Transcript Routine screening for NCDs in rural and urban sub

Universal Health Coverage: From Promise to Practice
... moving to the rear end of practice:
Develop and evaluate a piece of basic secondary disease prevention,
meant to contribute to UHC
Routine screening for NCDs in rural and urban sub-Saharan Africa
Routine screening for NCDs in rural and urban sub-Saharan Africa
Ellis Owusu-Dabo, PhD
Group Leader, Non-Communicable Diseases
Bernhard Nocht Institute for Tropical Medicine, Hamburg,
stationed in Kumasi, Ghana
Changing Patterns of Disease Burden in sub-Saharan Africa:
Building Research Capacity
for Non-Communicable and Infectious Disease Control
through District Health Empowerment (BRIDGE)
Kumasi Centre for Collaborative Research (KCCR)
Joint venture
of the Ministry of Health, Ghana,
Kwame Nkrumah University, Kumasi,
and Bernhard Nocht Institute, Hamburg,
Designed as a research platform
to support joint Ghanaian-international projects
Based
on a State Agreement of 1998,
which has recently been extended beyond 2018
Routine screening for NCDs in rural and urban sub-Saharan Africa
Situation
• Twenty years from now, NCDs will cause
the major disease burden in sub-Saharan Africa
• The causes of the increase are hypothetical
• In sub-Saharan Africa, disease prevention and health care are
designed for IDs – acute intervention (except HIV)
• NCDs require long-term follow-up of patients
• NCDs are in high-income countries predominantly diagnosed
by opportunistic health visits
Routine screening for NCDs in rural and urban sub-Saharan Africa
Partners
•
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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University of Ghana, Accra, Ghana
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Hospital Engineering Ltd, Tuttlingen, Germany, and Accra, Ghana
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University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hamburg Institute of International Economics, Hamburg, Germany
•
Technical University Dresden, Dresden, Germany
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Université d‘Antananarive, Madagascar
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Institut des Recherches en Sciences de la Santé, Ouagadougou, Burkina Faso
Routine screening for NCDs in rural and urban sub-Saharan Africa
Proposed Study Design (I)
•
Ensure support of MoH and local health administration
(District Health Management Teams)
•
Ensure availability of 4 essential drugs
(Glibenclamide, Metformin; Lisonopril, Nifedipine)
Routine screening for NCDs in rural and urban sub-Saharan Africa
Proposed Study Design (II)
Recruit one District Hospital (DH) each and associated Primary Health Centres (PHCs) of ...
rural,
poor urban,
rich urban districts
PHC
Private
Hospital?
DH
Management
Team
Central
Lab
Routine screening for NCDs in rural and urban sub-Saharan Africa
Proposed Study Design (III)
•
Introduce in PHCs
- simple NCD tests, i.e. for blood glucose, blood pressure, height and weight, spirometry
- simple and user-friendly documentation, incl. secured cloud, anonymisation option
- SOPs for consultations, treatments and DH referrals
•
Ensure/introduce in DHs
- the same diagnostics as in PHCs and access to Central Lab
- the same documentation as in PHCs
- SOPs for consultations, treatments and follow-ups
- under discussion: ultrasound, ECG, exercise ECG
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Establish Central Lab and introduce
- improved NCD routine of fasting glucose, GPT, cholesterol
- improved ID routine of bacterial culture and antibiotic resistance
- antibiotic stewardship for DHs
Routine screening for NCDs in rural and urban sub-Saharan Africa
Proposed Study Design (IV)
•
Establish Management Team incl. officers to co-ordinate training, technical development
with link to engineering, manufacturers
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Establish Central Lab incl. biochemistry, bacterial culture
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Continuously train district health staff, introduce incentives
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Monitor staff compliance, evaluate and possibly adopt suggestions for improvement
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Negotiate with Ghanaian MoH screening (as treatment) to be covered by
National Health Insurance
Routine screening for NCDs in rural and urban sub-Saharan Africa
Proposed Study Design (V)
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Evaluate usefulness of introduced devices (diagnoses with/without)
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Replicate and evaluate set-up in two more urban centres outside Ghana
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Approach an evaluation of the cost-effectiveness of introduced devices
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Compare NCD prevalences in the rural, poor urban and rich urban districts
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Have expert team search data for neglected/disregarded diseases
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Search for potential causes for changing disease patterns by estimating
- physical activities by interrogation
- dietary habits by interrogation
- infection histories by serology
- environmental toxin loads by HPLC and GC-MS
- social stress histories by hair cortisol layers
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Verify evidence by randomized studies based on 2010/2011 Ghana census
Routine screening for NCDs in rural and urban sub-Saharan Africa
Potential
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Addresses relevant issues, NCDs in SSA and antibiotic resistance
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Development of standard equipment and SOPs may facilitate quality management
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Development of standard equipment may reduce implementation costs
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Set-up esp. documentation may facilitate clinical trials
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Research component might hint at causes for change and, thereby, at prevention
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Research component might reveal additional targets for prevention in the North
Thank you