Understanding non-communicable diseases: combining health surveillance with local knowledge to improve rural primary health care in South Africa.
Understanding non-communicable diseases: combining health surveillance with local knowledge to improve rural primary health care in South Africa.
复制标题
了解非传染性疾病：将卫生监测与当地知识相结合，改善南非农村初级卫生保健。
DOI：
10.1080/16549716.2020.1852781
复制
发表时间：
2021-01-01
影响因子：
2.6
通讯作者：
Twine R
中科院分区：
文献类型：
--
作者：
Cowan E;D'Ambruoso L;van der Merwe M;Witter S;Byass P;Ameh S;Wagner RG;Twine R
背景：非传染性疾病是一种非传染性的长期疾病，每年造成4000万人死亡。87%的非传染性疾病过早死亡发生在低收入和中等收入国家。目的：开发提供非传染性疾病死亡率的综合生物社会学帐户的方法；并探索扩展死亡率数据在初级卫生保健系统中的实用价值。方法：我们从研究区的研究项目中获得数据。对数据进行了三个步骤的分析：[a)分析非传染性疾病死亡率的水平、原因和情况[n=1,166]，包括口头尸检在内的最新人口普查数据，以及参与性研究提供的关于农村非传染性疾病患者生活经历的定性数据；[b]确定分析之间的趋同和分歧领域；[c)利用与卫生系统利益攸关方的接触，探讨数据的实际相关性。结果：在这种情况下，非传染性疾病在死亡率中占很大比例[36%]。退伍军人管理局的数据显示，在临终关怀中存在多种障碍。许多死亡归因于资源和卫生系统的问题[分别为21%和19%]。定性研究提供了丰富的补充细节，说明了风险产生、积累并表现为获得临终关怀的过程、与慢性贫困有关的问题以及诊所对低质量护理的看法。对实际相关性的探讨表明，非传染性疾病服务长期资金不足，迫切需要关于非传染性疾病负担的有力、及时的数据。结论：VA数据使NCD死亡率的重大负担得以量化，并揭示了死亡时及周围的获取障碍。定性研究将这些障碍与背景联系起来，解释了它们如何以及为什么存在和持续。卫生系统分析显示，分配给非传染性疾病的资源短缺，需要强有力的研究来提供与当地相关的证据，以组织和提供护理。语用学、跨学科和混合方法分析提供了复杂问题的相关表述，以提供更有效的回应。
Background: NCDs are non-infectious, long-term conditions that account for 40 million deaths per annum. 87% of premature NCD mortality occurs in low- and middle-income countries. Objective: The aims were:develop methods to provide integrated biosocial accounts of NCD mortality; and explore the practical utility of extended mortality data for the primary health care system. Methods: We drew on data from research programmes in the study area. Data were analysed in three steps: [a]analysis of levels, causes and circumstances of NCD mortality [n = 4,166] from routine census updates including Verbal Autopsy and of qualitative data on lived experiences of NCDs in rural villages from participatory research; [b] identifying areas of convergence and divergence between the analyses; and [c]exploration of the practical relevance of the data drawing on engagements with health systems stakeholders. Results: NCDs constituted a significant proportion of mortality in this setting [36%]. VA data revealed multiple barriers to access in end-of-life care. Many deaths were attributed to problems with resources and health systems [21%;19% respectively]. The qualitative research provided rich complementary detail on the processes through which risk originates, accumulates and is expressed in access to end-of-life care, related to chronic poverty and perceptions of poor quality care in clinics. The exploration of practical relevance revealed chronic under-funding for NCD services, and an acute need for robust, timely data on the NCD burden. Conclusions: VA data allowed a significant burden of NCD mortality to be quantified and revealed barriers to access at and around the time of death. Qualitative research contextualised these barriers, providing explanations of how and why they exist and persist. Health systems analysis revealed shortages of resources allocated to NCDs and a need for robust research to provide locally relevant evidence to organise and deliver care. Pragmatic interdisciplinary and mixed method analysis provides relevant renditions of complex problems to inform more effective responses.
登录
查看更多内容
影响因子：
168.9
作者：
Alwan, Ala;MacLean, David R.;Bettcher, Douglas
通讯作者：
Bettcher, Douglas
DOI：
10.2471/blt.06.036574
发表时间：
2007-11-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Janssens, B;Van Damme, W;Zachariah, R
通讯作者：
Zachariah, R
影响因子：
7.2
作者：
Hullur, Nitya;D'Ambruoso, Lucia;Byass, Peter
通讯作者：
Byass, Peter
影响因子：
168.9
作者：
AbouZahr, Carla;Cleland, John;Szreter, Simon
通讯作者：
Szreter, Simon
影响因子：
5.5
作者：
Fottrell, Edward;Byass, Peter
通讯作者：
Byass, Peter