Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review

Christiani, Yodi; Dhippayom, Teerapon; Chaiyakunapruk, Nathorn

doi:10.3402/gha.v9.32505

Cited by 9 publications

(10 citation statements)

References 42 publications

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“…The socioeconomic inequalities we observed in the utilisation of hypertension and T2D management services in Indonesia are consistent with findings on socioeconomic inequalities in access to NCD‐related healthcare services in HICs and some LMICs . Our results can be interpreted in relation to three important, interrelated dimensions in access to health care: the approachability, availability and affordability of services .…”

Section: Discussionsupporting

confidence: 89%

“…Many LMICs struggle to provide adequate access to NCD management for all population groups, in particular for lower‐income groups . Multi‐country studies have shown that socioeconomic inequalities in the management and prevalence of NCDs exist in high‐income countries (HICs) and in some LMICs . The prevalence of NCDs is higher in lower‐socioeconomic groups, creating a sense of urgency for countries to design and implement strategies to safeguard access to NCD management services for those who need it most.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic inequalities in the utilisation of hypertension and type 2 diabetes management services in Indonesia

Mulyanto

Kringos

Kunst

2019

Tropical Med Int Health

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SummaryObjectivesTo describe socioeconomic inequalities in the utilisation of hypertension and type 2 diabetes (T2D) management services in the Indonesian population and to determine whether education level and geographical location contribute to inequalities.MethodsCross‐sectional study using data from the 2014 Indonesia Family Life Survey (N = 30 762 for hypertension; N = 6758 for T2D). Socioeconomic status was measured by household consumption. The prevalence of hypertension and T2D was determined using internationally standardised clinical measurement, while disease management was defined by participation in screening and current use of medication. The relative index of inequality (RII) was used to estimate inequalities, adjusted to education level and geographical location.ResultsFor all household consumption quintiles, we observed low rates of screening participation for T2D and low medication use in both hypertension and T2D. We found socioeconomic inequalities in screening participation for hypertension (RII 2.68, 95% CI 2.42–2.96) and T2D (RII 7.30, 95% CI 5.48–9.72) and also for medication use in hypertension (RII 3.09, 95% CI 2.28–4.18) and T2D (RII 2.81, 95% CI 1.09–7.27). Education level contributed to socioeconomic inequalities in screening utilisation for both hypertension and T2D. Geographical location contributed to inequalities in screening utilisation and medication use for T2D. Socioeconomic inequalities in medication use for hypertension and T2D were larger among men than women.ConclusionsLarge socioeconomic inequalities were found in the utilisation of hypertension and T2D management services in Indonesia. Improving affordability, availability and approachability of services is crucial to reduce such inequalities.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Socioeconomic inequalities in the utilisation of hypertension and type 2 diabetes management services in Indonesia

Mulyanto

Kringos

Kunst

2019

Tropical Med Int Health

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“…This limitation, if not corrected, will continue to hamper the effective management of the disease. The finding supports research highlighting that patients living in rural areas were at a greater disadvantage in accessing health care services and managing chronic diseases [15,26].…”

Section: Discussionsupporting

confidence: 81%

Risk Factors, Knowledge, Attitudes and Practices of Type 2 Diabetics Attending Industry, Campbellville Health Centers and West Demerara Hospital, Guyana

Mallampati¹

2021

ujph

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The objective of this study was to examine the risk factors, knowledge, attitudes, and practices of type 2 diabetic patients attending three health care facilities (Industry and Campbellville Health Centers and the West Demerara Regional Hospital) in Guyana, May and June 2019. This study utilized a quantitative, descriptive and cross-sectional approach. The sampling technique used was non-probability and purposive sampling. The participants included 114 diabetic patients attending three selected health centers in Guyana. The study used a pretested questionnaire to collect survey data. Data were analyzed using SPSS version 20.0. Statistical analysis methods were mean, median, standard deviation, percentages, cross-tabulation, p-value, chi-square, ANOVA and Friedman test. Study results indicated that risk factors such as age, ethnicity, family history, BMI had no significant relationship with the onset of diabetes among the study population. Findings revealed that the mean average of participants' RBS, BP, fasting blood sugar, HbA1C and lipid profile were high. Participants demonstrated an inadequate level of knowledge and practices. Some of the participants had challenges accessing specific laboratory tests and Insulin. Findings concluded that there is a critical need for improving diabetic knowledge and healthy practices among diabetic patients. Establishing culturally oriented and multi-sectoral diabetic self-care management programs is imperative to manage diabetes effectively.

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“…Barriers to accessing diabetes health care in developing countries include affordability, poor access to healthcare facilities and essential medicines, and a lack of sustainable financing and reliable supply systems (Table ). Patients with diabetes living in rural or remote areas, those with a low education level, and those with a low income or low SES have low access to diabetes medications, primarily due to inconsistent policies towards primary health care . The increasing cost of insulin and medications, primarily borne by underserved populations, is an additional area of concern …”

Section: Managementmentioning

confidence: 99%

Diabetes in developing countries

Misra

Gopalan

Jayawardena

et al. 2019

Journal of Diabetes

181

129

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Highlights• Diabetes in developing countries is increasing and often undiagnosed. In South Asians, diabetes and related metabolic abnormalities develop at a younger age and at a lower body mass index and waist circumference than in Whites. • Overall glycemic control and management of diabetes is suboptimal, driven by multiple factors (eg, unawareness, cost of drugs and insulin etc.), and the load of complications is high. • To stem this epidemic, strong actions for prevention and management are required using innovative and low-cost approaches. AbstractThere has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro-and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.

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Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review

Cited by 9 publications

References 42 publications

Socioeconomic inequalities in the utilisation of hypertension and type 2 diabetes management services in Indonesia

Socioeconomic inequalities in the utilisation of hypertension and type 2 diabetes management services in Indonesia

Risk Factors, Knowledge, Attitudes and Practices of Type 2 Diabetics Attending Industry, Campbellville Health Centers and West Demerara Hospital, Guyana

Diabetes in developing countries

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