Non-communicable Diseases Services Research Articles

Should Healthcare for NCDs Be Equated with Other Goods and Services? — Commodification of Health Care in NDCs

Healthcare services for Non-Communicable Diseases (NCDs) cannot be simply treated as tradable goods or services. The debate surrounding whether healthcare should be equated to commodities is complex, involving economic, ethical, and social considerations. While market-driven approaches can enhance innovation and efficiency, critics caution against the risks of inequality and the erosion of social solidarity. Commodification of NCD healthcare may worsen existing disparities, prioritize profit over patient well-being, and neglect prevention strategies. Balancing efficiency with equity and preventive measures is essential in managing NCDs effectively while addressing the shortcomings of a commodified healthcare system.

Implementation factors of non-communicable disease policies and programmes for children and youth in low-income and middle-income countries: a systematic review

IntroductionDespite declared life-course principles in non-communicable disease (NCD) prevention and management, worldwide focus has been on older rather than younger populations. However, the burden from childhood NCDs has mounted; particularly...

Effectiveness of the health and wellness centers in improving identification and primary care of non-communicable diseases in Chhattisgarh State of India

ABSTRACT Introduction: India launched a national initiative named Health and Wellness Centres (HWCs) in 2018 to provide population-based primary care including for the non-communicable diseases (NCDs) in rural areas. The current study assesses whether operationalization of HWCs improved the detection of NCDs and increased the share of public sector facilities in providing NCD services. Methods: Two rounds of household surveys were conducted in rural Chhattisgarh in 2019 and 2022. With a focus on NCDs, the household survey covered a representative sample of individuals above the age of 30 years – 2760 individuals in 2019 and 2638 in 2022. Multi-variate regression analysis was carried out to determine effects of HWCs on identification of NCDs and utilization of public sector services. Results: The population covered by HWCs had 25% greater chance of being identified with NCDs as compared to the population without HWCs (AOR = 1.25, P = 0.03). The NCD patients living in areas covered by HWCs had 70% greater chance of utilizing the public healthcare facilities (AOR = 1.70, P = 0.01). In the population covered by HWCs, the share of the public sector in NCD care increased from 41.2% in 2019 to 62.1% in 2022, whereas the share of informal private providers dropped from 23.5% in 2019 to 8.4% in 2022. Conclusion: The HWCs showed effectiveness in increasing detection of NCDs at the population level and bringing a larger share of NCD patients to utilize public sector services. They can prove to be a crucial architectural correction for improving primary care service delivery for NCDs and other population health needs in India.

Analysis of The Utilization of Posbindu Program Services For Non-Communicable Diseases (NCDS) In The Community at the M Public Health Center

Non-communicable diseases have become the main cause of death globally and nationally, due to the high number of NCDs which continue to increase every year, so to control PTM risk factors in Indonesia, the government established the Posbindu PTM program. However, the utilization of Posbindu PTM in the working area of the Brand Health Center has not reached the target of 100%. This study aims to determine the factors associated with the utilization of Posbindu PTM. This type of research is quantitative with cross-sectional design and the analysis used is univariate and bivariate. The population in this study were people suffering from non-communicable diseases in the working area of the Brand Health Center. The sample in this study amounted to 100 people. The results showed that out of 100 respondents, 60.0% used Posbindu PTM. Variables related to the utilization of Posbindu PTM were knowledge (p=0.001), mileage (p=0.011), family support (p=0.004), attitude (p=0.001), and health status (p=0.002). The variable that is not related to the utilization of Posbindu PTM is the variable support from health workers (p=0.423). It is recommended for puskesmas to further improve the quality of life of the community through collaboration with health workers such as cadres..

Experiences and lessons from using digital technology for noncommunicable disease services during the COVID-19 pandemic in the Eastern Mediterranean Region

Background: Harnessing digital technology for health service provision is inevitable, especially after the dramatic increase in demand during the COVID-19 pandemic and the observed global disruption of health services especially for People Living with Noncommunicable Diseases (PLWNCDs). Aims: To document and share experiences, challenges and lessons learned from the use of digital health interventions (DHIs) for noncommunicable disease (NCD) service delivery during the COVID-19 pandemic in the Eastern Mediterranean Region (EMR). Methods: We conducted a documentary research on the use of DHIs for continuity of NCD services during the COVID-19 pandemic in EMR. We collected our data using a questionnaire that was developed and administered by email to WHO NCD focal persons at the ministries of health of all EMR countries. Using the WHO classification of DHIs we then mapped the various interventions and the stakeholders involved. Results: Seven countries – Islamic Republic of Iran, Jordan, Oman, Qatar, Saudi Arabia, Sudan, and United Arab Emirates – shared their documentations. Documented DHIs used by countries to overcome the disruption of services during the pandemic were mostly on the use of client-to-provider telemedicine for NCD services. The level of implementation varied between countries. NCD and mental health helplines and COVID-19 prevention awareness campaigns for PLWNCDs were the most mentioned interventions. Conclusions: DHIs for NCD service provision were implemented during the COVID-19 pandemic in all settings: highmiddle- and low-income countries in the EMR. There is a high potential for incorporating DHIs within health systems to increase access to health services beyond the pandemic. Documentation, regulation and national capacity-building for mainstreaming DHIs in public health services in the EMR are strongly encouraged, based on each country’s needs.

Human resources challenges in the management of diabetes and hypertension in Mozambique.

The major burden of non-communicable diseases (NCDs) globally occurs in low-and middle-income countries, where this trend is expected to increase dramatically over the coming years. The resultant change in demand for health care will imply significant adaptation in how NCD services are provided. This study aimed to explore self-reported training and competencies of healthcare providers, and the barriers they face in NCD services provision. A qualitative design was used to conduct this study. Data was collected through semi-structured interviews with government officials within the Mozambican Ministry of Health, district health authorities, health facility managers, and health providers at urban and rural health facilities of Maputo, in Mozambique. The data was then analyzed under three domains: provider´s capacity building, health system structuring, and policy. A total of 24 interviews of the 26 planed with managers and healthcare providers at national, district, and health facility levels were completed. The domains analyzed enabled the identification and description of three themes. First, the majority of health training courses in Mozambique are oriented towards infectious diseases. Therefore, healthcare workers perceive that they need to consolidate and broaden their NCD-related knowledge or else have access to NCD-related in-service training to improve their capacity to manage patients with NCDs. Second, poor availability of diagnostic equipment, tools, supplies, and related medicines were identified as barriers to appropriate NCD care and management. Finally, insufficient NCD financing reflects the low level of prioritization felt by managers and healthcare providers. There is a gap in human, financial, and material resources to respond to the country's health needs, which is more significant for NCDs as they currently compete against major infectious disease programming, which is better funded by external partners. Healthcare workers at the primary health care level of Mozambique's health system are inadequately skilled to provide NCD care and they lack the diagnostic equipment and tools to adequately provide such care. Any increase in global and national responses to the NCD challenge must include investments in human resources and appropriate equipment.

Equity and unmet need of non-communicable diseases services in Saudi Arabia using a National Household Survey (2019).

Saudi Arabia is implementing a comprehensive health system transformation in health services provision, governance, and financing. Given the high burden of non-communicable diseases (NCD), a key objective of the transformation is to integrate NCD prevention and treatment into primary care. The study objectives were to assess primary care service use for treatment of NCDs, to quantify existing inequities in preventive services utilization, and to identify regional and sociodemographic factors associated with these inequities. Using the 2019 Kingdom of Saudi Arabia World Health Survey, multivariable logistic regression models were conducted to identify predictors of utilization of primary care services for NCD prevention and treatment, unmet need among those with a diagnosis of diabetes, hypertension, or dyslipidemia, and unmet need in breast and cervical cancer screening. Among those with an NCD diagnosis, living in a high-income household was associated with a lower probability of having an unmet need compared to those in low-income households. Furthermore, rural residents were less likely to have an unmet need compared to urban residents (OR 0.58, p=0.029). Individuals without a perceived need for healthcare within the last 12 months had three times the probability of unmet need in comparison to those with such a perceived need (p<0.001). Women in all regions had a lower probability of ever having a mammogram compared to women in the central regions around Riyadh. Women with an education above a secondary level had five times the odds of undergoing cervical cancer screening and three times the likelihood of ever having a mammogram (P=0.012, p=0.02) than other women. Compared to women in low-income households, those in middle (OR 1.99, P=0.026), upper middle (OR 3.47, p<0.001), or high-income households (OR 2.59, p<0.001) had a higher probability of having had cervical cancer screening. Inequities in NCD treatment and prevention services' utilization in Saudi Arabia are strongly associated with region of living, population density, wealth, income, education and perceived need for health care. More research is needed to better understand the extent of unmet primary care needs for NCD and how to address the underlying contributing factors to access inequities.

Health system's availability and readiness of health facilities for chronic non-communicable diseases: Evidence from the Ethiopian national surveys.

Non-communicable diseases (NCDs) currently cause more deaths than all other causes of deaths. Cardiovascular disease, diabetes, cancer, and chronic respiratory diseases-threaten the health and economies of individuals and populations worldwide. This study aimed to assess the availability and readiness of health facilities for chronic non-communicable diseases (NCDs) and describe the changes of service availability for common NCDs in Ethiopia. Methods We used data from the 2014 Ethiopia Service Provision Assessment Plus (ESPA +) and 2016 and 2018 Service Availability and Readiness Assessment (SARA) surveys, which were cross-sectional health facility-based studies. A total of 873 health facilities in 2014, 547 in 2016, 632 in 2018 were included in the analysis. (ESPA+) and SARA surveys are conducted as a census or a nationally/sub-nationally representative sample of health facilities. Proportion of facilities that offered the service for diabetes, cardiovascular disease, chronic respiratory disease, cancer diseases, mental illness, and chronic renal diseases was calculated to measure health service availability. The health facility service readiness was measured using the mean availably of tracer items that are required to offer the service. Thus, 13 tracer items for diabetes disease, 12 for cardiovascular disease, 11 for chronic respiratory disease and 11 cervical cancer services were used. The services available for diagnosis and management did not show improvement between 2014, 2016 and 2018 for diabetes (59%, 22% and 36%); for cardiovascular diseases (73%, 41% and 49%); chronic respiratory diseases (76%, 45% and 53%). Similarly, at the national level, the mean availability of tracer items between 2014, 2016 and 2018 for diabetes (37%, 53% and 48%); cardiovascular diseases (36%, 41% and 42%); chronic respiratory diseases (26%, 27% and 27%); and cancer diseases (6%, 72% and 51%). However, in 2014 survey year, the mean availability of tracer items was 7% each for mental illness and chronic renal diseases, respectively. The majority of the health facilities have low and gradual decrement in the availability to provide NCDs services in Ethiopia. There is a need to increase NCD service availability and readiness at primary hospitals and health centers, and private and rural health facilities where majority of the population need the services.

Strengthening primary health care through integration of non-communicable disease services: Insights from the abundant health model in Vietnam

ABSTRACT Vietnam is aging rapidly, leading to a substantial rise in morbidity and mortality associated with non-communicable diseases (NCDs). Despite the Government’s 2015 NCD care and management guidelines, there was no practical implementation. From 2018 to 2020, the Abundant Health (AH) model was introduced to enhance the screening and management of hypertension and diabetes at community health stations (CHSs). This study explores the potential for scaling up this model to other provinces in Vietnam and identifying structural enabling factors and challenges based on the model’s lessons learned. The study was conducted in five provinces of Vietnam, using a mixed methods approach of desk review, focus group discussions, key informant interviews, and a survey. Intervention feasibility and acceptability were evaluated using the framework developed by Gadke et al., with a scale of 5 points indicating the highest rating for upscaling the AH model. The sample comprised 164 healthcare providers, 5 group discussions, and 14 focus group discussions. The overall statistical value for Cronbach’s alpha was 0.87, the factor analysis identified 4 factors, and the scale is appropriate for evaluation. The AH model received high average scores for relevance (4.25 over 3 items) and acceptability (4.24 over 4 items). However, feasibility (including suitability and affordability) obtained a lower score (3.65 over 7 items), with primary concerns regarding the availability of local funding for activities (3.04) and the adequacy of equipment and medicines at CHSs (3.08). Enabling factors for delivering quality NCD services at the primary level included strong government commitment to NCD management at the grassroots health level and high community demand for quality NCD management and continuum services. The most significant barriers identified were the scarcity of physicians at CHSs and high staff turnover. The AH model, which encompasses screening, management, and treatment of hypertension and diabetes at CHSs, has demonstrated feasibility and potential for upscaling in Vietnam. Moreover, this model can be adopted in other low- and middle-income countries.

Landscaping tuberculosis multimorbidity: findings from a cross-sectional study in India

BackgroundMultimorbidity, the concurrent presence of two or more chronic conditions is an emerging public health challenge. Till date, most of the research have focused on the presence and interaction of selected co-morbidities in tuberculosis (TB). There exist a critical knowledge gap on the magnitude of multimorbidity among TB patients and its impact on health outcomes.MethodsWe undertook a cross-sectional study to assess the prevalence and patterns of multimorbidity among newly diagnosed TB patients in two states of India. A total of 323 patients were interviewed using a structured multimorbidity assessment questionnaire for primary care (MAQ-PC). MAQ-PC is already validated for Indian population and elicits 22 chronic conditions. We defined TB multimorbidity as the co-existence of TB with one or more chronic conditions and identified commonly occurring dyads (TB + single condition) and triads (TB + two conditions).ResultsMore than half (52%) of TB patients reported multimorbidity. Among dyads, depression, diabetes mellitus (DM), acid peptic disease (APD), hypertension, chronic alcoholism, arthritis and chronic back ache (CBA) were the most common co-occurring conditions while ‘DM + arthritis’, ‘depression + APD’, ‘depression + DM’ were the most commonly occurring triads among TB patients. Factors such as increasing age, low levels of education, alcohol abusers, drug-resistant TB and having health insurance were significantly associated with multimorbidity among TB patients.ConclusionsOur findings suggest high prevalence of multimorbidity among newly diagnosed TB patients in India. The presence of concordant and discordant conditions with TB may increase the health complexity, thus necessitating appropriate care protocols. Given, the current situation, wherein TB and non-communicable diseases (NCD) services are delivered through collaborative framework between programmes, there is a need for addressing multimorbidity at the healthcare delivery level.

Does Engagement in HIV Care Affect Screening, Diagnosis, and Control of Noncommunicable Diseases in Sub-Saharan Africa? A Systematic Review and Meta-analysis

Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may provide opportunities to increase access to NCD services in under-resourced environments. We conducted a systematic review and meta-analysis to evaluate whether use of antiretroviral therapy (ART) was associated with increased screening, diagnosis, treatment, and control of diabetes, hypertension, chronic kidney disease, or cardiovascular disease among people living with HIV in sub-Saharan Africa (SSA). A comprehensive search of electronic literature databases for studies published between 01 January 2011 and 31 December 2022 yielded 26 studies, describing 13,570 PLWH in SSA, 61% of whom were receiving ART. Random effects models were used to calculate summary odds ratios (ORs) of the risk of diagnosis by ART status and corresponding 95% confidence intervals (95% CIs), where appropriate. ART use was associated with a small but imprecise increase in the odds of diabetes diagnosis (OR 1.07; 95% CI 0.71, 1.60) and an increase in the odds of hypertension diagnosis (OR 2.10, 95% CI 1.42, 3.09). We found minimal data on the association between ART use and screening, treatment, or control of NCDs. Despite a potentially higher NCD risk among PLWH and regional efforts to integrate NCD and HIV care, evidence to support effective care integration models is lacking.

Telemedicine Utilization Patterns and Implications Amidst COVID-19 Outbreaks in Thailand Under Public Universal Coverage Scheme.

During COVID-19 pandemic, telemedicine was a strategy to facilitate healthcare service delivery minimizing the risk of direct exposure among people. In Thailand, the National Health Security Office has included telemedicine services under the Universal Coverage Scheme to support social distancing policies to reduce the spread of COVID-19. This study aimed to determine the patterns of telemedicine service use during major COVID-19 outbreaks including Alpha, Delta, and Omicron in Thailand. We retrospectively analyzed a dataset of telemedicine e-claims from the National Health Security Office, which covers services reimbursed under the Universal Coverage Scheme between December 2020 and August 2022. An interrupted time-series analysis, Pearson correlation analysis and binary logistic regression were performed. Almost 70% of the patients using telemedicine services were over 40 years old. Most patients used services for mental health problems (25.6%) and major noncommunicable diseases, including essential hypertension (12.6%) and diabetes mellitus (9.2%). The daily number of using telemedicine service was strongly correlated with the number of COVID-19 new cases detected. An immediate change in the trend of using telemedicine was detected at the onset of outbreaks along with the surge of infection. The follow-up use of telemedicine services was not substantial among female, older adults patients and those with non-communicable diseases except mental health problems, and infectious diseases. Strategies need to be developed to reinforced healthcare resources for telemedicine during the surge of outbreaks and sustain the use of telemedicine services for chronic and infectious diseases, regardless of the pandemic, and promote the efficiency of healthcare systems.

Psychometric Validation of the Translated and Adapted Bengali Version of the HLS-EU-Q16/Q6 for Adults.

Health Literacy (HL) emerges as a critical tool in addressing the escalating burden of noncommunicable diseases (NCDs) and their associated costs. Particularly in Bangladesh, where the inadequacy of HL presents multifaceted challenges, there is an urgent need to address this issue. This study aimed to translate and evaluate the Bengali versions of the European Health Literacy Questionnaire with 16 items (HLS-EU Q16) and its shorter 6-item version (HLS-EU Q6), as there is currently no validated Bengali tool for assessing HL. This article used a subset of data from a Bangladeshi national survey of Primary Healthcare (PHC) facilities. The study included adults seeking Non-Communicable Disease (NCD) services at PHCs. Validity and reliability testing succeeded in a detailed back-to-back translation. The statistics covered were descriptive, Cronbach's internal consistency, confirmatory factor analysis, and the chi-square test. Following the translation and preliminary testing, minor rephrasing and the insertion of Item-Relevant Stimulus Material were performed to ensure cultural equivalency. The Confirmatory Factor Analysis produced a 3-factor structure for the HLS-EU-Q16 that included a second-order general component, confirming the viability of using an HL total score. A 3-factor model based on a priori was determined to be suitable for the factor structure of the HLS-EU-Q6. The model fit indices (Chi-square/df, TLI, AGFI, CFI, GFI, SRMR, RMSEA, and PCLOSE) supported CFA models of both scales. The internal consistency of the translated and adapted instruments was α = .934 and .857, respectively. This study showed that the Bengali version of the HLS-EU-Q16 and HLS-EU-Q6 are psychometrically sound, have clear factor structures, and are equivalent to the original models. However, the HLS-EU_Q16 is recommended over the shorter version considering its better psychometric properties.

Formation of Health Volunteer for Integrated Non-Communicable Diseases (Posbindu PTM) Services in Geblagan, Tamantiro, Kasihan, Bantul

Integrated Non-Communicable Disease Development Post (POSBINDU PTM) is an activity for monitoring and early detection of integrated PTM risk factors (heart disease, diabetes, lung disease, asthma, and cancer). The target of Posbindu PTM activities is 15-59 years (productive age) with the hope that if they are healthy at productive age, then they can become quality elderly. The problem faced by Indonesian people who are of productive age is that they do not know that they have hypertension or diabetes mellitus, because they are often asymptomatic early in the course of the disease. The service is carried out by identifying the Padukuhan Geblagan community who have the potential to become Posbindu PTM health volunteer. The selected health volunteers are then given training related to Posbindu PTM activities. This training begins with the provision of material related to Posbindu PTM, providing material related to the types of diseases that are included in non-communicable diseases, providing material related to how to identify non-communicable diseases, providing material related to the technical implementation of Posbindu PTM, demonstrating the implementation of Posbindu PTM and redemonstrating the implementation of Posbindu. The result of this activity is that Posbindu PTM health volunteer have been trained with a 5- table system with a total of 20 people. PTM Posbindu health volunteers who have received training can carry out Posbindu PTM activities properly. The health volunteers that were formed consisted of all levels of society, RT administrators, PKK administrators and community leaders. The Padukuhan Geblagan PTM Posbindu has been launched by the Tamantirto Village Government, witnessed by the Kasihan 1 Health Center staff and named the Posbindu PTM SEHAT (Sehat, Enerjik, Hidup, Aman, Tentram).

Integrated Care and Social Protection for Senior Citizens In West Africa: A Scoping Review

Background: West Africa's population is aging at a rapid rate, and the prevalence of older adults with multiple chronic conditions is rising. However, there is little information available about healthcare policies for this age group in this region ten years after the Madrid International Plan of Action on Ageing (MIPAA). To manage the physical and psychosocial needs of senior citizens, a greater integration of healthcare services is required.&#x0D; Methods: A scoping review was conducted adhering to the Joana Briggs Institute’s systematic scoping review protocol guidelines. A simple search strategy was developed to collate relevant articles from PubMed, Google Scholar, and AJOL, as well as policy databases, between 2002 and 2022. Articles were included if published in English and related to primary care, social care, and multi-morbidity among older persons in West Africa.&#x0D; Results: The findings yielded three thematic issues. First, most West African countries have policies on healthy aging; however, only a few have coherent policies on access to healthcare for older people and the availability of social safety nets, highlighting the need for policymakers to provide coherence and avenues for integration. Secondly, while integration of non-communicable disease services focuses on individual-level services rather than multi-sectoral integration, there is also a poor focus on mental health and sexual and reproductive health integration. Finally the inherent capacity development needs and technical up-skilling requirements require a whole-system approach with contextual nuances.&#x0D; Conclusion: The literature is increasingly recognizing an aging population and the prevalence of multi-morbidity in West Africa. Countries in West Africa, in response to the MIPAA, have formulated policies with regards to older persons' healthcare needs; however, improvements in clinical care at the individual setting level may not be sufficient. A deliberate whole-system approach that fosters multi-sectoral collaboration for integrated healthcare might go a long way toward better outcomes for senior citizens and a step forward toward universal health coverage.

Improving integrated depression and non-communicable disease care in Malawi through engaged leadership and supportive implementation climate

BackgroundLow- and middle-income countries often lack access to mental health services, leading to calls for integration within other primary care systems. In sub-Saharan Africa, integration of depression treatment in non-communicable disease (NCD) settings is feasible, acceptable, and effective. However, leadership and implementation climate challenges often hinder effective integration and quality of services. The aim of this study was to identify discrete leadership strategies that facilitate overcoming barriers to the integration of depression care in NCD clinics in Malawi and to understand how clinic leadership shapes the implementation climate.MethodsWe conducted 39 in-depth interviews with the District Medical Officer, the NCD coordinator, one NCD provider, and the research assistant from each of the ten Malawian NCD clinics (note one District Medical Officer served two clinics). Based on semi-structured interview guides, participants were asked their perspectives on the impact of leadership and implementation climate on overcoming barriers to integrating depression care into existing NCD services. Thematic analysis used both inductive and deductive approaches to identify emerging themes and compare among participant type.ResultsThe results revealed how engaged leadership can fuel a positive implementation climate where clinics had heightened capacity to overcome implementation barriers. Effective leaders were approachable and engaged in daily operations of the clinic and problem-solving. They held direct involvement with and mentorship during the intervention, providing assistance in patient screening and consultation with treatment plans. Different levels of leadership utilized their respective standings and power dynamics to influence provider attitudes and perceptions surrounding the intervention. Leaders acted by informing providers about the intervention source and educating them on the importance of mental healthcare, as it was often undervalued. Lastly, they prioritized teamwork and collective ownership for the intervention, increasing provider responsibility.ConclusionTraining that prioritizes leadership visibility and open communication will facilitate ongoing Malawi Ministry of Health efforts to scale up evidence-based depression treatment within NCD clinics. This proves useful where extensive and external monitoring may be limited. Ultimately, these results can inform successful strategies to close implementation gaps to achieve integration of mental health services in low-resource settings through improved leadership and implementation climate.Trial registrationThese findings are reported from ClinicalTrials.gov, NCT03711786. Registered on 18/10/2018. https://clinicaltrials.gov/ct2/show/NCT03711786.

Self-care and healthcare seeking practices among patients with hypertension and diabetes in rural Uganda

Background Implementing effective self-care practices for non-communicable diseases (NCD) prevents complications and morbidity. However, scanty evidence exists among patients in rural sub-Saharan Africa (SSA). We sought to describe and compare existing self-care practices among patients with hypertension (HTN) and diabetes (DM) in rural Uganda. Methods Between April and August 2019, we executed a cross-sectional investigation involving 385 adult patients diagnosed with HTN and/or DM. These participants were systematically randomly selected from three outpatient NCD clinics in the Nakaseke district. Data collection was facilitated using a structured survey that inquired about participants’ healthcare-seeking patterns, access to self-care services, education on self-care, medication compliance, and overall health-related quality of life. We utilized Chi-square tests and logistic regression analyses to discern disparities in self-care practices, education, and healthcare-seeking actions based on the patient’s conditions. Results Of the 385 participants, 39.2% had only DM, 36.9% had only HTN, and 23.9% had both conditions (HTN/DM). Participants with DM or both conditions reported more clinic visits in the past year than those with only HTN (P = 0.005). Similarly, most DM-only and HTN/DM participants monitored their weight monthly, unlike those with only HTN (P&lt;0.0001). Participants with DM or HTN/DM were more frequently educated about their health condition(s), dietary habits, and weight management than those with only HTN. Specifically, education about their conditions yielded adjusted odds ratios (aOR) of 5.57 for DM-only and 4.12 for HTN/DM. Similarly, for diet, aORs were 2.77 (DM-only) and 4.21 (HTN/DM), and for weight management, aORs were 3.62 (DM-only) and 4.02 (HTN/DM). Medication adherence was notably higher in DM-only participants (aOR = 2.19). Challenges in self-care were significantly more reported by women (aOR = 2.07) and those above 65 years (aOR = 5.91), regardless of their specific condition(s). Conclusion Compared to rural Ugandans with HTN-only, participants with DM had greater utilization of healthcare services, exposure to self-care education, and adherence to medicine and self-monitoring behaviors. These findings should inform ongoing efforts to improve and integrate NCD service delivery in rural SSA.

Management of chronic conditions in resource limited settings: multi stakeholders’ perception and experiences with receiving and providing integrated HIV, diabetes and hypertension services in Tanzania

BackgroundThe rising prevalence of non-communicable diseases (NCDs) alongside the continuing high burden of HIV poses a serious challenge to middle- and low-income countries’ healthcare systems. Pilot studies of integrated models of service delivery for HIV, hypertension and diabetes have demonstrated that they are feasible and acceptable among patients and care providers. This study assessed multi-stakeholders’ perspectives of the delivery and receipt of integrated care in Tanzania.MethodsA qualitative process evaluation was conducted in Dar es Salaam region of Tanzania where the integrated service delivery model was implemented from July to November 2021. In-depth interviews were held with seven key informants at the national, regional and district levels, eight healthcare providers, two researchers working at the integrated clinic and forty patients benefiting from integrated services at a large hospital. Three focus group discussions were held with community leaders and residents of the hospital’s catchment area, and clinic level observations were conducted. Thematic analysis was conducted followed by the use of Bronfenbrenner’s ecological model to identify factors pertinent to sustaining and scaling up of the integrated model.ResultsParticipants of the study at all levels were aware of the increased prevalence of NCDs specifically for hypertension and diabetes and were concerned about the trend of increasing co-morbid conditions among people living with HIV (PLHIV). The integrated service delivery model was positively perceived by stakeholders because of its multiple benefits for both patients and the healthcare system. These include stigma and discrimination reduction, improved quality of care, efficient use of limited resources, cost and time saving, reduced duplication of services and fostering of early detection for undiagnosed conditions. The organisation of the clinic was critical in increased satisfaction. Several challenges were observed, which included costs for NCD services relative to free care for HIV and inconsistent availability of NCD medications.ConclusionStakeholders reported numerous benefits of the integrated service delivery model that are fundamental in improving the health of many Tanzanians living with NCDs and HIV. These benefits highlight the need for policy and decision-makers to sustain and expand the integrated service delivery model as a solution to many challenges facing the health system especially at the primary care level.

Exploring health promotion efforts for non-communicable disease prevention and control in Ghana.

Noncommunicable diseases (NCDs) are a growing public health challenge in Ghana. Health promotion can provide useful avenues to reduce the incidence of NCDs in the country. We used the Ottawa Framework to assess health promotion efforts for the prevention and control of NCDs in Ghana. Data were collected using key informant interviews and documentary sources. A content analysis approach was adopted for data analysis using Nvivo 11 Software. We found a strong policy framework for NCD prevention in Ghana with the ratification of several international protocols and resolutions and the development of national and specific NCD-related policies. Implementation of these policies, however, remains achallenge due to limited resources and the overconcentration on communicable diseases. Attempts have been made to create a supportive environment through increased access to NCD services but there are serious challenges. Respondents believe the current environment does not support healthy eating and promotes unhealthy use of alcohol. The Community-based Health Planning and Services (CHPS) program engenders community participation in health but has been affected by inadequate resources. Personal skills and education programs on NCDs are erratic and confined to a few municipalities. We also found that NCD services in Ghana continue to be clinical and less preventative. These findings have far-reaching implications for practice and require health planners in Ghana to pay equal attention in terms of budgetary allocations and other resources to both NCDs and communicable diseases.

Access to comprehensive services for HIV and non-communicable diseases in sub-Saharan Africa

Access to comprehensive services for HIV and non-communicable diseases in sub-Saharan Africa