Capacity of Ugandan public sector health facilities to prevent and control non-communicable diseases: an assessment based upon WHO-PEN standards

Abstract

BackgroundNon-communicable diseases (NCDs) are increasing in prevalence in low-income countries including Uganda. The Uganda Ministry of Health has prioritized NCD prevention, early diagnosis, and management. However, research on the capacity of public sector health facilities to address NCDs is limited.MethodsWe developed a survey guided by the literature and the standards of the World Health Organization Pacakage of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-Resource Settings. We used this tool to conduct a needs assessment in 53 higher-level public sector facilities throughout Uganda, including all Regional Referral Hospitals (RRH) and a purposive sample of General Hospitals (GH) and Health Centre IVs (HCIV), to: (1) assess their capacity to detect and manage NCDs; (2) describe provider knowledge and practices regarding the management of NCDs; and (3) identify areas in need of focused improvement. We collected data on human resources, equipment, NCD screening and management, medicines, and laboratory tests. Descriptive statistics were used to summarize our findings.ResultsWe identified significant resource gaps at all sampled facilities. All facilities reported deficiencies in NCD screening and management services. Less than half of all RRH and GH had an automated blood pressure machine. The only laboratory test uniformly available at all surveyed facilities was random blood glucose. Sub-specialty NCD clinics were available in some facilities with the most common type being a diabetes clinic present at eleven (85%) RRHs. These facilities offered enhanced services to patients with diabetes. Surveyed facilities had limited use of NCD patient registries and NCD management guidelines. Most facilities (46% RRH, 23% GH, 7% HCIV) did not track patients with NCDs by using registries and only 4 (31%) RRHs, 4 (15%) GHs, and 1 (7%) HCIVs had access to diabetes management guidelines.ConclusionsDespite inter-facility variability, none of the facilities in our study met the WHO-PEN standards for essential tools and medicines to implement effective NCD interventions. In Uganda, improvements in the allocation of human resources and essential medicines and technologies, coupled with uptake in the use of quality assurance modalities are desperately needed in order to adequately address the rapidly growing NCD burden.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3426-x) contains supplementary material, which is available to authorized users.

Predictors of 30-day and 90-day mortality among hemorrhagic and ischemic stroke patients in urban Uganda: a prospective hospital-based cohort study

“…The dissimilarities may be explained by the differences in stroke care and management as well as type of rehabilitation programs between countries. However in Uganda, the presence of continuum of poverty [26] may lead to poor accessibility to hospital care, late presentation of severe stroke and poor compliance to medication with eventual poor health outcomes [8]. A recent study in Uganda found that only 27% of medicines and 32% of diagnostic tests for diabetes and cardiovascular disease were affordable by most people [27].…”

“…All-stroke mortality from the available Ugandan hospital-based studies, is estimated to be between 30 and 40% at 1 month [5,6], which is much higher than the 20% mortality reported in the rest of the world [7]. Hence, the increasing burden of stroke in the SSA region will put a huge burden on the already overstretched health care system and resources [8].…”

“…In Nigeria, 30-day mortality has been associated with advanced age, low level of consciousness on admission to hospital and higher National Institute of Health Stroke Scale (NIHSS) score [13]; presence of comorbid conditions such as diabetes mellitus (DM) has been associated with a higher long term mortality in Ghana [17]. In developing countries including Uganda, resources for stroke care and rehabilitation are still largely lacking particularly in lower health facilities [8]. However, the WHO has emphasized the importance of developing robust national surveillance systems to monitor stroke frequency and outcomes particularly in developing countries [18].…”

Availability and affordability of essential medicines and diagnostic tests for diabetes mellitus in sub-Saharan Africa: A systematic review.

“…There was an observed heterogeneity of the study ndings. Among the 19 studies conducted in one region of SSA, the majority were from the Eastern region (n = 11, 58%) [11][12][13][14][15][16][17][18][19][20][21]. About 26% (n = 5) [22][23][24][25][26]and 16% (n = 3) [27][28][29] of the remaining studies were conducted in the Southern and Western region respectively.…”

“…A total of 14 studies (66.7%) investigated the availability of at least one diagnostic test for DM. Among the recommended diagnostic tests for DM in the WHO PEN, availability of blood glucose tests was the most investigated (13 studies, 92.9%) [11, 13, 14, 17-22, 26-29, 31] while microalbuminuria tests were the least investigated (2 studies, 14.3%) [11,20].…”