Exploring chronic disease in Bolivia: A cross-sectional study in La Paz

Abstract

PurposeThis study seeks to develop an understanding that can guide development of programs to improve health and care for individuals with Non-Communicable Diseases (NCDs) in La Paz, Bolivia, where NCDs are prevalent and primary care systems are weak. This exploratory investigation examines the characteristics of chronic disease patients in the region, key health related behaviors, and their perceptions of the care that they receive. The longer-term goal is to lay groundwork for interventional studies based on the principles of the Chronic Care Model (CCM).Subjects and methodsThe study is based on two surveys of adults (> 18 years old) administered in 2014 in La Paz, Bolivia. A total of 1165 adult patients participated in the first screening survey. A post-screening second survey, administered only on those who qualified based on Survey 1, collected more detailed information about the subjects’ general health and health related personal circumstances, several health behaviors, health literacy, and their perceptions of care received. A final data set of 651 merged records were used for analysis.ResultsCharacteristic of a low-income country, the majority of participants had low levels of education, income, health literacy and high rates of under/unemployment. Nearly 50% of participants reported 2 or more NCDs. Seventy-four percent (74%) of respondents reported low levels of medication adherence and 26% of the population was found to have an undiagnosed depressive disorder. Overall, the perception of care quality was low (60%), particularly in those under the age of 45. Significant relationships emerged between several sociodemographic characteristics, health behaviors, and perceptions that have major implications for improving NCD care in this population.ConclusionsThese findings illustrate some of the challenges facing low-income countries where reversing the tide of NCDs is of great importance. The prevalence of NCDs coupled with challenging social determinants of health, poor medication adherence, low health literacy, and perceptions of low quality of healthcare highlight several areas of opportunity for intervention.

Needs and resources of people with type 2 diabetes in peri-urban Cochabamba, Bolivia: a people-centred perspective

“…Bolivia is a LMIC with a human development index of 0.70 in 2018, ranked as 15th of the 20 countries in Latin-America [ 32 ]. It is characterised by a high prevalence of chronic disease and a weak PHC system [ 33 ] with a long history of selective programs and a biomedical hospital centric focus [ 34 ]. Notwithstanding the introduction in 2008 [ 35 ] of a public health care model based on intercultural community family health, encouraging broad participation while incorporating both Western and indigenous (traditional) medicines, progress has not been evaluated [ 36 , 37 ].…”

Prevalence and determinants of cardiovascular disease risk factors using the WHO STEPS approach in Cochabamba, Bolivia

“…Moreover, the planning units of the Departmental Health Services and municipal governments do not have estimates of the magnitude of the problem locally, and therefore no prioritized interventions based on their own population characteristics can be properly implemented [9–11]. The existing studies in Bolivia have reported a high prevalence of obesity (60.7%) [12], high blood pressure (36%) [13], alcohol consumption (85%) [14], and sedentarism (67.2%) [15]. Nevertheless, these studies were focused on a limited number of risk factors, several were hospital-based, and none of them used the World Health Organization (WHO) STEPS methodology (Surveillance of Noncommunicable Diseases), so that they lacked a comprehensive picture of current cardiovascular and behavioural risk factors at the population level.…”

Needs and resources of people with type 2 diabetes in peri-urban Cochabamba, Bolivia: A people-centred perspective.

“…Bolivia is a LMIC with a human development index of 0.70 in 2018, ranked as 15 th of the 20 countries in Latin-America [32]. It is characterised by a high prevalence of chronic disease and a weak PHC system [33] with a long history of selective programs and a biomedical hospital centric focus [34]. Notwithstanding the introduction in 2008 [35] of a public health care model based on intercultural community family health, encouraging broad participation while incorporating both Western and indigenous (traditional) medicines, progress has not been evaluated [36,37].…”