Addressing the double-burden of diabetes and tuberculosis : Lessons from Kyrgyzstan

Background: The incidence of diabetes and tuberculosis co-morbidity is rising, yet little work has been done to understand potential implications for health systems, healthcare providers and individuals. Kyrgyzstan is a priority country for tuberculosis control and has a 5% prevalence of diabetes in adults, with many health system challenges for both conditions. Methods: Patient exit interviews collected data on demographic and socio-economic characteristics, health spending and care seeking for people with diabetes, tuberculosis and both diabetes and tuberculosis. Qualitative data were collected through semi-structured interviews with healthcare workers involved in diabetes and tuberculosis care, to understand delivery of care and how providers view effectiveness of care. Results: The experience of co-affected individuals within the health system is different than those just with tuberculosis or diabetes. Co-affected patients do not receive more care and also have different care for their tuberculosis than people with only tuberculosis. Very high levels of catastrophic spending are found among all groups despite these two conditions being included in the Kyrgyz state benefit package especially for medicines. Conclusions: This study highlights that different patterns of service provision by disease group are found. Although Kyrgyzstan has often been cited as an example in terms of health reforms and developing Primary Health Care, this study highlights the challenge of managing conditions that are viewed as "too complicated" for non-specialists and the impact this has on costs and management of individuals

Coping with the economic burden of Diabetes, TB and co-prevalence - Evidence from Bishkek, Kyrgyzstan

Background: The increasing number of patients co-affected with Diabetes and TB may place individuals with low socio-economic status at particular risk of persistent poverty. Kyrgyz health sector reforms aim at reducing this burden, with the provision of essential health services free at the point of use through a State-Guaranteed Benefit Package (SGBP). However, despite a declining trend in out-of-pocket expenditure, there is still a considerable funding gap in the SGBP. Using data from Bishkek, Kyrgyzstan, this study aims to explore how households cope with the economic burden of Diabetes, TB and co-prevalence. Methods: This study uses cross-sectional data collected in 2010 from Diabetes and TB patients in Bishkek, Kyrgyzstan. Quantitative questionnaires were administered to 309 individuals capturing information on patients' socioeconomic status and a range of coping strategies. Coarsened exact matching (CEM) is used to generate socio-economically balanced patient groups. Descriptive statistics and logistic regression are used for data analysis. Results: TB patients are much younger than Diabetes and co-affected patients. Old age affects not only the health of the patients, but also the patient's socio-economic context. TB patients are more likely to be employed and to have higher incomes while Diabetes patients are more likely to be retired. Co-affected patients, despite being in the same age group as Diabetes patients, are less likely to receive pensions but often earn income in informal arrangements. Out-of-pocket (OOP) payments are higher for Diabetes care than for TB care. Diabetes patients cope with the economic burden by using social welfare support. TB patients are most often in a position to draw on income or savings. Co-affected patients are less likely to receive social welfare support than Diabetes patients. Catastrophic health spending is more likely in Diabetes and co-affected patients than in TB patients. Conclusions: This study shows that while OOP are moderate for TB affected patients, there are severe consequences for Diabetes affected patients. As a result of the underfunding of the SGBP, Diabetes and co-affected patients are challenged by OOP. Especially those who belong to lower socio-economic groups are challenged in coping with the economic burden

Синтез и рентгенографическое исследование феррита состава YbBiNaFe2O6,5

Способом высокотемпературной твердофазной реакции синтезирована сложная оксидная фаза состава YbBiNaFe2O6,5. Методом рентгенофазового анализа впервые исследована структура, определены тип сингонии, параметры элементарной ячейки, рентгенографические и пикнометрические плотности. Индицирование рентгенограммы проводили методом гомологии от исходной флюоритной структуры δ­Bі2O3.  Методом наименьших квадратов уточнены параметры кристаллической решетки. Параметры орторомбической решетки сложного смешанного феррита при значении числа формульных единиц Z=4 равны – а=5,2319, в=5,2186, с=7,5702 Å.  Корректность результатов индицирования рентгенограмм сложного смешанного феррита подтверждена хорошим соответствием экспериментальных и расчетных значений обратных величин квадратов межплоскостных расстояний (104/d2). Удовлетворительная согласованность величин рентгеновской и пикнометрической плотностей ρрент.=8,353, ρпикн.=8,328 г/см3 доказывает правильность результатов эксперимента. Проведен сравнительный анализ взаимосвязи параметров кристаллической решетки с параметрами кристаллических решеток исходного оксида δ­Bі2O3. Анализ показывает, что значения параметров «а» и «в» удовлетворительно совпадают с параметрами кристаллической решетки δ­Bі2O3, параметр «с» искажен от значения параметра «а» на √2

The Impact of Health Systems on Diabetes Care in Low and Lower Middle Income Countries

This review will highlight the current challenges and barriers to diabetes management in low and lower middle income countries using the World Health Organization's 6 Building Blocks for Health Systems (service delivery; healthcare workforce; information; medical products, vaccines and technologies; financing; and leadership and governance). Low and lower middle income countries are characterized by low levels of income and insufficient health expenditure. These countries face a shift in disease burden from communicable to non-communicable diseases including diabetes. Many argue that health systems in these countries do not have the capacity to meet the needs of people with chronic conditions such as diabetes. A variety of barriers exist in terms of organization of health systems and care, human resources, sufficient information for decision-making, availability and affordability of medicines, policies, and alleviating the financial burden of care. These health system barriers need to be addressed, taking into account the need to have diabetes included in the global development agenda and also tailoring the response to local contexts including the needs of people with diabetes