Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries.
Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries.
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DOI：
10.1136/bmjopen-2020-038842
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发表时间：
2020-10-10
期刊：
影响因子：
2.9
通讯作者：
Bukhman G
中科院分区：
文献类型：
--
作者：
Gupta N;Coates MM;Bekele A;Dupuy R;Fénelon DL;Gage AD;Getachew T;Karmacharya BM;Kwan GF;Lulebo AM;Masiye JK;Mayige MT;Ndour Mbaye M;Mridha MK;Park PH;Dagnaw WW;Wroe EB;Bukhman G
非传染性疾病和伤害在低收入国家的死亡率和发病率中占很大比例，其中许多发生在生命早期，而且比高收入国家更严重。我们的目的是评估各种急慢性NCDI疾病所需的基本设备和药物的可用性。对现有横断面调查数据进行二次分析。我们使用了来自孟加拉国、刚果民主共和国、埃塞俄比亚、海地、马拉维、尼泊尔、塞内加尔和坦桑尼亚的服务提供评估调查的数据，重点关注每个国家的一级公立转诊医院。我们确定了诊断和管理4种急性和9种慢性NCDI疾病所需的成套设备和药物，并确定了卫生设施中这些物品的可用性。总共包括797家医院。药物和设备可得性最高的是急性癫痫（国家估计为40%至95%）和1-2期高血压（28%至83%）。1型糖尿病（1%-70%）、2型糖尿病（3%-57%）、哮喘（0%-7%）和急性糖尿病（0%-26%）和哮喘（0%-4%）的可用性较低。很少有医院有治疗心力衰竭（0%-32%）、风湿性心脏病（0%-23%）、高血压急诊（0%-64%）或急性小手术（0%-5%）的设备或药物。慢性疼痛的数据仅限于两个国家。基本药物和设备的可得性低于以前设施报告的服务可得性。我们的研究结果表明，在8个低收入国家的一级转诊医院，各种非传染性疾病的基本设备和药物的可得性很低。有必要在现有护理平台中下放和整合国家自主发展方案的服务，并改进评估和监测，以充分实现全民健康覆盖。
Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions. Secondary analysis of existing cross-sectional survey data. We used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country. We defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities. Overall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1–2 hypertension (28%–83%). Availability was low for type 1 diabetes (1%–70%), type 2 diabetes (3%–57%), asthma (0%–7%) and acute presentations of diabetes (0%–26%) and asthma (0%–4%). Few hospitals had equipment or medications for heart failure (0%–32%), rheumatic heart disease (0%–23%), hypertensive emergencies (0%–64%) or acute minor surgical conditions (0%–5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability. Our findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.
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