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Using simulated patients to mimic 9 established noncommunicable and infectious diseases, we assessed ChatGPT's performance in treatment recommendations for common diseases in low- and middle-income countries. ChatGPT had a high level of accuracy in both correct diagnoses (20/27, 74%) and medication prescriptions (22/27, 82%) but a concerning level of unnecessary or harmful medications (23/27, 85%) even with correct diagnoses. ChatGPT performed better in managing noncommunicable diseases than infectious ones. These results highlight the need for cautious AI integration in health care systems to ensure quality and safety.
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Países en Desarrollo , Humanos , Simulación de Paciente , Calidad de la Atención de Salud/normas , Atención a la Salud/normas , Enfermedades no Transmisibles/terapia , Enfermedades TransmisiblesRESUMEN
BACKGROUND: People living with HIV and non-communicable diseases (NCDs) are reported to experience challenges in accessing affordable and high-quality NCD care services. Consequently, the World Health Organization (WHO) recommends care integration of NCDs within the HIV services in resource-limited regions. The available opportunities and challenges need to be understood and addressed for an effective integration process. This study explored opportunities and challenges for integrating NCDs within HIV care and treatment services in Tanzania. METHODS: An exploratory qualitative case study was conducted in Tanzania between April and July 2022. A total of 22 key informants working at the ministerial level, supervising the provision of healthcare services in Tanzania, were recruited purposefully for in-depth interviews. Thematic analysis was employed during the study. RESULTS: Several opportunities were identified in the study for HIV/NCD services integration including the existence of an integration policy, the availability of regulations and guidelines, the existence of donor support, the presence of physical space and reliable information and communication systems, human resources adequacy, and political will to support the process. However, participants voiced concerns over the costs related to service integration, difficulties in reallocating donor funds, and hesitance of the healthcare providers as likely challenges to effective integration. CONCLUSION: The findings of this study underscore that the effective and sustainable care integration of NCDs within HIV services relies on the availability of policy, funds, infrastructures, human resources, and stakeholders' willingness to support the process.
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Infecciones por VIH , Enfermedades no Transmisibles , Investigación Cualitativa , Humanos , Tanzanía , Infecciones por VIH/terapia , Enfermedades no Transmisibles/terapia , Prestación Integrada de Atención de Salud/organización & administraciónRESUMEN
BACKGROUND: In Sub-Saharan Africa (SSA), there is a noticeable shift from infectious diseases to chronic non-communicable diseases (CNCDs) based on recent studies. However, other studies suggest that social support can significantly improve self-care, increase knowledge of disease symptoms, and ultimately increase overall well-being in patients with CNCDs. In this study, we investigated the influence of perceived social support on treatment adherence among adults living with CNCDs in the Ho Municipality. METHODS: This was a health facility-based cross-sectional study among 432 adults living with cancer, diabetes, chronic kidney disease (CKD), stroke, and hypertension in the Ho Municipality of the Volta Region, Ghana. We adopted the Multi-dimensional Scale of Perceived Social Support (MSPSS), Medication Adherence Rating Scale and independent items to collect data. Logistic regression models were used to analyze the data with STATA v17.0 at 95% Confidence Intervals with statistical significance set at p<0.05. RESULTS: Majority of the participants (62%) reported high levels of perceived social support. While friends were the main source of support (69.4%), significant others provided the least support (45.4%). Among the dimensions of treatment adherence, participants demonstrated the highest adherence to reviews/check-ups (98.8%), while medication adherence had the highest level of non-adherence (38%). We did not find a significant association between perceived social support and overall treatment adherence, except for individuals with low perceived social support from friends (aOR = 8.58, 95% CI = 4.21,17.52), who were more likely to exhibit high adherence to behavioural and lifestyle recommendations. CONCLUSION: While the majority of respondents reported high perceived social support, there was no significant link between social support and overall treatment adherence. However, individuals with low support from friends showed a notably increased adherence to behavioural and lifestyle recommendations. This underscores the nuanced impact of social support on specific aspects of adherence, highlighting the need for targeted interventions tailored to individual support networks.
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Enfermedades no Transmisibles , Apoyo Social , Humanos , Ghana , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Adulto , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/terapia , Enfermedades no Transmisibles/psicología , Enfermedad Crónica/psicología , Anciano , Cumplimiento y Adherencia al Tratamiento/psicología , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Cumplimiento de la Medicación/psicología , Cumplimiento de la Medicación/estadística & datos numéricos , Instituciones de SaludRESUMEN
The growing financial burden of noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA) hinders the attainment of the sustainable development goals. However, there has been no updated synthesis of evidence in this regard. Therefore, our study summarizes the current evidence in the literature and identifies the gaps. We systematically search relevant databases (PubMed, Scopus, ProQuest) between 2015 and 2023, focusing on empirical studies on NCDs and their financial burden indicators, namely, catastrophic health expenditure (CHE), impoverishment, coping strategies, crowding-out effects and unmet needs for financial reasons (UNFRs) in SSA. We examined the distribution of the indicators, their magnitudes, methodological approaches and the depth of analysis. The 71 included studies mostly came from single-country (nâ =â 64), facility-based (nâ =â 52) research in low-income (nâ =â 22), lower-middle-income (nâ =â 47) and upper-middle-income (nâ =â 10) countries in SSA. Approximately 50% of the countries lacked studies (nâ =â 25), with 46% coming from West Africa. Cancer, cardiovascular disease (CVD) and diabetes were the most commonly studied NCDs, with cancer and CVD causing the most financial burden. The review revealed methodological deficiencies related to lack of depth, equity analysis and robustness. CHE was high (up to 95.2%) in lower-middle-income countries but low in low-income and upper-middle-income countries. UNFR was almost 100% in both low-income and lower-middle-income countries. The use of extreme coping strategies was most common in low-income countries. There are no studies on crowding-out effect and pandemic-related UNFR. This study underscores the importance of expanded research that refines the methodological estimation of the financial burden of NCDs in SSA for equity implications and policy recommendations.
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Costo de Enfermedad , Gastos en Salud , Enfermedades no Transmisibles , Enfermedades no Transmisibles/economía , Humanos , África del Sur del Sahara , Gastos en Salud/estadística & datos numéricos , PobrezaRESUMEN
AIMS: This study aims to compare the trends in the quality of hospital care for WHO's three disease groups pre-, during, and post-COVID-19 pandemic peak in Thailand. METHODS: The study utilized existing hospital admission data from the Thai Health Information Portal (THIP) database, covering the period from 2017 to 2022. We categorized WHO's three disease groups: poverty-related, noncommunicable, and injury groups using the International Classification of Diseases (ICD)-10 of initial admission of patients, and we analyzed three major outcomes: prolonged (≥ 90th percentile) length of stay (LOS), hospital mortality, and readmission pre-, during, and post-COVID-19 pandemic peak. Relative weight (RW) of hospital reimbursements was used as a surrogate measure of the severity of the diseases. RESULTS: The average prolonged LOS of patients with poverty disease pre-, during, and post-COVID-19 pandemic peak were 7.1%, 10.8%, 9.05%, respectively. Respective hospital mortality rates were 5.02%, 6.22%, 6.05% and readmission were 6.98/1,000, 6.16/1,000, 5.43/1,000, respectively. For non-communicable diseases, the respective proportions in the prolonged LOS were 9.0%, 9.12%, and 7.58%, with respective hospital mortality being 10.65%, 8.86%, 6.62%, and readmissions were 17.79/1,000, 13.94/1,000, 13.19/1,000, respectively. The respective prolonged LOS for injuries were 8.75%, 8.55%, 8.25%. Meanwhile, respective hospital mortality were 4.95%, 4.05%, 3.20%, and readmissions were 1.99/1,000, 1.60/1,000, 1.48/1,000, respectively. The RW analysis reveals diverse impacts on resource utilization and costs. Most poverty-related and noncommunicable diseases indicate increased resource requirements and associated costs, except for HIV/AIDS and diabetes mellitus, showing mixed trends. In injuries, road traffic accidents consistently decrease resource needs and costs, but suicide cases show mixed trends. CONCLUSIONS: COVID-19 had a more serious impact, especially prolonged LOS and hospital mortality for poverty-related diseases more than noncommunicable diseases and injuries.
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COVID-19 , Mortalidad Hospitalaria , Tiempo de Internación , Enfermedades no Transmisibles , Readmisión del Paciente , Pobreza , Humanos , COVID-19/mortalidad , COVID-19/epidemiología , COVID-19/economía , Tailandia/epidemiología , Enfermedades no Transmisibles/mortalidad , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/economía , Readmisión del Paciente/estadística & datos numéricos , Mortalidad Hospitalaria/tendencias , Masculino , Femenino , Heridas y Lesiones/mortalidad , Heridas y Lesiones/economía , Heridas y Lesiones/epidemiología , Persona de Mediana Edad , Adulto , Anciano , SARS-CoV-2 , PandemiasRESUMEN
BACKGROUND: With global climate change, the health threats of ambient high temperature have received widespread attention. However, latest spatio-temporal patterns of the non-communicable diseases (NCDs) burden attributable to high temperature have not been systematically reported. We aimed to analyze vulnerable areas and populations based on a detailed profile for the NCDs burden attributable to high temperature globally. METHODS: We obtained data from the Global Burden of Diseases (GBD) Study (2019) to describe the temporal and spatial patterns of NCDs burden attributable to high temperature globally from 1990-2019. Then we analyzed the differences by region, sex, and socio-demographic index (SDI). Finally, the ageperiodcohort (APC) model was utilized to explore the age, period, and cohort effects of NCDs mortality caused by high temperature. RESULTS: In 2019, the number of deaths and Disability-adjusted life years (DALYs) from high-temperature-related NCDs was about 150,000 and 3.4 million globally, of which about 70% were in South Asia and North Africa and Middle East, and the burden was higher in men. Among 204 countries and territories, the highest age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were observed in Oman and United Arab Emirates, respectively. The global burden showed an upward trend from 1990 to 2019, with an EAPC of 3.66 (95%CI: 3.14-4.18) for ASMR and 3.68 (95%CI: 3.16-4.21) for ASDR. Cardiovascular diseases were the main contributors to the global burden of high-temperature-related NCDs in 2019. The age and period effect in APC model showed an increasing trend globally. There was a significant negative correlation between SDI and both ASMR (r = -0.17) and ASDR (r = -0.20) from 1990 to 2019. CONCLUSION: There was an increasing trend of the global burden of high-temperature-related NCDs. The burden was likely to be higher in males and the elderly, as well as in countries and regions with less economically and socially developed and in tropical climates. Surveillance and prevention measures should be implemented with a focus on these vulnerable areas and susceptible populations.
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Cambio Climático , Carga Global de Enfermedades , Salud Global , Calor , Enfermedades no Transmisibles , Humanos , Enfermedades no Transmisibles/mortalidad , Enfermedades no Transmisibles/epidemiología , Masculino , Femenino , Carga Global de Enfermedades/tendencias , Persona de Mediana Edad , Anciano , Adulto , Salud Global/estadística & datos numéricos , Calor/efectos adversos , Adulto Joven , Adolescente , Años de Vida Ajustados por Discapacidad , Niño , Preescolar , Lactante , Anciano de 80 o más Años , Costo de EnfermedadRESUMEN
BACKGROUND: The Nyakaza-Move-for-Health intervention program was developed in response to the alarming rise in non-communicable diseases (NCDs) globally, in sub-Saharan Africa and South Africa. The rise in NCDs is attributed to the low levels of participation in physical activity (PA) among adolescents. Therefore, this study aimed to design a culturally tailored PA intervention for adolescents, guided by the Intervention Mapping (IM) protocol. The intervention program aims to address the multifaceted determinants of physical activity behavior, promote healthy lifestyles and improve adolescent fitness levels. METHODS: The Intervention Mapping protocol was applied to design the intervention program. The IM has 6 steps: (1) Needs assessment, (2) developing a logic model of the problem (LMP), (3) Formulating program outcomes and objectives, (4) Program design and production, (5) Generating implementation plan, and (6) Generating intervention evaluation plan. Participants included (n = 48) adolescent learners recruited from 8 (n = 8) participating schools. Adolescent learners participated in focus group discussions (FGD) to identify personal, interpersonal and environmental determinants of physical inactivity. Twenty-six (n = 26) key informant stakeholders participated in a stakeholder engagement workshop (SEW) to determine the motivators and constraints in implementing physical activity interventions. RESULTS: The Nyakaza intervention program's process development involved extensive stakeholder engagement, capacity development training, and integration of community feedback into the design. The intervention included a social marketing campaign and structured after-school physical activity sessions based on the Health Belief Model (HBM) and Transtheoretical Model (TTM). Implementation and evaluation plans were created, emphasizing real-time monitoring and adaptations. Strategies to enhance parental and community support were developed to address participation barriers. Although not tested in this study, these plans laid a robust foundation for fostering sustainable behavior change and improving physical activity among adolescents in resource-constrained settings. CONCLUSION: The Nyakaza-Move-for-Health intervention demonstrates a promising framework for promoting adolescent physical activity and addressing Non-Communicable Diseases in a culturally relevant manner. The systematic approach, grounded in the intervention mapping protocol, ensured a robust and replicable intervention design. Future research should focus on long-term follow-up, integrating objective physical activity measures, and expanding the program to include nutrition education. Addressing identified barriers, such as parental involvement, is crucial for enhancing the intervention's effectiveness and sustainability.
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Ejercicio Físico , Grupos Focales , Promoción de la Salud , Humanos , Adolescente , Sudáfrica , Promoción de la Salud/métodos , Femenino , Masculino , Evaluación de Necesidades , Estilo de Vida Saludable , Desarrollo de Programa , Enfermedades no Transmisibles/prevención & controlRESUMEN
Mais de 700.000 pessoas perdem suas vidas para o suicídio a cada ano. A Organização Mundial da Saúde (OMS) defende que os países ajam na prevenção do suicídio, idealmente por meio de uma estratégia nacional de prevenção do suicídio. Os governos e as comunidades podem excercer seus papéis na contribuição para a prevenção do suicídio implementando o guia VIVER A VIDA - uma abordagem da OMS para a prevenção do suicídio, a fim de que os países possam desenvolver uma estratégia nacional de prevenção. O guia destina-se a todos os países, que possuem ou não, uma estratégia nacional de prevenção do suicídio; pontos focais nacionais ou locais para prevenção do suicídio e partes interessadas da comunidade com interesse ou que já estejam envolvidas na implementação de atividades de prevenção do suicídio. Este guia serve como um catalisador para que os governos tomem medidas baseadas em evidências. Permite aos países proteger as vidas de pessoas que se encontram em situação de sofrimento intolerável e em risco de suicídio, apresentando uma abordagem multissetorial de prevenção, uma vez que todos nós temos a responsabilidade de trabalhar juntos para prevenir o suicídio.
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Suicidio , Depresión , Trastornos Mentales , Valor de la Vida , Salud Mental , Enfermedades no TransmisiblesRESUMEN
To address the rising incidence of non-communicable diseases (NCDs) and promote healthier eating habits, Japan requires a culturally tailored Nutrient Profile Model. This study aimed to develop a Nutrient Profile Model for Dishes in Japan version 1.0 (NPM-DJ (1.0)) that corresponds to the nutritional issues and food culture in Japan. The aim of the NPM-DJ (1.0) was to promote the health of the general population, and to prevent the increase in NCDs in Japan. The NPM-DJ (1.0) categorizes dishes into staples, sides, mains, mixed dishes, and mixed dishes with staples. The model evaluates dishes based on energy, saturated fats, sugars, and sodium as restricted nutrients, while considering protein, dietary fiber, and the weight of certain food groups as recommended nutrients. The distribution of the overall score for each dish category was analyzed and a rating algorithm was created. The baseline, modification points, and final scores were significantly lower for side dishes than for staple dishes. In contrast, the baseline points and final scores were significantly higher for mixed dishes with staple. The model effectively differentiated nutritional profiles across five dishes categories, which may promote healthier dish reformulation by food businesses operators and encourage consumers to select healthier dishes.
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Valor Nutritivo , Salud Pública , Japón , Humanos , Dieta Saludable , Conducta Alimentaria , Nutrientes/análisis , Enfermedades no Transmisibles/prevención & control , Enfermedades no Transmisibles/epidemiologíaRESUMEN
BACKGROUND: Multicomponent interventions based on a comprehensive geriatric assessment (CGA) could promote active aging and improve health status in older people with Noncommunicable Chronic Diseases (NCDs), but conflicting evidences are available. AIM: To evaluate the efficacy of a CGA-based multicomponent personalized preventive program (PPP) in reducing unplanned hospitalization rates during 12-month follow-up in community-dwelling older people with NCDs. MATERIALS AND METHODS: In this randomized clinical trial (RCT), 1216 older adults recruited by 33 general practitioners (GPs) will be randomly allocated to intervention group (IG) or usual care control group (CG). The IG will receive a multicomponent PPP developed on the findings of the CGA-based Multidimensional Prognostic Index short-form (Brief-MPI), including structured interventions to improve functional, physical, cognitive, and nutritional status, to monitor NCDs and vaccinations, and to prevent social isolation. Participants in the CG will receive usual care. Brief-MPI, resilience, and health-related quality of life will be assessed after 6 and 12 months. Moreover, saliva samples will be collected at baseline in IG to measure biomarkers of oxidative stress, inflammatory cytokines, and oral microbiome. EXPECTED RESULTS: The CGA-based PPP might reduce unplanned hospitalization rates and potentially institutionalization rates, emergency department (ED) and unplanned GP visits, and mortality. Further outcomes explored in the IG will be the adherence to PPP, resilience, health-related quality of life, and multidimensional frailty as assessed by the Brief-MPI. CONCLUSIONS: Results will suggest whether the CGA-based multicomponent PPP is able to improve specific outcomes in a primary care setting. TRIAL REGISTRATION: ClinicalTrials.gov; identifier: NCT06224556 ; Registered January 25, 2024.
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Evaluación Geriátrica , Enfermedades no Transmisibles , Atención Primaria de Salud , Humanos , Anciano , Enfermedades no Transmisibles/prevención & control , Enfermedad Crónica , Femenino , Masculino , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Hospitalización/estadística & datos numéricos , Vida Independiente , Anciano de 80 o más Años , Medicina de Precisión/métodosRESUMEN
ABSTRACTNon-communicable diseases (NCDs) are a major contributor to the global burden of disease, increasingly impacting low-income and marginalised populations in low- and middle-income countries such as Sri Lanka. Microfinance could be a potential approach to target NCDs. Using an ethnographic approach with thematic analysis, this study explored the nexus between microfinance and NCD outcomes. In-depth interviews were conducted with 29 micro-loan borrowing women across 15 field sites within Puttalam district in Sri Lanka. The findings revealed that perceived increases in income from microfinance loans contributed to enhanced household health savings ability, enabling the purchase of medicines bought out-of-pocket and from privately owned pharmacies, and spending for NCD-relevant health emergencies and health-related transportation. Additionally, perceived income increases also influenced the behavioural risks, including the spending and consumption of food, and physical activity levels, both positively and negatively. The microfinance networks also influenced women's perceived social support, psychological stress and coping mechanisms, and health information transmission, positively and negatively. The findings from this study provide important insights on how financial inclusion programs such as microfinance influence the health determinants and outcomes relevant to NCDs. This can help address ways to target both NCDs and inequities of socioeconomically disadvantaged and marginalised populations, particularly women.
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Enfermedades no Transmisibles , Humanos , Sri Lanka , Femenino , Adulto , Persona de Mediana Edad , Investigación Cualitativa , Entrevistas como Asunto , Salud de la Mujer , Antropología CulturalRESUMEN
INTRODUCTION: The North-eastern region of India has a relatively higher prevalence of substance use, which together with poor dietary practices and a lack of physical activity is one of the key risk factors for NCDs among older adults in the region. Understanding the prevalence of NCDs and their relationship to substance use can help develop preventive strategies and sensitization in North-eastern India. OBJECTIVE: To assess the prevalence of NCDs and the strength of the association of substance abuse among the geriatric population of North-eastern states in India, for the development of preventive strategies. METHODS: Data from the Longitudinal Ageing Study in India (LASI Wave-I, 2017-18) were drawn to develop this paper. The bi-variate and binary logistic regression analyses were carried out to predict the association between non-communicable diseases and substance use adjusting select socio-demographic characteristics. RESULTS: The paper revealed the prevalence of NCDs among urban people (61.45%) is higher than among rural people (42.45%). Hypertension (37.29%) can be seen as the most prevalent disease among the following given NCDs followed by Diabetes (8.94%). The chances of having Cancer are nineteen times higher (OR = 19.8; C.I. = 18.82-20.83) if an individual has past smoking behaviour after controlling for socio-demographic and physical activity variables. CONCLUSION: Since, the high prevalence of hypertension correlated with the high level of substance abuse, require immediate attention to develop appropriate intervention strategies for its control (substance abuse) and prevention of hypertension. In a lower middle-income country like India, preventive measures, rather than curative measures will be cost-effective and helpful.
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Enfermedades no Transmisibles , Trastornos Relacionados con Sustancias , Humanos , India/epidemiología , Masculino , Femenino , Anciano , Enfermedades no Transmisibles/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Persona de Mediana Edad , Prevalencia , Estudios Longitudinales , Factores de Riesgo , Anciano de 80 o más Años , Población Rural/estadística & datos numéricos , Hipertensión/epidemiología , Población Urbana/estadística & datos numéricosRESUMEN
OBJECTIVE: Healthy lifestyle centres (HLCs), a state service that screens for major non-communicable disease (NCD) risk factors and promotes lifestyle modifications in Sri Lanka, report underutilisation. The study aimed to assess the effectiveness of a participatory intervention to empower communities in improving HLC utilisation. DESIGN: A quasi-experimental study based on the principles of community-based participatory research SETTING: Six rural communities each as the intervention (IG) (Gampaha district) and comparison (CG) groups (Kalutara district) from the capital province of Sri Lanka. PARTICIPANTS: Study population was healthy individuals aged 35-65 years, the target group of HLCs in Sri Lanka. A random sample of 498 individuals was selected from each group for evaluation. INTERVENTIONS: Community support groups (CSGs) were established and empowered using health promotion approach from August 2019 to February 2020. Group discussions and participatory mapping were conducted to identify determinants of underutilisation of HLCs, design activities to address prioritised determinants and develop indicators to monitor the progress of CSGs. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was improvement of HLC utilisation and the secondary outcome was initiation of lifestyle modifications. RESULTS: Significant improvements were seen in the IG, compared with the CG in the seven determinants that contribute to HLC utilisation. The largest differences were seen in reducing negative perceptions of susceptibility for NCDs (pre=64.7%; post=33.3%; p<0.001) and usefulness of screening (pre=66.6%; post=17.3%; p<0.001). The HLC utilisation in IG increased by 29.5% (pre=5.85%; 95% CI 3.74 to 7.95, post=35.3%; 95% CI 30.9 to 39.8, p<0.001), while the utilisation of the CG showed no difference. Furthermore, there was an improvement in the proportion of users who initiated lifestyle modification (pre=64.3%; post=89.9%; p=0.039) in IG, which was not observed in CG. CONCLUSION: HLC utilisation and initiation of lifestyle modification can be improved by a community-based health promotion intervention through empowering CSGs. TRIAL REGISTRATION NUMBER: SLCTR/2019/028.
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Investigación Participativa Basada en la Comunidad , Empoderamiento , Promoción de la Salud , Estilo de Vida Saludable , Humanos , Sri Lanka , Persona de Mediana Edad , Femenino , Masculino , Adulto , Promoción de la Salud/métodos , Anciano , Población Rural , Enfermedades no Transmisibles/prevención & controlRESUMEN
BACKGROUND: Non-communicable diseases (NCDs) are a global epidemic challenging global public health authorities while imposing a heavy burden on healthcare systems and economies. AIM: To explore and compare the prevalence of NCDs in South Asia, the Caribbean, and non-sub-Saharan Africa, aiming to identify both commonalities and differences contributing to the NCD epidemic in these areas while investigating potential recommendations addressing the NCD epidemic. METHOD: A comprehensive search of relevant literature was carried out to identify and appraise published articles systematically using the Cochrane Library, Ovid, Google Scholar, PubMed, Science Direct, and Web of Science search engines between 2010 and 2023. A total of 50 articles fell within the inclusion criteria. RESULTS: Numerous geographical variables, such as lifestyle factors, socio-economic issues, social awareness, and the calibre of the local healthcare system, influence both the prevalence and treatment of NCDs. The NCDs contributors in the Caribbean include physical inactivity, poor fruit and vegetable intake, a sedentary lifestyle, and smoking, among others. While for South Asia, these were: insufficient societal awareness of NCDs, poverty, urbanization, industrialization, and inadequate regulation implementation in South Asia. Malnutrition, inactivity, alcohol misuse, lack of medical care, and low budgets are responsible for increasing NCD cases in Africa. CONCLUSION: Premature mortality from NCDs can be avoided using efficient treatments that reduce risk factor exposure for individuals and populations. Proper planning, implementation, monitoring, training, and research on risk factors and challenges of NCDs would significantly combat the situation in these regions.
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Enfermedades no Transmisibles , Humanos , Enfermedades no Transmisibles/epidemiología , Prevalencia , Factores de Riesgo , Región del Caribe/epidemiología , África/epidemiología , Asia/epidemiología , Estilo de Vida , Femenino , Masculino , Factores Socioeconómicos , Conducta Sedentaria , Sur de Asia , Pueblos CaribeñosRESUMEN
BACKGROUND: Initiatives aiming to assess the impact of rare diseases on population health might be hampered due to the complexity of disability-adjusted life years (DALYs) estimation. This study aimed to give insight into the epidemiological data sources and methodological approaches used in studies that estimated DALYs for chronic non-communicable rare diseases (CNCRD), and compare its results. METHODS: A literature strategy was developed for peer-review search in Embase and Medline, and also performed on grey literature databases and population health and/or rare disease-focused websites. We included studies that determined the burden of CNCRD listed on the Orphanet's and/or the Genetic and Rare Diseases information center (GARD) websites. We excluded communicable and occupational diseases, rare cancers, and cost-effectiveness/benefit studies. Two researchers independently screened the identified records and extracted data from the final included studies. We used the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) statement to assess the quality of reporting of the included studies. The data synthesis depicted the studies' characteristics, their distribution by geographic coverage and the group of disease(s) they focused on, the methods and data input sources used and estimated DALY per case. RESULTS: In total, 533 titles were screened, and 18 studies were included. These studies covered 19 different CNCRDs, of which most fell in the disease category "Diseases of the nervous system". Diverse methodological approaches and data input sources were observed among burden of CNCRD studies. A wide range of DALY per case was observed across the different studies and diseases included. CONCLUSIONS: A low number of burden of CNCRD studies was observed and most estimates resulted from multi-country studies, underlining the importance of international cooperation to further CNCRD research. This study revealed a lack of epidemiological data and harmonization of methods which hampers comparisons across burden of CNCRD studies.
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Años de Vida Ajustados por Discapacidad , Enfermedades Raras , Humanos , Enfermedades Raras/epidemiología , Enfermedades no Transmisibles/epidemiología , Enfermedad Crónica , Costo de Enfermedad , Años de Vida Ajustados por Calidad de VidaRESUMEN
INTRODUCTION: Healthcare financing systems, dependent on out-of-pocket expenditure(OOPE), impose a heavy burden on those who use the services regularly, such as patients suffering from chronic diseases. High OOPE for health services leads to decreased utilization of the services and/or catastrophic health expenditure, which would significantly impede the achievement of Universal Health coverage. OBJECTIVE: We aimed to determine variations in OOPE and factors associated with Catastrophic Health Expenditure (CHE) of households with patients suffering from non-communicable diseases(NCDs) in four districts. METHODS: A survey was conducted among 2344 adult patients having selected NCD/s. Multi-stage stratified cluster sampling selected respondents from 4 districts representing urban, rural, semi-urban, and estate. Data was collected using a validated interviewer-administered questionnaire. Logistic regression identified the predictors of CHE(> 40%). Significance was considered as 0.05. RESULTS: Common NCDs were hypertension(29.1%), diabetes(26.8.0%), hyperlipidaemia(9.8%) and asthma(8.2%). Only 13% reported complications associated with NCDs. Fifty-six percent(N = 1304) were on regular clinic follow-up, and majority utilized western-medical government hospitals(N = 916,70.2%). There were 252 hospital admissions for chronic-disease management in the past 12 months. Majority(86%) were admitted to government sector hospitals. Most patients incurred nearly SLR 3000 per clinic visit and SLR 3300 per hospital admission. CHE was beyond 40% for 13.5% of the hospital admissions and 6.1% of the regular clinic follow-up. Patients admitted to private sector hospitals had 2.61 times higher CHE than those admitted to government sector hospitals. CONCLUSIONS: Patients with NCDs incurred high OOPE and faced CHE during healthcare seeking in Sri Lanka. The prevalence of NCDs and complications were high among the participants. Patients with chronic conditions incur high OOPE for a single clinic visit and a hospital admission. Patients incur high OOPE on direct medical costs, and district-wise variations were observed. The proportion with more than 40% CHE on monthly clinic care was high. Patients being followed up in the government sector are more likely to have CHE when obtaining healthcare and are more likely to face barriers in obtaining needed health services. The services rendered to patients with chronic conditions warrant a more integrative approach to reduce the burden of costs and related complications.
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Financiación Personal , Gastos en Salud , Humanos , Femenino , Masculino , Gastos en Salud/estadística & datos numéricos , Sri Lanka/epidemiología , Enfermedad Crónica/epidemiología , Persona de Mediana Edad , Adulto , Financiación Personal/estadística & datos numéricos , Enfermedad Catastrófica/economía , Encuestas y Cuestionarios , Anciano , Composición Familiar , Estudios Transversales , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/economía , Enfermedades no Transmisibles/terapiaRESUMEN
BACKGROUND: Ethiopia's health system is overwhelmed by the growing burden of non-communicable diseases (NCDs). In this study, we assessed the availability of and readiness for NCD services and the interaction of NCD services with other essential and non-NCD services. METHODS: The analysis focused on four main NCD services: diabetes mellitus, cardiovascular diseases, chronic respiratory diseases, and cancer screening. We used data from the 2018 Ethiopian Service Availability and Readiness Assessment (SARA) survey. As defined by the World Health Organization, readiness, both general and service-specific, was measured based on the mean percentage availability of the tracer indicators, such as trained staff and guidelines, equipment, diagnostic capacity, and essential medicines and commodities needed for delivering essential health services and NCD-specific services, respectively. The survey comprised 632 nationally representative healthcare facilities, and we applied mixed-effects linear and ordered logit models to identify factors affecting NCD service availability and readiness. RESULTS: Only 8% of facilities provided all four NCD services. Availability varied for specific services, with cervical cancer screening being the least available service in the country: less than 10% of facilities, primarily higher-level hospitals, provided cervical cancer screening. General service readiness was a strong predictor of NCD service availability. Differences in NCD service availability and readiness between regions and facility types were significant. Increased readiness for specific NCD services was significantly associated with increased readiness for communicable disease services and interacted with the readiness for other NCD services. CONCLUSION: NCD service availability has considerable regional variation and is positively associated with general and communicable disease services readiness. Readiness for specific NCD services interacted with one another. The findings suggest an integrated approach to service delivery, focussing holistically on all disease services, is needed. There also needs to be increased attention to reducing resource allocation variation between facility types and locations.
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Accesibilidad a los Servicios de Salud , Enfermedades no Transmisibles , Humanos , Etiopía , Enfermedades no Transmisibles/terapia , Enfermedades no Transmisibles/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Detección Precoz del Cáncer/estadística & datos numéricos , Atención a la Salud/organización & administración , Diabetes Mellitus/terapia , Enfermedades Cardiovasculares/terapia , Femenino , Instituciones de Salud/estadística & datos numéricos , Enfermedades Respiratorias/terapia , Enfermedades Respiratorias/epidemiologíaRESUMEN
The Advocate’s Toolkit for Making Epilepsy a Priority in the Americas was developed to help individuals and organizations to identify opportunities that provides full participation of people with epilepsy in the community. It was developed for organizations looking for guidance, ideas, or inspiration as they develop advocacy projects around epilepsy. The toolkit is aimed at civil society organizations working across the Region of the Americas and has been heavily influenced by the needs and experiences of people with epilepsy. The various modules and topics addressed in this toolkit can be used both as a step-by-step guide to lead in the advocacy planning process, or as a reference or set of stand-alone resources that can be used when encountering a problem or opportunity in the context of existing epilepsy policy, legislation, or access to care. It is not meant as a stand-alone guide on how to conduct advocacy activities. Instead, it provides key prompts for reflection and discussion, basic advocacy pointers (the theory), and essential tools to help civil society to work logically through the various stages of an advocacy planning cycle. It is meant to be versatile and useful to a variety of audiences. It recognises that stigma is a major barrier preventing social inclusion and access to health care and treatment for people with epilepsy. Civil society can use the guidance, evidence, and templates to promote epilepsy as a public health priority in their local community or at the national, and regional levels. The toolkit was co-developed by the Pan American Health Organization and the International Bureau for Epilepsy (IBE) with important input from key stakeholders, including persons with epilepsy and their families, and with healthcare providers from the Region. It includes input from others with a connection to epilepsy either personally or through an organization. Through an initial needs assessment, stakeholders provided their perspectives on resources that were currently available to them, best practices they wanted to share, areas where they were seeking support, and opportunities for additional support or collaboration. This toolkit was developed based on that input as well as on feedback on initial drafts. The toolkit can be used as a companion document to support implementation of the WHO Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders (IGAP) which recognises that epilepsy is treatable, medication can be made affordable and basic epilepsy care can be provided at the primary care level for all people. All countries across the Americas have ratified IGAP and the UN SDG’s and can use this toolkit to plan their advocacy. The toolkit is full of resources, ideas, and guidance for addressing and dismantling stigma and for monitoring and evaluating progress towards implementation of the IGAP.
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Epilepsia , Enfermedades del Sistema Nervioso , Atención Primaria de Salud , Enfermedades no TransmisiblesRESUMEN
Background: Health policies form the foundation for provisioning best level care and are important for all stakeholders including patients and healthcare providers. Health policy analysis and evaluation allows policy makers to improve an existing policy, terminate a non-effective policy and to successfully implement future policies.The objective was to assess the coherence between the two local policy documents on NCD prevention and control in Sri Lanka, the national NCD policy (NCD policy) and the multisectoral action plan (MSAP), and to assess the consistency of MSAP with the global action plan for NCDs. Methods: The content analysis of the NCD policy and MSAP of Sri Lanka was conducted based on the modified criteria developed to the 'Analysis of determinants of policy impact' model, by two reviewers independently. Coherence between MSAP and the global NCD action plan were also assessed by two reviewers independently. Consensus for discrepancy was achieved through discussion. Results: Accessibility was the strongest criteria for the NCD policy, while, resources and obligations were the weakest. Goals and monitoring and evaluation criteria were the strongest in the MSAP. Requirement for improvement were identified in policy background, goals, monitoring and evaluation, and public opportunities for the NCD policy. Accessibility, policy background, resources, public opportunities and obligations require further improvement in the MSAP. The MSAP is well coherent with the global road map for NCD prevention and control. Conclusion: Policy documents related to NCD prevention and control in Sri Lanka are coherent with the global action plan, while, there are areas within the local policy documents that need to be improved to enhance the coherence between the local documents. Lessons learnt by this activity need to be utilized by Sri Lanka and other countries to improve the uniformity between the NCD policy documents within the country as well as internationally.
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Países en Desarrollo , Política de Salud , Enfermedades no Transmisibles , Sri Lanka , Humanos , Enfermedades no Transmisibles/prevención & control , Asia Sudoriental , Formulación de PolíticasRESUMEN
BACKGROUND: Workplaces are an important setting to deliver programs to reduce risk factors for noncommunicable diseases (NCDs). To help decision makers understand the most current and relevant evidence regarding effectiveness of workplace programs, we conducted an umbrella review to present a comprehensive synthesis of the large volume of literature. METHODS: Systematic reviews of workplace interventions targeting primary risk factors for NCDs-unhealthy diet, insufficient physical activity, overweight/obesity, tobacco use, and/or excessive alcohol use-published since 2010 were sourced. For each risk factor, reviews were categorized by intervention type and quality. The most recent, high-quality review was included for each intervention type. Evidence for the effectiveness of each intervention type was then broadly classified based on the review summary findings. RESULTS: Twenty-one reviews were included. Most reviews focused on diet (n = 5), physical activity (n = 7), or obesity (n = 9) interventions, with fewer targeting alcohol (n = 2) or tobacco (n = 2) use. Reviews of interventions focusing on individual behavior (such as education or counseling) were most common. Across diet, obesity, physical activity, and tobacco use, multicomponent interventions were consistently likely to be classified as "likely effective." Motivational interviewing and broad health promotion interventions were identified as "promising" for alcohol use. CONCLUSION: This umbrella review identified that multicomponent workplace interventions were effective to reduce NCD risk factors. There is a gap around interventions targeting alcohol use as most syntheses lacked enough studies to draw conclusions about effectiveness. Exploring the impact of interventions that utilize policy and/or environmental strategies is a critical gap for future research.