Trujillo, C., Ferrari, G., Ngoga, G., Mclaughlin, A., Davies, J., Tucker, A., Randolph, C., Cook, R., Park, P. H., Bukhman, G., Adler, A. J. & Pierre, J
Achieving glycaemic targets for people living with diabetes (PLWD) is challenging, especially in settings with limited resources. Programmes need to addressgaps in knowledge, skills and self-management. Diabetes Self-Management Education (DSME) is an evidence-based intervention to educate and empower PLWD to improve self-management activities. This protocol describes a pilot study assessing the feasibility, acceptability and effect on clinical outcomes of implementing DSME in clinics caring for people living with insulin-dependent diabetes in Liberia.
Adler, A. J., Ruderman, T., Valeta, F., Drown, L., Trujillo, C., Ferrari, G., Msekandiana, A., Wroe, E., Kachimanga, C., Bukhman, G. & Park, P. H.
The majority of people living with type 1 diabetes (PLWT1D) struggle to access high-quality
care in low-income countries (LICs), and lack access to technologies, including continuous glucose monitoring (CGM), that are considered standard of care in high resource settings. To our knowledge, there are no studies in the literature describing the feasibility or effectiveness of CGM at rural first-level hospitals in LICs.This is a 3-month, 2:1open-randomised trial to assess the feasibility and clinical outcomes of introducing CGM to the entire population of 50 PLWT1D in two hospitals in rural Neno, Malawi.
Coates, M. M., Ezzati, M., Robles Aguilar, G., Kwan, G. F., Vigo, D., Mocumbi, A. O., Becker, A. E., Makani, J., Hyder, A. A., Jain, Y., Stefan, D. C., Gupta, N., Marx, A. & Bukhman, G.
The health of populations living in extreme poverty has been a long-standing focus of global development efforts, and continues to be a priority during the Sustainable Development Goal era. However, there has not been a systematic attempt to quantify the magnitude and causes of the burden in this specific population for almost two decades. We estimated disease rates by cause for the world’s poorest billion and compared these rates to those in high-income populations.
Chantelle Boudreaux, Prebo Barango, Alma Adler, Patrick Kaobre, Amy McLaughlin, Mohamed Ould Sidi Mohamed, Paul H. Park, Steven Shongwe, Jean Marie Dangou, Gene Bukhman
Health Policy and Planning 2022
Addressing severe chronic NCDs across Africa:
measuring demand for the Package of Essential Non-communicable Disease Interventions-Plus (PEN-Plus)
Severe chronic non-communicable diseases (NCDs) pose important challenges for health systems across Africa. This study explores the current availability of and demand for decentralization of services for four high-priority conditions: insulin-dependent diabetes, heart failure, sickle cell disease, and chronic pain. Countries reported widespread gaps in service availability at all levels. We found that just under half (49%) of respondents report that services for insulin-dependent diabetes are generally available at the secondary level (district hospital); 32% report the same for heart failure, 27% for chronic pain and 14% for sickle cell disease. Reported gaps are smaller at tertiary level (referral hospital) and larger at primary care level (health centres). Respondents report ambitious plans to introduce and decentralize these services in the coming 5 years. Respondents from 32 countries (86%) hope to make all services available at tertiary hospitals, and 21 countries (57%) expect to make all services available at secondary facilities. These priorities align with the Package of Essential NCD Interventions-Plus. Efforts will require strengthened infrastructure and supply chains, capacity building for staff and new monitoring and evaluation systems for efficient implementation. Many countries will need targeted financial assistance in order to realize these goals. Nearly all (36/37) respondents request technical assistance to organize services for severe chronic NCDs.
Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient specialty clinic associated with a district hospital in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, heart failure and rheumatic heart disease.
