Availability and affordability of medicines and diagnostic tests recommended for management of asthma and chronic obstructive pulmonary disease in sub-Saharan Africa: a systematic review

Kibirige, Davis; Sanya, Richard E.; Nantanda, Rebecca; Worodria, William; Kirenga, Bruce

doi:10.1186/s13223-019-0329-2

Cited by 36 publications

(31 citation statements)

References 24 publications

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“…Similar to previous studies [41][42][43][44], many countries reported limited availability of essential NCD medicines and technologies. Only Cabo Verde and Mauritius report availability of all ten essential NCD medicines and six essential NCD technologies in their PHC facilities.…”

Section: Discussionsupporting

confidence: 85%

“…Cabo Verde has achieved these targets through strong political commitment to strengthen PHC services as part of their UHC agenda [ 45 ]. The limited availability of affordable medicines and diagnostic tests is a complex challenge in sub-Saharan Africa [ 43 ]. Minimal competition among few numbers of suppliers in LMICs affects medicine supply and cost.…”

Section: Discussionmentioning

confidence: 99%

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How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization’s African regional targets

et al. 2020

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In Africa, mortality due to non-communicable diseases (NCDs) is projected to overtake the combined mortality from communicable, maternal, neonatal, and nutritional diseases by 2030. To address this growing NCD burden, primary health care (PHC) systems will require substantial reorientation. In this study, we reviewed the progress of African countries towards integrating essential NCD services into PHC. Methods A review of World Health Organization (WHO) reports was conducted for all 47 countries in the WHO African Region. To report each country's progress, we used an a priori framework developed by the WHO regional office for Africa (AFRO). Twelve indicators were used to measure countries' progress. The proportion of countries meeting each indicator was tabulated using a heat map. Correlation between country income status and attainment of each indicator was also assessed. Findings No country met all the recommended indicators to integrate NCD services into PHC and seven countries met none of the indicators. Few countries (30%) had nationally approved guidelines for NCD management and very few reported availabilities of all essential NCD

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization’s African regional targets

et al. 2020

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“…9 In addition, drugs for CRDs can be less available and affordable, especially in low-income settings, including SSA, where the availability and affordability of medicines and diagnostics recommended for the management of asthma and COPD is a big challenge. 10 Fortunately, the rational use of pharmacotherapy for CRDs could be complemented by non-pharmacological treatments. For COPD, pulmonary rehabilitation (PR) is well established as a highly effective intervention that improves symptoms, quality of life and survival 11 , and a recent trial has shown a substantial reduction in the risk of readmission in patients who undertake PR immediately after admissions for COPD.…”

Section: O N C L U S I O N Smentioning

confidence: 99%

Evidence for pulmonary rehabilitation in chronic respiratory diseases in sub-Saharan Africa: a systematic review

Bickton

Fombe

Chisati³

et al. 2020

int j tuberc lung dis

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BACKGROUND: Pulmonary rehabilitation (PR) is a highly effective non-pharmacological treatment for patients with chronic respiratory diseases.OBJECTIVE: To synthesise the evidence for PR practice and efficacy in sub-Saharan Africa.METHODS: We searched in PubMed and Scopus for relevant studies and scanned reference lists of relevant studies from these databases for additional studies. Articles meeting the inclusion criteria were included. Pre-determined data were extracted independently by two reviewers. A narrative synthesis approach was used in the interpretation of findings.RESULTS: Six studies were included, totalling 275 participants. Indications for PR were chronic obstructive pulmonary disease, asthma, pulmonary tuberculosis and post-tuberculosis lung disease. Programmes ran for 6–12 weeks, universally incorporated exercise, and variously used home-based and hospital-based delivery models. All were interventional studies, of which two were randomised controlled trials, and primarily reported pulmonary function and exercise tolerance endpoints. Evidence for individualising the exercise regimen was available in three studies.CONCLUSIONS: There is limited evidence on PR design and efficacy in sub-Saharan Africa, but available data support its use in a variety of chronic respiratory conditions. Future studies should report core outcome sets and their individualised exercise and education regimens.

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“…Our study in Sudan focussed only on district level health facilities including those where an integrated approach to delivering a package of care for CLD is operational (29). These facilities had peak ow meters and were more likely to have asthma guidelines, both of which were found to be frequently unavailable for CLD care in sub-Saharan African contexts (30). However, experience with asthma care and overall higher readiness for CLD care did not translate to improved care of CLD in general as seen in failure of the facilities to diagnose even a case of COPD from among over 12,000 adult patients seen over a month's period.…”

Section: Discussionmentioning

confidence: 99%

Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems?

Egere

Shayo

Ntinginya³

et al. 2021

Preprint

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BackgroundChronic Lung Diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system. MethodsWe conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was scored as a composite of availability of service-specific tracer items from the WHO service availability checklist in three domains: staff training and guidelines, diagnostics and equipment, and basic medicines. Qualitative data were analysed using the same domains.ResultsOne health facility in Tanzania and five in Sudan, attained a CLD readiness score of ≥50% for CLD care. Scores ranged from 14.9% in a dispensary to 53.3% in a health centre in Tanzania, and from 36.4% to 86.4% in Sudan. The least available tracer items across both countries were trained human resources and guidelines, and peak flow meters. Only two facilities had COPD guidelines. Patient vignette analysis revealed significant gaps in clinicians’ capacity to manage CLD. Key informants identified low prioritization as key barrier to CLD care. Conclusion: Gaps in service availability and readiness for CLD care in Tanzania and Sudan threaten attainment of universal health coverage in these settings. Detailed assessments by health systems researchers in discussion with stakeholders at all levels of the health system can identify critical blockages to reimagining CLD service provision with people-centred, integrated approaches at its heart.

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Availability and affordability of medicines and diagnostic tests recommended for management of asthma and chronic obstructive pulmonary disease in sub-Saharan Africa: a systematic review

Cited by 36 publications

References 24 publications

How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization’s African regional targets

How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization’s African regional targets

Evidence for pulmonary rehabilitation in chronic respiratory diseases in sub-Saharan Africa: a systematic review

Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems?

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