Association between country preparedness indicators and quality clinical care for cardiovascular disease risk factors in 44 lower- and middle-income countries:A multicountry analysis of survey data

BackgroundCardiovascular diseases are leading causes of death, globally, and health systems that deliver quality clinical care are needed to manage an increasing number of people with risk factors for these diseases. Indicators of preparedness of countries to manage cardiovascular disease risk factors (CVDRFs) are regularly collected by ministries of health and global health agencies. We aimed to assess whether these indicators are associated with patient receipt of quality clinical care.Methods and findingsWe did a secondary analysis of cross-sectional, nationally representative, individual-patient data from 187,552 people with hypertension (mean age 48.1 years, 53.5% female) living in 43 low- and middle-income countries (LMICs) and 40,795 people with diabetes (mean age 52.2 years, 57.7% female) living in 28 LMICs on progress through cascades of care (condition diagnosed, treated, or controlled) for diabetes or hypertension, to indicate outcomes of provision of quality clinical care. Data were extracted from national-level World Health Organization (WHO) Stepwise Approach to Surveillance (STEPS), or other similar household surveys, conducted between July 2005 and November 2016. We used mixed-effects logistic regression to estimate associations between each quality clinical care outcome and indicators of country development (gross domestic product [GDP] per capita or Human Development Index [HDI]); national capacity for the prevention and control of noncommunicable diseases ('NCD readiness indicators' from surveys done by WHO); health system finance (domestic government expenditure on health [as percentage of GDP], private, and out-of-pocket expenditure on health [both as percentage of current]); and health service readiness (number of physicians, nurses, or hospital beds per 1,000 people) and performance (neonatal mortality rate). All models were adjusted for individual-level predictors including age, sex, and education. In an exploratory analysis, we tested whether national-level data on facility preparedness for diabetes were positively associated with outcomes. Associations were inconsistent between indicators and quality clinical care outcomes. For hypertension, GDP and HDI were both positively associated with each outcome. Of the 33 relationships tested between NCD readiness indicators and outcomes, only two showed a significant positive association: presence of guidelines with being diagnosed (odds ratio [OR], 1.86 [95% CI 1.08-3.21], p = 0.03) and availability of funding with being controlled (OR, 2.26 [95% CI 1.09-4.69], p = 0.03). Hospital beds (OR, 1.14 [95% CI 1.02-1.27], p = 0.02), nurses/midwives (OR, 1.24 [95% CI 1.06-1.44], p = 0.006), and physicians (OR, 1.21 [95% CI 1.11-1.32], p ConclusionIn this study, we observed that indicators of country preparedness to deal with CVDRFs are poor proxies for quality clinical care received by patients for hypertension and diabetes. The major implication is that assessments of countries' preparedness to manage CVDRFs should not rely on proxies; rather, it should involve direct assessment of quality clinical care

2. Non-Communicable Diseases, NCD Program Managers and the Politics of Progress

2.1 Background Non-communicable diseases (NCDs) are a defining problem of the twenty-first century, with an estimated economic loss of 7 trillion US dollars (USD) and counting to low- and middle-income countries (LMICs) between 2011 and 2025. By 2020, NCDs are expected to cause seven out of every ten deaths in developing countries. This challenge raises many questions, including how to raise the priority of NCDs on national policy agendas, augment capacities and identify resources to overcome..

Agricultura familiar para el desarrollo rural incluyente

Las comunidades indígenas Mayas de la península de Yucatán han practicado la antigua tradición de agricultura familiar, en particular los huertos caseros, para garantizar su seguridad alimentaria. Con el objetivo de mejorar la práctica tradicional considerando paradigmas de la ciencia moderna, por una parte, se colectaron datos para definir la complejidad estructural y diversidad funcional a partir de 20 huertos familiares en cinco comunidades: X - Maben, X - Pichil, X - Yatil, San José II y Melchor Ocampo; y por otra, se organizaron grupos de discusión para dilucidar la estrategia de gestión practicada por las comunidades nativas. Los resultados mostraron que los huertos son manejados principalmente por las mujeres. También mostraron que el propósito principal del crecimiento y mantenimiento de los huertos familiares es garantizar la producción de alimentos nutritivos durante todo el año. Y, por último que los huertos caseros también sirven para propósitos secundarios tales como la provisión de productos y servicios para la medicina tradicional. El estudio sugiere que se debe de promover e invertir en huertos caseros para mejorar las estrategias de desarrollo incluyente en ambientes socio-culturales y biofísicos similares

Waterpipe tobacco smoking (WTS) control policies:global analysis of available legislation and equity considerations

INTRODUCTION: The Framework Convention on Tobacco Control (FCTC) offers guidance on evidence-based policies to reduce tobacco consumption and its burden of disease. Recently, it has provided guidance for alternative tobacco products, such as the waterpipe. Waterpipe tobacco smoking (WTS) is prevalent worldwide and policies to address it need to take into consideration its specificities as a mode of smoking. In parallel, a growing body of literature points to the potential of evidence-based tobacco control policies to increase health inequities. This paper updates a previous global review of waterpipe tobacco policies and adds an equity lens to assess their impact on health inequities. METHODS: We reviewed policies that address WTS in 90 countries, including 10 with state-owned tobacco companies; 47 were included in our final analysis. We relied primarily on the Tobacco-Free Kids organisation's Tobacco Control Laws website, providing access to tobacco control laws globally. We categorised country tobacco policies by the clarity with which they defined and addressed waterpipe tobacco in relation to nine FCTC articles. We used the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status and Social capital) framework for the equity analysis, by reviewing equity considerations referenced in the policies of each country and including prevalence data disaggregated by equity axis and country where available. RESULTS: Our results revealed very limited attention to waterpipe policies overall, and to equity in such policies, and highlight the complexity of regulating WTS. We recommend that WTS policies and surveillance centre equity as a goal. CONCLUSIONS: Our recommendations can inform global policies to reduce WTS and its health consequences equitably across population groups.</p