Effectiveness of self-financing patient-led support groups in the management of hypertension and diabetes in low- and middle-income countries: systematic review

OBJECTIVE: There is insufficient evidence on the role of self-financing patient support groups in the control of blood pressure (BP) and/or diabetes in low- and middle-income countries (LMICs). We conducted a systematic review to investigate the effectiveness of these groups in BP and glycaemic control. METHODS: We searched PubMed, Embase, SCOPUS, Web of Science, Global Health, African Journals Online, CINAHL and African Index Medicus for published peer-reviewed articles from inception up to November 2021. Grey literature was obtained from OpenGrey. Studies on patient support groups for hypertension and/or diabetes with a component of pooling financial resources, conducted in LMICs, were included. Narrative reviews, commentaries, editorials and articles published in languages other than English and French were excluded. Study quality and risk of bias were assessed using the National Institutes of Health Quality assessment tool and the revised Cochrane risk-of-bias tool. Results are reported according to PRISMA guidelines. RESULTS: Of 724 records screened, three studies met the criteria: two trials conducted in Kenya and a retrospective cohort study conducted in Cambodia. All studies reported improvement in BP control after 12 months follow-up with reductions in systolic BP of 23, 14.8, and 16.9 mmHg, respectively. Two studies reported diabetes parameters. The first reported improvement in HbA1c (reduction from baseline 10.8%, to 10.6% at 6 months) and random blood sugar (baseline 8.9 mmol/L, to 8.5 mmol/L at 6 months) but these changes did not achieve statistical significance. The second reported a reduction in fasting blood glucose (baseline-216 mg/dl, 12 months-159 mg/dl) in diabetic patients on medication. CONCLUSION: Self-financing patient support groups for diabetes and hypertension are potentially effective in the control of BP and diabetes in LMICs. More studies are needed to add to the scarce evidence base on the role of self-financing patient support groups

Attitudes and perceptions towards epilepsy in an onchocerciasis-endemic region of Tanzania: a mixed approach to determine the magnitude and driving factors

Background: Epilepsy remains a significant public health concern in Tanzania, with affected individuals enduring stigma, whether through actions or perceptions. Myths, misunderstandings, and misconceptions about epilepsy have persisted due to a multitude of factors. Here, we assessed attitudes and perceptions toward epilepsy in Mahenge. Methods: A cross-sectional study utilising a mixed-methods approach was undertaken in eight villages in the Ulanga district of Mahenge, integrating a semi-structured questionnaire and focus group discussions (FGDs). The questionnaire involved 778 community members, and 15 FGDs were conducted (seven groups with people with epilepsy and eight without). Descriptive statistics, chi-square, and logistic regression were used for quantitative analysis, while we used NVivo version 14 for thematic analysis of qualitative data. Results: Of 778 participants, over half were women (425, 54.6%) with a median age of 41 years (IQR: 30–55) and most had completed primary education (79.9%). The majority of participants were aware of epilepsy (96.8%), yet they displayed low knowledge (51%), negative attitudes (45.5%), and perceptions (42.1%) towards the disorder. A low level of understanding was significantly associated with negative attitudes (Adjusted Odds Ratio [AOR] = 1.89, 95%CI: 1.41–2.53) and perceptions (AOR = 3.22, 95%CI: 2.05–5.04) towards epilepsy. In the qualitative analysis, often hereditary factors and infections were named as causes of epilepsy, along with misconceptions involving witchcraft and divine punishment. There was also a misconception about the contagiousness of epilepsy. Traditional healers were often the initial point of treatment. Epilepsy-related stigma was evident, with individuals with epilepsy facing derogatory labels, social isolation, and barriers to education. Lastly, there was a lack of understanding regarding a possible association between epilepsy and onchocerciasis. Conclusions: Despite high awareness of epilepsy, there is insufficient understanding, negative attitudes, and perceptions, including misconceptions and stigma about this neurologic condition. Community-based education programmes are essential for promoting proper healthcare-seeking behaviour and dispelling myths

The psychology of the tropics : conceptions of tropical danger and lunacy in British East Africa

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

'Things that matter': missionaries, government, and patients in the shaping of Uganda's leprosy settlements, 1927-1951

This thesis examines the role of missionaries, the colonial government, and leprosy patients in the formation of leprosy settlements in Uganda, from the first inception of the settlements in 1927, until 1951 when the nature of leprosy control in Uganda changed, with the government appointment of a Protectorate leprologist and the creation of more treatment centres. It focuses on four leprosy settlements opened between 1930 and 1934 by the Anglican Church Missionary Society (CMS) and the British and Irish Catholic Franciscan Missionary Sisters for Africa (FMSA) and Mill Hill Mission (MHM). Firstly, this thesis explores the ways in which the differing goals, ideologies, and resources of the Protestant CMS and the Catholic FMSA and MHM shaped the formation of and social environment within leprosy settlements in a highly Christianised and denominationally divided Uganda. Secondly, it examines the relationship between the CMS and Franciscan leprosy missions and the government, exploring the cooperation and conflict that their spiritual and medical priorities had upon the social lives of patients within Uganda’s leprosy settlements. Thirdly, this thesis assesses the extent to which missionaries consciously endeavoured to engineer a social environment for leprosy patients within settlements that conformed to their ideal of Christianised, modern African communities, as well the roles that healthy and leprous Ugandans chose to play in response to these attempts at social engineering. Missionaries and Ugandan leprosy patients had different priorities, but far from being passive receptacles of the ‘civilising’ mission, most leprosy patients were active agents in pursuing their own medical, social, and economic priorities through life in the settlements.This thesis is not currently available in ORA

Psychiatry’s 'golden age': making sense of mental health care in Uganda, 1894-1972

This thesis investigates the emergence of an internationally renowned psychiatric community in Uganda. Starting at the beginning of colonial rule in 1894, it traces the changing nature of mental health care both within and beyond the state, examining the conditions that allowed psychiatry to develop as a significant intellectual tradition in the years following Independence in 1962. This ‘golden age’ of psychiatry saw Uganda establish itself as a leader of mental health care in Africa, an aspect of history that is all the more marked for its contrast with the almost complete collapse of mental health care after the expulsion of the Asian population by Idi Amin in 1972. Using a wide range of new source material, including interviews with psychiatrists, traditional healers, and community elders, this thesis pushes the history of psychiatry in Africa beyond the examination of government policy and colonial hegemony. It brings together the history of psychiatry with the histories of missionary medicine, medical education, and international health by asking what types of people, institutions, and organisations were involved in the provision of mental health care; how important the growth of Makerere Medical School was for intellectual and institutional psychiatry; and how ‘African’ mental health care had become by the end of the period. It presents a history of mental health care in a country that has tended to be overshadowed by Kenya in the historiography, yet whose engagement with medical missionaries and efforts to advance medical training meant that the trajectory of psychiatry came to be quite different. Focusing in particular on the significance of western-trained Ugandan medical practitioners for mental health care, the thesis not only analyses African psychiatrists as historical actors in their own right, but represents the first attempt to examine the development of psychiatric education in Africa.This thesis is not currently available via ORA

Women and childbirth in Haile Selassie's Ethiopia

As the first analytic history of Ethiopian medicine, this thesis explores the interchange between the institutional development of a national medical network and the lived experiences of women as patients and practitioners of medicine from the years 1940-1975. Using birth and gender as mechanisms to explore the nation's public health history allows me to pursue alternative threads of enquiry: I ask questions not only about state activities and policy pursuits, but also about the relevance and acceptance of those actions in the lives of the citizenry. This thesis is also the first medical history of a non-colonial African country, opening up new questions about the role of non-Western actors in the expansion of Western medicine in the twentieth century. I explore the ways in which the exceptional history of Ethiopia can be couched in existing narratives of African modernity, medicine, and birth history. Issues of local agency and the creation of new social elites in the pursuit of modernity are all pertinent to the case of Ethiopia. Through both extensive archival research and oral interviews of nearly 200 participants in Haile Selassie's medical campaigns, I argue that the extent to which the imperial medical project in Ethiopia 'succeeded' was highly predicated on pre-existing conditions of gender, class, and geography.This thesis is not currently available in OR

Women and childbirth in Haile Selassie's Ethiopia

As the first analytic history of Ethiopian medicine, this thesis explores the interchange between the institutional development of a national medical network and the lived experiences of women as patients and practitioners of medicine from the years 1940-1975. Using birth and gender as mechanisms to explore the nation's public health history allows me to pursue alternative threads of enquiry: I ask questions not only about state activities and policy pursuits, but also about the relevance and acceptance of those actions in the lives of the citizenry. This thesis is also the first medical history of a non-colonial African country, opening up new questions about the role of non-Western actors in the expansion of Western medicine in the twentieth century. I explore the ways in which the exceptional history of Ethiopia can be couched in existing narratives of African modernity, medicine, and birth history. Issues of local agency and the creation of new social elites in the pursuit of modernity are all pertinent to the case of Ethiopia. Through both extensive archival research and oral interviews of nearly 200 participants in Haile Selassie's medical campaigns, I argue that the extent to which the imperial medical project in Ethiopia 'succeeded' was highly predicated on pre-existing conditions of gender, class, and geography