The online version of this article (doi:10.1186/s12875-017-0613-5) contains supplementary material, which is available to authorized users.
Chronic diseases, primarily cardiovascular disease, respiratory disease, diabetes and cancer, are the leading cause of death and disability worldwide. In sub-Saharan Africa (SSA), where communicable disease prevalence still outweighs that of non-communicable disease (NCDs), rates of NCDs are rapidly rising and evidence for primary healthcare approaches for these emerging NCDs is needed.
A systematic review and evidence synthesis of primary care approaches for chronic disease in SSA. Quantitative and qualitative primary research studies were included that focused on priority NCDs interventions. The method used was best-fit framework synthesis.
Three conceptual models of care for NCDs in low- and middle-income countries were identified and used to develop an a priori framework for the synthesis. The literature search for relevant primary research studies generated 3759 unique citations of which 12 satisfied the inclusion criteria. Eleven studies were quantitative and one used mixed methods. Three higher-level themes of screening, prevention and management of disease were derived. This synthesis permitted the development of a new evidence-based conceptual model of care for priority NCDs in SSA.
For this review there was a near-consensus that passive rather than active case-finding approaches are suitable in resource-poor settings. Modifying risk factors among existing patients through advice on diet and lifestyle was a common element of healthcare approaches. The priorities for disease management in primary care were identified as: availability of essential diagnostic tools and medications at local primary healthcare clinics and the use of standardized protocols for diagnosis, treatment, monitoring and referral to specialist care.
Additional file 1: Literature results for the a priori framework. (DOCX 25 kb)12875_2017_613_MOESM1_ESM.docx
Additional file 2: Models of care for NCDs in LMIC. (DOCX 16 kb)12875_2017_613_MOESM2_ESM.docx
Additional file 3: Example of search terms for primary research studies. (DOCX 16 kb)12875_2017_613_MOESM3_ESM.docx
Additional file 4: Quality assessment of primary research studies. (DOCX 97 kb)12875_2017_613_MOESM4_ESM.docx
Additional file 5: A Priori themes in primary research studies for NCDs Interventions in SSA. (DOCX 18 kb)12875_2017_613_MOESM5_ESM.docx
Additional file 6: A Priori themes in primary research studies for NCD interventions in SSA. (DOCX 17 kb)12875_2017_613_MOESM6_ESM.docx
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380(9859):2095–128. CrossRef
World Health Organization. WHO global status report on non-communicable diseases 2010. Geneva: World Health Organization; 2011.
Maher D, Ford N, Unwin N. Priorities for developing countries in the global response to non-communicable diseases. Glob Health. 2012;11:8(14).
Harries A, Jahn A. Adapting the DOTS framework for tuberculosis control to the management of non-communicable diseases in Sub-Saharan Africa. PLoS Med. 2008;10:5(6).
World Health Organization. Sixty-fifth World Health Assembly. Second Report of Committee A, Agenda Item 13.1/2. Geneva: World Health Organization; 2012.
Sahasrabuddhe VV, Parham GP, Mwanahamuntu MH, Vermund SH. Cervical cancer prevention in low-and middle-income countries: feasible, affordable, essential. Cancer Prev Res. 2012;5(1):11–7. CrossRef
Carroll C, Booth A, Leaviss J, Rick J. “Best fit” framework synthesis: refining the method. BMC Med Res Methodol. 2013;13:13(37). CrossRef
Carroll C, Booth A, Cooper K. A worked example of “best fit” framework synthesis: a systematic review of views concerning the taking of some potential chemopreventive agents. BMC Med Res Methodol. 2013;16:11(29).
Critical Appraisal Skills Programme. Oxford, UK: CASP UK; 2013 [cited 13 Jan 2014]. Available from: http://www.casp-uk.net/.
Pastakia SD, Ali SM, Kamano JH, Akwanalo CO, Ndege SK, Buckwalter VL, et al. Screening for diabetes and hypertension in a rural low income setting in western Kenya utilizing home-based and community-based strategies. Glob Health. 2013;16:9(21).
Rabkin M, Zenebe M, Bruce K, Ahmed R, Koler A, Tadesse Y, et al. Strengthening health systems for chronic care: leveraging HIV programs to support diabetes services in Ethiopia and Swaziland. J Trop Med. 2012;137460:18.
Mamo Y, Seid E, Adams S, Gardiner A, Parry E. A primary healthcare approach to the management of chronic disease in Ethiopia: an example for other countries. Clin Med. 2007;7(3):228–31. CrossRef
World Health Organization. Task shifting to tackle health care worker shortage: HIV/AIDs Programme - strengtening health services to fight HIV/AIDS. Geneva: World Health Organization; 2007.
Zachariah R, Ford N, Philips M, Lynch S, Massaquoi M, Janssens V, et al. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg. 2012;103(6):549–88. CrossRef
Unwin N, Mugusi F, Aspray T, Whiting D, Edwards R, Mbanya JC, et al. Tackling the emerging pandemic of non-communicable diseases in sub-Saharan Africa: The essential NCD health intervention project. Public Health. 1999;113(3):141–6. PubMed
Maher D, Ford N, Unwin N. Priorities for developing countries in the global response to non-communicable diseases. Glob Health. 2012;8(1):1–8. CrossRef
Libamba E, Makombe S, Harries A, Chimziz R, Salaniponi FM, Schouten EJ, Mpazanje R. Scaling up Antiretrovirla therapy in Malawi - implications for managing other chronic diseases in resource-limited countries. J Acquir Immune Defic Syndr. 2009;52 Suppl 1:14–6.
World Health Organization. World Health Statistics. Geneva: World Health Organization; 2011.
Rabkin M, Kruk ME, El-Sadr WM. HIV, aging and continuity care: strengthening health systems to support services for noncommunicable diseases in low-income countries. AIDS. 2012;26 Suppl 1:77–83. CrossRef
Olmen J, Schellevis F, Damme W, Kegels G, Rasschaert F. Management of chronic diseases in sub-Saharan Africa: cross-fertilisation between HIV/AIDS and diabetes care. J Trop Med. 2012;349312:97.
Snilstveit B, Oliver S, Vojtkova M. Narrative approaches to systematic review and synthesis of evidence for international development policy and practice. J Dev Eff. 2012;4(3):409–29.
- A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa
- BioMed Central
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