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Mulupi, Stephen, Ayakaka, Irene, Tolhurst, Rachel 
ORCID: https://orcid.org/0000-0002-3005-6641, Kozak, Nicole, Shayo, Elizabeth, Abdalla, Elhafiz, Osman, Rashid, Egere, Uzochukwu ORCID: https://orcid.org/0000-0002-0282-6004, Mpagama, Stellah G, Chinouya, Martha, Chikaphupha, Kingsley Rex, ElSony, Asma, Meme, Helen, Oronje, Rose, Ntinginya, Nyanda Elias, Obasi, Angela ORCID: https://orcid.org/0000-0001-6801-8889 and Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536
(2022)
'What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries'. BMJ Open, Vol 12, Issue 7, e052105.
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Abstract
Objectives
Chronic respiratory diseases (CRD) are among the top four non-communicable diseases globally. They are associated with poor health and approximately 4 million deaths every year. The rising burden of CRD in low/middle-income countries will strain already weak health systems. This study aimed to explore the perspectives of healthcare workers and other health policy stakeholders on the barriers to effective diagnosis and management of CRD in Kenya, Malawi, Sudan, Tanzania and Uganda.
Study design
Qualitative descriptive study.
Settings
Primary, secondary and tertiary health facilities, government agencies and civil society organisations in five sub-Saharan African countries.
Participants
We purposively selected 60 national and district-level policy stakeholders, and 49 healthcare workers, based on their roles in policy decision-making or health provision, and conducted key informant interviews and in-depth interviews, respectively, between 2018 and 2019. Data were analysed through framework approach.
Results
We identified intersecting vicious cycles of neglect of CRD at strategic policy and healthcare facility levels. Lack of reliable data on burden of disease, due to weak information systems and diagnostic capacity, negatively affected inclusion in policy; this, in turn, was reflected by low budgetary allocations for diagnostic equipment, training and medicines. At the healthcare facility level, inadequate budgetary allocations constrained diagnostic capacity, quality of service delivery and collection of appropriate data, compounding the lack of routine data on burden of disease.
Conclusion
Health systems in the five countries are ill-equipped to respond to CRD, an issue that has been brought into sharp focus as countries plan for post-COVID-19 lung diseases. CRD are underdiagnosed, under-reported and underfunded, leading to a vicious cycle of invisibility and neglect. Appropriate diagnosis and management require health systems strengthening, particularly at the primary healthcare level.
| Item Type: | Article |
|---|---|
| Corporate Authors: | On behalf of The NIHR International Multidisciplinary Programme to Address Lung Health and TB in Africa (IMPALA) Consortium |
| Subjects: | W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Administration and Organization > WA 540 National and state health administration WF Respiratory System > WF 140 Diseases of the respiratory system (General) |
| Faculty: Department: | Clinical Sciences & International Health > International Public Health Department Education |
| Digital Object Identifer (DOI): | https://doi.org/10.1136/bmjopen-2021-052105 |
| SWORD Depositor: | JISC Pubrouter |
| Depositing User: | JISC Pubrouter |
| Date Deposited: | 05 Oct 2022 14:02 |
| Last Modified: | 06 Jun 2023 16:36 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/20920 |
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