An effective system of nurse‐led diabetes care in rural Africa

Abstract

We conclude that a simple protocol and education-based diabetes care system can be successfully introduced and run by nurses in rural Africa. Medium-term glycaemic improvements are excellent and the service has been very well received.

Feasibility and quality of cardiovascular disease prevention within a community-based health insurance program in rural Nigeria

“…A pilot study in a health facility nearby the study clinic with a similar patient population but without access to insurance showed that many patients did not return after initial diagnosis. Most other prospective studies from SSA describing CVD prevention care programs also report high loss-to-follow-up rates, the majority over 50% at 1 year of follow-up [20][21][22][23][24][25]. Studies reporting higher patient retention provided free care [15,26].…”

“…Studies from high-income countries examining blood pressure control in black populations, in whom blood pressure control is more difficult to achieve than in Caucasian populations, reported lower control rates than observed in our study, ranging from 14 to 59% [46][47][48][49] in treated hypertension patients. In addition, several prospective studies from SSA evaluated CVD prevention care [15,16,[20][21][22][23][24][25][26]50]. Most studies focused on treatment outcomes only, without reporting process outcomes or systematically collected data on health system-related barriers to guideline implementation.…”

The insulin dilemma in resource-limited countries. A way forward?

“…In South Africa [33] and Ghana [34] such restructuring of hospital services and educational initiatives have reduced in-patient mortality owing to hyperglycaemic emergencies. Nurse-led programmes using simple protocols and empowerment-based patient education have improved glycaemic control in people with type 2 diabetes in remote rural areas of Africa [35]. Twinning programmes between the USA and Eritrea [36], and the UK and Mozambique [15], have improved glycaemic control and/or insulin supply.…”

Costs of cardiovascular disease prevention care and scenarios for cost saving

“…In our study, doctors indicated that monthly visits were needed to ensure patient adherence, and dispensary of large drug stocks to patients was considered unsafe [13]. Monthly visits have also been reported in other studies from SSA [35,36]. In addition, previous studies typically used cost estimates based on the cheapest guideline-based drugs available on the international market.…”