Systematic review on epidemiology, interventions and management of noncommunicable diseases in acute and emergency care settings in Kenya

Abstract

Introduction Mortality and morbidity from Non-Communicable Diseases (NCDs) in Africa are expected to worsen if the status quo is maintained. Emergency care settings act as a primary point of entry into the health system for a spectrum of NCD-related illnesses, however, there is a dearth of literature on this population. We conducted a systematic review assessing available evidence on epidemiology, interventions and management of NCDs in acute and emergency care settings in Kenya, the largest economy in East Africa and a medical hub for the continent. Methods All searches were run on July 15, 2015 and updated on December 11, 2020, capturing concepts of NCDs, and acute and emergency care. The study is registered at PROSPERO (CRD42018088621). Results We retrieved a total of 461 references, and an additional 23 articles in grey literature. 391 studies were excluded by title or abstract, and 93 articles read in full. We included 10 articles in final thematic analysis. The majority of studies were conducted in tertiary referral or private/mission hospitals. Cancer, diabetes, cardiovascular disease and renal disease were addressed. Majority of the studies were retrospective, cross-sectional in design; no interventions or clinical trials were identified. There was a lack of access to basic diagnostic tools, and management of NCDs and their complications was limited. Conclusion There is a paucity of literature on NCDs in Kenyan emergency care settings, with particular gaps on interventions and management. Opportunities include nationally representative, longitudinal research such as surveillance and registries, as well as clinical trials and implementation science to advance evidence-based, context-specific care.

Epidemiology and clinical characteristics of adult patients presenting to a low resource, tertiary care emergency department in Pakistan: Challenges & Outcomes

“…6 An African study estimated that up to 24 million lives and nearly one billion Disability Adjusted Life Years (DALY) could be saved by improving healthcare in systems heavily reliant on Eds. 7 Pakistan lacks a comprehensive national disease prevalence data set, a major challenge in assessing disease burden. 8,9 Unfortunately, the only attempt at an ED-based surveillance system known as the Pak-NEDS pilot study was unable to sustain itself due to budget limitations.…”

“… 6 An African study estimated that up to 24 million lives and nearly one billion Disability Adjusted Life Years (DALY) could be saved by improving healthcare in systems heavily reliant on Eds. 7 …”

Where do people with hypertension or type 2 diabetes seek care when ill? A cross-sectional study on sociodemographic correlates of utilization of healthcare facilities in rural Kenya

“…According to the 2015 Kenya STEPwise survey for NCDs, 97% of the Kenyan adult population are exposed to one of the four major risk factors (i.e., tobacco, alcohol, unhealthy diets, and lack of physical activity) and 25% are exposed to three or more [2]. Additionally, it has been noted that there is a lack of access to medication and health facilities in rural areas of Kenya, where a majority of the population lives [5]. Moreover, data on utilization patterns of healthcare facilities for NCDs and sociodemographic factors that affect these patterns are lacking in rural Kenya.…”