Rational and design of SATRACD study: detecting subclinical anthracycline therapy related cardiac dysfunction in low income country

Background: Anthracycline therapy-related cardiac dysfunction (ATRCD) is the most notorious adverse side-effect of chemotherapy. It has become a significant cardiovascular health concern for long-term cancer survivors. With the emerging concept of subclinical ATRCD and newer diagnostictools (Speckle Tracking Echocardiography (STE) and biomarkers), detecting anthracycline cardiac toxicity at an early stage has become an important step to prevent severe cardiac dysfunction and improve the cardiovascular outcome in cancer survivors. Despite the increasing population at risk in sub-Saharan Africa (SSA), there is no contemporary data in Uganda to address the burden, pathogenesis and risk factors of subclinical ATRCD. This big gap in knowledge has led to a lack of local guidelines for monitoring and management of ATRCD. Methods: SATRACD (Detecting Subclinical Anthracycline Therapy Related Cardiac Dysfunction In Low Income Country) study is an observational prospective cohort study. Three hundred and fifty-three anthracycline naïve cancer patients will be recruited at baseline. Patients are followed up on completion of anthracycline-based chemotherapy and at 6 months after completion of anthracycline therapy. Data on demographics, cancer profile and clinical presentation will be collected at baseline. Comprehensive cardiac assessment will be performed at each visit, including electrocardiogram, conventional echo- cardiography, STE, cardiac and oxidative stress markers. We will be able to determine the incidence of subclinical and clinical ATRCD at 6 months after completion of anthracycline therapy, determine whether hypertension is a major risk factor for ATRCD, evaluate the role of conventional echocardiography parameters, and biomarkers for detecting subclinical ATRCD. Conclusion: This SATRACD study will provide contemporary data on Ugandan cancer patients who have subclinical and clinical ATRCD, help in the development of local strategies to prevent and manage ATRCD, and improve cardiovascular outcome for Ugandan cancer survivors. Keywords: SATRACD study; subclinical anthracycline therapy; cardiac dysfunction; low income country.

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Unplanned attendances of cancer patients to an outpatient unit in a low-income country: A prospective study from Sudan

South African Journal of Oncology ◽

10.4102/sajo.v4i0.126 ◽

2020 ◽

Vol 4 ◽

Author(s):

Moawia M.A. Elhassan ◽

Safa I.H. Taha ◽

Maha M.A. Maatoug

Keyword(s):

Prospective Study ◽

Cancer Patients ◽

Low Income ◽

Income Country ◽

Low Income Country ◽

Outpatient Unit ◽

A Prospective Study

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Validation of the SF12 mental and physical health measure for the population from a low-income country in sub-Saharan Africa

Health and Quality of Life Outcomes ◽

10.1186/s12955-020-01323-1 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Julius Ohrnberger ◽

Laura Anselmi ◽

Eleonora Fichera ◽

Matt Sutton

Keyword(s):

Physical Health ◽

Low Income ◽

Sub Saharan Africa ◽

Income Country ◽

Low Income Country ◽

Health Measure ◽

Sub Saharan ◽

Mental And Physical Health

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Setting up a nurse-led model of care for management of Hypertension and Diabetes Mellitus in a high HIV prevalence context in rural Zimbabwe: a descriptive study

10.21203/rs.2.14916/v1 ◽

2019 ◽

Author(s):

Marthe Marie Frieden ◽

Blessing Zamba ◽

Nisbert Mukumbi ◽

Patron Titsha Mafaune ◽

Brian Makumbe ◽

...

Keyword(s):

Diabetes Mellitus ◽

Low Income ◽

Descriptive Study ◽

Communicable Diseases ◽

Hiv Prevalence ◽

Sub Saharan Africa ◽

Income Country ◽

Model Of Care ◽

Non Communicable Diseases ◽

Low Income Country

Abstract Background In light of the increasing burden of non-communicable diseases on health systems in low- and middle-income countries, particularly in Sub-Saharan Africa, context adapted cost effective service delivery models are now required as a matter of urgency. Multiple models have thus been trialled across Africa with varying degrees of success. Zimbabwe is a low-income country with unique socio-economic challenges but similar dual disease burden of infectious chronic diseases such as HIV and non-communicable diseases. We aim to describe the experience of setting up and organising a nurse-led Diabetes Mellitus (DM) and Hypertension (HTN) model of care in a rural context of a low-income country from July 2016 to June 2019.Methods A descriptive study based on a conceptual framework successfully applied in the roll-out of antiretroviral therapy in Manicaland Province, Zimbabwe. Attempting to mirror the HIV experience, we describe the key enablers in the design and implementation of the model: decentralization of services, integration of care, simplification of management guidelines, mentoring and task-sharing, provision of affordable medicines, quality assured laboratory support, patient empowerment, a dedicated monitoring and evaluation system, and a robust referral system.Results 11 out of 51 health facilities were selected in Chipinge district, of which nine were primary health care (PHC) clinics and two were hospitals. DM/HTN services were set up and integrated into the general out-patient department or pre-existing HIV clinics. In one hospital, an integrated chronic care clinic was established. Through structured intensive mentoring, including simplified protocols, nurses in seven PHC facilities and one hospital developed sufficient knowledge and skills to diagnose, initiate treatment and monitor DM/HTN patients. Overall, more than 3000 patients were registered in a dedicated recording system and offered education. Free medication with differentiated periodic refills and regular monitoring of blood pressure and/or blood glucose with the use of glycosylated haemoglobin were provided.Conclusion Our experience shows that it is feasible to implement nurse-led decentralized integrated DM/HTN care in a high HIV prevalence rural, low-income context. Developing a context-adapted efficient model of care is a dynamic process.

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