Building on the HIV chronic care platform to address noncommunicable diseases in sub-Saharan Africa

Eighty percent of people with stroke live in low- to middle-income nations, particularly in sub-Saharan Africa (SSA) where stroke has increased by more than 100% in the last decades. More than one-third of all epilepsy−related deaths occur in SSA. HIV infection is a risk factor for neurological disorders, including stroke and epilepsy. The vast majority of the 38 million people living with HIV/AIDS are in SSA, and the burden of neurological disorders in SSA parallels that of HIV/AIDS. Local healthcare systems are weak. Many standalone HIV health centres have become a platform with combined treatment for both HIV and noncommunicable diseases (NCDs), as advised by the United Nations. The COVID-19 pandemic is overwhelming the fragile health systems in SSA, and it is feared it will provoke an upsurge of excess deaths due to the disruption of care for chronic diseases such as HIV, TB, hypertension, diabetes, and cerebrovascular disorders. Disease Relief through Excellent and Advanced Means (DREAM) is a health programme active since 2002 to prevent and treat HIV/AIDS and related disorders in 10 SSA countries. DREAM is scaling up management of NCDs, including neurologic disorders such as stroke and epilepsy. We described challenges and solutions to address disruption and excess deaths from these diseases during the ongoing COVID-19 pandemic.

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Urbanization and International Trade and Investment Policies as Determinants of Noncommunicable Diseases in Sub-Saharan Africa

Progress in Cardiovascular Diseases ◽

10.1016/j.pcad.2013.09.016 ◽

2013 ◽

Vol 56 (3) ◽

pp. 281-301 ◽

Cited By ~ 24

Author(s):

Ashley Schram ◽

Ronald Labonté ◽

David Sanders

Keyword(s):

International Trade ◽

Sub Saharan Africa ◽

Noncommunicable Diseases ◽

Investment Policies ◽

Sub Saharan ◽

Trade And Investment

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Noncommunicable Diseases: Yet Another Challenge for Human Immunodeficiency Virus Treatment and Care in Sub-Saharan Africa

Clinical Infectious Diseases ◽

10.1093/cid/ciz1104 ◽

2019 ◽

Vol 71 (8) ◽

pp. 1874-1876 ◽

Cited By ~ 1

Author(s):

Brian K Agan ◽

Vincent C Marconi

Keyword(s):

Human Immunodeficiency Virus ◽

Sub Saharan Africa ◽

Noncommunicable Diseases ◽

Human Immunodeficiency Virus Treatment ◽

Immunodeficiency Virus ◽

Sub Saharan

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Electronic Cigarettes for Curbing the Tobacco-Induced Burden of Noncommunicable Diseases: Evidence Revisited with Emphasis on Challenges in Sub-Saharan Africa

Pulmonary Medicine ◽

10.1155/2016/4894352 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Jobert Richie N. Nansseu ◽

Jean Joel R. Bigna

Keyword(s):

Tobacco Smoking ◽

Electronic Cigarettes ◽

Sub Saharan Africa ◽

Noncommunicable Diseases ◽

Quit Smoking ◽

Sub Saharan ◽

Never Smokers ◽

Second Hand Smoking ◽

And Control

Introduction. This review examines whether electronic cigarettes (e-cigs) implementation or vulgarization in sub-Saharan Africa (SSA) could be helpful in curtailing the toll of tobacco smoking in the region. Discussion. There are about 1.3 billion smokers worldwide, with nearly 80% of them living in developing countries where the burden of tobacco-related illnesses and deaths is the heaviest. Studies report that e-cigs may facilitate smoking cessation, reduction, or abstinence and may pose only a small fraction of the risks of traditional tobacco cigarettes; e-cigs may also considerably reduce second-hand smoking. Thereby, implementation of e-cig use could help to substantially reduce the burden driven by tobacco smoking in SSA, in a particular context of lack of regulations and control policies towards this threat. However, the evidence is not clear on whether e-cigs are risk-free, especially if used in the long term. Conclusions. On the whole, if e-cigs were to be introduced in SSA, they should be strictly recommended to current and/or ex-smokers as a method to quit smoking or prevent relapse and never-smokers should be strongly encouraged to avoid using these devices. Bans on sales of e-cigs to youngsters should be legislated, e-cig advertisements prohibited, and their usage continuously controlled and monitored.

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Addressing Care Continuity and Quality Challenges in the Management of Chronic Noncommunicable Diseases in a Sub-Saharan Private Healthcare Sector: a Case for Health Information Systems (Preprint)

10.2196/preprints.18899 ◽

2020 ◽

Author(s):

Aisha Walcott-Bryant ◽

Sekou Remy ◽

William Ogallo ◽

Katherine Tryon ◽

Winnie Shena ◽

...

Keyword(s):

Health Information ◽

Digital Health ◽

Healthcare Systems ◽

Sub Saharan Africa ◽

Healthcare Sector ◽

Noncommunicable Diseases ◽

Care Providers ◽

Private Healthcare ◽

Care Continuity ◽

Sub Saharan

BACKGROUND The rise of noncommunicable diseases in sub-Saharan Africa places strain on already stretched healthcare systems, that have traditionally focused on infectious diseases. Healthcare provision is fragmented, and there is a dearth of literature on the experiences, challenges, and solutions for improving the management of noncommunicable diseases in sub-Saharan private healthcare sectors. OBJECTIVE We investigated the management of hypertension in the Kenyan private healthcare sector to understand how a health information system could be used to address care continuity and quality challenges in the management of hypertension and other noncommunicable diseases. METHODS We conducted in-depth interviews and direct observations at 18 healthcare institutions in Kenya. We analyzed the data to identify the key challenges and proposed solutions to the challenges. We subsequently used the generated insights to propose the design of a digital health solution for enabling care quality and continuity at the study setting and similar ecosystems. RESULTS The private healthcare sector in Kenya is fragmented and faces challenges such as high cost of care, limited healthcare literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care coordination is hindered by suboptimal encounter data collection, limited view of patient histories, and little trust between care providers. Patient health records are siloed in multiple paper and electronic systems that lack integration. The proposed digital health platform system supports care coordination and continuity within fragmented healthcare systems by enabling patient-consented data sharing while ensuring that care providers in separate facilities have holistic views of the patient’s clinical and non-clinical history. CONCLUSIONS Health information systems can play a pivotal role in addressing the care continuity and quality challenges in the management of noncommunicable diseases in sub-Saharan Africa private healthcare sectors. Leveraging technology and processes to support patients managing chronic noncommunicable diseases in disparate clinical and nonclinical settings (e.g. at home and in support groups) is critical.

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Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda

BMJ Global Health ◽

10.1136/bmjgh-2019-001449 ◽

2019 ◽

Vol 4 (3) ◽

pp. e001449 ◽

Cited By ~ 6

Author(s):

Lauren Anne Eberly ◽

Christian Rusangwa ◽

Loise Ng'ang'a ◽

Claire C Neal ◽

Jean Paul Mukundiyukuri ◽

...

Keyword(s):

Heart Failure ◽

Chronic Care ◽

District Hospital ◽

Sub Saharan Africa ◽

Primary Health ◽

Start Up ◽

Primary Health Centres ◽

Health Centres ◽

Per Capita ◽

Sub Saharan

BackgroundIntegrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient specialty clinic associated with a district hospital in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, heart failure and rheumatic heart disease.MethodsA retrospective costing analysis was conducted from the facility perspective using data from administrative sources and the electronic medical record systems of Butaro District Hospital in rural Rwanda. We determined initial start-up and annual operating financial cost of the Butaro district advanced NCD clinic for the fiscal year 2013–2014. Per-patient annual cost by disease category was determined.ResultsA total of US$47 976 in fixed start-up costs was necessary to establish a new advanced NCD clinic serving a population of approximately 300 000 people (US$0.16 per capita). The additional annual operating cost for this clinic was US$68 975 (US$0.23 per capita) to manage a 632-patient cohort and provide training, supervision and mentorship to primary health centres. Labour comprised 54% of total cost, followed by medications at 17%. Diabetes mellitus had the highest annual cost per patient (US$151), followed by heart failure (US$104), driven primarily by medication therapy and laboratory testing.ConclusionsThis is the first study to evaluate the costs of integrated, decentralised chronic care for some severe NCDs in rural sub-Saharan Africa. The findings show that these services may be affordable to governments even in the most constrained health systems.

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Regional Overview on the Double Burden of Malnutrition and Examples of Program and Policy Responses: African Region

Annals of Nutrition and Metabolism ◽

10.1159/000503671 ◽

2019 ◽

Vol 75 (2) ◽

pp. 127-130 ◽

Cited By ~ 4

Author(s):

Adelheid W. Onyango ◽

Juddy Jean-Baptiste ◽

Betty Samburu ◽

Tshimi Lynn Moeng Mahlangu

Keyword(s):

Age Groups ◽

Health Sector ◽

Lifestyle Changes ◽

Sub Saharan Africa ◽

World Health ◽

Noncommunicable Diseases ◽

African Region ◽

Double Burden ◽

Double Burden Of Malnutrition ◽

Sub Saharan

Sub-Saharan Africa is experiencing the double burden of malnutrition (DBM) with high levels of undernutrition and a growing burden of overweight/obesity and diet-related noncommunicable diseases (NCDs). Undernourishment in sub-Saharan Africa increased between 2010 and 2016. Although the prevalence of chronic undernutrition is decreasing, the number of stunted children under 5 years of age is increasing due to population growth. Meanwhile, overweight/obesity is increasing in all age groups, with girls and women being more affected than boys and men. It is increasingly recognized that the drivers of the DBM originate outside the health sector and operate across national and regional boundaries. Largely unregulated marketing of cheap processed foods and nonalcoholic beverages as well as lifestyle changes are driving consumption of unhealthy diets in the African region. Progress toward the goal of ending hunger and malnutrition by 2030 requires intensified efforts to reduce undernutrition and focused action on the reduction of obesity and diet-related NCDs. The World Health Organization is developing a strategic plan to guide governments and development partners in tackling all forms of malnutrition through strengthened policies, improved service delivery, and better use of data. It is only through coordinated and complementary efforts that strides can be made to reduce the DBM.

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Aging and the Rising Burden of Noncommunicable Diseases in Sub-Saharan Africa and other Low- and Middle-Income Countries: A Call for Holistic Action

The Gerontologist ◽

10.1093/geront/gnz102 ◽

2019 ◽

Vol 60 (5) ◽

pp. 806-811 ◽

Cited By ~ 4

Author(s):

Razak M Gyasi ◽

David R Phillips

Keyword(s):

Sub Saharan Africa ◽

Vulnerable Groups ◽

Noncommunicable Diseases ◽

Mortality Data ◽

African Countries ◽

Middle Income ◽

Middle Income Countries ◽

Demographic Aging ◽

Sub Saharan ◽

Low And Middle Income

Abstract Noncommunicable diseases (NCDs) are a prevalent and growing burden among older cohorts in sub-Saharan Africa and other low- and middle-income countries (LMICs) as in many wealthier parts of the world. This stems from the combined effects of factors such as demographic aging, behavioral transitions, and developmental origins of health and disease. A crucial characteristic of many NCDs is that their personal and family impacts and costs are not accurately reflected in mortality data. Their effects are often chronic and long-term and can cause morbidity, loss of work ability, and impaired quality of life over a prolonged period. Unless addressed seriously, the continuing increase of NCDs and their burden in sub-Saharan African countries and other LMICs will almost certainly undermine progress toward achieving the target of reducing by 25% premature mortality from NCDs in these countries by 2025 and also one-third reduction of NCDs target by 2030. To have any chance of meeting or even getting near to these targets, this article calls for action by national and regional governments to strengthen universal health coverage (UHC), economic empowerment of vulnerable groups, public–private partnerships, effective fiscal regulation, and public education on NCDs, their risk factors and impacts in sub-Saharan Africa in particular and most LMICs globally.

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Hypertension Education Intervention with Ugandan Nurses Working in Hospital Outpatient Clinic: A Pilot Study

Nursing Research and Practice ◽

10.1155/2014/710702 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Godfrey Katende ◽

Sara Groves ◽

Kathleen Becker

Keyword(s):

Pilot Study ◽

Outpatient Clinic ◽

Education Program ◽

Sub Saharan Africa ◽

Noncommunicable Diseases ◽

Post Intervention ◽

Health Crisis ◽

Low Levels ◽

Sub Saharan ◽

And Control

Noncommunicable diseases (NCDs) pose a significant global burden in both developed and developing countries. It is estimated that, by 2025, 41.7% of males and 38.7% of females in Sub-Saharan Africa will develop high blood pressure (HBP). This is particularly true in Uganda with hypertensive prevalence rates estimated to range from 22.5% to 30.5%. Coupled with low levels of detection, treatment, and control, hypertension represents a Ugandan public health crisis. An innovative WHO-ISH education program culturally was adapted in a pilot study and focused on knowledge, skills, and attitudes (KSA) of nurses caring for hypertensive patients in an outpatient clinic. Pre-post intervention data was collected and analyzed in which significant improvements were noted on all the three outcome measures. This pilot study demonstrated that nurses’ knowledge, skills, and attitudes could be significantly improved with a multimodal education program implemented in a low resource environment.

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