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. Issue 7 (29th July 2022)

• Record Type: Journal Article
• Authors: Mulupi, Stephen; Ayakaka, Irene; Tolhurst, Rachel; Kozak, Nicole; Shayo, Elizabeth Henry; Abdalla, Elhafiz; Osman, Rashid; Egere, Uzochukwu; Mpagama, Stellah G; Chinouya, Martha; Chikaphupha, Kingsley Rex; ElSony, Asma; Meme, Helen; Oronje, Rose; Ntinginya, Nyanda Elias; Obasi, Angela; Taegtmeyer, Miriam
• Other Names: author non-byline.; Addo-Yobo Emmanuel author non-byline.; Allwood Brian author non-byline.; Banda Hastings author non-byline.; Bates Imelda author non-byline.; Binegdie Amsalu author non-byline.; Falade Adegoke author non-byline.; Khan Jahangir author non-byline.; Lesosky Maia author non-byline.; Mbatchou Bertrand author non-byline.; Mortimer Kevin author non-byline.; Mutayoba Beatrice author non-byline.; Niessen Louis author non-byline.; Rylance Jamie author non-byline.; Bertel Squire S author non-byline.; Worodria William author non-byline.; Zar Heather author non-byline.; Zulu Eliya author non-byline.; Zurba Lindsay author non-byline.
• Is Part Of: BMJ open. Volume 12:Issue 7(2022)
• Publication Date: 2022-07-29
• Subjects: Asthma -- Health policy -- Protocols & guidelines -- EDUCATION & TRAINING (see Medical Education & Training) -- PRIMARY CARE -- Chronic airways disease; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2021-052105
• Languages: English
• ISSNs: 2044-6055

Abstract

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.