Browsing by Subject "Non-communicable disease"

The prevalence of hyperlipidemia, along with other non-communicable diseases, is on the rise in low- and middle-income countries. Given the resource-limited setting, a myriad of diagnostic challenges exist with traditional laboratory-based lipid tests, including mobility, timeliness, and laboratory infrastructure. Novel technology in the form of "point of care" devices seeks to overcome such barriers by providing immediate results without dependency on significant laboratory infrastructure. CardioChek PA (Polymer Technology Systems, Inc., Indianapolis, United States) is a point of care lipid measuring device and is readily available in Kenya. However, it has not been validated in this setting. In this study, I assess the accuracy of CardioChek PA with respect to standard laboratory-based testing, which is currently the gold standard.

In Webuye, Kenya, two blood samples were collected from 246 subjects to simultaneously measure the lipid levels via both CardioChek PA and the gold standard. All subjects were adults, and geographic stratified sampling methods were applied. Statistical analysis of the novel device's accuracy was based on percent bias, which is the standardized approach established by the National Cholesterol Education Program (NCEP) of the National Institute of Health (NIH). The NCEP suggests that percent bias be ≤±3% for low-density lipoprotein (LDL) cholesterol, ≤±5% for high-density lipoprotein (HDL) cholesterol, ≤±5% for total cholesterol (TC), and ≤±4% for triglycerides (TG). Misclassification rates and absolute percent bias were also analyzed.

This study found the CardioChek PA analyzer to be substantially inaccurate for LDL cholesterol (-25.9% bias), HDL cholesterol (-8.2% bias), and TC (-15.9% bias). For TG, the CardioChek PA performed well with a percent bias of 0.03%. However, the TG absolute percent bias (27.7%) and proportion of patients outside of the NCEP range (85%) reflected substantial inaccuracy of measurements. Moreover, those patients at higher risk of complications from hyperlipidemia were most likely to be misclassified into a lower risk category. Thus, we conclude that CardioChek PA is inaccurate and not suitable for our clinical setting. Furthermore, the findings highlight the need to validate new diagnostic tools in the appropriate setting prior to scale up regardless of its potential for novel utility.

Background: In recent decades there has been an escalating epidemic of diabetes in Ghana. However, there has been little research on the economic burdens associated with diabetes in Ghana, despite diabetes's costly nature. This study investigated economic burdens and financial protections of households with diabetes patient(s) in urban Ghana.

Methods: Questionnaire-based interviews were conducted with 40 diabetes patients and their household heads in two urban communities in the city of Accra, Ghana. Information was obtained regarding participants' demographic and socioeconomic characteristics, patterns of healthcare utilization, direct and indirect costs, and financial protections pertaining to diabetes treatment and management. Cost-­of-­illness analysis and catastrophic health expenditure computation were conducted to investigate the costs associated with diabetes and households' affordability. Statistical tests were also conducted to analyze the effect of the National Health Insurance Scheme (NHIS) on the costs associated with diabetes.

Results: The total cost of diabetes for 40 households was estimated to be 14,989 cedis/month, of which 66.5% was direct cost and 30.2% was indirect cost. 52.9% of the households occurred catastrophic health expenditure. The means of outpatient and inpatient expenditure were 136 and 418 Cedi/month, respectively. NHIS had a positive financial protection effect on the economic burden of diabetes, while this effect was diminished by deficiencies in NHIS. Extended family was the main resource of financial support for diabetes treatment and management.

Conclusion: The economic burden of diabetes is high in urban Ghana, with a catastrophic effect on households. Except for NHIS, patients' financial support mainly comes from personal resources rather than public resources. Social supports and improvements in NHIS are needed to protect households with diabetes patient(s) against financial risks.

Background: Primary healthcare is an important facet of non-communicable disease treatment and eHealth is a viable strategy to strengthen PHC in urban low-middle income settings such as in Lima, Peru. This study aimed to describe the current use of eHealth technologies in primary healthcare settings in urban Peru, assess the perceived effectiveness of eHealth technologies in NCD service delivery at the PHC level, and identify barriers and facilitators to the utilization of eHealth technologies at the PHC level.

Methods: In-depth interviews using a semi-structured interview guide were conducted among identified and invited policy makers, researchers and experts, and healthcare workers in Lima, Peru. Three districts in Lima were selected and interviews with healthcare workers were conducted at facilities from those districts. Interviews were transcribed and thematic analysis was utilized to identify themes in the data.

Results: A total of 14 participants were interviewed, including 2 policymakers, 5 experts, and 7 healthcare workers. Current use of eHealth were electronic medical records and telehealth applications. Participants were in favor of eHealth use and perceived eHealth as being effective. Human resources and digital literacy were factors cited as facilitators while data security, political climate, and compatibility were seen as barriers to implementation and utilization of eHealth.

Conclusions: The use of eHealth in Peru is still in its early stages, particularly in PHC settings and for service delivery of NCDs. At the intersection of these three topics there has been little progression of integration and utilization. Sentiment towards eHealth among researchers, policymakers, and healthcare workers is high and a number of barriers must be addressed to implement and utilize eHealth and reap its benefits.