Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries
Context and objectives Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential...
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BMJ Publishing Group
2020-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/10/e038842.full |
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| author | Biraj Man Karmacharya Neil Gupta Paul H Park Gene Bukhman Emily B Wroe Matthew M Coates Abebe Bekele Roodney Dupuy Darius Leopold Fénelon Anna D Gage Theodros Getachew Gene F Kwan Aimée M Lulebo Jones K Masiye Mary Theodory Mayige Maïmouna Ndour Mbaye Malay Kanti Mridha Wubaye Walelgne Dagnaw |
| author_facet | Biraj Man Karmacharya Neil Gupta Paul H Park Gene Bukhman Emily B Wroe Matthew M Coates Abebe Bekele Roodney Dupuy Darius Leopold Fénelon Anna D Gage Theodros Getachew Gene F Kwan Aimée M Lulebo Jones K Masiye Mary Theodory Mayige Maïmouna Ndour Mbaye Malay Kanti Mridha Wubaye Walelgne Dagnaw |
| author_sort | Biraj Man Karmacharya |
| collection | DOAJ |
| description | Context and objectives Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions.Design Secondary analysis of existing cross-sectional survey data.Setting We used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country.Outcome measures We defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities.Results Overall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1–2 hypertension (28%–83%). Availability was low for type 1 diabetes (1%–70%), type 2 diabetes (3%–57%), asthma (0%–7%) and acute presentations of diabetes (0%–26%) and asthma (0%–4%). Few hospitals had equipment or medications for heart failure (0%–32%), rheumatic heart disease (0%–23%), hypertensive emergencies (0%–64%) or acute minor surgical conditions (0%–5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability.Conclusions Our findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage. |
| format | Article |
| id | doaj-art-a7885f61186f43e8b1d59d5aa45e62a0 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-a7885f61186f43e8b1d59d5aa45e62a02024-11-17T02:20:11ZengBMJ Publishing GroupBMJ Open2044-60552020-10-01101010.1136/bmjopen-2020-038842Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countriesBiraj Man Karmacharya0Neil Gupta1Paul H Park2Gene Bukhman3Emily B Wroe4Matthew M Coates5Abebe Bekele6Roodney Dupuy7Darius Leopold Fénelon8Anna D Gage9Theodros Getachew10Gene F Kwan11Aimée M Lulebo12Jones K Masiye13Mary Theodory Mayige14Maïmouna Ndour Mbaye15Malay Kanti Mridha16Wubaye Walelgne Dagnaw17Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Province 3, NepalCenter for Integration Science, Brigham and Women`s Hospital, Boston, Massachusetts, USA1 Center for Integration Science, Division of Global Health Equity, Brigham and Women`s Hospital, Boston, Massachusetts, USADivision of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USADepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USADivision of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USAHealth System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, EthiopiaLe Ministère de la Santé Publique et de la Population, Port-au-Prince, HaitiZanmi Lasante, Port-au-Prince, HaitiDepartment of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USAHealth System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, EthiopiaProgram in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USAKinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of CongoNoncommunicable Diseases and Mental Health Clinical Services, Malawi Ministry of Health, Lilongwe, MalawiNational Institute for Medical Research, Dar es Salaam, TanzaniaDepartment of Internal Medicine, University Hospital Center of Dakar, Cheikh Anta Diop University, Dakar, SenegalCenter for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, BangladeshNCDI Poverty Network, Addis Ababa, EthiopiaContext and objectives Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions.Design Secondary analysis of existing cross-sectional survey data.Setting We used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country.Outcome measures We defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities.Results Overall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1–2 hypertension (28%–83%). Availability was low for type 1 diabetes (1%–70%), type 2 diabetes (3%–57%), asthma (0%–7%) and acute presentations of diabetes (0%–26%) and asthma (0%–4%). Few hospitals had equipment or medications for heart failure (0%–32%), rheumatic heart disease (0%–23%), hypertensive emergencies (0%–64%) or acute minor surgical conditions (0%–5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability.Conclusions Our findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.https://bmjopen.bmj.com/content/10/10/e038842.full |
| spellingShingle | Biraj Man Karmacharya Neil Gupta Paul H Park Gene Bukhman Emily B Wroe Matthew M Coates Abebe Bekele Roodney Dupuy Darius Leopold Fénelon Anna D Gage Theodros Getachew Gene F Kwan Aimée M Lulebo Jones K Masiye Mary Theodory Mayige Maïmouna Ndour Mbaye Malay Kanti Mridha Wubaye Walelgne Dagnaw Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries BMJ Open |
| title | Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries |
| title_full | Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries |
| title_fullStr | Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries |
| title_full_unstemmed | Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries |
| title_short | Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries |
| title_sort | availability of equipment and medications for non communicable diseases and injuries at public first referral level hospitals a cross sectional analysis of service provision assessments in eight low income countries |
| url | https://bmjopen.bmj.com/content/10/10/e038842.full |
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