What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries
Objectives Chronic respiratory diseases (CRD) are among the top four non-communicable diseases globally. They are associated with poor health and approximately 4 million deaths every year. The rising burden of CRD in low/middle-income countries will strain already weak health systems. This study aim...
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BMJ Publishing Group
2022-07-01
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| author | Angela Obasi Rachel Tolhurst Kingsley Rex Chikaphupha Miriam Taegtmeyer Kevin Mortimer Louis Niessen Maia Lesosky Jahangir Khan William Worodria Jamie Rylance Lindsay Zurba Imelda Bates Stellah G Mpagama Elizabeth Henry Shayo Rose Oronje Emmanuel Addo-Yobo Brian Allwood Hastings Banda Amsalu Binegdie Adegoke Falade Bertrand Mbatchou Beatrice Mutayoba Nyanda Elias Ntinginya Heather Zar Eliya Zulu Helen Meme Uzochukwu Egere Asma Elsony Martha Chinouya S Bertel Squire Stephen Mulupi Irene Ayakaka Nicole Kozak Elhafiz Abdalla Rashid Osman |
| author_facet | Angela Obasi Rachel Tolhurst Kingsley Rex Chikaphupha Miriam Taegtmeyer Kevin Mortimer Louis Niessen Maia Lesosky Jahangir Khan William Worodria Jamie Rylance Lindsay Zurba Imelda Bates Stellah G Mpagama Elizabeth Henry Shayo Rose Oronje Emmanuel Addo-Yobo Brian Allwood Hastings Banda Amsalu Binegdie Adegoke Falade Bertrand Mbatchou Beatrice Mutayoba Nyanda Elias Ntinginya Heather Zar Eliya Zulu Helen Meme Uzochukwu Egere Asma Elsony Martha Chinouya S Bertel Squire Stephen Mulupi Irene Ayakaka Nicole Kozak Elhafiz Abdalla Rashid Osman |
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| description | Objectives Chronic respiratory diseases (CRD) are among the top four non-communicable diseases globally. They are associated with poor health and approximately 4 million deaths every year. The rising burden of CRD in low/middle-income countries will strain already weak health systems. This study aimed to explore the perspectives of healthcare workers and other health policy stakeholders on the barriers to effective diagnosis and management of CRD in Kenya, Malawi, Sudan, Tanzania and Uganda.Study design Qualitative descriptive study.Settings Primary, secondary and tertiary health facilities, government agencies and civil society organisations in five sub-Saharan African countries.Participants We purposively selected 60 national and district-level policy stakeholders, and 49 healthcare workers, based on their roles in policy decision-making or health provision, and conducted key informant interviews and in-depth interviews, respectively, between 2018 and 2019. Data were analysed through framework approach.Results We identified intersecting vicious cycles of neglect of CRD at strategic policy and healthcare facility levels. Lack of reliable data on burden of disease, due to weak information systems and diagnostic capacity, negatively affected inclusion in policy; this, in turn, was reflected by low budgetary allocations for diagnostic equipment, training and medicines. At the healthcare facility level, inadequate budgetary allocations constrained diagnostic capacity, quality of service delivery and collection of appropriate data, compounding the lack of routine data on burden of disease.Conclusion Health systems in the five countries are ill-equipped to respond to CRD, an issue that has been brought into sharp focus as countries plan for post-COVID-19 lung diseases. CRD are underdiagnosed, under-reported and underfunded, leading to a vicious cycle of invisibility and neglect. Appropriate diagnosis and management require health systems strengthening, particularly at the primary healthcare level. |
| format | Article |
| id | doaj-art-b9ff72ab956f4611a981c414e0df1db9 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-b9ff72ab956f4611a981c414e0df1db92025-01-30T16:30:15ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-052105What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries Angela Obasi0Rachel Tolhurst1Kingsley Rex Chikaphupha2Miriam Taegtmeyer3Kevin Mortimer4Louis NiessenMaia Lesosky5Jahangir KhanWilliam WorodriaJamie Rylance6Lindsay ZurbaImelda Bates7Stellah G Mpagama8Elizabeth Henry Shayo9Rose Oronje10Emmanuel Addo-YoboBrian AllwoodHastings BandaAmsalu BinegdieAdegoke FaladeBertrand MbatchouBeatrice MutayobaNyanda Elias Ntinginya11Heather Zar12Eliya ZuluHelen Meme13Uzochukwu Egere14Asma Elsony15Martha Chinouya16S Bertel SquireStephen Mulupi17Irene Ayakaka18Nicole Kozak19Elhafiz Abdalla20Rashid Osman215 Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UKDepartment of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UKHealth Systems and Policy Research Unit, REACH Trust Malawi, Lilongwe, MalawiInternational Public Health, Liverpool School of Tropical Medicine, Liverpool, UKUniversity of Cambridge, Cambridge, UKNational Heart and Lung Institute, Imperial College London, London, UKDepartment of Medicine, College of Medicine, Blantyre, Malawi5 Centre for Capacity Research, Liverpool School of Tropical Medicine, Liverpool, UKMedical Department, Kibong’oto Infectious Diseases Hospital/Kilimanjaro Christian Medical University, Kilimanjaro, United Republic of TanzaniaDepartment of Policy Analysis and Advocacy, National Institute for Medical Research, Dar es Salaam, TanzaniaAfrican Institute for Development Policy (AFIDEP), Nairobi, Kenya14 National Institute for Medical Research, Dar es Salaam, United Republic of TanzaniaDepartment of Pediatrics and Child Health, University of Cape Town, Rondebosch 7700, Western Cape, South AfricaKenya Medical Research Institute (KEMRI), Nairobi, KenyaInternational Public Health, Liverpool School of Tropical Medicine, Liverpool, UKLung Health Department, Epi-Lab, Khartoum, SudanEducation Department, Liverpool School of Tropical Medicine, Liverpool, UKInternational Public Health, Liverpool School of Tropical Medicine, Liverpool, UKInternational Public Health, Liverpool School of Tropical Medicine, Liverpool, UKInternational Public Health, Liverpool School of Tropical Medicine, Liverpool, UKLung Health Department, Epi-Lab, Khartoum, SudanLung Health Department, Epi-Lab, Khartoum, SudanObjectives Chronic respiratory diseases (CRD) are among the top four non-communicable diseases globally. They are associated with poor health and approximately 4 million deaths every year. The rising burden of CRD in low/middle-income countries will strain already weak health systems. This study aimed to explore the perspectives of healthcare workers and other health policy stakeholders on the barriers to effective diagnosis and management of CRD in Kenya, Malawi, Sudan, Tanzania and Uganda.Study design Qualitative descriptive study.Settings Primary, secondary and tertiary health facilities, government agencies and civil society organisations in five sub-Saharan African countries.Participants We purposively selected 60 national and district-level policy stakeholders, and 49 healthcare workers, based on their roles in policy decision-making or health provision, and conducted key informant interviews and in-depth interviews, respectively, between 2018 and 2019. Data were analysed through framework approach.Results We identified intersecting vicious cycles of neglect of CRD at strategic policy and healthcare facility levels. Lack of reliable data on burden of disease, due to weak information systems and diagnostic capacity, negatively affected inclusion in policy; this, in turn, was reflected by low budgetary allocations for diagnostic equipment, training and medicines. At the healthcare facility level, inadequate budgetary allocations constrained diagnostic capacity, quality of service delivery and collection of appropriate data, compounding the lack of routine data on burden of disease.Conclusion Health systems in the five countries are ill-equipped to respond to CRD, an issue that has been brought into sharp focus as countries plan for post-COVID-19 lung diseases. CRD are underdiagnosed, under-reported and underfunded, leading to a vicious cycle of invisibility and neglect. Appropriate diagnosis and management require health systems strengthening, particularly at the primary healthcare level.https://bmjopen.bmj.com/content/12/7/e052105.full |
| spellingShingle | Angela Obasi Rachel Tolhurst Kingsley Rex Chikaphupha Miriam Taegtmeyer Kevin Mortimer Louis Niessen Maia Lesosky Jahangir Khan William Worodria Jamie Rylance Lindsay Zurba Imelda Bates Stellah G Mpagama Elizabeth Henry Shayo Rose Oronje Emmanuel Addo-Yobo Brian Allwood Hastings Banda Amsalu Binegdie Adegoke Falade Bertrand Mbatchou Beatrice Mutayoba Nyanda Elias Ntinginya Heather Zar Eliya Zulu Helen Meme Uzochukwu Egere Asma Elsony Martha Chinouya S Bertel Squire Stephen Mulupi Irene Ayakaka Nicole Kozak Elhafiz Abdalla Rashid Osman What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries BMJ Open |
| title | What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries |
| title_full | What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries |
| title_fullStr | What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries |
| title_full_unstemmed | What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries |
| title_short | What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries |
| title_sort | what are the barriers to the diagnosis and management of chronic respiratory disease in sub saharan africa a qualitative study with healthcare workers national and regional policy stakeholders in five countries |
| url | https://bmjopen.bmj.com/content/12/7/e052105.full |
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