20
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Readiness of Ugandan health services for the management of outpatients with chronic diseases

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objective

          Traditionally, health systems in sub‐Saharan Africa have focused on acute conditions. Few data exist on the readiness of African health facilities ( HFs) to address the growing burden of chronic diseases ( CDs), specifically chronic, non‐communicable diseases ( NCDs).

          Methods

          A stratified random sample of 28 urban and rural Ugandan HFs was surveyed to document the burden of selected CDs by analysing the service statistics, service availability and service readiness using a modified WHO Service Availability and Readiness Assessment questionnaire. Knowledge, skills and practice in the management of CDs of 222 health workers were assessed through a self‐completed questionnaire.

          Results

          Among adult outpatient visits at hospitals, 33% were for CDs including HIV vs. 14% and 4% at medium‐sized and small health centres, respectively. Many HFs lacked guidelines, diagnostic equipment and essential medicines for the primary management of CDs; training and reporting systems were weak. Lower‐level facilities routinely referred patients with hypertension and diabetes. HIV services accounted for most CD visits and were stronger than NCD services. Systems were weaker in lower level HFs. Non‐doctor clinicians and nurses lacked knowledge and experience in NCD care.

          Conclusion

          Compared with higher level HFs, lower‐level ones are less prepared and little used for CD care. Health systems in Uganda, particularly lower level HFs, urgently need improvement in managing common NCDs to cope with the growing burden. This should include the provision of standard guidelines, essential diagnostic equipment and drugs, training of health workers, supportive supervision and improved referral systems. Substantially better HIV basic service readiness demonstrates that improved NCD care is feasible.

          Translated abstract

          Objectif

          Traditionnellement, les systèmes de santé en Afrique subsaharienne ont mis l'accent sur les maladies aiguës. Peu de données existent sur l’état d'apprêtement des établissements de santé ( ES) africains pour faire face à la charge croissante des maladies chroniques ( MC), spécifiquement chroniques, les maladies non transmissibles ( MNT).

          Méthodes

          Un échantillon aléatoire stratifié de 28 ES urbains et ruraux ougandais a été interrogé pour documenter la charge de MC sélectionnées, en analysant les statistiques des services, la disponibilité des services et l'apprêtement des services à l'aide d'un questionnaire SARA modifié de l’ OMS. Les connaissances, compétences et pratiques dans la prise en charge des MC de 222 agents de la santé ont été évaluées par le biais d'un questionnaire auto‐administré.

          Résultats

          Parmi les visites ambulatoires d'adultes dans les hôpitaux, 33% étaient pour des MC dont le VIH, contre 14% et 4% dans les centres de santé de taille moyenne et petite, respectivement. Beaucoup d’ ES manquaient de directives, de matériel de diagnostic et des médicaments essentiels pour la prise en charge primaire des MC; les systèmes de formation et de report étaient faibles. Les établissements de niveau inférieur référaient couramment les patients souffrant d'hypertension et de diabète. Les services VIH enregistraient la plupart des visites de MC et étaient plus préparés que les services des MNT. Les systèmes étaient moins préparés dans les ES de niveau inférieur. Les cliniciens non‐médecins et les infirmier(e)s manquaient de connaissances et d'expérience dans les soins des MNT.

          Conclusion

          Comparés aux ES de niveau supérieur, ceux de niveau inférieur sont moins bien préparés et peu utilisés pour les soins de MC. Les systèmes de santé en Ouganda, particulièrement les ES de niveau inférieur, ont urgemment besoin d'amélioration pour la prise en charge des MNT courantes afin de pouvoir faire face à la charge croissante. Cela devrait inclure la fourniture de directives standard, l’équipement de diagnostic et les médicaments essentiels, la formation des agents de santé, la supervision formative et l'amélioration des systèmes d'aiguillage. L'apprêtement substantiellement meilleur des services VIH de base démontre que l'amélioration des soins des MNT est faisable.

          Translated abstract

          Objetivo

          Tradicionalmente, los sistemas sanitarios en África subsahariana se han centrado en condiciones agudas. Existen pocos datos sobre el nivel de preparación de los centros sanitarios ( CS) africanos para afrontar la cada vez mayor carga de enfermedades crónicas ( EC), específicamente las enfermedades crónicas no transmisibles ( ECNs).

          Métodos

          Se evaluó una muestra estratificada y aleatoria de 28 SC urbanos y rurales de Uganda, para documentar la carga de ECs mediante el análisis de estadísticas del servicio, disponibilidad de servicios y nivel de preparación de los servicios utilizando una modificación del cuestionario SARA de la OMS. Se evaluaron los conocimientos, las capacidades y las prácticas en el manejo de las ECs de 222 trabajadores sanitarios mediante un cuestionario autocompletado.

          Resultados

          Entre los adultos que visitaron los hospitales como pacientes externos, un 33% lo hizo por ECs incluyendo VIH versus 14% y 4% en centros sanitarios de tamaño medio y pequeño, respectivamente. En muchos CSs había una falta de guías, equipos de diagnóstico y medicamentos esenciales para el manejo primario de ECs; los sistemas de formación e informes eran débiles. Los centros de menor nivel referían a sus pacientes con hipertensión y diabetes de forma rutinaria. Los servicios de VIH recibían la mayoría de las visitas por ECs y eran más fuertes que los servicios para ECNs. Los sistemas eran más débiles en CSs de menor nivel. Los sanitarios no médicos y las enfermeras no tenían ni los conocimientos ni la experiencia para la atención de ECN.

          Conclusión

          Comparado con CS de mayor nivel, los de menor nivel están menos preparados y poco acostumbrados a la atención de ECs. Los sistemas sanitarios en Uganda, en particular los CS de menor nivel, necesitan mejorar urgentemente el manejo de ECN para afrontar una carga que va en aumento. Ello incluye contar con guías estandarizadas, equipos de diagnóstico y medicamentos esenciales, entrenamiento de los trabajadores sanitarios, supervisión de apoyo y sistemas de referencia mejorados. Unos servicios de atención básica al VIH sustancialmente mejores son la prueba de que es factible contar con una atención mejorada de las ECN.

          Related collections

          Most cited references13

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          Tackling Africa's chronic disease burden: from the local to the global

          Africa faces a double burden of infectious and chronic diseases. While infectious diseases still account for at least 69% of deaths on the continent, age specific mortality rates from chronic diseases as a whole are actually higher in sub Saharan Africa than in virtually all other regions of the world, in both men and women. Over the next ten years the continent is projected to experience the largest increase in death rates from cardiovascular disease, cancer, respiratory disease and diabetes. African health systems are weak and national investments in healthcare training and service delivery continue to prioritise infectious and parasitic diseases. There is a strong consensus that Africa faces significant challenges in chronic disease research, practice and policy. This editorial reviews eight original papers submitted to a Globalization and Health special issue themed: "Africa's chronic disease burden: local and global perspectives". The papers offer new empirical evidence and comprehensive reviews on diabetes in Tanzania, sickle cell disease in Nigeria, chronic mental illness in rural Ghana, HIV/AIDS care-giving among children in Kenya and chronic disease interventions in Ghana and Cameroon. Regional and international reviews are offered on cardiovascular risk in Africa, comorbidity between infectious and chronic diseases and cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe. We discuss insights from these papers within the contexts of medical, psychological, community and policy dimensions of chronic disease. There is an urgent need for primary and secondary interventions and for African health policymakers and governments to prioritise the development and implementation of chronic disease policies. Two gaps need critical attention. The first gap concerns the need for multidisciplinary models of research to properly inform the design of interventions. The second gap concerns understanding the processes and political economies of policy making in sub Saharan Africa. The economic impact of chronic diseases for families, health systems and governments and the relationships between national policy making and international economic and political pressures have a huge impact on the risk of chronic diseases and the ability of countries to respond to them.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Monitoring service delivery for universal health coverage: the Service Availability and Readiness Assessment

            Objective To describe the Service Availability and Readiness Assessment (SARA) and the results of its implementation in six countries across three continents. Methods The SARA is a comprehensive approach for assessing and monitoring health service availability and the readiness of facilities to deliver health-care interventions, with a standardized set of indicators that cover all main programmes. Standardized data-collection instruments are used to gather information on a defined set of selected tracer items from public and private health facilities through a facility sample survey or census. Results from assessments in six countries are shown. Findings The results highlight important gaps in service delivery that are obstacles to universal access to health services. Considerable variation was found within and across countries in the distribution of health facility infrastructure and workforce and in the types of services offered. Weaknesses in laboratory diagnostic capacities and gaps in essential medicines and commodities were common across all countries. Conclusion The SARA fills an important information gap in monitoring health system performance and universal health coverage by providing objective and regular information on all major health programmes that feeds into country planning cycles.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              Leveraging Rapid Community-Based HIV Testing Campaigns for Non-Communicable Diseases in Rural Uganda

              Background The high burden of undiagnosed HIV in sub-Saharan Africa limits treatment and prevention efforts. Community-based HIV testing campaigns can address this challenge and provide an untapped opportunity to identify non-communicable diseases (NCDs). We tested the feasibility and diagnostic yield of integrating NCD and communicable diseases into a rapid HIV testing and referral campaign for all residents of a rural Ugandan parish. Methods A five-day, multi-disease campaign, offering diagnostic, preventive, treatment and referral services, was performed in May 2011. Services included point-of-care screening for HIV, malaria, TB, hypertension and diabetes. Finger-prick diagnostics eliminated the need for phlebotomy. HIV-infected adults met clinic staff and peer counselors on-site; those with CD4≤100/µL underwent intensive counseling and rapid referral for antiretroviral therapy (ART). Community participation, case-finding yield, and linkage to care three months post-campaign were analyzed. Results Of 6,300 residents, 2,323/3,150 (74%) adults and 2,020/3,150 (69%) children participated. An estimated 95% and 52% of adult female and male residents participated respectively. Adult HIV prevalence was 7.8%, with 46% of HIV-infected adults newly diagnosed. Thirty-nine percent of new HIV diagnoses linked to care. In a pilot subgroup with CD4≤100, 83% linked and started ART within 10 days. Malaria was identified in 10% of children, and hypertension and diabetes in 28% and 3.5% of adults screened, respectively. Sixty-five percent of hypertensives and 23% of diabetics were new diagnoses, of which 43% and 61% linked to care, respectively. Screening identified suspected TB in 87% of HIV-infected and 19% of HIV-uninfected adults; 52% percent of HIV-uninfected TB suspects linked to care. Conclusions In an integrated campaign engaging 74% of adult residents, we identified a high burden of undiagnosed HIV, hypertension and diabetes. Improving male attendance and optimizing linkage to care require new approaches. The campaign demonstrates the feasibility of integrating hypertension, diabetes and communicable diseases into HIV initiatives.
                Bookmark

                Author and article information

                Journal
                Trop Med Int Health
                Trop. Med. Int. Health
                10.1111/(ISSN)1365-3156
                TMI
                Tropical Medicine & International Health
                John Wiley and Sons Inc. (Hoboken )
                1360-2276
                1365-3156
                08 July 2015
                October 2015
                : 20
                : 10 ( doiID: 10.1111/tmi.2015.20.issue-10 )
                : 1385-1395
                Affiliations
                [ 1 ]Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS EntebbeUganda
                [ 2 ]Ministry of Health KampalaUganda
                [ 3 ] MRC Tropical Epidemiology GroupLondon School of Hygiene & Tropical Medicine LondonUK
                [ 4 ]Mwanza Intervention Trials Unit and Weill Bugando School of Medicine MwanzaTanzania
                [ 5 ] Department of Non‐communicable Disease EpidemiologyLondon School of Hygiene & Tropical Medicine LondonUK
                Author notes
                [*] [* ] Corresponding Author David Katende, Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Plot 51‐59 Nakiwogo road, P.O. Box 49, Entebbe, Uganda. E‐mails: david.katende@ 123456mrcuganda.org
                Article
                TMI12560
                10.1111/tmi.12560
                4758403
                26095069
                a54f7f7f-cfad-48d9-9536-7bce7cdc34e6
                © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Pages: 11
                Funding
                Funded by: UK Medical Research Council
                Categories
                Original Article
                Original Research Papers
                Custom metadata
                2.0
                tmi12560
                October 2015
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.7.6 mode:remove_FC converted:18.02.2016

                Medicine
                outpatients,chronic diseases,healthcare systems,health services,sub‐saharan africa,uganda,patients ambulatoires,maladies chroniques,systèmes de santé,services de santé,afrique subsaharienne,ouganda

                Comments

                Comment on this article