Burden Of NCDs Research Articles

Critical Analysis of Nutritional Factors in Disease Epidemiology and Prevention

The burden of NCDs, including obesity, diabetes, CVDs, and some cancers, has upped the importance of nutrition in the health of a nation. Malnutrition and over nutrition, which are the major nutritional factors, play important roles in disease distribution in the world. With regard to the analysis of this paper, the author has given a critical perspective on how dietary habits, socioeconomic factors, and cultural practices are determinants of the epidemiology of diseases. Therefore, the present paper employs a literature review, epidemiological data, and case studies to unveil the connection between diet and disease as well as the way forward. Some of the discoveries made include understanding that poor diets are the leading causes of NCDs, micronutrient deficiencies are still a problem with the poor, and processed foods are very much a threat. The discussion reviews the difficulties in shifting to a healthier diet. It presents solutions for the economic issue and the behavioral modification problem in policy-making, healthcare approaches, and public health practice.

Collaborative efforts of the Joint Action PreventNCD and the WHO Europe to protect children from harmful marketing

Abstract Control and counter the effects of advertisements and online marketing is one of the policy actions that will be explored within the JA Prevent NCD that has the overall aim to “reduce the burden of cancer and other NCDs and common risk factors, both at a personal and societal level, and support member states by taking a holistic approach for the prevention of cancer and other NCDs, through coordinated action”. The work that will be building on the JA Best-ReMaP sustainability framework recommendations to improve the effective implementation of policies to reduce harmful marketing of unhealthy food, would at the same time comprehensively address also tobacco and alcohol maketing. Thirteen different countries are involved in the work package on regulation and taxation that has the overall objective to “improve compliance, coherence, wider implementation and enforcement of fiscal and regulative measures targeting major NCD-risks factors.” This includes a broad range of tasks from mapping existing policies and frameworks, accumulating knowledge on health taxes and fiscal policies, promoting the use of joint nutrient profile models, assessing the impact of labelling on products to create healthier behaviors, supporting the implementation of policies to reduce the impact of harmful marketing, strengthening regulations towards hazardous substances and developing monitoring indicators for policies for prevention of NCD. An overview of the concrete collaborative actions to support the implementation of the marketing regulation will be given: (1) on JA work with the MSs and especially presidency countries, to allow for the discussions on the development of the EU regulation for reduction of the harmful marketing; (2) on the EU stakeholders positions regarding marketing regulation; (3) on the collaborative actions in scaling up the KidAd app. (5) the development of an algorithm to detect alcohol, tobacco and nicotine-containing products will be jointly developed and piloted.

Revealing the influence of food industry actors in relation to nutritional policies in Belgium

Abstract Unhealthy food is one of the prevailing risk factors of NCDs and cancers, making the food industry a key player in their prevention. However, evidence-based public health policies aimed at reducing consumption of unhealthy food, may threaten industry sales. In response, food industry actors try to influence the development and implementation of these nutritional policies by engaging in corporate political activities (CPA). As part of the Joint Action PreventNCD, the CPA of relevant food industry actors in relation to public health nutritional policies will be assessed. In Belgium, strategies of Fevia, the umbrella organization of the food industry, are examined. This study analyses publicly available information collected from Fevia’s website, social media accounts (i.e. X and LinkedIn), newsletters and newspapers. A thematic qualitative analysis is conducted using established frameworks to categorize both framing and action strategies used by the industry. The categorization of framing strategies reveals how the food industry presents the actors, problems, and solutions. The framework of action strategies categorizes the CPA of the food industry under the following six strategies: information and messaging; financial incentives; constituency building; legal action; policy substitution; opposition fragmentation and destabilization. Preliminary results indicate that the industry often frames itself as ‘the good actor’ and primarily uses strategies such as ‘information and messaging’, ‘constituency building’ and ‘policy substitution’ to influence policies in Belgium in their favor. In the next phase, interviews with stakeholders (e.g. policymakers, politicians,...) will be performed to collect undocumented information. Overall, this research sheds light on the ongoing CPA of the food industry and will increase transparency in their influence on the development and implementation of effective nutritional policies aimed at reducing the burden of NCDs and cancers. Key messages • This study reveals how the umbrella organization of the food industry in Belgium influences public health nutritional policies through various corporate political action and framing strategies. • Identifying these CPA increases awareness of the industry’s influence, but also promotes their transparency and accountability, which is crucial for reliable and effective nutritional policy.

Is too much sugar bitter? The impacts of sugars on health.

This paper reviews the associations between sugars consumption and non-communicable diseases. Systematic reviews demonstrate associations between sugars intake and dental caries, weight gain, type 2 diabetes and cardiovascular diseases. Children consuming more sugar-sweetened beverages (SSBs) are 1.55 times more likely to be overweight. In adults, higher consumption of SSBs is associated with a 27% higher relative risk of developing type 2 diabetes. In adults, greater free sugar consumption was positively associated with total CVD (HR 1.07; 95% CI: 1.03-1.10), ischaemic heart disease (HR 1.06; 95%CI: 1.02,1.10), and stroke (HR 1.10, 95% CI: 1.04, 1.17). Those consuming sugars higher than the recommended level of 10% of total energy are more likely to develop dental caries; 42 out of 50 studies involving children and 5 out of 5 in adults reported at least one positive association between sugars and caries. Reduction in sugars consumption requires a myriad of interventions to reduce supply and demand at national and global levels, fiscal policies, alongside high-quality research and promoting environments to reduce the burden of NCDs.

Design and Implementation of Brief Interventions to Address Noncommunicable Diseases in Uzbekistan.

In Uzbekistan, NCDs, including cardiovascular diseases, cancer, and diabetes, accounted for over 80% of mortality in 2019. In 2021, national stakeholders, in conjunction with the World Health Organization, identified brief interventions (BIs) to implement in primary health care settings to change unhealthy behaviors and reduce the burden of NCDs in the country. BIs consist of a validated set of questions to identify and measure NCD behavioral risk factors and a short conversation with patients/clients about their behavior, as well as the provision of a referral opportunity for further in-depth counseling or treatment if needed. We used a multimethod approach of document review, participatory workshops, and key informant interviews to describe how BIs were designed and implemented in Uzbekistan and generated a theory of change for its large-scale implementation. BIs in Uzbekistan targeted 4 risk factors (alcohol use, tobacco use, unhealthy diet, and physical inactivity) and entailed training clinicians on how to conduct behavioral change counseling using the 5As and 5Rs toolkit, conducting supportive supervision, and using feedback to improve service delivery. The program was collaboratively designed by multiple stakeholders across sectors, including the Ministries of Health, Higher Education, Science, and Innovations, with buy-in from key political leaders. The potential impact of the program (i.e., reducing the incidence of NCDs) was mediated by several intermediate and implementation outcomes at the individual, primary care, and community levels operating along multiple pathways. Significant health system challenges remain to the program, such as limited human resources, lack of incentives for clinicians, outdated systems and data collection processes for performance monitoring, and coordination among different relevant sectors. These and other challenges will need to be addressed to ensure the effective large-scale implementation of BIs in Uzbekistan and similar LMICs.

Perspectives for the Prevention of Noncommunicable Diseases in Tanzania: Is Knowledge Translated into Practice?

In Tanzania, where over a third of the society is impoverished, the burden of NCDs which account for about two-fifths of all disability-adjusted life years (DALYs) and one-third of premature deaths has doubled in the past two decades. However, notwithstanding a wider realization of the escalating burden of NCDs across Tanzania, the link between NCD awareness and lifestyle practices at the population level is not well characterized. We aimed to establish the gap between NCD knowledge and healthy behaviors. This multi-regional community-based cross-sectional study was conducted in 5 regions of Tanzania between September 2022 and June 2023. A 22-item standardized tool evaluating various NCD risk behaviors was used in knowledge assessment and a cut-off of ≥70% was used to denote good knowledge. Bivariate analyses were performed to compare knowledge of NCD risk factors across various NCD risk subgroups. All tests were two tailed, and the significance was set at p<0.05. A total of 5121 individuals were consecutively enrolled. The mean age was 47.2 years and females comprised over three-fifths (60.8%) of the participants. With regard to behavioral NCD risks, physical inactivity, unhealthy diet, smoking and alcohol consumption were present in 79.0%, 70.2%, 2.1% and 17.6% of participants, respectively. Moreover, biological risk factors, ie, excess body weight, hypertension, and diabetes were present in 68.4%, 55.8% and 13.0% of participants, respectively. The mean knowledge score was 77.1% and 70.3% of participants demonstrated good knowledge of NCD risk factors. Except for smoking, individuals who showed awareness of various NCD risk factors were found to have significant rates of risky behaviors. Despite sufficient NCD risk knowledge, incongruent lifestyle practices persist, highlighting a crucial concern. This suggests that awareness of NCDs and their risks may influence motivation for change but may not necessarily result in lifestyle modification.

Cost analysis for initiating an integrated package of essential non-communicable disease interventions (PEN-Plus) in Kondoa District Hospital, Tanzania: a time-driven activity-based costing (TDABC) study protocol

IntroductionNon-communicable diseases (NCDs) constitute approximately 74% of global mortality, with 77% of these deaths occurring in low-income and middle-income countries. Tanzania exemplifies this situation, as the percentage of total disability-adjusted...

Prevalence of Hypertension and Associated Factors among Patients Attending Hoima Regional Referral Hospital, Hoima District Western Uganda

Hypertension is an important contributor to the global burden of disease and mortality, and is a growing public concern in the developing world but data on hypertension and its associated factors among populations in the developing nations is minimal. However, in Uganda as the rest of Sub-Saharan Africa (SSA), emphasis has been placed on communicable diseases which are also highly prevalent in the region. This study assessed the prevalence of hypertension and its associated factors among adults twenty years and above attending Hoima Regional Referral Hospital. A cross-sectional study design was used. The study employed qualitative and quantitative research approaches to collect data. This study found a relatively high prevalence of hypertension (17.1%) among patients attending Hoima Regional Referral Hospital. The prevalence of hypertension in this peri-urban study area confirms the growing public health challenge of non-communicable diseases in Uganda. However, community-based studies are required to determine the extent of this problem and the associated factors of hypertension in Ugandan communities, owing to the increasing burden of NCDs in developing countries. We need interventions that aim to reduce the associated factors identified in this study, targeting the entire population to lower the risk and prevalence of hypertension. Keywords: Hypertension, Sub-Saharan Africa, Communicable diseases, cardiovascular diseases.

Identifying key factors for successful formulation and implementation of healthcare policies on non-communicable diseases: a multinational analysis.

Non-communicable diseases (NCDs) are a major public health concern that accounts for 74% of global deaths each year. The increasing burden of NCDs exhausts public health resources and threatens the achievement of the 2030 agenda for sustainable development. The purpose of this study is to thematically analyze the contributory factors in the health policy process and reforms to strengthen the prevention of NCDs across borders, as well as the milestones achieved through the process of policy-making, change, and implementation. This study informs and draws on the findings of contributory factors in the health policy process for preventing NCDs across borders: United States, England, Sweden, Bangladesh, Singapore, South Korea, and Thailand. Ten experts from the seven countries were recruited purposively for a semi-structured interview (e-Interview) on the NCD policy-making process in their countries, either through health ministries or the authors' network. This descriptive qualitative study design is guided by the "Three I's" framework of public policy (institutions, ideas, and interests). In addition to the information obtained from the interviewee, data were also sourced from relevant documents and homepages suggested by the interviewee, as well as health homepages of the countries. The following themes were generated: (1) environmental policies and social determinants, (2) multistakeholder involvement, (3) interministerial collaboration, (4) independent evidence and review institution, (5) integrated health data, and (6) primary care system. There was a shift from individual-targeted policies to environmental policies and social determinants. Notably, national campaigns were developed through non-governmental organizations (NGOs) for the primary prevention of NCDs. The shift from behavioral modification and treatment to social determinants is important. NCDs are broad and require a multisector and multilevel approach. Establishing an organization or hierarchical body to overlook NCDs could result in increased awareness, focus, and surveillance and enhance the policy process.

Tobacco control in Qatar from 2002 to 2022: 20 years of progress and challenges.

Tobacco use and exposure has been known as one of the leading causes of premature mortality worldwide. Tobacco control measures have been considered one of the strategies for reducing the burden of NCDs, improving public health, and strengthening the health system's response to threats and pandemics. The State of Qatar has put tobacco control a national public health priority as it has adopted various tobacco control measures that the WHO classified as high-impact measures. This has resulted in achieving tobacco control milestones which led to constant monitoring of tobacco use and the provision of smoking cessation services at all healthcare levels. However, there is still much work to be done to fill the gaps and respond to the emergence of novel tobacco products and market strategies in an effective way. This review highlights the status of tobacco use and exposure in the State of Qatar, and focus on the progress, and challenges in the implementation of tobacco control policies and smoking cessation services between 2002 and 2022.

Disease burden in Belgium in 2040: Methodological considerations

Abstract Non-communicable diseases (NCDs) are responsible for a significant proportion of global morbidity and mortality, placing a substantial burden on individuals, communities, and healthcare systems. To effectively plan and allocate resources for prevention and treatment, it is crucial to understand the future burden of NCDs. Projections of prevalence of NCDs can provide valuable insights into the future burden of disease and inform policy decisions and resource allocation. These projections can include various factors such as changes in demographics, health determinants, and healthcare access. By predicting future trends in disease prevalence, policymakers can better anticipate the demand for health services, identify areas where prevention efforts can be targeted, and allocate resources more effectively. For example, projections can help policymakers understand the potential impact of interventions such as increased physical activity, improved diet, or increased access to healthcare services. Several methods can be used to project future NCD prevalence, such as generalised linear models, age-period-cohort models, and microsimulation models. Each of these methods come with advantages and disadvantages. Based on our current projections using generalised linear models within a Bayesian framework, the burden of most NCDs will increase by 2040. In this presentation, the thought-process will be addressed to implement future projections in Belgium for NCDs. We will also present the initial results of the projections based on generalised linear models. These projections can help to reduce the burden of NCDs on individuals and society, and ultimately improve public health outcomes.

7.A. Workshop: How could sustainable public food policies add to curbing childhood obesity in EU? Best-ReMaP case

Abstract Childhood obesity is a global public health problem in Europe and worldwide, influenced mainly by the nutrition and physical in/activity behaviours which are impacted by the structural food environment in which the child and his/her caregivers make lifestyle decisions. Individual eating behaviour is a complex societal practice, influenced by structural factors of the obesogenic environment with several health risks. Overweight and its associated chronic diseases (NCDs) reduce life expectancy in OECD countries by 2.7 years on average and 8.4% of the health budget of OECD countries will be spent to treat the consequences of overweight over the next thirty years. Including direct and indirect effects, overweight and obesity reduces GDP by 3.3% on average in both OECD countries and EU28 Member States. Joint Action ‘Best-ReMaP - Healthy Food for a Healthy Future’ (www.bestremap.eu)of 24 participating EU Member states (MSs) aims to contribute to positive changes in food environment in EU, by contributing to the improvement the quality of the food offer in EU, while placing public health at the centre of food systems-related policies and practice. With an ultimate goal to support EU and national efforts to reduce the burden of NCDs, Best-ReMaP addresses the selected food policies from three interrelated angles, which could influence children's food choices: (1) food reformulation (how the composition of the processed foods can be better monitored and producers more motivated to reformulate for healthier food options at the European and national levels); (2) reduction of food marketing (how the traditional and digital food marketing and advertising activities could be better monitored and regulated), and (3) public food procurements - PFP (how public institutions could procure foods that's healthier, of higher quality and more sustainable). Different actions have been considered, allowing for the possible sustainable implementation of the three up-mentioned policies, such as: three policy frameworks, food system indicator for the EU Semester, EU level branded foods database, different networks (experts, high level), equity aspects (existing knowledge and research gaps). The workshop is aiming to: • Showcase the value of monitoring of concrete food policies, to enable the regular reporting on the progress and implementation obstacles and argued engagement with stakeholders. • Increase participants’ understanding and awareness of the challenges of the concrete sustainable implementation of actions of the Best-ReMaP food policies. The workshop will offer an opportunity to: • Present the sustainable outputs of the Best-ReMaP implementation approaches, outlining the attempts in harmonizing monitoring actions for food reformulation and marketing, and piloting the PFP tools. • Inform participants about the benefits of the sustainable EU frameworks for three policy actions, and other sustainability mechanisms, developed by the Best-ReMaP consortium. Key messages • New evidence on the sustainable implementation of the policy actions in Best-ReMaP food policies (reformulation, marketing, public food procurement) are presented. • Three frameworks for action for EU and MSs, and food system indicator for the European Semester are discussed.

Managing medical emergencies: Sustainable pre-hospital medical education in Rwanda

&#x0D; &#x0D; &#x0D; INTRODUCTION: In Rwanda, non-communicable diseases accounted for 44% of all reported deaths as of 2016. Yet, there is very limited data on pre-hospital management of emergency medical conditions in LMICs. We evaluated the impact of a pre-hospital medical emergencies training course and train-the-trainers program for Service d’Aide Medicale Urgente (SAMU) to address the burden of NCDs.&#x0D; METHODS: A 100-question baseline assessment was administered to 25 SAMU staff to assess knowledge of basic anatomy, physiology, medicine, obstetrics, pediatrics, trauma, and scene safety. A two-day Emergency Medical Care Course (EMCC) was developed. Two cohorts (one for instructors and another one for staff) from ten district and provincial hospitals. EMCC 1 and a one- day educator course were conducted for the instructor core. They then taught the second cohort of trainees (EMCC 2).&#x0D; RESULTS: In the baseline assessment of 25 SAMU staff, the median score was 56% overall and 54% in medical. EMCC 1 median scores were 43% vs 86% (pre vs post), p&lt;0.001 using matched pair analysis of 18 participants. EMCC 2 median scores were 45% vs 82% (pre vs post), p&lt;0.001 using matched pair analysis of 16 participants. A one-way ANOVA mean square analysis showed no statistically significant difference between the two cohorts post-training, with similar post- assessment scores.&#x0D; DISCUSSION: This study showed that the course improved knowledge for an instructor core and staff from district and provincial hospitals, confirming the effectiveness of a train-the-trainers model, which will allow for sustainability in pre-hospital emergency medical training in Rwanda.&#x0D; &#x0D; &#x0D;

Statement of the Sociedad Argentina de Pediatría on the prevention of non-communicable diseases: the need to strengthen knowledge and reinforce strategies

Research in recent decades has revealed that an adverse environment in the developmental stage can produce a greater susceptibility to phenotypes related to cardiovascular disease, diabetes, hypertension, or neurobehavioral disorders, among other chronic noncommunicable diseases. These diseases, whose tendency is increasing especially in countries with high social vulnerability, cause premature deaths and constitute the first cause of death in adult life as well as a great cost to public health. Aware of the need to prevent these diseases from the first thousand days of life, the Sociedad Argentina de Pediatría created the DOHaD Committee and formulated a statement for the prevention of NCDs, to which Latin American countries also adhered. We believe that the application of the declared strategies with interdisciplinary and intersectoral actions sustained over time will contribute to building health, reducing the burden of NCDs, and to greater wellbeing and productivity for the people.

Burden of non-communicable diseases and the achievement of the sustainable development goals in 2030 in Mercosur countries

ObjectivesThe aims of this article were to analyse the burden of NCDs and their RFs in the Mercosur countries between 1990 and 2019 and to project mortality trends for 2030. Study designEpidemiological study of time series. MethodsThe present study used data from the Global Burden of Disease study. The absolute number of deaths, mortality rates, disability-adjusted life years, years of life lost, years lived with disability and the burden of premature mortality by NCD attributable to the RFs were evaluated. Projections were made up to 2030. Age-standardised rates were used to draw comparisons by years and by countries. The analysis was conducted using the RStudio software. ResultsBetween 1990 and 2019, a decrease was found in the premature mortality rates caused by NCDs in all the countries, except for Paraguay, which remained stable. When analysing premature mortality rates due to NCDs up to 2030, it was predicted that none of the countries would achieve the sustainable development goal of a one-third reduction in premature mortality by NCDs. Regarding the impacts of the RFs for NCDs, smoking, dietary risks, high blood pressure (BP) and high body mass index (BMI) were the main risks attributable to premature deaths due to NCDs. ConclusionsThe results showed that mortality rates are declining in Mercosur countries; however, none of the countries are predicted to achieve the sustainable development goal of a one-third reduction in mortality due to NCDs by 2030. In addition to access to adequate treatment, progress is required in public regulation actions to reduce RFs, such as smoking, dietary risks, high BP and high BMI.

Comparative Analysis of Risk Factors for the Burden of NCDs in Men in European and Asia-Pacific countries (Observational Observations)

Comparative Analysis of Risk Factors for the Burden of NCDs in Men in European and Asia-Pacific countries (Observational Observations)

#6798 BURDEN OF NONCOMMUNICABLE DISEASES ATTRIBUTABLE TO KIDNEY DYSFUNCTION: RESULTS FROM THE GLOBAL BURDEN OF DISEASE STUDY 2019

Abstract Background and Aims Non-communicable diseases (NCD) represent a major public health and disability burden worldwide. The UN Sustainable Development Goal (SDG) target 3.4 called for reducing premature mortality from NCD by one third through prevention and treatment by 2030. To lessen the impact of the burden of NCD, evidence-based and precise data are needed for making policy and allocating resources. However, the burden of NCD attributable to kidney dysfunction has not been systematically estimated. We aimed to estimate the global latest trend of kidney dysfunction-related NCD quantified by death and disability-adjusted life-years (DALY) at global, regional, and national levels using data extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Method In GBD study 2019, kidney dysfunction is classified as level 2 risk factor for disease in metabolic risk factors hierarchy, which refers to glomerular filtration rate (GFR) &amp;lt;60 mL/min/1·73 m² or albumin-to-creatine ratio (ACR) &amp;gt;30 mg/g. The GBD study 2019 provides a systematic assessment of published, publicly available, and contributed data on mortality and disability-adjusted life-years (DALY), which were estimated with Bayesian geospatial regression using data at global, regional and country level. Further analyses were performed by year, age, sex, and regions in 204 countries. To assess the change trend, we calculated the estimated annual percentage change (EAPC) of age-standardized rate with the linear regression model. The Socio-demographic Index (SDI) was used as an comprehensive indicator of national socioeconomic status. we explored the relationship between age-standardized mortality or DALY rate and SDI using Pearson's correlation analysis. Additionally, burdens in main types of NCD (including cardiovascular disease and chronic kidney disease) attributable to impaired kidney function were analyzed. Results From 1990 to 2019, the absolute numbers of death and DALYs increased, while the age-standardized rates of deaths and DALYs of NCD attributable to kidney dysfunction deceased worldwide. The age-standardized mortality decreased by an average of −0.35% (95% UI −0.41 to −0.29) per year, from 45.17(95% UI 37.62 to 52.33) per 100,000 population in 1990 to 40.64(95% UI 34.81 to 46.71) per 100,000 population in 2019. Over the same interval, the age-standardized DALYs rate declined from 1024.13 (95% UI 898.38 to 1154.8) per 100,000 population to 945.31 (95% UI 836.33 to 1066.77) per 100,000 population, with an EAPC of −0.25% (95% UI −0.31 to −0.19). Globally, gender imbalance existed over the past 29 years, the burden in males were higher than those in females. Besides, the burden of NCDs as a result of kidney dysfunction increased with age growth, and the elder had higher rate of death and DALYs. Geographically, the age-standardized DALYs rate attributable to kidney dysfunction increased in Central Latin America, Southern Sub-Saharan Africa, Caribbean, Central Asia, Andean Latin America, Oceania, Southeast Asia. Age-standardized death and DALY rates demonstrated a higher burden in low, low-middle and middle SDI countries than those in high-middle and high SDI countries. Conclusion The result of the present work implied that the NCD as a result of kidney dysfunction has been an important contribution to the increasing burden of NCD over the past several decades, particularly in developing countries. Therefore, greater efforts are needed to carry out early screening and detection, primary care, and reasonable resource allocation to reduce mortality and the long-term burden, especially in low-to-middle Sociodemographic Index regions. Our data would provide the necessary information for priority setting and precision planning of health services to prevent and control NCD.

Mapping digital health ecosystems in Africa in the context of endemic infectious and non-communicable diseases

Investments in digital health technologies such as artificial intelligence, wearable devices, and telemedicine may support Africa achieve United Nations (UN) Sustainable Development Goal for Health by 2030. We aimed to characterize and map digital health ecosystems of all 54 countries in Africa in the context of endemic infectious and non-communicable diseases (ID and NCD). We performed a cross-national ecological analysis of digital health ecosystems using 20-year data from the World Bank, UN Economic Commission for Africa, World Health Organization, and Joint UN Programme on HIV/AIDS. Spearman’s rank correlation coefficients were used to characterize ecological correlations between exposure (technology characteristics) and outcome (IDs and NCDs incidence/mortality) variables. Weighted linear combination model was used as the decision rule, combining disease burden, technology access, and economy, to explain, rank, and map digital health ecosystems of a given country. The perspective of our analysis was to support government decision-making. The 20-year trend showed that technology characteristics have been steadily growing in Africa, including internet access, mobile cellular and fixed broadband subscriptions, high-technology manufacturing, GDP per capita, and adult literacy, while many countries have been overwhelmed by a double burden of IDs and NCDs. Inverse correlations exist between technology characteristics and ID burdens, such as fixed broadband subscription and incidence of tuberculosis and malaria, or GDP per capita and incidence of tuberculosis and malaria. Based on our models, countries that should prioritize digital health investments were South Africa, Nigeria, and Tanzania for HIV; Nigeria, South Africa, and Democratic Republic of the Congo (DROC) for tuberculosis; DROC, Nigeria, and Uganda for malaria; and Egypt, Nigeria, and Ethiopia for endemic NCDs including diabetes, cardiovascular disease, respiratory diseases, and malignancies. Countries such as Kenya, Ethiopia, Zambia, Zimbabwe, Angola, and Mozambique were also highly affected by endemic IDs. By mapping digital health ecosystems in Africa, this study provides strategic guidance about where governments should prioritize digital health technology investments that require preliminary analysis of country-specific contexts to bring about sustainable health and economic returns. Building digital infrastructure should be a key part of economic development programs in countries with high disease burdens to ensure more equitable health outcomes. Though infrastructure developments alongside digital health technologies are the responsibility of governments, global health initiatives can cultivate digital health interventions substantially by bridging knowledge and investment gaps, both through technology transfer for local production and negotiation of prices for large-scale deployment of the most impactful digital health technologies.

Patient satisfaction with chronic disease care and its associated factors in primary health care facilities in Johannesburg, South Africa.

Patient satisfaction is a widely used indicator of assessing health care quality and has been used by policymakers to consider the needs of patients when developing suitable strategies for safe and high-quality care. However, in South Africa, the dual burden of HIV and NCDs has implications for the health system, whereby the factors influencing the quality of care and patient satisfaction may be unique to this context. Thus, this study examined the predictors affecting chronic disease patients' levels of satisfaction with care in Johannesburg, South Africa. A cross-sectional study was conducted among 2,429 chronic disease patients at 80 primary healthcare facilities in Johannesburg, South Africa. A questionnaire derived from existing literature and patient satisfaction frameworks was used to measure the level of satisfaction of patients when receiving care. Patients' overall satisfaction was categorized into not satisfied and satisfied. Cronbach's alpha was used to assess scale reliability. Factor analysis was used as a data dimension reduction approach and the Kaiser-Meyer-Olkin and the Bartlett test of sphericity were used to test the sampling adequacy and to examine the inter-independence of the items. Logistic regression was used to determine factors associated with being satisfied. Significance was set at 5%. The majority of chronic disease patients 65.5% (n = 1,592) were aged 18-30 years; 63.8% (n = 1,549) were females, 55.1% (n = 1,339) were married and 2,032 (83.7%) were satisfied with care. The factor analysis results were in five sub-scales namely improving values and attitudes, cleanliness of the clinic, safe and effective care, infection control, and on the availability of medicines. In adjusted models, patients aged >51years had an increased odds of 3.18 (95% CI:1.31-7.75) of being satisfied compared to those aged 18-30 years and patients who had visited the clinic at least 6 times had 51% increased odds of being satisfied (AOR = 1.51,95% CI:1.13-2.03). The odds of being satisfied increased by 28% (AOR = 1.28,95% CI:1.07-1.53), 45% (AOR = 1.45,95% CI:1.2-1.75), 34% (AOR = 1.34,95% CI:1.13-1.59) and 4.31 (95% CI:3.55-5.23) for every score increase in the factors like improving values and attitudes, cleanliness of clinic safe and effective care and availability of medicine, respectively. Key predictors of patient satisfaction were found to be sociodemographic factors including age, distance to the clinic, number of visits and waiting times as well as factors such as improving values and attitudes, cleanliness of the clinic, waiting time, safety and effective care and availability of medicines. Adjustment of existing frameworks for addressing context-specific improvement of patient experiences such as security and safety is recommended to ensure healthcare quality and service utilization for better chronic disease outcomes in South Africa.

Differential of physical activities and its association with hypertension and diabetes in Myanmar

Background: Myanmar has been facing a high and growing burden of NCDs. Since regular physical activity has been recognized as one of the effective strategies in prevention and control of NCDs, promotion of physically active lifestyle might help in combatting a number of NCDs. This study was conducted to assess the sociodemographic differentials of physical activity and to identify the association between the insufficient physical activity and occurrence of hypertension and diabetes using data extracted from Myanmar STEP-2014-data. Methods: This study was further data analysis on 2014 STEP survey and included (5791) 40-64-year-aged participants, a subsample of STEP survey. Binary logistic regression with clustered robust standard error method was applied to estimate the effect of insufficient physical activity on occurrence of hypertension and diabetes. Results: The findings revealed that 17.5% [95%CI: 16.5%, 18.5%] of participants had the insufficient physical activity, 41.9% [95%CI: 40.6%, 43.2%] had raised blood pressure and 16.9% [95%CI: 15.9%, 17.9%] had raised blood glucose. After adjusting other covariates, the significant association between insufficient physical activity and raised blood pressure was not found; whereas insufficient physical activity was significantly contributed to occurrence of raised blood glucose. Conclusions: The present study highlighted the importance of physical activity in occurrence of raised blood glucose. The proportions of insufficient physical activity, raised blood pressure and raised blood glucose were observed as a rising pattern with increasing in age. Community-based health promotion program targeted at promoting physically active lifestyle should be adapted to interventions that are appropriate to different age structures.