Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

Godman, Brian; Basu, Debashis; Pillay, Yogan; Mwita, Julius Chacha; Rwegerera, Godfrey Mutashambara; Paramadhas, Bene D. Anand; Tiroyakgosi, Celda; Okwen, Patrick; Niba, Loveline Lum; Nonvignon, Justice; Sefah, Israel Abebrese; Oluka, Margaret; Guantai, Anastasia Nkatha; Kibuule, Dan; Kalemeera, Francis; Mubita, Mwangana; Fadare, Joseph; Ogunleye, Olayinka O; Distiller, Larry A.; Rampamba, Enos M; Wing, Jeffrey; Mueller, Debjani; Alfadl, Abubakr A.; Amu, Adefolarin A; Matsebula, Zinhle; Kalungia, Aubrey Chichonyi; Zaranyika, Trust; Masuka, Nyasha; Wale, Janney; Hill, Ruaraidh; Kurdi, Amanj; Timoney, Angela; Campbell, Stephen; Meyer, Johanna Catharina

doi:10.3389/fphar.2020.00108

Cited by 90 publications

(101 citation statements)

References 193 publications

(293 reference statements)

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“…We believe this is the first study to qualitatively identify key factors influencing prescribing practices and NSTG compliance across disease areas building on assessments of guideline adherence in specific treatment and disease areas as well as ways to improve the content and pragmatism of national STGs among sub-Saharan African countries [10,[16][17][18]. This is a concern given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa and their impact on morbidity, mortality and costs [5,[19][20][21][22][23][24][25][26][27]. The prescribing indicators were typically sub-optimal compared with the Namibia and WHO/INRUD standards, similar to other African countries [9,15].…”

Section: Discussionmentioning

confidence: 99%

Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

et al. 2020

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Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0 ± 1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the findings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare.

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Section: Discussionmentioning

confidence: 99%

Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

et al. 2020

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“…However, we need to be mindful of a range of healthcare issues including the unintended consequences on both health and socioeconomic circumstances. This builds on Table 3, as well as Tables 3A and 4A, for individual African countries combined with recommendations for all key stakeholder groups in Africa going forward in the management of both infectious and non-infectious diseases as well as clinical and economic issues surrounding fixed dose combinations (Godman et al, 2019;Godman et al, 2020a;Godman et al, 2020b;Godman et al, 2020c;Godman et al, 2020d).…”

Section: Key Lessons Among Individual African Countries and Implicatimentioning

confidence: 99%

“…• Enhance the professionalism of HCWs including initiatives to reduce inappropriate prescribing of antimicrobials where this occurs (Godman et al, 2020a;Khan et al, 2020 • Promote and fund operational/national research on the impact of COVID-19 on infectious diseases (including AMR) and non-infectious diseases especially the unintended consequences ( Table 3). This is particularly important in Africa where national programmes are just starting to address AMR as well as NCDs including CVD, diabetes, and mental health (Mendelson and Matsoso, 2015;Keates et al, 2017;Ghana Ministry of Health, 2018;Godman et al, 2020a;Godman et al, 2020b;Godman et al, 2020c) • Continue to promote research into potential risk factors for morbidity and mortality among African patients given the differences that can exist between patients in Africa and those in high income countries • Continue with research programmes aimed at mitigating against infectious diseases (including AMR) and non-infectious diseases across countries to add to the debate about the potential impact of unintended consequences • Instigate research into new ways to manage patients with both infectious diseases and NCDs where there are constraints on patient access including better use of new technologies including telemedicine and consultations through the internet/ mobile telephones NB: AMR, Antimicrobial Rsistance; CVD, Coronary Vascular Disease; EBM, Evidence-base medicine; HTA, Health Technology Assessment; NCDs, Noncommunicable diseases; PPE, Personal Protective Equipment; SME, Small and Medium size enterprise. BOX 2 | Health technology assessment/ evidence based medicine.…”

Section: Leadership and Governancementioning

confidence: 99%

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

Ogunleye

Basu

Mueller³

et al. 2020

Front. Pharmacol.

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163

215

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Background: The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. Objective: Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. Our Approach: Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. Ongoing Activities: Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on Ogunleye et al. COVID-19 in Africa NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. Conclusion: There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other.

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“…There is also a concern that low-and middle-income countries (LMICs) are less able to cope with pandemics despite experience with infectious diseases. This includes Africa which is already struggling with high rates of both infectious and non-infectious diseases [10,11], alongside a fragile health system. As a result, the United Nations and WHO predicted that at the end of April or beginning of May there could be up to 44 million cases of COVID-19 in the first year of the pandemic in Africa, with up to 190,000 deaths if containment measures failed [12].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 pandemic in resource-poor countries: challenges, experiences and opportunities in Ghana

Afriyie

Asare

Amponsah

et al. 2020

J Infect Dev Ctries

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The novel coronavirus, SARS-CoV-2, which causes COVID-19, is seen world-wide. In developing countries, adequate health facilities and staff numbers are a concern. Ghana recorded its first 2 cases of COVID-19 on 12 March 2020. On 30 March 2020, a partial lockdown for 14 days was imposed and later extended along with other measures. By the end of the initial lockdown, 19 April 2020, an estimated 86,000 people had been traced and 68,591 tests performed. Of the 68,591 tests, there were 1,042 (1.5%) positive cases, 9 deaths, and 99 recoveries, with Ghana ranked number one among African countries in administering tests per million people. Ghana’s effective track and trace system, as well as lockdown and other measures, have helped limit mortality with only 85 recorded deaths by 23 June 2020. Scientists from three facilities of the University of Ghana have also successfully sequenced the genomes of COVID-19 from 15 confirmed cases, and the Food and Drugs Authority in Ghana have also helped address shortages by fast-tracking certification of hand sanitizers and local production of 3.6 million standardized personal protective equipment. There has also been the development of prototypes of locally-manufactured mechanical ventilators to meet local need at intensive care units. Most people have also resorted to changing diets and the use of supplements to boost their immune system. Although initial results are encouraging, further research is needed to understand the dynamics of COVID-19 in Ghana and provide additional guidance.

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Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future

Cited by 90 publications

References 193 publications

Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

COVID-19 pandemic in resource-poor countries: challenges, experiences and opportunities in Ghana

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