Anti-diabetic drugs in the private and public sector in Dar es Salaam, Tanzania

Objectives: To compare availability, cost, affordability and sources of anti-diabetic drugs between private and public health facilities in Dar es Salaam, Tanzania. Design: Cross sectional descriptive study.Setting: Diabetic clinics in private and public health facilities in Dar es Salaam, Tanzania. Subjects: Eighty patients randomly selected and 45 health facility personnel staff working in the diabetic clinics. Semi-structured questionnaires and a checklist were used to collect the information. Results: Oral hypoglycaemic agents were available in all seven private and three public facilities that were studied. Private facilities stocked more types of oral hypoglycaemic agents than public facilities, which stocked only chlorpropamide and tolbutamide, based on the National Essential Drugs List. The cost of chlorpropamide was five times higher in private facilities compared to public facilities. Insulin was also available in all the facilities. The price of animal insulin in private health facilities was ten times that in public health facilities. Human insulin, which is generally more expensive than animal insulin, was only available in private facilities. Although prices were much lower in public facilities, affordability emerged as a common issue in both private and public facilities. Conclusions: Urban private health facilities offer a wider choice for the needs of diabetic patients but this advantage is compromised by higher prices as compared to public facilities as well as inconsistent supply across facilities. Public health facilities offer only a limited selection of essential oral hypoglycaemics and insulin but at a lower price and across all facilities. Twenty six per cent and 10% of patients in public and private facilities respectively are unable to afford anti-diabetic drugs. The need for intervention to increase affordability of anti-diabetic drugs is evident. Financing and cost of drugs needs to be addressed, either by means of health insurance or other mechanisms, in this era of increasing prevalence of diabetes mellitus among developing countries

Anti-Diabetic Drugs In The Private And Public Sector In Dar Es Salaam, Tanzania

Objectives: To compare availability, cost, affordability and sources of anti-diabeticdrugs between private and public health facilities in Dar es Salaam, Tanzania.Design: Cross sectional descriptive study.Setting: Diabetic clinics in private and public health facilities in Dar es Salaam,Tanzania.Subjects: Eighty patients randomly selected and 45 health facility personnel staffworking in the diabetic clinics. Semi-structured questionnaires and a checklist wereused to collect the information.Results: Oral hypoglycaemic agents were available in all seven private and three publicfacilities that were studied. Private facilities stocked more types of oral hypoglycaemicagents than public facilities, which stocked only chlorpropamide and tolbutamide,based on the National Essential Drugs List. The cost of chlorpropamide was five timeshigher in private facilities compared to public facilities. Insulin was also available inall the facilities. The price of animal insulin in private health facilities was ten timesthat in public health facilities. Human insulin, which is generally more expensive thananimal insulin, was only available in private facilities. Although prices were muchlower in public facilities, affordability emerged as a common issue in both privateand public facilities.Conclusions: Urban private health facilities offer a wider choice for the needs ofdiabetic patients but this advantage is compromised by higher prices as compared topublic facilities as well as inconsistent supply across facilities. Public health facilitiesoffer only a limited selection of essential oral hypoglycaemics and insulin but at alower price and across all facilities. Twenty six per cent and 10% of patients in publicand private facilities respectively are unable to afford anti-diabetic drugs. The needfor intervention to increase affordability of anti-diabetic drugs is evident. Financingand cost of drugs needs to be addressed, either by means of health insurance orother mechanisms, in this era of increasing prevalence of diabetes mellitus amongdeveloping countries

A Qualitative Exploration of the Mental Health and Psychosocial Contexts of HIV-Positive Adolescents in Tanzania

Although 85% of HIV-positive adolescents reside in sub-Saharan Africa, little is known about the psychosocial and mental health factors affecting their daily well-being. Identifying these contextual variables is key to development of culturally appropriate and effective interventions for this understudied and high-risk population. The purpose of this study was to identify salient psychosocial and mental health challenges confronted by HIV-positive youth in a resource-poor Tanzanian setting. A total of 24 qualitative interviews were conducted with a convenience sample of adolescents aged 12–24 receiving outpatient HIV care at a medical center in Moshi, Tanzania. All interviews were audio-recorded, transcribed, and coded using thematic analysis. Psychosocial challenges identified included loss of one or more parents, chronic domestic abuse, financial stressors restricting access to medical care and education, and high levels of internalized and community stigma among peers and other social contacts. Over half of youth (56%) reported difficulties coming to terms with their HIV diagnosis and espoused related feelings of self-blame. These findings highlight the urgent need to develop culturally proficient programs aimed at helping adolescents cope with these manifold challenges. Results from this study guided the development of Sauti ya Vijana (The Voice of Youth), a 10-session group mental health intervention designed to address the psychosocial and mental health needs of HIV-positive Tanzanian youth

H3Africa multi-centre study of the prevalence and environmental and genetic determinants of type 2 diabetes in sub-Saharan Africa: study protocol.

The burden and aetiology of type 2 diabetes (T2D) and its microvascular complications may be influenced by varying behavioural and lifestyle environments as well as by genetic susceptibility. These aspects of the epidemiology of T2D have not been reliably clarified in sub-Saharan Africa (SSA), highlighting the need for context-specific epidemiological studies with the statistical resolution to inform potential preventative and therapeutic strategies. Therefore, as part of the Human Heredity and Health in Africa (H3Africa) initiative, we designed a multi-site study comprising case collections and population-based surveys at 11 sites in eight countries across SSA. The goal is to recruit up to 6000 T2D participants and 6000 control participants. We will collect questionnaire data, biophysical measurements and biological samples for chronic disease traits, risk factors and genetic data on all study participants. Through integrating epidemiological and genomic techniques, the study provides a framework for assessing the burden, spectrum and environmental and genetic risk factors for T2D and its complications across SSA. With established mechanisms for fieldwork, data and sample collection and management, data-sharing and consent for re-approaching participants, the study will be a resource for future research studies, including longitudinal studies, prospective case ascertainment of incident disease and interventional studies

The need for an integrated approach for chronic disease research and care in Africa.

With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa

Macroalgae associated with Tanjung Adang Laut seagrass meadow, Sungai Pulai estuary, Johor, Malaysia, from 2015 to 2017

The seagrass meadow in Tanjung Adang Laut shoal in Johor, Malaysia, harbors a diverse macroalgal species assemblage with a wide range of forms from the simple crustose, foliose and filamentous to complex structures. Their co-existence with seagrasses contributes significantly to the structure and function of the ecosystem. A monthly survey of macroalgae using quadrats at 10 m intervals along two fixed-line transects and random quadrat samplings around the shoal was conducted from 2015 to 2017, during land reclamation in a nearby area, to assess their species diversity, life forms, and coverage. A total of 38 species of macroalgae comprising 16 Chlorophyta, 7 Ochrophyta, and 15 Rhodophyta were present with the majority of macroalgae being epipelic. In 2015 and 2016, the macroalgae attained maximum coverage from February to May with 94–100% and 88–100% coverage, respectively, and declined in June. In 2017, the macroalgae massively proliferated from February to April with 83–100% coverage and declined in May. Amphiroa fragilissima was the dominant species followed by Hydropuntia edulis, Gracilaria salicornia, Stypopodium zonale and Avrainvillea erecta in both quadrats along the line transects and random quadrats. In Tanjung Adang Laut shoal there were a temporary shift of plant population from a decline in seagrass to an increase or mass proliferation of specific macroalgae species, e.g., A. fragilissima, H. edulis and G. salicornia, which suggests the influence of increased development pressures and environmental disturbance in the nearby area

The need for an integrated approach for chronic disease research and care in Africa

With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa

Integrating diabetes, hypertension and HIV care in sub-Saharan Africa: a Delphi consensus study on international best practice

Background: Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. The aim of this study was to identify key components, outcomes, and best practice in integrated service provision for the prevention, identification and treatment of HIV, hypertension and diabetes. Methods: An international, multi stakeholder e-Delphi consensus study was conducted over two successive rounds. In Round 1, 24 participants were asked to score 27 statements, under the headings ‘Service Provision’ and ‘Benefits of Integration’, by importance. In Round 2, the 16 participants who completed Round 1 were shown the distribution of scores from other participants along with the score that they attributed to an outcome and were asked to reflect on the score they gave, based on the scores of the other participants and then to rescore if they wished to. Nine participants completed Round 2. Results: Based on the Round 1 ranking, 19 of the 27 outcomes met the 70% threshold for consensus. Four additional outcomes suggested by participants in Round 1 were added to Round 2, and upon review by participants, 22 of the 31 outcomes met the consensus threshold. The five items participants scored from 7 to 9 in both rounds as essential for effective integrated healthcare delivery of health services for chronic conditions were improved data collection and surveillance of NCDs among people living with HIV to inform integrated NCD/HIV programme management, strengthened drug procurement systems, availability of equipment and access to relevant blood tests, health education for all chronic conditions, and enhanced continuity of care for patients with multimorbidity. Conclusions: This study highlights the outcomes which may form key components of future complex interventions to define a model of integrated healthcare delivery for diabetes, hypertension and HIV in sub-Saharan Africa

Integrating care for diabetes and hypertension with HIV care in sub-Saharan Africa: A scoping review.

Introduction: Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. A scoping review mapped extant policy and evidence based literature on the feasibility of integrating NCD care with HIV in the region. Methods: A scoping review methodology was utilised to conduct a systematic search of peer-reviewed and grey literature published in English language and with no date limitation. A systematic search was conducted on PubMed, Embase, CINAHL, and the Cochrane library. The initial search identified 231 records considered for inclusion in this review. Twelve duplicate records were removed. The remaining 219 records were screened by title and abstract of which 165 records were excluded and 54 records were selected for full-text review. A further 16 records were excluded due to a lack of relevance or the unavailability of the full text article. Finally, 38 were charted and analysed thematically. Results: Thirty-eight studies were included. These comprised a range of different models to integrate NCD and HIV care in the region, reflecting differences in health system environments, and disease epidemiology. The studies provide a variety of evidence that integration of HIV and NCD care can be feasible and can improve clinical effectiveness and identify barriers and facilitators to integration and task shifting. The review confirms that integrated HIV and NCD care services is by-and-large feasible, being both clinically effective and cost-effective. Conclusion: The review may inform the understanding of how best to develop an integrated model of care service by reducing barriers to uptake, linkage and retention in HIV, diabetes and hypertension treatment in SSA countries