75%), while that for AGR was low (Kappa=11.0; AUC=59%). However, agreement was high (over 90%) among negative tests and among participants with risk factors for type 2 diabetes (obesity, overweight or hypertension). HbA1C had more procedural challenges than FPG. CONCLUSIONS Although low in the general sample, agreement between HbA1C and FPG is excellent among persons who test negative with either test. A single test can therefore identify the majority at lower risk for type 2 diabetes. Nurses if trained can conduct these tests.
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Affiliation(s)
- Roy William Mayega
- Department of Epidemiology, Biostatistics, Makerere University School of Public Health, Kampala, Uganda; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - David Guwatudde
- Department of Epidemiology, Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Fredrick Edward Makumbi
- Department of Epidemiology, Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | - Stefan Peterson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda; International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
| | - Göran Tomson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Medical Management Centre (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Claes-Göran Ostenson
- Department of Molecular Medicine and Surgery, Endocrine and Diabetes Unit, Karolinska Institutet, Stockholm, Sweden
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Abstract
The Africa Region (AFR), where diabetes was once rare, has witnessed a surge in the condition. Estimates for type 1 diabetes suggest that about 39,000 people suffer from the disease in 2013 with 6.4 new cases occurring per year per 100,000 people in children <14 years old. Type 2 diabetes prevalence among 20-79-year-olds is 4.9% with the majority of people with diabetes <60 years old; the highest proportion (43.2%) is in those aged 40-59 years. Figures are projected to increase with the numbers rising from 19.8 million in 2013 to 41.5 million in 2035, representing a 110% absolute increase. There is an apparent increase in diabetes prevalence with economic development in AFR with rates of 4.4% in low-income, 5.0% in lower-middle income and 7.0% in upper-middle income countries. In addition to development and increases in life-expectancy, the likely progression of people at high risk for the development of type 2 diabetes will drive the expected rise of the disease. This includes those with impaired glucose tolerance, the prevalence of which is 7.3% among 20-79-year-olds in 2013. Mortality attributable to diabetes in 2013 in AFR is expected to be over half a million with three-quarter of these deaths occurring in those <60 years old. The prevalence of undiagnosed diabetes remains unacceptably high at 50.7% and is much higher in low income (75.1%) compared to lower- and upper-middle income AFR countries (46.0%). This highlights the inadequate response of local health systems which need to provide accessible, affordable and optimal care for diabetes.
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Affiliation(s)
- Nasheeta Peer
- Chronic Diseases of Lifestyle Research Unit, South African Medical Research Council, Durban, South Africa
| | - Andre-Pascal Kengne
- Chronic Diseases of Lifestyle Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu - Natal, South Africa
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon.
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van Olmen J, Schellevis F, Van Damme W, Kegels G, Rasschaert F. Management of Chronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV/AIDS and Diabetes Care. J Trop Med 2012; 2012:349312. [PMID: 23209477 DOI: 10.1155/2012/349312] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 10/16/2012] [Indexed: 12/19/2022] Open
Abstract
There is growing attention for chronic diseases in sub-Saharan Africa (SSA) and for bridges between the management of HIV/AIDS and other (noncommunicable) chronic diseases. This becomes more urgent with increasing numbers of people living with both HIV/AIDS and other chronic conditions. This paper discusses
the commonalities between chronic diseases by reviewing models of care, focusing on the two most dominant ones, diabetes mellitus type 2 (DM2) and HIV/AIDS. We argue that in order to cope with care for HIV patients and diabetes patients, health systems in SSA need to adopt new strategies taking into account essential elements of chronic disease care. We developed a “chronic dimension
framework,” which analyses the “disease dimension,” the “health provider dimension,” the patient or “person dimension,” and the “environment dimension” of chronic diseases. Applying this framework to HIV/AIDS and DM2 shows that it
is useful to think about management of both in tandem, comparing care delivery platforms and self-management strategies. A literature review on care delivery models for diabetes and HIV/AIDS in SSA revealed potential elements for cross-fertilisation: rapid scale-up approaches through the public health approach by simplification and decentralisation; community involvement, peer support, and self-management strategies; and strengthening health services.
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Rabkin M, Kruk ME, El-Sadr WM. HIV, aging and continuity care: strengthening health systems to support services for noncommunicable diseases in low-income countries. AIDS 2012; 26 Suppl 1:S77-83. [PMID: 22781180 DOI: 10.1097/QAD.0b013e3283558430] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although health systems in most low-income countries largely provide episodic care for acute symptomatic conditions, many HIV programs have developed effective, locally owned and contextually appropriate policies, systems and tools to support chronic care services for persons living with HIV (PLWH). The continuity of care provided by such programs may be especially critical for older PLWH, who are at risk for more rapid progression of disease and are more likely to have complications of HIV and its treatment than their younger counterparts. Older PLWH are also more likely to have other chronic noncommunicable diseases (NCDs), including hypertension, diabetes, cancers and chronic lung disease. As the number of older PLWH rises, enhanced chronic care systems will be required to optimize their health and wellbeing. These systems, lessons and resources can also be leveraged to support the burgeoning numbers of HIV-negative individuals with chronic NCD in need of ongoing care.
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van Gemert F, van der Molen T, Jones R, Chavannes N. The impact of asthma and COPD in sub-Saharan Africa. Prim Care Respir J 2012; 20:240-8. [PMID: 21509418 DOI: 10.4104/pcrj.2011.00027] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many countries in sub-Saharan Africa have the highest risk of developing chronic diseases and are the least able to cope with them. AIMS To assess the current knowledge of the prevalence and impact of asthma and chronic obstructive pulmonary disease (COPD) in sub- Saharan Africa. METHODS A literature search was conducted using Medline (1995-2010) and Google Scholar. RESULTS Eleven studies of the prevalence of asthma in sub-Saharan Africa were identified, all of which showed a consistent increase, particularly in urban regions. The data on asthma show a wide variation (5.7-20.3%), with the highest prevalence in 'westernised' urban areas. Only two studies of the prevalence of COPD in sub-Saharan Africa have been performed. Nevertheless, COPD has become an increasing health problem in sub-Saharan Africa due to tobacco smoking and exposure to biomass fuels. In most countries of sub-Saharan Africa, 90% of the rural households depend on biomass fuel for cooking and heating, affecting young children (acute lower respiratory infections) and women (COPD). This is the cause of significant mortality and morbidity in the region. CONCLUSIONS Asthma and COPD in sub-Saharan Africa are under-recognised, under-diagnosed, under-treated, and insufficiently prevented. A major priority is to increase the awareness of asthma and COPD and their risk factors, particularly the damage caused by biomass fuel. Surveys are needed to provide local healthcare workers with the possibility of controlling asthma and COPD.
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Affiliation(s)
- Frederik van Gemert
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands.
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Coburn KD, Marcantonio S, Lazansky R, Keller M, Davis N. Effect of a community-based nursing intervention on mortality in chronically ill older adults: a randomized controlled trial. PLoS Med 2012; 9:e1001265. [PMID: 22815653 PMCID: PMC3398966 DOI: 10.1371/journal.pmed.1001265] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 05/29/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Improving the health of chronically ill older adults is a major challenge facing modern health care systems. A community-based nursing intervention developed by Health Quality Partners (HQP) was one of 15 different models of care coordination tested in randomized controlled trials within the Medicare Coordinated Care Demonstration (MCCD), a national US study. Evaluation of the HQP program began in 2002. The study reported here was designed to evaluate the survival impact of the HQP program versus usual care up to five years post-enrollment. METHODS AND FINDINGS HQP enrolled 1,736 adults aged 65 and over, with one or more eligible chronic conditions (coronary artery disease, heart failure, diabetes, asthma, hypertension, or hyperlipidemia) during the first six years of the study. The intervention group (n = 873) was offered a comprehensive, integrated, and tightly managed system of care coordination, disease management, and preventive services provided by community-based nurse care managers working collaboratively with primary care providers. The control group (n = 863) received usual care. Overall, a 25% lower relative risk of death (hazard ratio [HR] 0.75 [95% CI 0.57-1.00], p = 0.047) was observed among intervention participants with 86 (9.9%) deaths in the intervention group and 111 (12.9%) deaths in the control group during a mean follow-up of 4.2 years. When covariates for sex, age group, primary diagnosis, perceived health, number of medications taken, hospital stays in the past 6 months, and tobacco use were included, the adjusted HR was 0.73 (95% CI 0.55-0.98, p = 0.033). Subgroup analyses did not demonstrate statistically significant interaction effects for any subgroup. No suspected program-related adverse events were identified. CONCLUSIONS The HQP model of community-based nurse care management appeared to reduce all-cause mortality in chronically ill older adults. Limitations of the study are that few low-income and non-white individuals were enrolled and implementation was in a single geographic region of the US. Additional research to confirm these findings and determine the model's scalability and generalizability is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT01071967. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Kenneth D Coburn
- Health Quality Partners, Doylestown, Pennsylvania, United States of America.
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Abstract
Global changes and new managerial challenges require new concepts of health and well-being in organizational contexts. In the South African context, health and well-being of managers have gained relevance in organizations and in management sciences. International organizations, in particular, attempt to address the increasing demand for health care and the delivery of health services to their managers. Careful and appropriate health management requires research to evaluate context-specific health concepts and strategies. The purpose and aim of this article is to assess managerial concepts on health and well-being that could be used by the organization to contribute to managerial well-being by implementing health promotion according to managerial needs. At the same time, this article contributes to salutogenetic health research that is very rare with regard to the South African organizational management research.This study is a multi-method research study conducted in a selected international organization in South Africa. However, in this article, selected qualitative findings will only be presented.This organizational study presents selected research findings on health concepts and strategies employed by managers. Findings demonstrate that the managerial concepts of health and strategies mainly refer to not only physical but also to mental and spiritual aspects, with a priority on physical health and well-being.The findings presented are based on qualitative research methods and their research criteria.This assessment serves as a foundation for new approaches to health management within the international work context in South Africa. It also contributes to a paradigm shift from pathogenetic to salutogenetic concepts of health and well-being within the South African organizational work context.The article produces new insights into the qualitative health concepts of South African managers and expatriates and contributes to promoting salutogenesis in organization within South Africa.
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Abstract
Global changes and new managerial challenges require new concepts of health and well-being in organizational contexts. In the South African context, health and well-being of managers have gained relevance in organizations and in management sciences. International organizations, in particular, attempt to address the increasing demand for health care and the delivery of health services to their managers. Careful and appropriate health management requires research to evaluate context-specific health concepts and strategies. The purpose and aim of this article is to assess managerial concepts on health and well-being that could be used by the organization to contribute to managerial well-being by implementing health promotion according to managerial needs. At the same time, this article contributes to salutogenetic health research that is very rare with regard to the South African organizational management research.This study is a multi-method research study conducted in a selected international organization in South Africa. However, in this article, selected qualitative findings will only be presented.This organizational study presents selected research findings on health concepts and strategies employed by managers. Findings demonstrate that the managerial concepts of health and strategies mainly refer to not only physical but also to mental and spiritual aspects, with a priority on physical health and well-being.The findings presented are based on qualitative research methods and their research criteria.This assessment serves as a foundation for new approaches to health management within the international work context in South Africa. It also contributes to a paradigm shift from pathogenetic to salutogenetic concepts of health and well-being within the South African organizational work context.The article produces new insights into the qualitative health concepts of South African managers and expatriates and contributes to promoting salutogenesis in organization within South Africa.
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Abstract
OBJECTIVE To expand the evidence base on the prevalence of non-communicable disease (NCD) risk factors in rural Africa, in particular among older adults aged 50 and older. METHODS Cross-sectional study in three rural sites in Malawi, Rwanda and Tanzania. One person was interviewed from each of 665 households selected through a stratified random sampling procedure across the three sites. The questionnaire included socio-demographic characteristics, smoking and alcohol intake as well as a food frequency questionnaire. RESULTS Smoking rates among older men and women were higher than among adults under 50. While only 2.3% of women under 50 were current smokers, 21.0% of older women smoked (P<0.0001). Among men, 19.0% of men under 50 smoked versus 36.6% of older men (P=0.001). Alcohol consumption among older women aged 50 and older (45.0%) was more common (P=0.005) than among women under 50 (27.6%). Examining a set of five risk factors, more men aged 50 and older (49.5%) had two or more risk factors than men under 50 (25.5%) (P<0.0001). Similarly, 52.0% of women aged 50 and older had two or more risk factors, versus 24.1% of women under 50 (P<0.0001). CONCLUSION Contrary to what is seen in developed country settings, this study reveals high rates of smoking and alcohol consumption among men and women aged 50 years and older in rural Africa that puts them at risk of NCDs. The health of older adults in rural Africa has been neglected, and these findings highlight the importance of reaching out to older adults with messaging regarding diet, smoking, alcohol use and general health.
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Affiliation(s)
- Joel Negin
- Sydney School of Public Health, University of Sydney, Australia.
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Negin J, Wariero J, Cumming RG, Mutuo P, Pronyk PM. High Rates of AIDS-Related Mortality Among Older Adults in Rural Kenya. J Acquir Immune Defic Syndr 2010; 55:239-44. [DOI: 10.1097/qai.0b013e3181e9b3f2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lekoubou A, Awah P, Fezeu L, Sobngwi E, Kengne AP. Hypertension, diabetes mellitus and task shifting in their management in sub-Saharan Africa. Int J Environ Res Public Health 2010; 7:353-63. [PMID: 20616978 DOI: 10.3390/ijerph7020353] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 01/23/2010] [Indexed: 12/18/2022]
Abstract
Chronic diseases are becoming increasingly important in sub-Saharan Africa (SSA). The current density and distribution of health workforce suggest that SSA cannot respond to the growing demand for chronic disease care, together with the frequent infectious diseases. Innovative approaches are therefore needed to rapidly expand the health workforce. In this article, we discuss the evidences in support of nurse-led strategies for chronic disease management in SSA, with a focus on hypertension and diabetes mellitus.
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Affiliation(s)
- Alain Lekoubou
- Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon.
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Abstract
This article reviews the current status of cardiovascular disease (CVD) on the international scale. Presently viewed as an epidemic that has migrated from westernized societies to developing countries, several important issues are elaborated upon. They include the basis for the increasing prevalence of CVD and the associated societal implications. The challenges related to lack of resources and infrastructure support may also impede successful implementation of proven strategies to reduce CVD. In addition to traditional risk factors such as cigarette smoking, hypertension, obesity, hyperlipidemia, diabetes mellitus and insulin resistance, many developing countries must also contend with other risk biomarkers. Included in this grouping are human immunodeficiency virus/acquired immunodeficiency syndrome and other infectious/inflammatory processes as well as nutritional and vitamin deficiencies that make preventive measures more difficult to prioritize. Taken together, greater partnering between local governments, affiliated hospitals and international societies is needed to enhance and facilitate efforts aimed at optimizing standard of care measures in developing countries in order to reduce cardiovascular risk.
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Affiliation(s)
- Temilolu Olayinka Aje
- Temilolu Olayinka Aje, Michael Miller, Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Rm S3B06, 22 South Greene St., Baltimore, MD 21201, United States
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