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Background: With the double burden of rising chronic non-communicable diseases (NCDs) and persistent infectious diseases facing sub-Saharan Africa, integrated health service delivery strategies among resource-poor countries are needed. Our study explored the post-trial sustainability of a health system intervention to improve NCD care, introduced during a cluster randomised trial between 2013 and 2016 in Uganda, focusing on hypertension (HT) and type-2 diabetes mellitus (DM) services. In 2020, 19 of 38 primary care health facilities (HFs) that constituted the trial's original intervention arm until 2016 and 3 of 6 referral HFs that also received the intervention then, were evaluated on i) their facility performance (FPS) through health worker knowledge, and service availability and readiness (SAR), and ii) the quality-of-patient-care-and-experience (QoCE) received.
Methods: Cross-sectional data from the original trial (2016) and our study (2020) were compared. FPS included a clinical knowledge test with 222 health workers: 131 (2016) and 91 (2020) and a five-element SAR assessment of all 22 HFs. QoCE assessment was performed among 420 patients: 88 (2016) and 332 (2020). Using a pair-matched approach, FPS and QoCE summary scores were compared. Linear and random effects Tobit regression models were also analysed.
Results: The mean aggregate facility performance (FPS) in 2020 was lower than in 2016: 70.2 (95%CI = 66.0-74.5) vs. 74.8 (95%CI = 71.3-78.3) respectively, with no significant difference (p = 0.18). Mean scores declined in 4 of 5 SAR elements. Overall FPS was negatively affected by rural or urban HF location relative to peri-urban HFs (p < 0.01). FPS was not independently predicted but patient club functionality showed weak association (p = 0.09). QoCE declined slightly to 8.7 (95%CI = 8.4-91) in 2020 vs 9.5 (95%CI = 9.1-9.9) in 2016 (p = 0.02) while the proportion of patients receiving adequate quality care also declined slightly to 88.2% from 98.5% respectively, with no statistical difference (p = 0.20). Only the parent district weakly predicted QoCE (p = 0.05).
Conclusions: Four years after the end of research-related support, overall facility performance had declined as expected because of the interrupted supplies and a decline in regular supervision. However, both service availability and readiness and quality of HT/DM care were surprisingly well preserved. Sustainability of an NCD intervention in similar settings may remain achievable despite the funding instability following a trial's end but organisational measures to prepare for the post-trial phase should be taken early on in the intervention process.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10514956 | PMC |
http://dx.doi.org/10.1186/s12913-023-09983-7 | DOI Listing |
Mol Biol Rep
December 2024
Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Background: Blastocystis is a prevalent intestinal parasitic protist that infects both birds and animals. There are at least 44 subtypes (ST) of Blastocystis, with ST1-ST9 being found in humans. The correlation between specific subtypes and pathogenicity has not been definitively established.
View Article and Find Full Text PDFHeart Vessels
December 2024
Division of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, 86 Nishicho, Yonago, Japan.
The optimal procedural protocol for coronary stent deployment remains undetermined. Post-dilation with a high-pressure balloon is often performed to optimize the stent expansion. However, high-pressure dilation also carries the potential risk of coronary artery injury.
View Article and Find Full Text PDFRev Sci Instrum
December 2024
Lawrence Livermore National Laboratory, Livermore, California 94550, USA.
Ultra-intense short-pulse lasers interacting with matter are capable of generating exceptionally bright secondary radiation sources. The short pulse duration (picoseconds to nanoseconds), small source size (sub-mm), and comparable high peak flux to conventional single particle sources make them an attractive source for radiography using a combination of particle species, known as multimodal imaging. Simultaneous x-ray and MeV neutron imaging of multi-material objects can yield unique advantages for material segmentation and identification within the full sample.
View Article and Find Full Text PDFAllergy
December 2024
Department of Dermatology, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, St. Poelten, Austria.
Background: Birch pollen (BP) interacts with airway epithelial cells to cause allergic sensitization and allergy in predisposed individuals. However, the basic mechanisms underlying the clinical effects are poorly understood. Changes in gene expression and cytokine secretion in nasal mucosal cells upon BP exposure were determined in BP-allergic and non-allergic individuals.
View Article and Find Full Text PDFAJPM Focus
February 2025
Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland.
Introduction: Americans have increased their intake of food away from home, which is lower in quality and higher in calories than food prepared at home. The increase of operations that serve food also impacts the military nutrition environment-including all foods, beverages, and dietary supplements available to the military community-and its role in nutritional fitness.
Methods: As part of a pilot study, 5 military installations used the online Military Nutrition Environment Assessment Tool to evaluate their local food landscape.
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