Title
Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- And middle-income countries:a scoping review
Date Issued
21 November 2019
Access level
open access
Resource Type
review
Author(s)
Correia J.C.
Lachat S.
Lagger G.
Chappuis F.
Golay A.
Beran D.
Beran D.
Damasceno A.
Somerville C.
Suggs L.S.
Publisher(s)
BioMed Central
Abstract
Background: Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. Methods: Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. Results: 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). Conclusion: Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.
Volume
19
Issue
1
Language
English
OCDE Knowledge area
Políticas de salud, Servicios de salud
Scopus EID
2-s2.0-85075485304
PubMed ID
Source
BMC Public Health
ISSN of the container
14712458
Sponsor(s)
The COHESION (COmmunity HEalth System InnovatiON) Project is funded by the Swiss National Science Foundation and the Swiss Development Cooperation under the Swiss Program for Research on Global Issues for Development (grant number 160366, http://www.r4d.ch/) to DB. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Sources of information: Directorio de Producción Científica Scopus