Chronic Communicable Diseases Research Articles

Prevalence and patterns of chronic communicable and non-communicable diseases multimorbidity in sub-Saharan Africa: protocol for a systematic review

# Background The burden of multimorbidity is rising globally. In sub-Saharan Africa (SSA), the growing prevalence of non-communicable diseases alongside the already existing high burden of chronic communicable diseases such as human immunodeficiency virus (HIV) presents a complex form of multimorbidity relative to patterns observed in high income countries. There is a gap in understanding the true burden of multimorbidity in SSA, in particular at interface of chronic communicable and non-communicable diseases (NCDs). The primary objective of this systematic review is to identify, evaluate and summarise the evidence on the prevalence and patterns of chronic communicable and NCDs multimorbidity in SSA. # Methods and analysis This protocol was developed in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols (PRISMA-P) guidelines. A comprehensive search will be conducted on selected electronic databases including Medline, Embase, African Journals Online, based on a predefined search strategy for observational studies reporting primary data on multimorbidity from any country in the SSA region. Additionally, we will explore grey literature databases and check reference lists of included studies. Study selection, assessment of quality of included studies and data extraction will be carried out independently by two reviewers. A narrative synthesis will be conducted and meta-analysis will be carried out where applicable. # Conclusion The proposed systematic review will provide insights into the interface of chronic communicable diseases and NCDs in SSA. We expect this will provide additional insights into the true picture of multimorbidity in the region and assist policy makers to design appropriate prevention and management strategies. This review does not require ethical approval. Upon completion, it will be submitted for publication in peer-reviewed journals, and disseminated through relevant academic conferences. **Prospero registration**: CRD42020183539

The importance of promoting physical activity during the COVID-19 outbreak to control the worsening of old pandemics

The pandemic of coronavirus disease 2019 (COVID‐19) is an unprecedented public health emergency of global concern. Although the measures to contain the COVID-19 spreading is essential, there are old pandemics that we are still fighting and cannot be neglected during the current outbreak. Non communicable chronic diseases (NCDs) remain the leading cause of death worldwide. Indeed, physical inactivity is one of the most important risk factors for NCDs and it was considered a pandemic matter in 2012. Therefore, we discuss new strategies (i.e.: transition from center-based to home-based training) to increase motivation, participation, and adherence in physical activity during the COVID-19 to control the worsening of old pandemics.

Health Service Utilization Among African Migrants in China: A Nationwide Cross-Sectional Study

Background: As the number of African migrants in China has increased in recent years, many sociocultural and policy factors hindered their utilization of health services. However, few studies examined the current status of the health care utilization and influence factors among African migrants in China. Methodology: A large national cross-sectional study was conducted among African migrants in China in 2019. Participants were recruited both online and offline to participate in a self-report survey. Information on health service utilization and factors based on Andersen’s behavioral model were collected. Multivariable logistic regression was conducted to identify correlates of health service utilization. Results: A total of 1006 eligible participants from 74 cities of 27 provinces in China completed the survey and 28.5% of the sample reported utilizing health services in the past 12 months. Logistic regression analysis showed that longer duration in China, migration to China for business and study, living in apartment and dormitory in China, suffering from chronic diseases, communicable diseases, and greater depressive symptoms facilitated health service utilization. Conclusion: The health utilization among African migrants in China is low. The existing public health policy and intervention measures are needed to be improved to make health utilization more accessible and feasible for African migrants.

A Review of the Role of Smart Wireless Medical Sensor Network in COVID-19

The new global predicament situation has raised questions on our healthcare systems and its endurance to deliver quality medical services. It is for those tormented with COVID-19 and other patients suffering from other chronic, acute, trauma, and other communicable diseases while shielding the doctors, nurses, and other associated medical employees when treating the patients. The immense adaptation to sensors networks demonstrates its usefulness as a tool for the present so-called social distancing in the clinical monitoring of COVID-19 patients or other settings. The utilization of Wireless Medical Sensor Network (WMSN) upsurges the prominence for those who work for long hours treating COVID-19 patients, exposing themselves while risking their lives. This paper attempts to explore few good practices identified from the current pandemic, with a precise and robust vision of deploying sensor networks to accomplish quality healthcare while reducing the potential threat of COVID-19 transmission to general masses while treating others.

Integrated Management of HIV and NCDs within the Primary Health Care in the South African Context: A Comprehensive Literature Review

Introduction Low and middle-income countries, including South Africa, are facing a challenge of the dual burden of chronic communicable and non-communicable diseases, which again pose a challenge to the improvement of patients’ clinical outcomes in the primary health care facilities. The introduction of innovative intervention to address the dual burden in South Africa created a challenge on nurses working at primary health care facilities to acquire a new set of skills to improve patients’ clinical outcomes. HIV programmes have shown great improvement in patients with HIV. However, there is still much to be done to improve NCD management. The aim of this review was to understand the status of integrated management of HIV and NCDs in South Africa and document the strengths and opportunities to sustain the implementation of integrated management of HIV and NCDs in PHC facilities in South Africa. Methodology: A comprehensive literature review of integrated management of HIV and NCDs in South Africa was conducted and complemented with a hand search literature in the form of policy documents and guidelines that were obtained from the National Department of Health. Results: A total of 17 out of 183 documents were analysed. Various strengths and opportunities, such as availability of approved guidelines and standardised training for nurses, are essential for the sustainability of integrated management of HIV and NCDs in Primary Health care facilities in South Africa. Conclusion: The CLR revealed that South Africa has strengths and opportunities which can be used to sustain integrated management of HIV and NCDs at PHC facilities and develop a model to strengthen the implementation of integrated management of HIV and NCDs in other provinces with minimal resources.

Phytic Acid- an AntiNutrient Nutraceutical in Ethnic Vegetables Growing Wildly in Tribal Regions of Bangladesh

Phytate has nutraceutical property and scores of potential health benefits in spite of undesirable anti nutrient property. This article investigated phytic acid content in a wide variety of ethnic vegetables growing wildly in tribal regions of Bangladesh. The study was conducted on thirty four rare ethnic vegetables comprising 26 leafy and 8 non-leafy vegetables. A multiregional sampling plan was employed to collect representative samples. The vegetable were collected from weekly markets at Rangamati, Bandarban, Mymensing, Gazipur and Madhupur. The vegetable samples collected were identified and certified by a taxonomist of the Department of Botany, University of Dhaka. After taking the vegetables to the lab, the taxonomist confirmed their English and Scientific names. For the estimation of moisture 5g cleaned, air-dried, chopped and well mixed samples were taken and the remainder was first dried in the sun, then in an electric dryer. Dried samples were ground in a mechanical grinder, kept in auto seal packs and stored in clean desiccators to avoid further moisture gain. These samples (analytes) were ready for further analysis. Phytic acid was determined by Spectro-photometric method. The values reported were the means of three replicates. Two leafy and two non-leafy vegetables could not be identified taxonomically. Overall Phytic acid content in both leafy and non leafy vegetables was ranged from 3.10±0.07 to 72.18±0.56 mg per 100g edible portion. In leafy vegetables, Indian acalypha (<i>Acalypha indica</i>) contained the lowest content of phytic acid, while in the non leafy lowest phytic acid was present in the Greater Yam (Dioscorea alata). However, French/kidney bean (<i>Vigna grahamiana</i>), Bronze banana (<i>Musa ornata</i>), Yam (<i>Dioscorea bulbifera</i>), Lime (<i>Citrus aurantifolia</i>), Kamino (<i>Caesalpinia digyna</i>), Amsurothi, and tamarind leaves (<i>Tamarindus indica</i>) contained higher amount (ranged from 21.48±0.29 to 72.18±0.56 mg per 100g edible portion) of phytic acid followed by moderate amount of phytate contents in smartweed (<i>Ampelygonum chinense</i>), Greater galangal <i> (Alpinia nigra)</i>, Duggal fiber tree <i>leaves (Sarcochlamys pulcherrima)</i> and Ghima leaves (<i>Polycarpan prostratum</i>) (ranged from 15.8±0.81 to 19.49±0.79 mg per 100g edible portion). Some other vegetables also had a lower phytic acid content. These ethnic rare vegetables which are rich in phytic acid and other nutrients have both nutraceutical and antioxidant potential could cure future environment and stress induced non communicable chronic diseases.

P3817Predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in a rural South African setting

Abstract Background South Africa is undergoing an epidemiological transition with a dual burden of chronic communicable and non-communicable diseases. A pilot integrated chronic disease management (ICDM) model was initiated in 2011 by the National Department of Health in selected primary health care (PHC) facilities. The aim of the ICDM model is to leverage an established HIV treatment programme for non-communicable diseases (NCDs) for better health outcomes of patients with chronic diseases. Purpose This study determined predictors of controlled CD4 count and blood pressure (BP) in hypertension and HIV patients receiving antihypertension medication and antiretroviral drugs, respectively in PHC facilities in the Bushbuckridge sub-district of Mpumalanga province, South Africa. Methods This was a panel study to assess the effectiveness of the ICDM model in controlling patients' CD4 count and BP. Patients ≥18 years were recruited through a three-step sampling process into the ICDM model facilities (n=435) and comparison facilities (n=443) in the Bushbuckridge sub-district. Health outcome data (BP and CD4 counts) for each patient were retrieved from health facility records over 30 months (January 2011 to June 2013). Control of BP and CD4 counts were defined as BP &lt;140/90 mmHg and CD4 counts &gt;350 cells/mm3, respectively. Multilevel logistic regression analyses were conducted to determine predictors of controlled CD4 count and controlled hypertension. Data were analysed using Stata 14 statistical software. Results The odds of controlling CD4 count were increased by reception of care at the ICDM model facilities (OR=4.05, 95% CI: 2.77–5.92), but decreased by male gender (OR=0.52, 95% CI: 0.34–0.80). The odds of controlling hypertension were higher with increasing age: 40–49 years (OR=6.02, 95% CI: 2.07–17.57); 50–59 years (OR=23.17, 95% CI: 7.46–72.16); ≥60 years (OR=77.48, 95% CI: 25.03–82.26), but decreased by male gender (OR=0.38, 95% CI: 0.21–0.69). Conclusion Application of the ICDM model appeared effective in controlling patients' CD4 counts, but not their BP; hence, the HIV programme should be more extensively leveraged for hypertension treatment in health facilities in the study setting. Health education programmes to improve HIV treatment outcomes should focus on males. Hypertension educational programmes should target younger males in the study setting. Acknowledgement/Funding Fogarty International Centre of the National Institutes of Health under the Award number D43 TW008330

Assessment of Quality of Life Related to the Health of People Suffering from Chronic Diseases in Ouémé Department of Benin

Measuring health-related quality of life (HRQoL) facilitates the monitoring and evaluation of the population's health status, and country's public health policies. Studies undertaken in the Republic of Benin on this issue are quite rare. Objective: The objective is to study the level of HRQoL in people with chronic communicable or non-communicable diseases at the Oueme department in Benin. Method: This is a cross-sectional and analytical survey conducted at this department in 2018. Medical Outcomes Study SF-36 questionnaire was administered to 523 people over 15 years of age who were suffering from chronic disease, and they were selected by the snowball technique. The level of HRQoL defined in three modalities was determined from the four dimensions of each of its physical and mental components. Results: In the Oueme department, eight chronic diseases were identified and the level of HRQoL appeared higher in rural areas for hypertension, sickle cell disease and sinusitis. In total, 73.8% of people with chronic diseases had high levels of HRQoL. The level of HRQoL was higher in rural areas than in urban areas (85.2% versus 64.8%; p < 0.0001). Interventions on HRQoL at the Oueme department must take into account the disparities between urban and rural areas.

The integrated health service model: the approach to restrain the vicious cycle to chronic diseases

BackgroundIn life time, nearly each person succumbs to some sort of chronic disease and many develop complicated chronic diseases. It is critical to focus on preventive services with a relatively high health impact and favorable cost effectiveness. During routine health facility visits, it is advisable to evaluate both symptomatic and asymptomatic patients for their needs of health promotion and disease prevention services. This necessitates the development of an integrated health service (IHS) approach that incorporates health promotion, disease prevention and curative services.MethodsThere were two phases for the study. The first phase explored the degree of promotive and preventive health care delivery at the health centers and hospitals. Phase two, utilizing the Delphi strategy, centered on looking for agreement on the finding from phase 1 and on IHS approach. Delphi questions were created based on the results of phase 1, and the reply choices were tied to a five point Likert scale. Consensus was considered come to when 75% of the experts concurred on an issue. From that point, advance clarification and agreement was looked for by implies of a second-round assessment for scores between 50 and 75%. Agreement on proposed IHS model, application of case finding and Periodic Health Examination (PHE) approaches were also sought. This study focuses on finding from phase 2.ResultOf the twenty experts, 90% (n = 18) agreed that the IHS framework shows the causal relationship of diseases and included plausible intervention approaches. Experts reached consensus (90%;n = 18) that case finding testing,screening patients for conditions other than the medical care they sought at a particular time, can be performed at health facilities. All experts (100%; n = 20) recommended conducting periodic health examinations in selected diseases for patients who are apparently not sick.ConclusionThe Integrated Health Service (IHS) framework was agreed by experts to be a plausible method in describing the causal relationship of chronic non-communicable, communicable, and nutrition-related diseases. The framework can play a vital role by preventing the acquiring, progression, suffering or dying from diseases through restraining the vicious cycle of chronic diseases.

Natural killer T Cells: A Powerful Via in the Regulation of Non Communicable Chronic Diseases

The Natural Killer T cells (NKT) constitute a population of T lymphocytes that co-express an antigen receptor (TCR) and a marker of natural killer cells (NK1.1). We have found that after stimulation through TCR, the NKT cells secrete various cytokines that play an important role in the innate immune response and have a fundamental participation in the initial stages of the immune response to many pathogens and tumours. NKT cells belong to a group of autoreactive T cells that are generated in the thymus, which is why they have been found to play an important role in the regulation of different autoimmune diseases, such as type 1 diabetes, systemic lupus erythematosus, multiple sclerosis, and others. Also, in adulthood there is an aging of the immune system known as immunosenescence, where a decrease and alteration of the function of NKT cells has been observed, which leads to a greater oncological, viral and autoimmune diseases. It has also recently been found that these cells participate in bronchial inflammation in patients with allergic asthma as well as in rhinitis and atopic dermatitis; having these cells a clear role in the regulation of various diseases and that has not been studied as a therapeutic target.

Re-Aligning the focus on Ayurveda through Epigenetics

Dietary and other lifestyle factors have significantly changed over the past few centuries. At present Non communicable chronic diseases NCCDs are the leading causes of morbidity and mortality globally which are caused by unhealthy diet and lifestyle. In Ayurveda there is elaborate explanation of how to live what to do and what not to do ndash physically mentally emotionally socially and spiritually which can be categorized under Ahara Vihara and Sadvritta achara-vichara. These factors play a pivotal role in the maintenance of health and curing the diseases. For the globalization of this time tested science there is a need of understanding these principles through the lens of contemporary view. The recent emerging science of Epigenetics can be used to understand these principles. In this article an attempt is made to revalidate the principles of Ayurveda by re-aligning the focus through Epigenetics.

Palliative Care for Underserved Populations in Australia: Homeless Persons A Discourse-Historical Approach

This paper aims to report on the analysis of discourse used in palliative care and homelessness talk and text. Over 105,000 people identified themselves as homeless in the 2011 Australian census; however recent studies suggest that the true numbers of homeless are much higher. Data on housing and homelessness from the 2016 Australian census is due for release in early 2018. Homeless persons experience increased incidences of chronic illness, communicable diseases, injury and trauma and die earlier than the general population, but access health services less. Marginalisation appears to be experienced by homeless persons in access to a range of services, including palliative and end of life care. The discourse-historical approach, a form of critical discourse analysis, was used to explore a corpus of government, palliative care and homeless peak body and organizational documents, and interview transcripts to ascertain whether these discourses had an effect on access to palliative care service for homeless persons. Differences in the dominant discourses and worldviews in the homelessness and palliative care paradigms may have interfered with smooth access to and between services for homeless persons with palliative care needs. The voices of homeless persons generally, and those also challenged by palliative care needs, were either not present or interpreted by others in the talk and text explored in this paper. Conclusion/Recommendations: Developments in shared homelessness and palliative care space need to include homeless persons; education of palliative care and homeless service workers; funding models to support shared care arrangements; and a common shared language. Future research should focus on evaluating changes in discourse, practice, education of the workforce and on outcomes for homeless persons with palliative care needs.

Cardiovascular risk factors with an emphasis on hypertension in the Mura Indians from Amazonia

BackgroundThe Brazilian indigenous population is currently undergoing a process of epidemiological transition regarding the occurrence of communicable diseases, malnutrition and non-communicable chronic diseases. Chronic non-infectious diseases are the most common causes of death worldwide, and hypertension is one of the main cardiovascular risk factors. Thus, the main objective of this paper was to evaluate the prevalence of cardiovascular risk factors, with an emphasis on hypertension, in the Mura Indians living in the municipality of Autazes in the northern Brazilian state of Amazonas.MethodsThis cross-sectional study was conducted among 455 natives (57.8% women, 42.2 ± 16.7 years) selected by simple random sampling. Sociodemographic variables, habits and lifestyles, anthropometric data, fasting glycaemia and lipid profiles were evaluated. Blood pressure was measured with a validated automatic device. Values of p ≤ 0.05 were considered significant.ResultsThe prevalence of hypertension was 26.6%. The other cardiovascular risk factors were as follows: increased waist-hip ratio (85.1%); increased neck circumference (60.2%); increased waist circumference (48.6%); overweight (57.1%); physical inactivity (52.7%); use of alcoholic beverages (40.2%); high total cholesterol (27.5%); increased triglycerides (23.5%); smoking (20.4%); and diabetes mellitus (3.0%). In relation to non-hypertensive individuals, indigenous hypertensive individuals were (p ≤ 0.05) older and had a higher proportion of individuals living with partners and individuals who were retired, as well as a lower level of schooling and higher family income. The indigenous people living in urban areas had a higher prevalence of hypertension than did those living in rural areas. In relation to habits and lifestyles, hypertensive Indians had a lower prevalence of smoking, higher frequency of the use of animal fat during meal preparation, lower frequency of vegetable oil use and lower frequency of salt addition to already-prepared meals. An assessment of anthropometric variables and laboratory markers showed that the hypertensive indigenous individuals had higher values of body mass index, neck circumference, waist circumference, visceral fat, Conicity Index, and body fat than did the non-hypertensive individuals.ConclusionThe prevalence of hypertension and other important cardiovascular risk factors in the Mura Indians was high. This finding is probably due to the adoption of inappropriate habits and lifestyles.

Analyzing Policymaking for Tuberculosis Control in Nigeria

Today, tuberculosis (TB) is still one of the major threats to humankind, being the first cause of death by an infectious disease worldwide. TB is a communicable chronic disease that every year affects 10 million people and kills almost 2 million people in the world. The main key factors fueling the disease are the progressive urbanization of the population and poverty-related socioeconomic factors. Moreover, the lack of effective tools for TB diagnosis, prevention, and treatment has decisively contributed to the lack of an effective model to predict TB spread. In Nigeria, the rapid urbanization along with unprecedented population growth is causing TB to be endemic. This paper proposes a mathematical model to evaluate TB burden in Nigeria by using data obtained from the local TB control program in the community. This research aims to point out effective strategies that could be used to effectively reduce TB burden and death due to TB in this country at different levels. The study shows that efforts should be oriented to more active case finding rather than increasing the treatment effectiveness only. It also reveals that the persistence of the disease is related to a large number of latently infected individuals and quantifies the lives that could be saved by increasing the notification rate using active case finding strategy. We conclude that undiagnosis is the bottleneck that needs to be overcome in addition to the incorporation, improvement, and/or strengthening of treatment management and other essential TB control measures in Nigeria.

Prevalencia de trastornos mentales en relación con la prevalencia de enfermedades médicas crónicas en mayores de 18 años, departamento de Francisco Morazán y Olancho, año 2016

En Honduras no existen muchos estudios que analicen de manera global los trastornos mentales relacionados con los padecimientos de enfermedades médicas crónicas que afectan a los adultos. Se planteó analizar la relación entre prevalencia de trastornos mentales y la prevalencia de enfermedades médicas crónicas no transmisibles en adultos, a fin de conocer o no la presencia de estos trastornos y padecimientos. Se estudiaron 300 encuestados del área rural de los municipios de Cedros y El Porvenir, del departamento de Francisco Morazán, al mismo tiempo se estudiaron 300 adultos hombres y mujeres del departamento de Olancho y que residen en la cabecera departamental que es Juticalpa, zona urbana y rural; ambos estudios realizados en el 2016 a través de la Escala SRQ: Sirve para hacer un tamizaje de posibles trastornos mentales en adultos y la Encuesta OMS para detectar síntomas de enfermedades crónicas no trasmisibles (elaboración propia). Esta investigación empleó un enfoque cuantitativo, con un alcance correlacional, de corte transversal y un diseño no experimental. En el Departamento de Francisco Morazán área rural, la prevalencia de probables trastornos mentales en la población con enfermedades médicas crónicas fue de 42.7%, siendo los de mayor prevalencia: la depresión con 38.6%, la ansiedad 29.2% y el estrés postraumático con un 11.7%. Igualmente se encontró que un 55.7 % de las personas mayores de 18 años de Olancho presentan sintomatología de probable existencia de un trastorno mental siendo los de mayor prevalencia: drogas con un 31,1%, la depresión 30.7%, y la ansiedad con un 26%. En ambos departamentos las personas de 51 años en adelante presentaron los mayores porcentajes de padecer posibles trastornos mentales y enfermedades crónicas. Conclusión: a través de este estudio se puede observar la importancia de conocer manifestaciones psicológicas y emocionales que pueden presentar las personas encuestadas que refieren con padecimientos crónicos y la necesidad de implementar estrategias de prevención, ya que debido a la coexistencia de ambas condiciones deben ser consideradas en la planificación de los servicios de atención primaria de salud dados los altos costos y la duración de los tratamientos que requieren estos pacientes.

Patients experiences of self-management and strategies for dealing with chronic conditions in rural Malawi

Background: The high burden of chronic communicable diseases such as HIV/AIDS, and an escalating rise of non-communicable diseases (NCDs) in Malawi and other African countries, calls for a shift in how healthcare services are designed and delivered. Patient-centred care and patient self-management are critical elements in chronic care, and advocated as global strategies. Further evidence is needed around patient self-management practices, and how to best support patients with chronic conditions in the African context. Our study explored self-management practices of patients with different chronic conditions, and their strategies to overcome care challenges in a resource constrained setting in Malawi. To further unpack self-management mechanisms and patient adjustment processes, we make use of Bandura’s social cognitive theory. Methods: We conducted a mixed methods study, involving patients with different chronic conditions from a rural district in Malawi. Data included a longitudinal survey with 129 patients, 14 in-depth interviews, and four focus-group discussions with patients. We used a framework approach for qualitative data analysis and survey data analysed using descriptive statistics. Results: Patients demonstrated ability to self-manage their conditions, though this varied between conditions, and was influenced by individual and environmental factors. Factors included: ability to acquire appropriate disease-specific knowledge; poverty level; the presence of support from family caregivers and community-based support initiatives; the nature of one's social relations; and the ability to deal with stressors and stigma. NCD and HIV comorbid patients were more disadvantaged in their access to healthcare, as they experienced frequent drug stock-outs and incurred additional out of pocket costs when referred. These barriers contributed to delayed care, poorer treatment adherence and likelihood of poorer treatment outcomes. Patients proved resourceful and made adjustments in the face of (multiple) care challenges. Discussion and conclusion: We found that patient adaptiveness is an individualised process and relies on how well a patient is able to cope with circumstances in their environment. Bandura’s social cognitive theory further elaborates adaptation as a process where patients develop different mechanisms. For instance, patients create internal models based on successful management of past experiences/events to deal with current challenges (symbolising); or choose to avoid situations that cause distress (self-regulation); or observe and learn complex skills from others such as peers in support groups (vicarious learning). We found evidence of the development of such mechanisms, but it proved difficult to delineate them from the broader patient environment, which was characterised by a heavy reliance on family support and restricted access to resources in their external environment. These in turn influenced patient experiences and strategies for self-management. As Malawi strives towards attaining universal healthcare, affordability and access to NCD services through the public sector presents a formidable challenge, particularly for the rural parts of the country. We recommend introducing peer-patient and support group initiatives for patients with NCDs, and further investments in the decentralisation of integrated health services. Limitation: Our research focused on one rural district in Malawi, hence transferability of our findings to contexts with different characteristics, such as urban setting(s), should be taken into consideration.

Management of hyperglycemia in pregnancy: a major step to promote the health of whole life cycle

As one common complication, hyperglycemia in pregnancy (HIP) can lead to short- and long- term effects on maternal-offspring and result in a vicious cycle when euglycemia is not achieved. HIP is proposed as the priority by multiple global stakeholders, from health policy makers (United Nation, Chinese government), academic organization (International Federation of Gynecology and Obstetrics, International Diabetes Federation and Developmental Origin of Health and Disease in China), health care providers, to the public. To solve the issue, united actions should be undertaken in various capacities to address the link between HIP and chronic non communicable diseases, including obesity and diabetes. Key words: Hyperglycemia; Pregnancy complications; Human development; Life style; Risk factors; Time factors

Patients experiences of self-management and strategies for dealing with chronic conditions in rural Malawi.

BackgroundThe high burden of chronic communicable diseases such as HIV/AIDS, and an escalating rise of non-communicable diseases (NCDs) in Malawi and other sub-Saharan African countries, calls for a shift in how health care services are designed and delivered. Patient-centred care and patient self-management are critical elements in chronic care, and are advocated as universal strategies. In sub-Saharan Africa, there is need for more evidence around the practice of patient self-management, and how to best support patients with chronic conditions in the African context. Our study explored self-management practices of patients with different chronic conditions, and their strategies to overcome care challenges in a resource-constrained setting in Malawi.MethodsThis is primarily a qualitative study, involving patients with different chronic conditions from one rural district in Malawi. Data are drawn from semi-structured questions of a survey with 129 patients (from the third of four-part data collection series), 14 in-depth interviews, and four focus-group discussions with patients (n = 31 respondents). A framework approach was used for qualitative analysis, and descriptive statistical analysis was performed on survey data.ResultsPatients demonstrated ability to self-manage their conditions, though this varied between conditions, and was influenced by individual and external factors. Factors included: 1) ability to acquire appropriate disease knowledge; 2) poverty level; 3) the presence of support from family caregivers and community-based support initiatives; 4) the nature of one’s social relations; and 5) the ability to deal with stressors and stigma. NCD and HIV comorbid patients were more disadvantaged in their access to care, as they experienced frequent drug stock-outs and incurred additional costs when referred. These barriers contributed to delayed care, poorer treatment adherence, and likelihood of poorer treatment outcomes. Patients proved resourceful and made adjustments in the face of (multiple) care challenges.ConclusionOur findings complement other research on self-management experiences in chronically ill patients with its analysis on factors and barriers that influence patient self-management capacity in a resource-constrained setting. We recommend expanding current peer-patient and support group initiatives to patients with NCDs, and further investments in the decentralisation of integrated health services to primary care level in Malawi.

Health challenges and access to health care among Syrian refugees in Jordan: a review.

Syrian refugees in Jordan are currently facing difficulties in accessing adequate healthcare. This study looked at the health conditions and barriers to accessing healthcare in Syrian refugees settled in Jordan. Pubmed, CINAHL and Google Scholar were searched for published cross-sectional studies on the health status of Syrian refugees, specifically the prevalence of chronic diseases, communicable diseases, physical impairments, emotional and mental health problems, and barriers to health care. The terms searched were: Syrian refugee, health access barriers, health access, chronic diseases, communicable diseases/infectious diseases, physical impairment and mental health. The prevalence and 95% confidence intervals (CI) were calculated. The literature search yielded 265 articles, of which 8 were eligible for inclusion. The prevalence of the conditions assessed were: chronic diseases, 29% (95% CI: 0.190-0.429); communicable diseases, 42.9% (95% CI: 0.184-0.713); emotional and mental health problems, 32.9% (95% CI: 0.191-0.504); physical impairment, 14.4% (95% CI: 0.056-0.322). Financial issues were the greatest barrier to accessing health care for 66% (95% CI: 0.449-0.823%). The health challenges of Syrian refugees are not just about chronic and acute diseases, injuries, or shortage of health resources or health disparities. It is a health burden that has become an economic, political and social crisis for the Jordanian government and its people, and measures and support to help Jordan continue to provide for refugees are needed.

Pediatricians and Public Health: Optimizing the Health and Well-Being of the Nation's Children.

Ensuring optimal health for children requires a population-based approach and collaboration between pediatrics and public health. The prevention of major threats to children's health (such as behavioral health issues) and the control and management of chronic diseases, obesity, injury, communicable diseases, and other problems cannot be managed solely in the pediatric office. The integration of clinical practice with public health actions is necessary for multiple levels of disease prevention that involve the child, family, and community. Although pediatricians and public health professionals interact frequently to the benefit of children and their families, increased integration of the 2 disciplines is critical to improving child health at the individual and population levels. Effective collaboration is necessary to ensure that population health activities include children and that the child health priorities of the American Academy of Pediatrics (AAP), such as poverty and child health, early brain and child development, obesity, and mental health, can engage federal, state, and local public health initiatives. In this policy statement, we build on the 2013 AAP Policy Statement on community pediatrics by identifying specific opportunities for collaboration between pediatricians and public health professionals that are likely to improve the health of children in communities. In the statement, we provide recommendations for pediatricians, public health professionals, and the AAP and its chapters.