Non-communicable Diseases In Uganda Research Articles

Caring for people with non-communicable diseases: the views and experiences of health and social care professionals in Uganda

Resource-limited health systems in sub-Saharan Africa struggle to provide population-wide high-quality primary healthcare, with particular concerns relating to professional workforce issues and the role of family caregivers. This qualitative study design explores the perceptions of (n = 19) health and social care professionals of the challenges they face in caring for individuals living with non-communicable diseases in Uganda. Identified challenges resulted from staffing and resource limitations, with wider issues relating to poverty and the burden placed on carers. As non-communicable diseases continue to rise, these empirical findings can inform developments in policy and service delivery in low and middle-income country contexts.

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.

Curbing the Rise of Noncommunicable Diseases in Uganda: Perspectives of Policy Actors.

Uganda faces a complex policy landscape as it simultaneously addresses infectious diseases and noncommunicable diseases (NCDs). The health system has been overwhelmed by the growing burden of NCDs across all socioeconomic strata. In this study, we sought to understand the policy context around NCDs in Uganda, the roles of actors both within and external to the government, and the factors shaping the development and implementation of NCD policies and programs in Uganda. We conducted in-depth interviews with 30 policy actors from the Ugandan Ministry of Health (MOH), nongovernmental organizations, and academia to understand the roles of different actors in the Ugandan NCD space, the programs and policy measures in discussion, and how to bridge any identified gaps. A thematic data analysis was conducted. All national actors viewed funding constraints as a critical barrier to developing and executing an NCD strategic plan and as a barrier to leading and coordinating NCD prevention and control efforts in Uganda. The crowding of nongovernment actors was found to fragment NCD efforts, particularly due to the weak implementation of a framework for action among NCD actors. Relatedly, limited recruitment of technical experts on NCDs within the MOH was viewed to further diminish the government's role in leading policy and program formulation and implementation. Though recent MOH efforts have aimed at addressing these concerns, some skepticism remains about the government's commitment to increase budgetary allocations for NCDs and to address the technical and human resources gaps needed to achieve NCD policy aims in Uganda. This study highlights the immediate need to mobilize more resources, reduce fragmented efforts in the NCD space, and prioritize investment in NCD prevention and management in Uganda.

Barriers to, and facilitators of, the adoption of a sugar sweetened beverage tax to prevent non-communicable diseases in Uganda: a policy landscape analysis

ABSTRACT Background Uganda is experiencing an increase in nutrition-related non-communicable diseases. Risk factors include overconsumption of sugar-sweetened beverages. Fiscal and taxation policies aim to make the consumption of healthier foods easier. However, the adoption and implementation of fiscal policies by countries are constrained by political and economic challenges. Objective We investigated the policy and political landscape related to the prevention of nutrition-related non-communicable diseases in Uganda to identify barriers to and facilitators of the adoption of sugar-sweetened beverage taxation in Uganda. Methods A desk-based policy analysis of policies related to nutrition-related non-communicable diseases and sugar-sweetened beverage taxation was conducted. Four key informant consultations (n = 4) were conducted to verify the policy review and to gain further insight into the policy and stakeholder contexts. Analysis was framed by Kingdon’s theory of agenda setting and policy change. Results Nutrition-related non-communicable diseases were recognised as an emerging problem in Uganda. The Government has adopted a comprehensive approach to improve diets, but implementation is slow. There is limited recognition of the consumption of sugar and sugar-sweetened beverages as a contributor to the nutrition-related non-communicable disease burden in policy documents. Existing taxes on soft drinks are lower than the World Health Organization’s recommended rate of 20% and do not target sugar content. The soft drink industry has been influential in framing the taxation debate, and the Ministry of Finance previously reduced taxation of sugar-sweetened beverages. Maintaining competitiveness in a regional market is an important business strategy. However, the Ministry of Health and other public health actors in civil society have been successful (albeit marginally) in countering reductions in taxation, which are supported by industry. Conclusions An established platform for sugar-sweetened beverage taxation advocacy exists in Uganda. Compelling local research that explicitly links soft drink taxes to health goals is essential to advance sugar-sweetened beverage taxation.

Patient experiences and perspectives on hypertension at a major referral hospital in rural southwestern Uganda: a qualitative analysis

ObjectivesNovel care models are needed to address the large burden of hypertension globally. We aimed to explore how patients in rural Uganda experience and perceive hypertension in order to understand...

Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: A descriptive time series analysis.

BackgroundAvailability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time.MethodsWe carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases.ResultsAvailability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price.ConclusionsWe conclude that there is a need for standardized, continuous monitoring to better characterize the availability and cost of essential medicines, understand demand for these medicines, and reduce uncertainty for patients.

Case Report of Non-Communicable Diseases in Uganda: Addressing Challenges with Access to Healthcare and How Community Health Workers May Be a Potential Solution

I removed my shoes and followed Esther* as we entered her house to meet her husband, Martin*. Esther is a community health worker (CHW) for the Ministry of Health in eastern rural Uganda. Earlier that day, I and the staff members from the non-governmental organization (NGO) I was working with accompanied Esther on her home visits. Esther periodically conducts these visits in her village to teach her community about a myriad of health topics, ranging from the importance of good sanitation practices to the use of mosquito nets. As I entered, I noticed Martin sitting up on a bed in the corner of the room. I waved to him, greeting him in Luganda and sat down, realizing that he did not acknowledge me as he was speaking across the room to his wife. He held a weak smile on his face, but it was apparent that it was partially an effort to mask some of his discomfort; his left leg was markedly more swollen than his right. After a few moments, I learned, with the help of a translator, how he could no longer see or walk, secondary to his chronic and uncontrolled hypertension.

Prescribing and dispensing practices for medicines used to treat non-communicable diseases in Uganda: a cross-sectional study

Abstract Background Non-communicable diseases (NCDs) are increasingly prevalent in low-income and middle-income countries (LMIC) and accessibility of medicines is essential for the management of these conditions. In Uganda, although many NCD medicines are now included in the national essential medicines list, sporadic evidence suggests that these medicines are widely unavailable to patients. The prescribing patterns of NCD medicines by providers and the dispensing patterns by dispensers represent important knowledge gaps in efforts to understand the care cascade for NCDs in Uganda. We aimed to describe the prescribing and dispensing practices for medicines used to treat NCDs, particularly hypertension, diabetes, and heart failure in Ugandan health-care facilities. Methods Based on WHO methodology, we did a cross-sectional study in which systematic sampling was used to collect data from patients attending outpatient NCD clinics at 15 higher-level public health-care facilities throughout Uganda. Demographic, prescribing, and dispensing information were collected using pre-tested structured questionnaires. Prescribing information was recorded from prescriptions, and dispensing information was obtained from medicine packets. Medicine tablets were counted by data collectors. Patients who reported not receiving all of their prescribed doses were contacted by phone to determine if they obtained the non-dispensed doses elsewhere. The primary outcome, which we term the Prescribing-Dispensing (P-D) Gap, was the percentage of prescribed doses that were not dispensed. Associations were tested using a linear mixed model. Findings We analysed data from 477 participants, of whom 454 (71%) were women. The average age was 51·4 years (SD 13·5). The mean number of drugs prescribed per encounter was 2·5 (SD 1·1), of which only 1·4 (0·9) drugs were dispensed. Overall, 82 591 total doses were prescribed, and 35 290·5 doses were dispensed, resulting in a P-D Gap of 57·3%. The P-D Gap was smaller for diabetes medicines than for medicines for cardiovascular diseases (46·2% vs 67·5%; p Interpretation A large P-D Gap exists for medicines used to treat NCDs in Ugandan public health-care facilities. The P-D Gap differs by medicine class and appears to be driven by medicine availability at public sector pharmacies. Most patients do not close this gap by purchasing medicines at private pharmacies, suggesting that under-treatment of these chronic conditions is widespread in patients who are already linked to care. Future work should explore feasible approaches to decrease this P-D Gap. Funding Doris Duke Clinical Research Fellowship.

Disparities in availability of essential medicines to treat non-communicable diseases in Uganda: A Poisson analysis using the Service Availability and Readiness Assessment.

ObjectiveAlthough the WHO-developed Service Availability and Readiness Assessment (SARA) tool is a comprehensive and widely applied survey of health facility preparedness, SARA data have not previously been used to model predictors of readiness. We sought to demonstrate that SARA data can be used to model availability of essential medicines for treating non-communicable diseases (EM-NCD).MethodsWe fit a Poisson regression model using 2013 SARA data from 196 Ugandan health facilities. The outcome was total number of different EM-NCD available. Basic amenities, equipment, region, health facility type, managing authority, NCD diagnostic capacity, and range of HIV services were tested as predictor variables.FindingsIn multivariate models, we found significant associations between EM-NCD availability and region, managing authority, facility type, and range of HIV services. For-profit facilities’ EM-NCD counts were 98% higher than public facilities (p < .001). General hospitals and referral health centers had 98% (p = .004) and 105% (p = .002) higher counts compared to primary health centers. Facilities in the North and East had significantly lower counts than those in the capital region (p = 0.015; p = 0.003). Offering HIV care was associated with 35% lower EM-NCD counts (p = 0.006). Offering HIV counseling and testing was associated with 57% higher counts (p = 0.048).ConclusionWe identified multiple within-country disparities in availability of EM-NCD in Uganda. Our findings can be used to identify gaps and guide distribution of limited resources. While the primary purpose of SARA is to assess and monitor health services readiness, we show that it can also be an important resource for answering complex research and policy questions requiring multivariate analysis.

Disparities in Availability of Essential Medicines to Treat Non-communicable Diseases in Uganda: A Cross-sectional Poisson Analysis Using the 2013 Service Availability and Readiness Assessment

Disparities in Availability of Essential Medicines to Treat Non-communicable Diseases in Uganda: A Cross-sectional Poisson Analysis Using the 2013 Service Availability and Readiness Assessment

Task shifting and capacity building for non-communicable diseases in Uganda

Task shifting and capacity building for non-communicable diseases in Uganda

Looking at non-communicable diseases in Uganda through a local lens: an analysis using locally derived data.

The demographic and nutritional transitions taking place in Uganda, just as in other low- and middle-income countries (LMIC), are leading to accelerating growth of chronic, non-communicable diseases (NCDs). Though still sparse, locally derived data on NCDs in Uganda has increased greatly over the past five years and will soon be bolstered by the first nationally representative data set on NCDs. Using these available local data, we describe the landscape of the globally recognized major NCDs- cardiovascular disease, diabetes, cancer, and chronic respiratory disease- and closely examine what is known about other locally important chronic conditions. For example, mental health disorders, spawned by an extended civil war, and highly prevalent NCD risk factors such as excessive alcohol intake and road traffic accidents, warrant special attention in Uganda. Additionally, we explore public sector capacity to tackle NCDs, including Ministry of Health NCD financing and health facility and healthcare worker preparedness. Finally, we describe a number of promising initiatives that are addressing the Ugandan NCD epidemic. These include multi-sector partnerships focused on capacity building and health systems strengthening; a model civil society collaboration leading a regional coalition; and a novel alliance of parliamentarians lobbying for NCD policy. Lessons learned from the ongoing Ugandan experience will inform other LMIC, especially in sub-Saharan Africa, as they restructure their health systems to address the growing NCD epidemic.

The prevalence and distribution of non-communicable diseases and their risk factors in Kasese district, Uganda : cardiovascular topics

To date there has been no population-based survey of the major risk factors for non-communicable diseases (NCD) in Uganda. Hospital-based data from urban centres report an increasing burden of NCDs in Uganda. This population-based survey aimed to describe the prevalence of risk factors for NCDs in a rural Ugandan district. The survey was conducted using the WHO STEPwise approach to surveillance of non-communicable diseases (STEPS) methodology. Participants (n = 611) were residents of the Kasese district selected in a one-step, complete survey of a rural district. Standardised international protocols were used to record history of disease, and measure behavioural risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity), physical characteristics [weight, height, waist and hip circumferences, blood pressure (BP)], fasting blood glucose (BG) and total cholesterol (TC) levels. Data were analysed using simple descriptive analysis. In this sample, the prevalence of hypertension (systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg) was 22.1% for men and 20.5% for women. Fifteen per cent of men and 16.8% of women were overweight [body mass index (BMI) ≥ 25 kg/m(2)] and 4.9% of men and 9.0% of women were obese (BMI ≥ 30 kg/m(2)). Nine per cent of participants were diabetic, 7.2% ate five or more combined servings of fruit per day while only 1.2% ate five or more combined servings of vegetables per day. Fifty-one per cent of the population were physically inactive and 9.6% were daily smokers. Thirty-one per cent of females had fasting blood sugar levels (FBS) ≥ 6.1 mmol/l while 10% of males had FBS > 6.1 mmol/l. This study presents evidence on the magnitude of NCDs, their risk factors and gender distribution in a rural population in Uganda, a poor country in east-central Africa. These data, when combined with urban population data, could be useful in the formulation and advocacy of NCD policy and plans of action in Uganda.