Randomised controlled trials on prevention, diagnosis and treatment of diabetes in African countries: a systematic review

Sandholzer-Yilmaz, Angelika Sabine; Kroeber, Eric Sven; Ayele, Wondimu; Frese, Thomas; Kantelhardt, Eva Johanna; Unverzagt, Susanne

doi:10.1136/bmjopen-2021-050021

Cited by 4 publications

(2 citation statements)

References 129 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Though a large body of published evidence exists on pharmacological agents and nonpharmacological interventions in regulating blood glucose concentration, the health systems' ability to support high-quality primary care in meeting patients' needs may be inadequate (2,(17)(18)(19)(20)(21). The essential management of non-communicable diseases (NCDs), particularly diabetes, has been postulated to depend largely on functioning health systems (22).…”

Section: Introductionmentioning

confidence: 99%

Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: a systematic review

Bondzie,

Amarteyfio,

Jahan

et al. 2024

Preprint

View full text Add to dashboard Cite

Type 2 diabetes is ambulatory care sensitive and adequate outpatient primary care supported by strong functional health systems can reduce avoidable complications and related mortality. A large body of published evidence exists on pharmacological agents and non-pharmacological interventions for the management of type 2 diabetes. However, the evidence on health systems’ ability to support patients’ primary care needs, especially in West Africa, where non-communicable disease (NCD) is an increasingly important part of the disease burden is uncertain. This systematic review explores the current published evidence on health systems interventions to support primary health facilities for type 2 diabetes care and impact on health outcomes, service access and quality in West Africa. The World Health Organization health systems building blocks and other post building blocks health systems frameworks guided our search and analysis. Only three pilot studies, including two randomized controlled trials and one pre-post study, met all our first inclusion criteria. However, we included 12 other studies which did not meet all the inclusion criteria but reported on a health system intervention for complete analysis: (The criteria were expanded to include studies conducted outside primary care settings. The rationale was that findings from such studies may influence primary care. Also, non-randomized control trials were later included). Our results showed that interventions with significant impact on glycemic control, treatment adherence, health literacy, and other associated outcomes addressed intersections between the individual health system blocks/areas. Thus, four cross-cutting themes related to the building blocks were found during analysis. The first theme was on interventions targeting the availability of trained health workers and the quality of their services; the second was on interventions targeting institutional infrastructure and resources for management; the third was on interventions targeting leadership and organizational culture and; the fourth was interventions targeting relationships among stakeholders. A fifth theme highlighting patients and family empowerment for type 2 diabetes control was also found in most of the interventions.ConclusionThese findings confirm that the rising burden of non-communicable diseases in West Africa, particularly type 2 diabetes, can be tackled by strong functional primary healthcare systems.

show abstract

Section: Introductionmentioning

confidence: 99%

Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: a systematic review

Bondzie,

Amarteyfio,

Jahan

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…These disproportionate number reflect the poor structures at various levels of the primary care management of non-communicable diseases in the 5 African region (7,8). Evidence exists on the effectiveness of pharmacological and nonpharmacological treatment for type 2 diabetes (9,10,11) but the health systems ability in meeting patients' needs may be inadequate (2,7).…”

Section: Introductionmentioning

confidence: 99%

Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: a systematic review protocol

Bondzie,

Jahan,

Balabanova

et al. 2023

Preprint

View full text Add to dashboard Cite

Type 2 diabetes remains a major global public health challenge particularly in the African region. Though evidence exists on pharmacological agents and non-pharmacological interventions in maintaining blood glucose concentration, the health systems ability in meeting patients’ needs may be inadequate. However, the management of non-communicable diseases particularly diabetes, have been postulated to depend largely on functioning health systems. This systematic review will therefore, summarize the current evidence on existing health systems interventions in primary health settings for type 2 diabetes care and health outcomes in West Africa and would explore the impact of these system-level interventions on service availability, accessibility and quality, as well as individualized outcomes such as glycemic control, disease awareness and treatment adherence. The review will be conducted in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The health system framework by Witter et al, 2019 will guide the system-level interventions and the search strategy to be explored in this review. This framework was designed to integrate the six building blocks of the World health’s organization (WHO) health systems framework and delineates how they work synergistically to improve specific health outcomes. We will search the following databases PubMed, Google scholar and Cumulated Index to Nursing and Allied Health Literature (CINAHL) between January 2000 to June 2023 and Car.info from inception to June 2023. The Cochrane Collaboration tool for assessing Risk of Bias will be implemented on each included study to assess for risk of bias. We will conduct a narrative synthesis and make comparisons across findings using Excel generated tables. The main limitation of this study is that we are likely to miss out on studies not conducted in English or French since our search would be conducted in English and French only. In Conclusion, this systematic review will outline the existing system-level interventions that aim to or already improve type 2 diabetes services in primary health facilities in West Africa and would allow for strengthening and co-production of successful interventions that can be generalised to the entire sub-region.

show abstract

Cohort profile: design, sociodemographic characteristics, chronic disease risk factors, and baseline hypertension and diabetes care cascades of the open, prospective Community-Based chronic disease Care Lesotho (ComBaCaL) cohort

Gerber,

Sanchez-Samaniego,

Tahirsylaj

et al. 2024

Preprint

View full text Add to dashboard Cite

Purpose: The open, prospective Community-Based chronic Care Lesotho (ComBaCaL) cohort is the first study to comprehensively investigate socioeconomic indicators, common chronic diseases and their risk factors in a remote rural setting in Lesotho. It serves as a platform for implementing nested trials using the Trials within Cohorts (TwiCs) design to assess community-based chronic care interventions. Here, we present the cohorts sociodemographic and chronic disease risk factor profile, including self-reported HIV prevalence and hypertension and diabetes care cascades. Participants: Since February 2023, Community Health Worker (CHWs) supported by a clinical decision support and data collection application, have enrolled inhabitants from 103 randomly selected rural villages in Butha-Buthe and Mokhotlong districts in North-East Lesotho. As of May 31, 2024, the cohort includes 5008 households with 14735 participants (55% female, median age 19 years). The cohorts socioeconomic status is low with an International Wealth Index of 26, a monthly household income of 42.4 USD and low levels of formal education. Among the 7917 adult participants, 42.5% are overweight or obese, with higher rates among women, and 33.1% smoke tobacco, with higher rates among men. Self-reported HIV prevalence is 15.1% with a 98.4% treatment rate. Hypertension prevalence is 17% with a 56% control rate and diabetes prevalence is 4% with a 39% control rate. Findings to date: The cohorts low socioeconomic status is linked to multiple health risks including insufficient access to clean energy, essential healthcare services, adequate sanitary facilities and secure food supply. Besides the expected high HIV prevalence, we found significant hypertension, diabetes and cardiovascular risk factor prevalences. While treatment and control rates for diabetes and hypertension are higher than in similar settings, they remain below global targets. Future plans: Ongoing cluster-randomized TwiCs, which will be completed in 2025, are assessing the effectiveness of community-based, CHW-led care interventions for diabetes and hypertension. CHWs will continue to closely monitor the cohort and integrate additional measurements such as HIV testing. This will provide further insights into the dynamics and interactions of chronic diseases and inform the development of future nested trials on innovative community-based prevention and care interventions. Registration:NCT05596773

show abstract

Randomised controlled trials on prevention, diagnosis and treatment of diabetes in African countries: a systematic review

Cited by 4 publications

References 129 publications

Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: a systematic review

Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: a systematic review

Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: a systematic review protocol

Cohort profile: design, sociodemographic characteristics, chronic disease risk factors, and baseline hypertension and diabetes care cascades of the open, prospective Community-Based chronic disease Care Lesotho (ComBaCaL) cohort

Contact Info

Product

Resources

About