Strengthening the delivery of asthma and chronic obstructive pulmonary disease care at primary health-care facilities: study design of a cluster randomized controlled trial in Pakistan

Khan, Muhammad Amir; Ahmed, Manzoor; Anil, Shirin; Walley, John

doi:10.3402/gha.v8.28225

Cited by 14 publications

(23 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A study in Pakistan plans to target low resource settings using various approaches such as providing COPD care in the existing tuberculosis clinics. 175 …”

Section: Strategies To Aid the Diagnosis And Management Of Copd Patiementioning

confidence: 99%

Defining and targeting health disparities in chronic obstructive pulmonary disease

Pleasants

Riley

Mannino

2016

COPD

139

136

View full text Add to dashboard Cite

The global burden of chronic obstructive pulmonary disease (COPD) continues to grow in part due to better outcomes in other major diseases and in part because a substantial portion of the worldwide population continues to be exposed to inhalant toxins. However, a disproportionate burden of COPD occurs in people of low socioeconomic status (SES) due to differences in health behaviors, sociopolitical factors, and social and structural environmental exposures. Tobacco use, occupations with exposure to inhalant toxins, and indoor biomass fuel (BF) exposure are more common in low SES populations. Not only does SES affect the risk of developing COPD and etiologies, it is also associated with worsened COPD health outcomes. Effective interventions in these people are needed to decrease these disparities. Efforts that may help lessen these health inequities in low SES include 1) better surveillance targeting diagnosed and undiagnosed COPD in disadvantaged people, 2) educating the public and those involved in health care provision about the disease, 3) improving access to cost-effective and affordable health care, and 4) markedly increasing the efforts to prevent disease through smoking cessation, minimizing use and exposure to BF, and decreasing occupational exposures. COPD is considered to be one the most preventable major causes of death from a chronic disease in the world; therefore, effective interventions could have a major impact on reducing the global burden of the disease, especially in socioeconomically disadvantaged populations.

show abstract

“…A study in Pakistan plans to target low resource settings using various approaches such as providing COPD care in the existing tuberculosis clinics. 175 …”

Section: Strategies To Aid the Diagnosis And Management Of Copd Patiementioning

confidence: 99%

Defining and targeting health disparities in chronic obstructive pulmonary disease

Pleasants

Riley

Mannino

2016

COPD

139

136

View full text Add to dashboard Cite

show abstract

“… 4 – 6 Ninety per cent of COPD deaths now occur in LMICs. 7 – 10 However, in many of these countries, governments and medical professionals have not historically given CRDs the attention they deserve. We set out to review the literature on the epidemiology of CRDs in sub-Saharan Africa (SSA), the Middle East and North Africa (MENA) with a focus on asthma and COPD.…”

Section: Introductionmentioning

confidence: 99%

The epidemiology of noncommunicable respiratory disease in sub-Saharan Africa, the Middle East, and North Africa

Ahmed¹,

Robinson

Mortimer

2017

Mal. Med. J

View full text Add to dashboard Cite

Noncommunicable diseases (NCDs) are a major and increasing global health issue. The World Health Organization (WHO) estimates that NCDs represent 63% of all global deaths of which 3.9 million are due to chronic respiratory diseases (CRDs) and Chronic Obstructive Pulmonary Disease (COPD) in particular. COPD is now the third most common cause of death globally; 90% of these deaths occur in Low and Middle Income Countries (LMICs). COPD affects 329 million people, almost 5% of the world's population. In addition, asthma affects 334 million people, again representing almost 5% of the world's population. There is limited literature published on the epidemiology of COPD and Asthma from Sub-Saharan Africa (SSA) and Middle East and North Africa (MENA). Both diseases are under-diagnosed and underestimated in both SSA and MENA regions. The burden of COPD in sub-Saharan Africa is disputed and reports offer variable prevalence estimates, ranging from 4.1% to almost 22.2%. SSA and MENA countries report similar mortality rates from COPD of 18 per 100,000 population (2001 data). Asthma is a less common cause of death than COPD but is a major cause of morbidity; WHO estimates that there are 250,000 deaths per year from asthma, mainly in LMICs and it remains in the top twenty causes of disability in children globally. Risk factors for CRD are genetic and environmental; the latter dominated by air pollution exposures including tobacco smoke, household air pollution, outdoor air pollution and occupational exposures.

show abstract

“…Phased implementation provides an opportunity to develop a randomised controlled trial. Trial sites are randomly allocated to early-implementation ‘intervention’ sites, and outcomes compared with those from pre-implementation ‘control’ sites, to estimate the effectiveness of the package relative to the existing service [ 4 , 23 – 25 ]. External research support is generally needed to plan and execute a randomised controlled trial [ 26 ].…”

Section: Ten Stepsmentioning

confidence: 99%

Embedded health service development and research: why and how to do it (a ten-stage guide)

Walley

Witter

Haque

et al. 2018

Health Res Policy Sys

Self Cite

View full text Add to dashboard Cite

In a world of changing disease burdens, poor quality care and constrained health budgets, finding effective approaches to developing and implementing evidence-based health services is crucial. Much has been published on developing service tools and protocols, operational research and getting policy into practice but these are often undertaken in isolation from one another. This paper, based on 25 years of experience in a range of low and middle income contexts as well as wider literature, presents a systematic approach to connecting these activities in an embedded development and research approach. This approach can circumvent common problems such as lack of local ownership of new programmes, unrealistic resource requirements and poor implementation.We lay out a ten-step process, which is based on long-term partnerships and working within local systems and constraints and may be tailored to the context and needs. Service development and operational research is best prioritised, designed, conducted and replicated when it is embedded within ministry of health and national programmes. Care packages should from the outset be designed for scale-up, which is why the piloting stage is so crucial. In this way, the resulting package of care will be feasible within the context and will address local priorities. Researchers must be entrepreneurial and responsive to windows of funding for scale-up, working in real-world contexts where funding and decisions do not wait for evidence, so evidence generation has to be pragmatic to meet and ensure best use of the policy and financing cycles. The research should generate tested and easily usable tools, training materials and processes for use in scale-up. Development of the package should work within and strengthen the health system and other service delivery strategies to ensure that unintended negative consequences are minimised and that the strengthened systems support quality care and effective scale up of the package.While embedded development and research is promoted in theory, it is not yet practiced at scale by many initiatives, leading to wasted resources and un-sustained programmes. This guide presents a systematic and practical guide to support more effective engagements in future, both in developing interventions and supporting evidence-based scale-up.

show abstract

Strengthening the delivery of asthma and chronic obstructive pulmonary disease care at primary health-care facilities: study design of a cluster randomized controlled trial in Pakistan

Cited by 14 publications

References 21 publications

Defining and targeting health disparities in chronic obstructive pulmonary disease

Defining and targeting health disparities in chronic obstructive pulmonary disease

The epidemiology of noncommunicable respiratory disease in sub-Saharan Africa, the Middle East, and North Africa

Embedded health service development and research: why and how to do it (a ten-stage guide)

Contact Info

Product

Resources

About