Claire Neal, Christian Rusangwa, Ryan Borg, Neo Tapela, Jean Claude Mugunga, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, Paul H. Park, Lawrence N. Shulman, Tharcisse Mpunga
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This study is one of the first to examine operating costs for implementing a cancer center in a low-income country. Having a strong commitment to cancer care, adapting clinical protocols to the local setting, shifting tasks, and creating collaborative partnerships make it possible for BCCOE to provide quality cancer care at a fraction of the cost seen in middle- and high-income countries, which has saved many lives and improved survival. Not all therapies, though, were available because of limited financial resources.
Gene F. Kwan, Lily D. Yan, Benito D. Isaac, Kayleigh Bhangdia, Waking Jean-Baptiste, Densa Belony, Anirudh Gururaj, Louine Martineau, Serge Vertilus, Dufens Pierre-Louis, Darius L. Fenelon, Lisa R. Hirschhorn, Emelia J. Benjamin, and Gene Bukhman
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Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti. We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associations of poverty with sex and distance from the health facility.
Among patients with NCD conditions in rural Haiti, poverty and hardship financing are highly prevalent. However, clinic patients were less poor compared with the community population. These data suggest barriers to care access particularly affect the poorest. Socioeconomic data must be collected at health facilities and during community-level surveillance studies to monitor equitable healthcare access.
Neil Gupta, Matthew M Coates, Abebe Bekele, Roodney Dupuy, Darius Leopold Fénelon, Anna D Gage, Theodros Getachew, Biraj Man Karmacharya, Gene F Kwan, Aimée M Lulebo, Jones K Masiye, Mary Theodory Mayige, Maïmouna Ndour Mbaye, Malay Kanti Mridha, Paul H Park, Wubaye Walelgne Dagnaw, Emily B Wroe, Gene Bukhman
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Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions.
We used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country.
Our findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.
Eberly, L. A., Rusingiza, E., Park, P. H., Ngoga, G., Dusabeyezu, S., Mutabazi, F., Harerimana, E., Mucumbitsi, J., Nyembo, P. F., Borg, R., Gahamanyi, C., Mutumbira, C., Ntaganda, E., Rusangwa, C., Kwan, G. F. & Bukhman, G.
Heart failure is a significant cause of morbidity and mortality in sub-Saharan Africa. Our understanding of the heart failure burden in this region has been limited mainly to registries from urban referral centers. Starting in 2006, a nurse-driven strategy was initiated to provide echocardiography and decentralized heart failure care within noncommunicable disease (NCD) clinics in rural district hospitals in Rwanda.
The results of the largest single-country heart failure cohort from rural sub-Saharan Africa demonstrate a persistent burden of rheumatic disease and nonischemic cardiomyopathies.
Lauren A. Eberly, MD, Emmanuel Rusingiza, MD, Paul H. Park, MD, MSc, Gedeon Ngoga, BS, RN, Symaque Dusabeyezu, RN, Francis Mutabazi, BCM, Emmanuel Harerimana, RN, Joseph Mucumbitsi, MD, Philippe F. Nyembo, MBChB, Ryan Borg, MPH, Cyprien Gahamanyi, RN, Cadet Mutumbira, BS, RN, Evariste Ntaganda, MD, MPH, Christian Rusangwa, MD, Gene F. Kwan, MD, and Gene Bukhman, MD, PhD
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To address gaps in care for the rural poor, the Rwandan Ministry of Health, supported by Inshuti Mu Buzima (Partners In Health—Rwanda), started to train nurses to provide care for a group of severe chronic noncommunicable diseases (NCDs), including heart failure, initially at 3 rural district hospitals, beginning in 2006.2 Nurses were trained in simplified diagnostic protocols incorporating basic echocar- diography to place patients into broad categories of heart failure most prevalent in the area.3 Treatment was administered based on category-specific pathways and delivered in the context of an integrated NCD clinic.
This represents the first reported strategy to successfully decentralize and integrate heart failure diagnosis and management at first-level hospitals in highly con- strained health systems.
Gene Bukhman, Ana O Mocumbi, Rifat Atun, Anne E Becker, Zulfiqar Bhutta, Agnes Binagwaho, Chelsea Clinton, Matthew M Coates, Katie Dain, Majid Ezzati, Gary Gottlieb, Indrani Gupta, Neil Gupta, Adnan A Hyder, Yogesh Jain, Margaret E Kruk, Julie Makani, Andrew Marx, J Jaime Miranda, Ole F Norheim, Rachel Nugent, Nobhojit Roy, Cristina Stefan, Lee Wallis, Bongani Mayosi, for the Lancet NCDI Poverty Commission Study GroupLeading global health and development institutions continue to view non-communicable diseases (NCDs) predominantly through the lens of epidemiological transitions, wherein NCDs are best understood in terms of ageing, urbanisation, lifestyle choices, and affluence. This narrow framing is expressed through the so-called 5 x 5 model, favoured by WHO, of five diseases (cardiovascular disease, cancer, diabetes, chronic respiratory diseases, and mental ill-health) and five risk factors (tobacco use, unhealthy diets, physical inactivity, harmful use of alcohol, and air pollution), and is enshrined in Sustainable Development Goals target 3.4 on reducing NCD mortality.
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The Lancet Commission on NCDs and injuries (NCDIs) among the poorest billion argues that the current global NCD agenda does not address the needs, perspectives, and rights of the world’s poor. NCDIs account for more than a third of the disease burden among the poorest billion and are attributable to a far more diverse set of conditions and risk factors than contained in the 5 x 5 model. The evidence and recommendations in this Commission report must prompt the expansion of the NCD agenda as a matter of justice and equity for the world’s poorest.
Sarah Matthews, Matthew M. Coates, Alice Bukhman, Celina Trujillo, Gina Ferrari, Wubaye Walelgne Dagnaw, Darius Leopold Fénelon, Theodros Getachew, Biraj Karmacharya, Nancy Charles Larco, Aimée M. Lulebo, Mary Theodory Mayige, Maïmouna Ndour Mbaye, Getahun Tarekegn, Neil Gupta, Alma Adler, and Gene Bukhman
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There has been increasing awareness about the importance of type 1 diabetes (T1D) globally. Diabetic ketoacidosis (DKA) is a life-threatening complication of T1D in low-income settings. Little is known about health system capacity to manage DKA in low- and lower-middle income countries (LLMICs). As such, we describe health system capacity to diagnose and manage DKA across nine LLMICs using data from Service Provision Assessments.
We examined data from 2028 higher-level and 7534 lower-level facilities. Of these, 1874 higher-level and 6636 lower-level facilities’ data were eligible for analysis. Availability of all item sets were low at higher-level facilities, where less than 50% had the minimal set of supplies, less than 20% had the full minimal set, and less than 15% had the ideal set needed to diagnose and manage DKA. Across countries in lower-level facilities, less than 14% had the minimal set of supplies and less than 9% the full set of supplies for diagnosis and transfer of DKA patients. No country had more than 20% of facilities with the minimal set of items needed to assess or manage DKA.
Neil Gupta, Ana Mocumbi, Said H. Arwal, Yogesh Jain, Abraham M. Haileamlak,
Solomon T. Memirie, Nancy C. Larco, Gene F. Kwan, Mary Amuyunzu-Nyamongo, Gladwell Gathecha, Fred Amegashie, Vincent Rakotoarison, Jones Masiye, Emily Wroe, Bhagawan Koirala, Biraj Karmacharya, Jeanine Condo, Jean Pierre Nyemazi, Santigie Sesay, Sarah Maogenzi, Mary Mayige, Gerald Mutungi, Isaac Ssinabuly Ann R. Akiteng, Justice Mudavanhu, Sharon Kapambwe, David Watkins, Ole Norheim, Julie Makani, Gene Bukhman;
NCDI Poverty National Commissions Authorship Group; NCDI Poverty Network Secretariat
Health sector priorities and interventions to prevent and manage noncommunicable diseases and injuries (NCDIs) in low- and lower-middle-income countries (LLMICs) have primarily adopted elements of the World Health Organization Global Action Plan for NCDs 2013–2020. However, there have been limited efforts in LLMICs to prioritize among conditions and health-sector inter- ventions for NCDIs based on local epidemiology and contextually relevant risk factors or that incorporate the equitable distribution of health outcomes. The Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion supported national NCDI Poverty Commissions to define local NCDI epidemiology, determine an expanded set of priority NCDI conditions, and recommend cost-effective, equitable health-sector interventions.
Emily B Wroe, Noel Kalanga, Elizabeth L Dunbar, Lawrence Nazimera, Natalie F Price, Adarsh Shah, Luckson Dullie, Bright Mailosi, Grant Gonani, Enoch P L Ndarama, George C Talama, Gene Bukhman, Lila Kerr,
Emilia Connolly, Chiyembekezo Kachimanga
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BMJOpen_Malawi_ICCC_Oct-2020Non-communicable diseases (NCDs) account for one-third of disability-adjusted life years in Malawi, and access to care is exceptionally limited. Integrated services with HIV are widely recommended, but few examples exist globally. We report descriptive outcomes from an Integrated Chronic Care Clinic (IC3).
The study includes an HIV–NCD clinic across 14 primary care facilities in the rural district of Neno, Malawi.
The IC3 model, built on an HIV platform, Health Office, Ministry of Health, facilitated rapid decentralisation and access to NCD Neno, Malawi services in rural Malawi. Clinical outcomes and retention in care are favourable, suggesting that integration of chronic disease care at the primary care level poses a way forward for the large dual burden of HIV and chronic NCDs.
Matthew M Coates, Alexander Kintu, Neil Gupta, Emily B Wroe, Alma J Adler, Gene F Kwan, Paul H Park, Ruma Rajbhandari, Anthony L Byrne, Daniel C Casey, Gene Bukhman
Non-communicable diseases (NCDs) cause a large burden of disease globally. Some infectious diseases cause an increased risk of developing specific NCDs. Although the NCD burden from some infectious causes has been quantified, in this study, we aimed to more comprehensively quantify the global burden of NCDs from infectious causes.
Globally, we quantified 130 million DALYs from NCDs attributable to infection, comprising 8·4% of all NCD DALYs.
