Abstract
BackgroundChronic diseases, primarily cardiovascular disease, respiratory disease, diabetes and cancer, are the leading cause of death and disability worldwide. In sub-Saharan Africa (SSA), where communicable disease prevalence still outweighs that of non-communicable disease (NCDs), rates of NCDs are rapidly rising and evidence for primary healthcare approaches for these emerging NCDs is needed.MethodsA systematic review and evidence synthesis of primary care approaches for chronic disease in SSA. Quantitative and qualitative primary research studies were included that focused on priority NCDs interventions. The method used was best-fit framework synthesis.ResultsThree conceptual models of care for NCDs in low- and middle-income countries were identified and used to develop an a priori framework for the synthesis. The literature search for relevant primary research studies generated 3759 unique citations of which 12 satisfied the inclusion criteria. Eleven studies were quantitative and one used mixed methods. Three higher-level themes of screening, prevention and management of disease were derived. This synthesis permitted the development of a new evidence-based conceptual model of care for priority NCDs in SSA.ConclusionsFor this review there was a near-consensus that passive rather than active case-finding approaches are suitable in resource-poor settings. Modifying risk factors among existing patients through advice on diet and lifestyle was a common element of healthcare approaches. The priorities for disease management in primary care were identified as: availability of essential diagnostic tools and medications at local primary healthcare clinics and the use of standardized protocols for diagnosis, treatment, monitoring and referral to specialist care.
Highlights
Chronic diseases, primarily cardiovascular disease, respiratory disease, diabetes and cancer, are the leading cause of death and disability worldwide
As per the inclusion criteria all of the interventions included a package of care for at least one of the priority Non-communicable disease (NCD) - diabetes mellitus (DM), cardiovascular disease (CVD) and asthma/chronic obstructive respiratory disease (COPD)
Four of the studies focused on HTN and DM management together [22, 25, 27, 30] and two studies developed an intervention focused on HTN, DM and asthma together [28, 31]
Summary
Primarily cardiovascular disease, respiratory disease, diabetes and cancer, are the leading cause of death and disability worldwide. Through lessons learned via the implementation of care models for HIV and TB (In the advent of delivering human immunodeficiency virus (HIV) and tuberculosis (TB) care in SSA), we have seen these chronic diseases treated effectively though primary care models for communicable diseases (CD) [8, 9]. Through these primary care models, decentralized clinics for chronic CD care has allowed for rapid and massive scaling up of HIV/TB services, allowing greater access to care primarily for patients in rural locations – by reducing travel time and costs [10]. In this review our aim is to systematically review the literature for evidence to guide the development of primary care models for DM, CVD and respiratory disease
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