Examining the Ugandan health system's readiness to deliver rheumatic heart disease-related services.
Anti-Bacterial Agents
/ supply & distribution
Cardiovascular Agents
/ supply & distribution
Case Management
/ statistics & numerical data
Health Facilities
/ economics
Health Knowledge, Attitudes, Practice
Humans
Rheumatic Heart Disease
/ diagnosis
Secondary Prevention
/ statistics & numerical data
Uganda
Journal
PLoS neglected tropical diseases
ISSN: 1935-2735
Titre abrégé: PLoS Negl Trop Dis
Pays: United States
ID NLM: 101291488
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
24
07
2020
accepted:
20
01
2021
revised:
26
02
2021
pubmed:
17
2
2021
medline:
11
6
2021
entrez:
16
2
2021
Statut:
epublish
Résumé
In 2018, the World Health Assembly mandated Member States to take action on rheumatic heart disease (RHD), which persists in countries with weak health systems. We conducted an assessment of the current state of RHD-related healthcare in Uganda. This was a mixed-methods, deductive simultaneous design study conducted in four districts of Uganda. Using census sampling, we surveyed health facilities in each district using an RHD survey instrument that was modeled after the WHO SARA tool. We interviewed health workers with experience managing RHD, purposively sampling to ensure a range of qualification and geographic variation. Our final sample included 402 facilities and 36 health workers. We found major gaps in knowledge of clinical guidelines and availability of diagnostic tests. Antibiotics used in RHD prevention were widely available, but cardiovascular medications were scarce. Higher levels of service readiness were found among facilities in the western region (Mbarara district) and private facilities. Level III health centers were the most prepared for delivering secondary prevention. Health worker interviews revealed that limited awareness of RHD at the district level, lack of diagnostic tests and case management registries, and absence of clearly articulated RHD policies and budget prioritization were the main barriers to providing RHD-related healthcare. Uganda's readiness to implement the World Health Assembly RHD Resolution is low. The forthcoming national RHD strategy must focus on decentralizing RHD diagnosis and prevention to the district level, emphasizing specialized training of the primary healthcare workforce and strengthening supply chains of diagnostics and essential medicines.
Sections du résumé
BACKGROUND
In 2018, the World Health Assembly mandated Member States to take action on rheumatic heart disease (RHD), which persists in countries with weak health systems. We conducted an assessment of the current state of RHD-related healthcare in Uganda.
METHODOLOGY/PRINCIPAL FINDINGS
This was a mixed-methods, deductive simultaneous design study conducted in four districts of Uganda. Using census sampling, we surveyed health facilities in each district using an RHD survey instrument that was modeled after the WHO SARA tool. We interviewed health workers with experience managing RHD, purposively sampling to ensure a range of qualification and geographic variation. Our final sample included 402 facilities and 36 health workers. We found major gaps in knowledge of clinical guidelines and availability of diagnostic tests. Antibiotics used in RHD prevention were widely available, but cardiovascular medications were scarce. Higher levels of service readiness were found among facilities in the western region (Mbarara district) and private facilities. Level III health centers were the most prepared for delivering secondary prevention. Health worker interviews revealed that limited awareness of RHD at the district level, lack of diagnostic tests and case management registries, and absence of clearly articulated RHD policies and budget prioritization were the main barriers to providing RHD-related healthcare.
CONCLUSIONS/SIGNIFICANCE
Uganda's readiness to implement the World Health Assembly RHD Resolution is low. The forthcoming national RHD strategy must focus on decentralizing RHD diagnosis and prevention to the district level, emphasizing specialized training of the primary healthcare workforce and strengthening supply chains of diagnostics and essential medicines.
Identifiants
pubmed: 33591974
doi: 10.1371/journal.pntd.0009164
pii: PNTD-D-20-01335
pmc: PMC7909659
doi:
Substances chimiques
Anti-Bacterial Agents
0
Cardiovascular Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0009164Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Am Soc Echocardiogr. 2014 Jan;27(1):42-9
pubmed: 24183541
J Am Coll Cardiol. 2018 Sep 18;72(12):1397-1416
pubmed: 30213333
Glob Heart. 2020 Feb 20;15(1):18
pubmed: 32489791
J Pediatr. 1992 Oct;121(4):569-72
pubmed: 1403390
Heart. 2019 Jan;105(1):60-66
pubmed: 30068532
S Afr Med J. 2008 Oct;98(10):780-1
pubmed: 19115751
Eur Heart J. 2018 Dec 21;39(48):4233
pubmed: 30576471
Cardiovasc J Afr. 2008 May-Jun;19(3):135-40
pubmed: 18568172
Glob Heart. 2017 Mar;12(1):47-62
pubmed: 28336386
Eur Heart J. 2015 May 7;36(18):1115-22a
pubmed: 25425448
Circulation. 1985 Dec;72(6):1155-62
pubmed: 4064266
Cardiovasc J Afr. 2016 May/Jun 23;27(3):184-187
pubmed: 26815006
Sudan J Paediatr. 2015;15(2):37-42
pubmed: 27493434
J Am Heart Assoc. 2020 Aug 4;9(15):e016053
pubmed: 32750303
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
Afr Health Sci. 2015 Dec;15(4):1182-8
pubmed: 26958019
N Engl J Med. 2017 Aug 24;377(8):713-722
pubmed: 28834488
Cardiovasc J Afr. 2013 Apr;24(3):80-5
pubmed: 23736132
Heart. 2017 Dec;103(23):1874-1879
pubmed: 28490619
Circ Cardiovasc Qual Outcomes. 2017 Nov;10(11):
pubmed: 29133472