Access to affordable medicines and diagnostic tests for asthma and COPD in sub Saharan Africa: the Ugandan perspective

Kibirige, Davis; Kampiire, Leaticia; Atuhe, David; Mwebaze, Raymond; Katagira, Winceslaus; Muttamba, Winters; Nantanda, Rebecca; Worodria, William; Kirenga, Bruce

doi:10.1186/s12890-017-0527-y

Cited by 44 publications

(65 citation statements)

References 9 publications

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“…Spirometry may be a good alternative that gives insight into the pulmonary status, however, discoordination due to muscle weakness and ataxia will often underestimate true lung function. Compared to other diagnostic tests described here, spirometry is relatively easy accessible and affordable but still not available in all hospitals [54]. In our experience, most patients have a restrictive pattern (explaining a low forced vital capacity), sometimes combined with obstructive pulmonary dysfunction.…”

Section: Pulmonologymentioning

confidence: 89%

Diagnosis and Management of Ataxia-Telangiectasia in Resource-Limited Settings

Aerde

Gaalen

et al. 2020

JICNA

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Ataxia-telangiectasia (A-T) is an autosomal recessive disorder linked to mutations in the ATM gene, and is characterized by neurodegeneration with an early onset cerebellar syndrome, hyperkinetic movement disorders, neuropathy, and oculocutaneous telangiectasia. Immunodeficiency, pulmonary disease, growth failure, diabetes mellitus, increased malignancy risk and hypersensitivity to ionizing radiation complicate the clinical picture. Serum alpha-fetoprotein levels are increased in patients with A-T and can therefore serve as a diagnostic marker for the disease. In resource-limited settings, diagnosis and management of patients with a rare and complex disorder such as A-T may be extremely challenging. This expert opinion-based guideline aims to give an overview of diagnosis and management of A-T in resource-limited settings, by prioritizing different options based on medical necessity, availability, and costs.

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Section: Pulmonologymentioning

confidence: 89%

Diagnosis and Management of Ataxia-Telangiectasia in Resource-Limited Settings

Aerde

Gaalen

et al. 2020

JICNA

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“…Despite these corrective measures, the "corrected" European standards continue to significantly overestimate the predictive ventilatory variables in Beninese subjects. Similarly, Dufetel et al (1990) showed in Africa that the total lung capacity among Togolese (in West Africa) men aged 25 to 55 years was lower by an average of 25%, and the other lung volumes were also 22% lower than those men of the same age and size [31] [32]. In this context, the authors concluded that it would be wrong to use a proportionality factor to define the reference spirometric values for black children based on the standards defined for Caucasian subjects [31] [32].…”

Section: Comparisons Of Our Standard Values With Those Of Ers-93mentioning

confidence: 99%

“…Similarly, Dufetel et al (1990) showed in Africa that the total lung capacity among Togolese (in West Africa) men aged 25 to 55 years was lower by an average of 25%, and the other lung volumes were also 22% lower than those men of the same age and size [31] [32]. In this context, the authors concluded that it would be wrong to use a proportionality factor to define the reference spirometric values for black children based on the standards defined for Caucasian subjects [31] [32]. The question then arises to know why, despite the ethnic corrections integrated into spirometers imported from Europe, the ventilatory variables measured in black African subjects are higher than those of their Caucasian counterparts of the same age, sex and height?…”

Section: Comparisons Of Our Standard Values With Those Of Ers-93mentioning

confidence: 99%

“…The answer to this question is at several levels. Indeed, Dufetel et al (1990) justified this difference by the fact that black children have smaller chest cages and longer limbs than Caucasian children, confirming that the rate of growth of physical characteristics is not the same from one ethnic group to another, given the different socio-economic and environmental conditions [31] [32]. In Brazil, for example, this reality is taken into account, especially as there are spirometric reference values applicable to adult white Brazilians different from those of other ethnic groups [33].…”

Section: Comparisons Of Our Standard Values With Those Of Ers-93mentioning

confidence: 99%

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FVC and FEV Reference Values for Beninese Individuals Aged 17 - 20 Years

Messan¹,

Lawani²,

Mama³

2019

OJRD

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Background: 1) To determine forced vital capacity (FVC) and forced expiratory volume in one second (FEV) for Beninese individuals of both sexes aged 17-20 years; 2) Compare the observed values to those calculated based on the algorithms of the spirometer used. Materials and Methods: The FVC and FEV values were first measured using a Micro Quark spirometer and then calculated from equations for the European Respiratory Society-93 (ERS-93) in 148 subjects, including 46 girls. In each age group, the measured values for the height of the subjects were considered the only variables used to calculate the equations for FVC and FEV with their 95% confidence intervals. The means of the FEV and FVC values were obtained by univariate analysis. Results: The calculated FEV and FVC values were significantly higher (p < 0.05) than those observed by spirometry. Conclusion: The correction factors incorporated in spirometers imported from Europe no longer seem appropriate to measure the physical characteristics of African subjects. The differences between the two methods of assessment should be used as new ethnic correction factors.

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“…COPD is the second leading cause of death in Nepal 4. COPD management in low/middle-income countries is suboptimal with diagnostic tests and medications largely unavailable or unaffordable for most people 5. Additionally, prior research has documented gaps in mid-level providers’ diagnostic and clinical decision-making skills in similar settings in Nepal6 and India 7…”

Section: Introductionmentioning

confidence: 99%

Implementing a quality improvement initiative for the management of chronic obstructive pulmonary disease in rural Nepal

Mehanni¹,

Jha

Kumar

et al. 2019

BMJ Open Qual

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BackgroundChronic obstructive pulmonary disease accounts for a significant portion of the world’s morbidity and mortality, and disproportionately affects low/middle-income countries. Chronic obstructive pulmonary disease management in low-resource settings is suboptimal with diagnostics, medications and high-quality, evidence-based care largely unavailable or unaffordable for most people. In early 2016, we aimed to improve the quality of chronic obstructive pulmonary disease management at Bayalpata Hospital in rural Achham, Nepal. Given that quality improvement infrastructure is limited in our setting, we also aimed to model the use of an electronic health record system for quality improvement, and to build local quality improvement capacity.DesignUsing international chronic obstructive pulmonary disease guidelines, the quality improvement team designed a locally adapted chronic obstructive pulmonary disease protocol which was subsequently converted into an electronic health record template. Over several Plan-Do-Study-Act cycles, the team rolled out a multifaceted intervention including educational sessions, reminders, as well as audits and feedback.ResultsThe rate of oral corticosteroid prescriptions for acute exacerbations of chronic obstructive pulmonary disease increased from 14% at baseline to >60% by month 7, with the mean monthly rate maintained above this level for the remainder of the initiative. The process measure of chronic obstructive pulmonary disease template completion rate increased from 44% at baseline to >60% by month 2 and remained between 50% and 70% for the remainder of the initiative.ConclusionThis case study demonstrates the feasibility of robust quality improvement programmes in rural settings and the essential role of capacity building in ensuring sustainability. It also highlights how individual quality improvement initiatives can catalyse systems-level improvements, which in turn create a stronger foundation for continuous quality improvement and healthcare system strengthening.

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Access to affordable medicines and diagnostic tests for asthma and COPD in sub Saharan Africa: the Ugandan perspective

Cited by 44 publications

References 9 publications

Diagnosis and Management of Ataxia-Telangiectasia in Resource-Limited Settings

Diagnosis and Management of Ataxia-Telangiectasia in Resource-Limited Settings

FVC and FEV Reference Values for Beninese Individuals Aged 17 - 20 Years

Implementing a quality improvement initiative for the management of chronic obstructive pulmonary disease in rural Nepal

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