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Article ; Online: An Exemplary National COVID-19 Vaccination

Sangay Phuntsho / Tshokey Tshokey / Mongal Singh Gurung / Sonam Wangdi / Sonam Wangchuk

Tropical Medicine and Infectious Disease, Vol 7, Iss 7, p

Lessons from Bhutan

2022 Volume 131

Abstract: Vaccination remains a key public health intervention against the COVID-19 pandemic. However, vaccine distribution and coverage are variable between countries due to access and implementation issues. Vaccine inequity was evident with some countries having ...

Abstract	Vaccination remains a key public health intervention against the COVID-19 pandemic. However, vaccine distribution and coverage are variable between countries due to access and implementation issues. Vaccine inequity was evident with some countries having no access to the vaccines while others have initiated multiple booster doses. We share Bhutan’s approach to COVID-19 vaccination and lessons learned during the successful conduct of a nationwide vaccination program. As of 12 December 2021, 80.3% of the Bhutanese population have received at least one dose of COVID-19 vaccine and 77.0% have received at least two doses. Considering age groups, 97.2% of adults (18 years) have received at least one dose and 93.6% have received at least two doses. The first dose coverage for the adolescents 12–17 years was 99.7% and second dose coverage was 92.3% since some were not yet due for their second dose at the time of writing this report. The well-established existing national immunization program was especially useful in the implementation of the national COVID-19 vaccination program. The Bhutan Vaccine System, a digital platform for registration and monitoring of vaccination, was rapidly developed and extensively utilized during the campaign. The selfless leadership of the king, the government, and prior detailed planning with multi-sectoral collaboration and coordination, was the key in this exemplary vaccination program. Bhutan has successfully vaccinated children between 5–11 years with high coverage and no serious issues. Many adults have also received first and second booster doses, based on their risks and preferences.
Keywords	Bhutan ; COVID-19 ; vaccination program ; national campaign ; Medicine ; R
Subject code	070
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Menstrual Hygiene Management—Knowledge, Attitudes, and Practices Among Female College Students in Bhutan

Tashi Tshomo / Mongal Singh Gurung / Safieh Shah / Julita Gil-Cuesta / Peter Maes / Rinchen Wangdi / Jamba Tobden

Frontiers in Reproductive Health, Vol

2021 Volume 3

Abstract: Background: Girls and women face substantial menstrual hygiene management (MHM) challenges in low- and middle-income countries. These challenges are related to inadequate knowledge and insufficient water, sanitation, and hygiene (WASH) facilities. ... ...

Abstract	Background: Girls and women face substantial menstrual hygiene management (MHM) challenges in low- and middle-income countries. These challenges are related to inadequate knowledge and insufficient water, sanitation, and hygiene (WASH) facilities. Currently, the literature on MHM among college-attending women in Bhutan is scarce. We aimed to explore the knowledge, attitudes, and practices (KAP) of female college students from all the 10 government colleges of Bhutan, documenting the conditions of available MHM facilities, from August to September 2018.Methods: A cross-sectional KAP survey was conducted with a random sample of female students from all years and a random sample of MHM facilities at each college and hostel. A questionnaire was adapted from a similar study conducted with school students in Bhutan. Socio-demographics, overall KAP findings, and differences in KAP between first and final year students were analyzed; college and hostel toilets were self-reported and directly observed.Results: In the survey, 1,010 participants completed the self-administered questionnaire. The comprehensive knowledge of menstruation was found to be low (35.5%) among participants. Half of the participants (50.3%) reported their mother as the source of information, and 35.1% of the participants agreed that women should not enter a shrine during menstruation. It was also reported that approximately 4% of median monthly pocket money was spent on the absorbents, and 96.9% of absorbents were wrapped before disposal. Half of the participants (55.1%) reported that their daily activities were affected due to menstruation, and 24.2% of the female students missed college due to dysmenorrhea. One-fifth of the participants (21.3%) reported unavailability of water in college, 80.1% of the participants reported absence of soap for hand washing, and 24.1% described no bins for disposal. The participants also reported that in 33.7% of hostel toilets, the door locks were missing. The direct observations also had similar ...
Keywords	knowledge ; attitudes ; practice ; menstruation ; menstrual cycle ; dysmenorrhea ; Reproduction ; QH471-489 ; Medicine (General) ; R5-920
Subject code	150 ; 410
Language	English
Publishing date	2021-08-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Journal ; Article ; Online: Factors associated with delivery at home in Bhutan

Mongal Singh Gurung / Dorji Pelzom / Sonam Wangdi / Tashi Tshomo / Pema Lethro / Tashi Dema

findings from the National Health Survey 2012

2018

Abstract: Background Despite Bhutan’s remarkable progress in the area of maternal and child health duringthe era of the Millennium Development Goals, a large proportion of pregnant women are still deliveringat home with no skilled attendant. Limited empirical ... ...

Abstract	Background Despite Bhutan’s remarkable progress in the area of maternal and child health duringthe era of the Millennium Development Goals, a large proportion of pregnant women are still deliveringat home with no skilled attendant. Limited empirical studies have been carried out to understand thefactors associated with delivery at home in Bhutan.Methods This cross-sectional analytical study used secondary data collected in the nationallyrepresentative National Health Survey 2012. The survey included a total of 2213 women aged15–49 years who had a live birth in the 2 years preceding the survey and were selected usingmultistage stratified cluster sampling. Weighted analysis was done to evaluate determinants for theplace of delivery. Unadjusted and adjusted prevalence ratios with 95% confidence intervals (CIs) werecalculated to assess the possible association of factors with home delivery.Results Out of 2213 women aged 15–49 years who had a live birth in the 2 years preceding thesurvey, 73.7% had an institutional delivery. Coverage of institutional delivery ranged from 49.4% inZhemgang district to 96.1% in Paro district. Women in the poorest wealth quintile were 7.35 timesmore likely to have a birth at home compared to women in the richest quintile (adjusted prevalenceratio [aPR]: 7.35, 95% CI: 2.59–20.9). The older mothers aged 30–49 years were 0.79 times(aPR: 0.79, 95% CI: 0.70–0.88) less likely to have a home delivery than mothers aged 15–19 years.Women who had fewer than four antenatal care visits were 1.50 times (aPR: 1.50, 95% CI: 1.35–1.66)more likely to give birth at home compared to those who had four or more visits. The mothers givingbirth for a third or more time were 1.88 times (aPR: 1.88, 95% CI: 1.60–2.22) more likely to give birthat home compared to those giving birth for the first time. Women living in rural areas were 2.87 times(aPR: 2.87, 95% CI: 1.42–5.77) more likely to deliver at home compared to those living in urban areasand women living in the eastern region of the country were 1.35 times ...
Keywords	Bhutan ; childbirth ; home delivery ; institutional delivery ; place of delivery
Language	English
Publisher	World Health Organization. Regional Office for South-East Asia
Document type	Journal ; Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Journal ; Article ; Online: Transforming health care through Bhutan’s digital health strategy

Mongal Singh Gurung / Garab Dorji / Sonalini Khetrapal / Sungsup Ra / Giridhara R Babu / Ramesh S Krishnamurthy

progress to date

2019

Abstract: Bhutan, a landlocked country in the eastern Himalayas with some of the most rugged and mountainousterrain in the world, is actively engaged in digital health strategy reforms aimed at improving theefficiency of the health information system. Aligned with ...

Abstract	Bhutan, a landlocked country in the eastern Himalayas with some of the most rugged and mountainousterrain in the world, is actively engaged in digital health strategy reforms aimed at improving theefficiency of the health information system. Aligned with Bhutan’s e-Government master plan, theNational eHealth strategy and action plan aims to improve health by empowering health-care providersand citizens through technology and by enabling data exchange for service delivery. The strategy hasfour primary areas of focus: (i) ensuring digital health governance arrangements; (ii) concentratingon strong foundations in terms of infrastructure and standards; (iii) prioritizing improvements in thecurrent health system in a phased, selective manner; and (iv) building the digital skills and knowledgeof health workers. With support from the Asian Development Bank and the World Health Organization,phase 1 of the strategy has been completed and the blueprint for the digital health information systemis in development. Phase 2 of the strategy will be implemented during 2020–2023 and will include workon (i) identity management for the health workforce; (ii) the implementation of a master patient indexand a secure longitudinal patient information system; and (iii) enabling all health facilities to access thesystems. Bhutan’s eHealth strategy has the potential to fundamentally transform the delivery of healthservices, strengthen primary health care and enable the development of a “One Health” public healthsurveillance system. 77 82
Keywords	Health Information Systems
Language	English
Publisher	World Health Organization. Regional Office for South-East Asia
Document type	Journal ; Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Alarming prevalence and clustering of modifiable noncommunicable disease risk factors among adults in Bhutan

Dorji Pelzom / Petros Isaakidis / Myo Minn Oo / Mongal Singh Gurung / Pemba Yangchen

BMC Public Health, Vol 17, Iss 1, Pp 1-

a nationwide cross-sectional community survey

2017 Volume 11

Abstract: Abstract Background Bhutan is currently facing a double burden of non-communicable (NCDs) and communicable diseases, with rising trends of NCDs. The 2014 STEPS survey identified high prevalence of several NCD risk factors; however, associations with ... ...

Abstract	Abstract Background Bhutan is currently facing a double burden of non-communicable (NCDs) and communicable diseases, with rising trends of NCDs. The 2014 STEPS survey identified high prevalence of several NCD risk factors; however, associations with socio-demographic characteristics as well as clustering of risk factors were not assessed. This study aimed to determine the distribution and clustering of modifiable NCD risk factors among adults in Bhutan and their demographic and social determinants. Methods This was secondary analysis of data from NCD Risk Factors WHO STEPS Survey 2014 in Bhutan. A weighted analysis was conducted to calculate the prevalence of NCD risk factors, and associations were explored using weighted log-binomial regression models. Results This study included 2822 Bhutanese aged 18–69 years; 52% were 18–39 years, 62% were female, and 69% were rural resident. Prevalence of high salt intake, unhealthy diet and tobacco use were 99, 67 and 25% respectively. Raised blood pressure was the commonest (36%) modifiable biological risk factor followed by overweight (33%). The median NCD risk factors per person was 3 (Inter Quartile Range: 2–4); 52.5%% had > = 3 risk factors. A statistically significant difference was found between male vs. female in alcohol consumption(aPR 0.71, 95% CI: 0.53–0.97), low physical activity(aPR 2.06, 95% CI: 1.54–2.75), impaired fasting glycaemia(aPR 1.24, 95% CI: 1.01–1.52), and being overweight(aPR 1.46, 95% CI: 1.31–1.63). Low physical activity was more common among those with secondary and above education level vs. those without any formal education(aPR 1.71, 95% CI: 1.24–2.35), and among those residing in urban areas vs. those in rural(aPR 3.43, 95% CI: 2.27–5.18). Older participants and urban residents were more likely to have > = 3 NCD risk factors compared to younger(aPR 1.46, 95% CI: 1.35–1.58) and rural residents(aPR 1.21, 95% CI: 1.10–1.32). Conclusion Lifestyle modifications at the population level are urgently required in Bhutan as several NCD risk ...
Keywords	Operation research ; SORT-IT ; WHO STEPS ; NCD ; Public aspects of medicine ; RA1-1270
Subject code	610
Language	English
Publishing date	2017-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Suicidal ideation and attempt among school going adolescents in Bhutan – a secondary analysis of a global school-based student health survey in Bhutan 2016

Tashi Dema / Jaya Prasad Tripathy / Sangay Thinley / Manju Rani / Tshering Dhendup / Chinmay Laxmeshwar / Karma Tenzin / Mongal Singh Gurung / Tashi Tshering / Dil Kumar Subba / Tashi Penjore / Karma Lhazeen

BMC Public Health, Vol 19, Iss 1, Pp 1-

2019 Volume 12

Abstract: Abstract Background Suicide is one of the leading causes of death and Disability Adjusted Life Years (DALYs) worldwide. The economic, emotional and human cost of suicidal behaviour to individuals, families, communities and society makes it a serious ... ...

Abstract	Abstract Background Suicide is one of the leading causes of death and Disability Adjusted Life Years (DALYs) worldwide. The economic, emotional and human cost of suicidal behaviour to individuals, families, communities and society makes it a serious public health issue. We aim to determine the prevalence and factors associated with self-reported suicidal behaviour (suicidal ideation and attempt) among school going adolescents (13–17 years). Methods This is a secondary analysis of a nationally representative data for Bhutan namely Global School Based Student Health Survey in 2016 which reports on various dimensions of adolescent health including suicidal behaviour. The survey employed a multistage sampling method to recruit participants aged 13–17 years (n = 5809) from 50 schools (25 each in rural and urban area). The survey used an anonymous self-administered pre-tested 84-item questionnaire. Weighted analysis was done. Adjusted prevalence ratios (aPRs) and adjusted Odds Ratios (aORs) have been presented with 95% confidence intervals (95% CI). Results A total of 667 (11.6%) adolescents reported considering a suicide attempt whereas 656 (11.3%) reported attempting suicide in the past 12 months. Among those reporting suicidal ideation, 388 (58.6%) reported attempting a suicide and 274 (41.4%) had ideation alone, whereas, 247 (38.9%) reported attempting a suicide without previous ideation. Female sex, food insecurity, physical attack, sexual violence, bullying, feeling of loneliness, low parental engagement, reported worry about lack of sleep, urge to use drugs/alcohol, smokeless tobacco use, drug abuse and parental smoking were the factors associated with suicidal attempt. All these factors except smokeless tobacco use and parental smoking were associated with suicidal ideation. Having helpful/close friends was found to be protective against suicide ideation. Conclusion Suicidal behaviour among school going adolescents in Bhutan is high and alarming, especially among girls. Bullying, sexual violence, feeling of ...
Keywords	Suicidal behaviour ; GSHS ; Adolescent ; Sexual violence ; Parental engagement ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2019-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Unmet need for hypercholesterolemia care in 35 low- and middle-income countries

Maja E Marcus / Cara Ebert / Pascal Geldsetzer / Michaela Theilmann / Brice Wilfried Bicaba / Glennis Andall-Brereton / Pascal Bovet / Farshad Farzadfar / Mongal Singh Gurung / Corine Houehanou / Mohammad-Reza Malekpour / Joao S Martins / Sahar Saeedi Moghaddam / Esmaeil Mohammadi / Bolormaa Norov / Sarah Quesnel-Crooks / Roy Wong-McClure / Justine I Davies / Mark A Hlatky /

Rifat Atun / Till W Bärnighausen / Lindsay M Jaacks / Jennifer Manne-Goehler / Sebastian Vollmer

PLoS Medicine, Vol 18, Iss 10, p e

A cross-sectional study of nationally representative surveys.

2021 Volume 1003841

Abstract: Background As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for ... ...

Abstract	Background As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. Methods and findings We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) ≥240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC <200 mg/dL or LDL-C <130 mg/dL). We further estimated how age, sex, education, body mass index (BMI), current smoking, having diabetes, and having hypertension are associated with cascade progression using modified Poisson regression models with survey fixed effects. High TC prevalence was 7.1% (95% CI: 6.8% to 7.4%), and high LDL-C prevalence was 7.5% (95% CI: 7.1% to 7.9%). The cascade analysis showed that 43% (95% CI: 40% to 45%) of study participants with high TC and 47% (95% CI: 44% to 50%) with high LDL-C ever had their cholesterol measured prior to the survey. About 31% (95% CI: 29% to 33%) and 36% (95% CI: 33% to 38%) were aware of their diagnosis; 29% (95% CI: 28% to 31%) and 33% (95% CI: 31% to 36%) were treated; 7% (95% CI: 6% to 9%) and 19% (95% CI: 18% to 21%) were controlled. We found substantial heterogeneity in cascade performance across countries and higher performances in upper-middle-income countries and the Eastern Mediterranean, Europe, ...
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Unmet need for hypercholesterolemia care in 35 low- and middle-income countries

Maja E. Marcus / Cara Ebert / Pascal Geldsetzer / Michaela Theilmann / Brice Wilfried Bicaba / Glennis Andall-Brereton / Pascal Bovet / Farshad Farzadfar / Mongal Singh Gurung / Corine Houehanou / Mohammad-Reza Malekpour / Joao S. Martins / Sahar Saeedi Moghaddam / Esmaeil Mohammadi / Bolormaa Norov / Sarah Quesnel-Crooks / Roy Wong-McClure / Justine I. Davies / Mark A. Hlatky /

Rifat Atun / Till W. Bärnighausen / Lindsay M. Jaacks / Jennifer Manne-Goehler / Sebastian Vollmer

PLoS Medicine, Vol 18, Iss

A cross-sectional study of nationally representative surveys

2021 Volume 10

Abstract	Background As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. Methods and findings We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) ≥240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC <200 mg/dL or LDL-C <130 mg/dL). We further estimated how age, sex, education, body mass index (BMI), current smoking, having diabetes, and having hypertension are associated with cascade progression using modified Poisson regression models with survey fixed effects. High TC prevalence was 7.1% (95% CI: 6.8% to 7.4%), and high LDL-C prevalence was 7.5% (95% CI: 7.1% to 7.9%). The cascade analysis showed that 43% (95% CI: 40% to 45%) of study participants with high TC and 47% (95% CI: 44% to 50%) with high LDL-C ever had their cholesterol measured prior to the survey. About 31% (95% CI: 29% to 33%) and 36% (95% CI: 33% to 38%) were aware of their diagnosis; 29% (95% CI: 28% to 31%) and 33% (95% CI: 31% to 36%) were treated; 7% (95% CI: 6% to 9%) and 19% (95% CI: 18% to 21%) were controlled. We found substantial heterogeneity in cascade performance across countries and higher performances in upper-middle-income countries and the Eastern Mediterranean, Europe, ...
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The state of diabetes treatment coverage in 55 low-income and middle-income countries

David Flood, MD / Jacqueline A Seiglie, MD / Matthew Dunn, MPH / Scott Tschida, MPhil / Michaela Theilmann, MA / Maja E Marcus, MA / Garry Brian, MBChB / Bolormaa Norov, MD / Mary T Mayige, PhD / Mongal Singh Gurung, PhD / Krishna K Aryal, PhD / Demetre Labadarios, ProfMBChB / Maria Dorobantu, ProfFESC / Bahendeka K Silver, MBChB / Pascal Bovet, MD / Jutta M Adelin Jorgensen, MD / David Guwatudde, ProfPhD / Corine Houehanou, MD / Glennis Andall-Brereton, PhD /

Sarah Quesnel-Crooks, MSc / Lela Sturua, PhD / Farshad Farzadfar, ProfMD / Sahar Saeedi Moghaddam, MSc / Rifat Atun, ProfFRCP / Sebastian Vollmer, ProfPhD / Till W Bärnighausen, ProfMD / Justine I Davies, ProfMD / Deborah J Wexler, MD / Pascal Geldsetzer, ScD / Peter Rohloff, MD / Manuel Ramírez-Zea, MD / Michele Heisler, ProfMD / Jennifer Manne-Goehler, MD

The Lancet. Healthy Longevity, Vol 2, Iss 6, Pp e340-e

a cross-sectional study of nationally representative, individual-level data in 680 102 adults

2021 Volume 351

Abstract: Summary: Background: Approximately 80% of the 463 million adults worldwide with diabetes live in low-income and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the scarce ... ...

Abstract	Summary: Background: Approximately 80% of the 463 million adults worldwide with diabetes live in low-income and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the scarce availability of nationally representative data on the current patterns of treatment coverage. The objectives of this study were to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment; and to describe country-level and individual-level characteristics that are associated with treatment. Methods: We did a cross-sectional analysis of pooled, individual data from 55 nationally representative surveys in LMICs. Our primary outcome of self-reported diabetes treatment coverage was based on population-level monitoring indicators recommended in the 2020 WHO Package of Essential Noncommunicable Disease Interventions. Surveys were included if they were done in 2008 or after in an LMIC, as classified by the World Bank in the year the survey was done; were nationally representative; had individual-level data; contained a diabetes biomarker (fasting glucose, random glucose, or glycated haemoglobin); and had data on one or more diabetes treatments. Our sample included non-pregnant individuals with an available diabetes biomarker who were at least 25 years of age. We assessed coverage of three pharmacological and three non-pharmacological treatments among people with diabetes. At the country level, we estimated the proportion of individuals reporting coverage by per-capita gross national income and geographical region. At the individual level, we used logistic regression models to assess coverage along several key individual characteristics including sex, age, body-mass index, wealth quintile, and educational attainment. In the primary analysis, we scaled sample weights such that countries were weighted equally. Findings: The final pooled sample from the 55 LMICs included 680 102 ...
Keywords	Geriatrics ; RC952-954.6 ; Medicine ; R
Subject code	360
Language	English
Publishing date	2021-06-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Health system performance for people with diabetes in 28 low- and middle-income countries

Jennifer Manne-Goehler / Pascal Geldsetzer / Kokou Agoudavi / Glennis Andall-Brereton / Krishna K Aryal / Brice Wilfried Bicaba / Pascal Bovet / Garry Brian / Maria Dorobantu / Gladwell Gathecha / Mongal Singh Gurung / David Guwatudde / Mohamed Msaidie / Corine Houehanou / Dismand Houinato / Jutta Mari Adelin Jorgensen / Gibson B Kagaruki / Khem B Karki / Demetre Labadarios /

Joao S Martins / Mary T Mayige / Roy Wong McClure / Omar Mwalim / Joseph Kibachio Mwangi / Bolormaa Norov / Sarah Quesnel-Crooks / Bahendeka K Silver / Lela Sturua / Lindiwe Tsabedze / Chea Stanford Wesseh / Andrew Stokes / Maja Marcus / Cara Ebert / Justine I Davies / Sebastian Vollmer / Rifat Atun / Till W Bärnighausen / Lindsay M Jaacks

PLoS Medicine, Vol 16, Iss 3, p e

A cross-sectional study of nationally representative surveys.

2019 Volume 1002751

Abstract: BACKGROUND:The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the ... ...

Abstract	BACKGROUND:The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. METHODS AND FINDINGS:We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%-9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%-5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%-78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. CONCLUSIONS:The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2019-03-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Inter-library loan at ZB MED

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Kategorien

Inter-library loan at ZB MED