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      Urban-Rural Disparities in Chronic Obstructive Pulmonary Disease Management and Access in Uganda

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          Abstract

          Introduction: Almost 90% of chronic obstructive pulmonary disease (COPD) deaths occur in low- and middle-income countries (LMICs), where there are large rural populations and access to health care for COPD is poor. The purpose of this study was to compare urban-rural provider experiences regarding systemic facilitators and barriers to COPD management and treatment access.

          Methods: We conducted a qualitative study using direct observations and in-depth semi-structured interviews with 16 and 10 health care providers in urban Kampala and rural Nakaseke, Uganda, respectively. We analyzed interviews by performing inductive coding using generated topical codes.

          Results: In both urban and rural districts, exposure to evidence-based practices for COPD diagnosis and treatment was limited. The biomedical definition of COPD is not well distinguished in rural communities and was commonly confused with asthma and other respiratory diseases. Urban and rural participants alike described low availability of medications, limited access to diagnostic tools, poor awareness of the disease, and lack of financial means for medical care as common barriers to seeking and receiving care for COPD. While there was greater access to COPD treatment in urban areas, rural populations faced more pronounced barriers in access to diagnostic equipment, following standard treatment guidelines, and training medical personnel in non-communicable disease (NCD) management and treatment.

          Conclusion: Our results suggest that health system challenges for the treatment of COPD may disproportionately affect rural areas in Uganda. Implementation of diagnostic and treatment guidelines and training health professionals in COPD, with a special emphasis on rural communities, will assist in addressing these barriers.

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          Author and article information

          Journal
          Chronic Obstr Pulm Dis
          Chronic Obstr Pulm Dis
          Chronic Obstr Pulm Dis
          Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation
          COPD Foundation Inc (Miami, USA )
          2372-952X
          2019
          4 January 2019
          : 6
          : 1
          : 17-28
          Affiliations
          [1]Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
          [2]Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
          [3]Department of Physiology, College of Health Sciences, Makerere University, Kampala, Uganda
          [4]UCL Respiratory, University College London, United Kingdom
          [5]Department of Medicine and Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
          Author notes
          Address correspondence to: Nicole Robertson, Email: Nicolemrobertson01@ 123456gmail.com Phone: (859) 468-9147

          We greatly acknowledge the health care providers who volunteered their time and made this study possible. A special thanks to the study sites-- Nakaseke District Hospital, LifeCare Clinic, HCII Kigegge, HCII Bukyare, HCII Biddabuggya, Nakaseke Private Pharmacy, MRB Drug Shop, Mulago National Referral Hospital, and Makerere University Lung Institute--for allowing us to conduct interviews at their facilities with their providers. We would also like to acknowledge Dr. Patricia Alupo, Faith Nassali, and our research assistant Rebecca Akello for their involvement in this study. This research was generously funded by the Irvin F. and Alice S. Etscorn International Summer Research Award and the Medical Research Council Grant MR/P008984/1 under the Global Excellence in COPD study.

          Author Contributions: Study concept and design was conducted by Nicole Robertson, Emily Nagourney, Trishul Siddharthan and Bruce Kirenga; Analysis and interpretation was provided by Nicole Robertson, Emily Nagourney and Trishul Siddharthan. Manuscript drafting for important intellectual content was provided by Nicole Robertson, Emily Nagourney and Trishul Siddharthan. Revising the manuscript for important intellectual content was provided by all authors.

          Article
          PMC6373590 PMC6373590 6373590
          10.15326/jcopdf.6.1.2018.0143
          6373590
          30775421
          a7c04a8e-6038-450c-80d6-a5daca7fe968
          JCOPDF © 2019
          History
          : 16 August 2018
          Funding
          This research was funded by the Medical Research Council Grant MR/P008984/1 under the Global Excellence in COPD Outcomes study and the Irvin F. and Alice S. Etscorn International Summer Research Award.
          Categories
          Original Research

          treatment access,low and middle-income countries,Uganda,copd,chronic obstructive pulmonary disease,Urban-rural health disparities

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