Economic Consequences of Rheumatic Heart Disease in Northern and Central Uganda

Opara, Chinonso; Kawakatsu, Yoshito; Atala, Jenifer; Watkins, David

doi:10.1016/s0735-1097(20)34237-6

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“…For example, ongoing research by our group has begun to shed light on the significant transportation barriers and catastrophic out-of-pocket costs faced by Ugandans with RHD. [25] Additionally, solving all access barriers does not ensure that RHD outcomes will be improved: Low quality of care potentially wastes scarce resources and undermines trust in health care systems. Patient uptake of penicillin prophylaxis and appropriate use of medications like warfarin have been documented to be low, even among those receiving care at tertiary academic hospitals.…”

Section: Discussionmentioning

confidence: 99%

Examining the Ugandan health system’s readiness to deliver rheumatic heart disease-related services

Ndagire

Kawakatsu²,

Nalubwama³

et al. 2021

PLoS Negl Trop Dis

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Background In 2018, the World Health Assembly mandated Member States to take action on rheumatic heart disease (RHD), which persists in countries with weak health systems. We conducted an assessment of the current state of RHD-related healthcare in Uganda. Methodology/Principal findings This was a mixed-methods, deductive simultaneous design study conducted in four districts of Uganda. Using census sampling, we surveyed health facilities in each district using an RHD survey instrument that was modeled after the WHO SARA tool. We interviewed health workers with experience managing RHD, purposively sampling to ensure a range of qualification and geographic variation. Our final sample included 402 facilities and 36 health workers. We found major gaps in knowledge of clinical guidelines and availability of diagnostic tests. Antibiotics used in RHD prevention were widely available, but cardiovascular medications were scarce. Higher levels of service readiness were found among facilities in the western region (Mbarara district) and private facilities. Level III health centers were the most prepared for delivering secondary prevention. Health worker interviews revealed that limited awareness of RHD at the district level, lack of diagnostic tests and case management registries, and absence of clearly articulated RHD policies and budget prioritization were the main barriers to providing RHD-related healthcare. Conclusions/Significance Uganda’s readiness to implement the World Health Assembly RHD Resolution is low. The forthcoming national RHD strategy must focus on decentralizing RHD diagnosis and prevention to the district level, emphasizing specialized training of the primary healthcare workforce and strengthening supply chains of diagnostics and essential medicines.

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Section: Discussionmentioning

confidence: 99%