scholarly journals Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038842
Author(s):  
Neil Gupta ◽  
Matthew M Coates ◽  
Abebe Bekele ◽  
Roodney Dupuy ◽  
Darius Leopold Fénelon ◽  
...  
Keyword(s):  
Low Income ◽  
Service Provision ◽  
Secondary Analysis ◽  
Communicable Diseases ◽  
Low Income Countries ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Mortality And Morbidity

Context and objectivesNon-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions.DesignSecondary analysis of existing cross-sectional survey data.SettingWe used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country.Outcome measuresWe defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities.ResultsOverall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1–2 hypertension (28%–83%). Availability was low for type 1 diabetes (1%–70%), type 2 diabetes (3%–57%), asthma (0%–7%) and acute presentations of diabetes (0%–26%) and asthma (0%–4%). Few hospitals had equipment or medications for heart failure (0%–32%), rheumatic heart disease (0%–23%), hypertensive emergencies (0%–64%) or acute minor surgical conditions (0%–5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability.ConclusionsOur findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.

scholarly journals NON-COMMUNICABLE DISEASES AND PAKISTAN’S SEHAT SAHULAT PROGRAM: A SNAPSHOT ANALYSIS OF READMISSIONS IN ISLAMABAD CAPITAL TERRITORY

2021 ◽  
Vol 71 (5) ◽  
pp. 1534-38
Author(s):  
Syed Fawad Mashhadi ◽  
Saira Maroof ◽  
Aliya Hisam ◽  
Sumaira Masood ◽  
Sonia Riaz ◽  
...  
Keyword(s):  
Low Income ◽  
Communicable Disease ◽  
Secondary Data ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Communicable Diseases ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
The Impact

Objective: To examine the impact of 30-day hospital readmission for non-communicable diseases on limited health-care resources of a low-income country like Pakistan in the light of available data from Pakistan’s Sehat Sahulat Program. Study Design: Retrospective analytical cross-sectional study. Place and Duration of Study: Health Services Academy, Islamabad Pakistan, from Jan 2016 to Jul 2020. Methodology: Secondary data of patients readmitted with non-communicable diseases in Sehat Sahulat Program, Islamabad, Pakistan. Universal sampling technique was utilized. Data was analyzed using SPSS version 27. Results: Islamabad (ICT) stands second highest for readmissions (n=1270) in which the 30-days readmission rate was 13.69%. Maximum number of readmissions were found in 50-59 years (344, 27.12%). Of 1270 ICT readmissions, 559 (44%) cases were readmitted with non-communicable diseases while rest of 711 (56%) cases were readmitted for acute infectious diseases or surgical procedures. Of 559 non-communicable diseases cases, 236 (42.21%) readmissions were having one non-communicable disease, 63 (11.27%) readmissions exhibited two or more non-communicable diseases and 260 (46.51%) were readmitted because of cancers (CA). Among males, the most common malignancy was CA lungs/ bronchus 24 (19.8%) while among females, CA Breast 80 (56.3%). Conclusion: Non-communicable diseases represent a significant burden on resource constrained, low-income countries. In view of the recurrent admissions that these chronic diseases inevitably incur, better resource allocation may help lessen this burden on fragile health systems creating better clinical outcomes for the penurious strata of Pakistan’s population.

scholarly journals Out of pocket payment, affordability and availability of essential medicines in Africa: systematic review

2021 ◽  
Vol 10 (2) ◽  
pp. 58-63
Author(s):  
Getahun Asmamaw ◽  
Dinksew Tewuhibo ◽  
Nardos Asffaw
Keyword(s):  
Low Income ◽  
Communicable Disease ◽  
Essential Medicine ◽  
Communicable Diseases ◽  
Essential Medicines ◽  
Low Income Countries ◽  
Health Coverage ◽  
African Countries ◽  
Non Communicable Diseases ◽  
Private And Public

Background: Availability and affordability of medicines are key determinants of universal health coverage, yet achieving them presents a major challenge especially in low-income countries. This study aims to overview the evidence on the accessibility of essential medicines in the African continent. Methods: A quantitative literature search published in English since 2014 was held from valid databases; such as, Scholar, Economic Literature, Global Health, PAIS International, and African Index Medicus. The search was erperformed from September 16 to 20, 2019. Two authors (G.A and D.T) screened the titles, reviewed the articles for inclusion, extracted the data, and conducted a quality assessment of the literature. The third author (N.A) commented on the review. We have used the universal definition of OOP, availability, and affordability. Results: Of 34, 06 articles initially identified, 19 were eligible for inclusion. These were cross-sectional and case-control household and health facility studies published in 2014 in Africa. They demonstrated that the availability of some essential medicine (antibiotics) >80% met WHO’s target. However, drugs for non-communicable diseases show unavailable that range within 20.1% to 60.8%. Households access health services mainly through OOP. An item patients’ expense more for, was fees for drugs (62.3%) (Congo) and was an expensive component of expenditure in private and public health facilities with a mean of 16.7USD and 25.5USD, respectively (Burkina-Faso). Drugs for non-communicable diseases were the most expensive than drugs for infectious diseases (median = 0.62 USD) (Ethiopia). The majority of core essential medicines in private and public outlets are unaffordable. There was a considerable variation in the affordability of basic treatment for infectious and non-communicable diseases. Interestingly, the potential source of inadequate availability of essential medicines and the presence of unaffordability was not investigated in Africa. Conclusion: Evidence suggests that even though, African countries show progress in coverage and affordability for some core essential medicines, it tills needs an effort to convey the WHO’s goal particularly for drugs of non-communicable disease. Future studies need to explore reasons for the persistent unavailability, unaffordability as well as high OOPs for medicines.

scholarly journals Integrated management of non-communicable diseases in low-income settings: palliative care, primary care and community health synergies

2018 ◽  
pp. bmjspcare-2018-001579 ◽  
Author(s):  
Daniel Munday ◽  
Vandana Kanth ◽  
Shadrach Khristi ◽  
Liz Grant
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Community Health ◽  
Low Income ◽  
Integrated Management ◽  
Premature Mortality ◽  
Communicable Diseases ◽  
Health Coverage ◽  
Non Communicable Diseases ◽  
Care Community

Palliative care is recognised as a fundamental component of Universal Health Coverage (UHC), which individual countries, led by the United Nations and the WHO, are committed to achieving worldwide by 2030—Sustainable Development Goal (SDG) 3.8. As the incidence of non-communicable diseases (NCD) in low-income and middle-income countries (LMICs) increases, their prevention and control are the central aspects of UHC in these areas. While the main focus is on reducing premature mortality from NCDs (SDG 3.4), palliative care is becoming increasingly important in LMICs, in which 80% of the need is found. This paper discusses the challenges of providing comprehensive NCD management in LMICs, the role of palliative care in addressing the huge and growing burden of serious health-related suffering, and also its scope for leveraging various aspects of primary care NCD management. Drawing on experiences in India and Nepal, and particularly a project on the India–Nepal border in which palliative care, community health and primary care-led NCD management are being integrated, we explore the synergies arising and describe a model where palliative care is integral to the whole spectrum of NCD management, from promotion and prevention, through treatment, rehabilitation and palliation. We believe this model could provide a framework for integrated NCD management more generally in rural India and Nepal and also other LMICs as they work to make NCD management as part of UHC a reality.

scholarly journals Prevalence of Non-Communicable Diseases among Retired Military Personnel

2021 ◽  
Vol 16 (2) ◽  
pp. 35-39
Author(s):  
Md Mazharul Islam Khan ◽  
Ariful Haque ◽  
- Md Shamimuzzaman ◽  
Chyochyo Nancy ◽  
Farzana Zafreen
Keyword(s):  
Diabetes Mellitus ◽  
Military Personnel ◽  
The Elderly ◽  
Communicable Diseases ◽  
Ischemic Heart ◽  
Military Hospital ◽  
Epidemiologic Transition ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Mortality And Morbidity

Introduction: Non-communicable diseases (NCDs) have become burning issues worldwide, especially among the elderly individuals. Bangladeshi elderly is also susceptible cohort to NCDs for its recent epidemiologic transition and the NCDs is casting as prominent risk for major mortality and morbidity related issues. Objectives: To find out the prevalence of common NCDs and its risk factors among the Bangladeshi retired military personnel. Methods: This cross-sectional study was conducted among the retired military personnel admitted in Combined Military Hospital (CMH), Savar from January 2019 to July 2019. A face-to-face interview was carried out among the respondents using a semi-structured questionnaire. Results: Among 153 retired military personnel; most common NCDs were hypertension (80.4%), diabetes mellitus 66.7%, ischemic heart disease37.3% and only 3.9 % had low back pain. Most of them accessed their health in CMH (66.7%), where 17.6% reported to Govt. hospital and only a minor portion (15.7%) to private hospital. Moreover, 70.6% of them were not willing to regular health check-up. Conclusions: The most common NCDs were hypertension, diabetes mellitus and ischemic heart disease. This study concluded with a few intervention strategies and community-based health promotion programs to reduce the burden of NCDs among the retired military personnel. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 35-39

scholarly journals A Delphi study for exploring nutritional policy priorities to reduce prevalence of non-communicable diseases in Islamic Republic of Iran

2019 ◽  
Vol 9 (3) ◽  
pp. 241-247 ◽  
Author(s):  
Hassan Eini Zinab ◽  
Naser Kalantari ◽  
Alireza Ostadrahimi ◽  
Jafar Sadegh Tabrizi ◽  
Samira Pourmoradian
Keyword(s):  
Delphi Study ◽  
Community Education ◽  
Policy Option ◽  
Communicable Diseases ◽  
Food Labeling ◽  
Policy Options ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Priority Policy

Background: Identifying and prioritizing the most appropriate policies for enhancing nutritional habits are vital for the prevention and control of non-communicable diseases (NCDs). This study was conducted to prioritize the nutritional policies in Iran. Methods: A cross-sectional survey applying the two-round Delphi technique was used to prioritize policy options in preventing the burden of NCDs. In the first round, the experts in health and nutrition policy were asked to prioritize 21 policy options on a 5-point Likert scale. After analyzing the first-round questionnaire, the highest mean and lowest dispersion index were calculated as an indicator of high-priority options. In the second round, the policy options suggested by the participants were added to the second-round questionnaire. Finally, the questionnaires were sent to all the participants in case they desired to change their opinions. Results: The expert achieved consensus on “principles of healthy eating” courses in the curriculum of students as a high-priority policy option. In this regard, “promoting community education and customizing healthy food choice” was the next high priority policy option. On the other hand, the lowest policy priority option was “sending free/low-price healthy drinks at home”. The three high priority policy categories were reformulating the content of food, enhancing the consumers’ knowledge, and food labeling, respectively. Conclusion: Our findings showed that reformulation, food promotion, and food labeling had the highest priorities for preventing NCDs in Iran. Although food provision policies were costeffective in developing countries such as Iran, it is essential to provide sub-structures for the reformulation of food products.

scholarly journals Improving access to healthcare for women in Tanzania by addressing socioeconomic determinants and health insurance: a population-based cross-sectional survey

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023013 ◽  
Author(s):  
Deogratius Bintabara ◽  
Keiko Nakamura ◽  
Kaoruko Seino
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Formal Education ◽  
Wealth Index ◽  
Population Based ◽  
Reproductive Age ◽  
Low Income Countries ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Low Income Country

ObjectiveThis study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country.DesignPopulation-based cross-sectional survey.SettingNationwide representative data for women of reproductive age obtained from the 2015–2016 Tanzania Demographic and Health Survey were analysed.Primary outcome measuresA composite variable, ‘problems in accessing healthcare’, with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone. Respondents who reported fewer or more problems placed in lower and higher categories, respectively.ResultsA total of 13 266 women aged 15–49 years, with a median age (IQR) of 27 (20–36) years were interviewed and included in the analysis. About two-thirds (65.53%) of the respondents reported at least one of the four major problems in accessing healthcare. Furthermore, after controlling for other variables included in the final model, women without any type of health insurance, those belonging to the poorest class according to the wealth index, those who had not attended any type of formal education, those who were not employed for cash, each year of increasing age and those who were divorced, separated or widowed were associated with greater problems in accessing healthcare.ConclusionThis study indicated the additive effects of barriers to healthcare in low-income countries such as Tanzania. Based on these results, improving uptake of health insurance and addressing social determinants of health are the first steps towards reducing women’s problems associated with accessing healthcare.

scholarly journals Availability of ENT Surgical Procedures and Medication in Low-Income Nation Hospitals: Cause for Concern in Zambia

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Lufunda Lukama ◽  
Chester Kalinda ◽  
Warren Kuhn ◽  
Colleen Aldous
Keyword(s):  
Surgical Procedures ◽  
Low Income ◽  
Care Delivery ◽  
National Policy ◽  
Low Income Countries ◽  
Health Concern ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Essential Drugs ◽  
High Prevalence

Background. Ear, nose, and throat (ENT) diseases are an oft overlooked global health concern. Despite their high prevalence and associated morbidity and mortality, ENT diseases have remained neglected in health care delivery. In Zambia and many other low-income countries, ENT services are characterized by poor funding, unavailable surgical procedures, and erratic supply of essential drugs. Objective. To investigate ENT service provision in Zambia with regard to availability of surgical procedures and supply of essential drugs. Methods. A descriptive cross-sectional survey was conducted using a piloted structured questionnaire between 17 January 2017 and 2 January 2018. Included in the study were the 109 hospitals registered with the Ministry of Health (MoH) across the 10 provinces of Zambia. Results. Of the participating hospitals, only 5.9% (n=1) and 40% (n=2) of Second-Level Hospitals (SLH) and Third-Level Hospitals (TLH), respectively, carried out tympanoplasty, myringotomy, and grommet insertion (M+G). Frontal trephination and external ethmoidectomy were offered in 11.7% (n=2) and 40% (n=2) of SLH and TLH, respectively. While tracheostomy (39.3%, n=24), tonsillectomy (27.9%, n=17), and adenoidectomy (27.9%, n=17) were the most widely performed head and neck procedures, laryngectomy was carried out by 1 hospital. Between 14.8% (n=9) and 36.1% (n=22) of hospitals lacked antibiotic and/or antiseptic ear drops. Despite 96.7% (n=59) of the respondents acknowledging ENT as an important branch of clinical practice, only 15.3% (n=4) of the hospitals had a budget for ENT. Also, 6.6% (n=4) of the respondents thought the discipline of ENT had received enough attention. Conclusion. ENT service delivery in Zambia is limited with regard to performed surgical procedures and availability of essential drugs, necessitating urgent intervention. The findings from this study may be used to direct national policy on the improvement of provision of ENT services in Zambia.

scholarly journals Association between socioeconomic status and prevalence of non-communicable diseases risk factors and comorbidities in Bangladesh: findings from a nationwide cross-sectional survey

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025538 ◽  
Author(s):  
Tuhin Biswas ◽  
Nick Townsend ◽  
Md Saimul Islam ◽  
Md Rajibul Islam ◽  
Rajat Das Gupta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Outcome Measures ◽  
Adult Population ◽  
Multivariable Analysis ◽  
Communicable Diseases ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Non Communicable Diseases

ObjectivesThis study aimed to examine the prevalence and distribution in the comorbidity of non-communicable diseases (NCDs) among the adult population in Bangladesh by measures of socioeconomic status (SES).DesignThis was a cross-sectional study.SettingThis study used Bangladesh Demographic and Health Survey 2011 data.ParticipantsTotal 8763 individuals aged ≥35 years were included.Primary and secondary outcome measuresThe primary outcome measures were diabetes mellitus (DM), hypertension (HTN) and overweight/obesity. The study further assesses factors (in particular SES) associated with these comorbidities (DM, HTN and overweight/obesity).ResultsOf 8763 adults,12% had DM, 27% HTN and 22% were overweight/obese (body mass index ≥23 kg/m2). Just over 1% of the sample had all three conditions, 3% had both DM and HTN, 3% DM and overweight/obesity and 7% HTN and overweight/obesity. DM, HTN and overweight/obesity were more prevalent those who had higher education, were non-manual workers, were in the richer to richest SES and lived in urban settings. Individuals in higher SES groups were also more likely to suffer from comorbidities. In the multivariable analysis, it was found that individual belonging to the richest wealth quintile had the highest odds of having HTN (adjusted OR (AOR) 1.49, 95% CI 1.29 to 1.72), DM (AOR 1.63, 95% CI 1.25 to 2.14) and overweight/obesity (AOR 4.3, 95% CI 3.32 to 5.57).ConclusionsIn contrast to more affluent countries, individuals with NCDs risk factors and comorbidities are more common in higher SES individuals. Public health approaches must consider this social patterning in tackling NCDs in the country.

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