Implementation of a non-communicable disease clinic in rural Sierra Leone: early experiences and lessons learned

AbstractThis study is an evaluation of the first cohort of patients enrolled in an outpatient non-communicable disease clinic in Kono, Sierra Leone. In the first year, the clinic enrolled 916 patients. Eight months after the enrollment of the last patient, 53% were still active in care, 43% had been lost to follow-up (LTFU) and 4% had defaulted. Of the LTFU patients, 47% only came for the initial enrollment visit and never returned. Treatment outcomes of three patient groups [HTN only (n = 720), DM only (n = 51), and HTN/DM (n = 96)] were analyzed through a retrospective chart review. On average, all groups experienced reductions in blood pressure and/or blood glucose of approximately 10% and 20%, respectively. The proportions of patients with their condition controlled also increased. As NCDs remain underfunded and under-prioritized in low-income countries, the integrated program in Kono demonstrates the possibility of improving outpatient NCD care in Sierra Leone and similar settings.

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Determinants of health seeking behavior for chronic non-communicable diseases and related out-of-pocket expenditure: results from a cross-sectional survey in northern Bangladesh

Journal of Health Population and Nutrition ◽

10.1186/s41043-019-0195-z ◽

2019 ◽

Vol 38 (1) ◽

Cited By ~ 2

Author(s):

Fatema Binte Rasul ◽

Olivier Kalmus ◽

Malabika Sarker ◽

Hossain Ishrath Adib ◽

Md Shahadath Hossain ◽

...

Keyword(s):

Low Income ◽

Multinomial Logistic Regression ◽

Communicable Disease ◽

Self Care ◽

Communicable Diseases ◽

Low Income Countries ◽

Health Seeking ◽

Non Communicable Diseases ◽

Professional Care ◽

Non Communicable Disease

Abstract Background In spite of high prevalence rates, little is known about health seeking and related expenditure for chronic non-communicable diseases in low-income countries. We assessed relevant patterns of health seeking and related out-of-pocket expenditure in Bangladesh. Methods We used data from a household survey of 2500 households conducted in 2013 in Rangpur district. We employed multinomial logistic regression to assess factors associated with health seeking choices (no care or self-care, semi-qualified professional care, and qualified professional care). We used descriptive statistics (5% trimmed mean and range, median) to assess related patterns of out-of-pocket expenditure (including only direct costs). Results Eight hundred sixty-six (12.5%) out of 6958 individuals reported at least one chronic non-communicable disease. Of these 866 individuals, 139 (16%) sought no care or self-care, 364 (42%) sought semi-qualified care, and 363 (42%) sought qualified care. Multivariate analysis confirmed that the following factors increased the likelihood of seeking qualified care: a higher education, a major chronic non-communicable disease, a higher socio-economic status, a lower proportion of chronic household patients, and a shorter distance between a household and a sub-district public referral health facility. Seven hundred fifty-four (87 %) individuals reported out-of-pocket expenditure, with drugs absorbing the largest portion (85%) of total expenditure. On average, qualified care seekers encountered the highest out-of-pocket expenditure, followed by those who sought semi-qualified care and no care, or self-care. Conclusion Our study reveals insufficiencies in health provision for chronic conditions, with more than half of all affected people still not seeking qualified care, and the majority still encountering considerable out-of-pocket expenditure. This calls for urgent measures to secure better access to care and financial protection.

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No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03747-2 ◽

2021 ◽

Author(s):

F. Wichlas ◽

V. Hofmann ◽

M. Moursy ◽

G. Strada ◽

C. Deininger

Keyword(s):

Surgical Treatment ◽

Soft Tissue ◽

Sierra Leone ◽

Low Income ◽

Soft Tissue Defect ◽

Low Income Countries ◽

Pelvic Surgery ◽

Closed Fractures ◽

Trauma Triage ◽

Tissue Defects

Abstract Introduction In low-income countries (LIC), international surgeons face the fact that there are patients they cannot treat. The goal of this study was to identify and analyze patients lost to treatment. Material and methods We analyzed retrospectively the data of 282 trauma victims from a non-governmental organizational (NGO) hospital in Sierra Leone, Africa. During a 3-month period (10.10.2015–08.01.2016), these patients had 367 injuries and underwent 263 orthopedic surgeries. Despite a clear indication, some patients did not receive surgical treatment. We identified these injuries and the reason why they could not be operated. The anatomic region of the injury was evaluated and if they had a bone or soft tissue defect or were infected. Results We identified 95 (25.89%) injuries in 70 patients (47 males; 23 females) that were not be operated. The reasons were lack of specific implants (no implant group; N = 33), no treatment strategy for the injury (no solution group; N = 29), and patients that were lost (lost patient group; N = 33), almost equally distributed by 1/3. In the no implant group were mainly closed fractures and fractures of the pelvis and the proximal femur. The implants needed were locking plates (N = 19), proximal femoral nails (N = 8), and implants for pelvic surgery (N = 6). In the no solution group were nearly all bone (P < 0.0000), soft tissue defects (P < 0.00001) and infections (P = 0.00003) compared to the rest and more open fractures (P < 0.00001). In the lost patients group, most fractures were closed (24 out of 33, P = 0.033). These fractures were mostly not urgent and were postponed repeatedly. Conclusion One quarter of the patients did not receive the surgical treatment needed. Besides acquisition of implants, surgical skills and expertise could be a solution for this issue. Nevertheless, these skills must be passed to local surgeons.

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Case Report: Severe Dental Abscess Complications in Rural Sierra Leone

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0923 ◽

2021 ◽

Author(s):

Rosa Roemers ◽

Aminata I. Sesay ◽

Musa G. Sesay ◽

Jan Henk Dubbink ◽

Heleen M. Koudijs ◽

...

Keyword(s):

Case Report ◽

Mortality Rate ◽

Sierra Leone ◽

Low Income ◽

Case Series ◽

Low Income Countries ◽

Prevalence Data ◽

Dental Abscess ◽

Dental Infections

Prevalence data on severe dental infections is scarce, particularly for low-income countries. Patients with dental abscess complications who presented from September 2020 until December 2020 in two hospitals in Tonkolili District, Sierra Leone, were included into this case series. We report on a total of 20 patients, median age 28 years, with severe complications of dental abscesses, with a mortality rate of 45%. This case series illustrates the severity of the dire consequences of the absence of access to basic dental and oral healthcare.

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A Systems Approach for Sustainably Reducing Childhood Diarrheal Deaths in Developing Countries

Public Health and Welfare ◽

10.4018/978-1-5225-1674-3.ch056 ◽

2016 ◽

pp. 1208-1227

Author(s):

Monica Gray

Keyword(s):

Developing Countries ◽

Low Income ◽

Systems Approach ◽

Developed Countries ◽

Lessons Learned ◽

Sub Saharan Africa ◽

Low Income Countries ◽

Health Crisis ◽

Industrialized Nations ◽

Sub Saharan

Diarrhea is the second leading cause of death and is the major cause of malnutrition in children under age 5 worldwide. More than 50 percent of the cases occur in developing countries, particularly in sub-Saharan Africa and Southeast Asia. Open defecation, substandard fecal disposal systems, and contaminated water supplies are the typical causes of diarrheal diseases. This public health crisis in low income countries mirrors the experiences of today's industrialized nations two centuries ago. The lessons learned from their sanitary evolution can be instructive in charting a sustainable path towards saving the lives of almost 2 million children annually. In this chapter a case study of Cuba's sanitary reformation is also presented to showcase successes, similar to those of developed countries, within a developing country and economically challenging context.

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Prevalence and access to care for cardiovascular risk factors in older people in Sierra Leone: a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2020-038520 ◽

2020 ◽

Vol 10 (9) ◽

pp. e038520

Author(s):

Maria Lisa Odland ◽

Tahir Bockarie ◽

Haja Wurie ◽

Rashid Ansumana ◽

Joseph Lamin ◽

...

Keyword(s):

Risk Factors ◽

Access To Care ◽

Sierra Leone ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Health System Strengthening ◽

Low Income Countries

IntroductionPrevalence of cardiovascular disease risk factors (CVDRFs) is increasing, especially in low-income countries. In Sierra Leone, there is limited empirical data on the prevalence of CVDRFs, and there are no previous studies on the access to care for these conditions.MethodsThis study in rural and urban Sierra Leone collected demographic, anthropometric measurements and clinical data from randomly sampled individuals over 40 years old using a household survey. We describe the prevalence of the following risk factors: diabetes, hypertension, dyslipidaemia, overweight or obesity, smoking and having at least one of these risk factors. Cascades of care were constructed for diabetes and hypertension using % of the population with the disease who had previously been tested (‘screened’), knew of their condition (‘diagnosed’), were on treatment (‘treated’) or were controlled to target (‘controlled’). Multivariable regression was used to test associations between prevalence of CVDRFs and progress through the cascade for hypertension with demographic and socioeconomic variables. In those with recognised disease who did not seek care, reasons for not accessing care were recorded.ResultsOf 2071 people, 49.6% (95% CI 49.3% to 50.0%) of the population had hypertension, 3.5% (3.4% to 3.6%) had diabetes, 6.7% (6.5% to 7.0%) had dyslipidaemia, 25.6% (25.4% to 25.9%) smoked and 26.5% (26.3% to 26.8%) were overweight/obese; a total of 77.1% (76.6% to 77.5%) had at least one CVDRF. People in urban areas were more likely to have diabetes and be overweight than those living in rural areas. Moreover, being female, more educated or wealthier increased the risk of having all CVDRFs except for smoking. There is a substantial loss of patients at each step of the care cascade for both diabetes and hypertension, with less than 10% of the total population with the conditions being screened, diagnosed, treated and controlled. The most common reasons for not seeking care were lack of knowledge and cost.ConclusionsIn Sierra Leone, CVDRFs are prevalent and access to care is low. Health system strengthening with a focus on increased access to quality care for CVDRFs is urgently needed.

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Prevalence and Determinants of Peripheral Neuropathy Among Adult Type II Diabetes Mellitus Patients Attending a Non-communicable Disease Clinic in Rural South India

Cureus ◽

10.7759/cureus.15493 ◽

2021 ◽

Author(s):

Prakash Mathiyalagen ◽

Sivagami Kanagasabapathy ◽

Zubaidabegum Kadar ◽

Anandaraj Rajagopal ◽

Kavita Vasudevan

Keyword(s):

Diabetes Mellitus ◽

Type Ii Diabetes ◽

South India ◽

Communicable Disease ◽

Type Ii Diabetes Mellitus ◽

Type Ii ◽

Adult Type ◽

Rural South ◽

Disease Clinic ◽

Non Communicable Disease

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A model for point of care testing for non-communicable disease diagnosis in resource-limited countries

Global Health Epidemiology and Genomics ◽

10.1017/gheg.2019.6 ◽

2019 ◽

Vol 4 ◽

Author(s):

Stuart Malcolm ◽

Joane Cadet ◽

Lindsay Crompton ◽

Vincent DeGennaro

Keyword(s):

Data Collection ◽

Low Income ◽

Communicable Disease ◽

Point Of Care ◽

Disease Diagnosis ◽

Health Study ◽

Point Of Care Testing ◽

Physical Measurements ◽

Geographical Regions ◽

Non Communicable Disease

Abstract Non-communicable disease diagnosis frequently relies on biochemical measurements but laboratory infrastructure in low-income settings is often insufficient and distances to clinics may be vast. We present a model for point of care (POC) epidemiology as used in our study of chronic disease in the Haiti Health Study, in rural and urban Haiti. Point of care testing (POCT) of creatinine, cholesterol, and hemoglobin A1c as well as physical measurements of weight, height, and waist circumference allowed for diagnosis of diabetes, chronic kidney disease, dyslipidemias, and obesity. Methods and troubleshooting techniques for the data collection of this study are presented. We discuss our method of community-health worker (CHW) training, community engagement, study design, and field data collection. We also discuss the machines used and our quality control across CHWs and across geographical regions. Pitfalls tended to include equipment malfunction, transportation issues, and cultural differences. May this paper provide information for those attempting to perform similar diagnostic and screening studies using POCT in resource poor settings.

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Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study

Health Policy and Planning ◽

10.1093/heapol/czaa050 ◽

2020 ◽

Vol 35 (8) ◽

pp. 931-940

Author(s):

Éimhín Ansbro ◽

Sylvia Garry ◽

Veena Karir ◽

Amulya Reddy ◽

Kiran Jobanputra ◽

...

Keyword(s):

Low Income ◽

Care Delivery ◽

Communicable Disease ◽

Host Population ◽

Syrian Refugees ◽

Task Sharing ◽

Primary Level ◽

Costing Study ◽

The Impact ◽

Non Communicable Disease

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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