Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework.
Toward the sustainability of health interventions implemented in sub-Saharan Africa: a systematic review and conceptual framework.
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DOI：
10.1186/s13012-016-0392-8
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发表时间：
2016-03-23
期刊：
影响因子：
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通讯作者：
Ogedegebe G
中科院分区：
文献类型：
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作者：
Iwelunmor J;Blackstone S;Veira D;Nwaozuru U;Airhihenbuwa C;Munodawafa D;Kalipeni E;Jutal A;Shelley D;Ogedegebe G
撒哈拉以南非洲(SSA)正面临疾病的双重负担，非传染性疾病(NCDs)的流行率不断上升，而传染病的负担仍然很高。尽管存在这些挑战，但仍有必要了解在撒哈拉以南非洲实施的卫生干预措施如何或在何种条件下得以持续。这项研究的目的是对实证文献进行系统的回顾，以探索在SSA实施的卫生干预措施是如何持续的。我们检索了MEDLINE、BioAbstrals、CINAHL、Embase、SqucINFO、SciELO、Web of Science和Google Scholar，以获得对撒哈拉以南非洲实施的卫生干预措施的可持续性进行调查的现有研究。我们还使用叙事合成来检查可能影响该区域卫生干预措施可持续性的因素，无论是积极的还是消极的。搜索确定了1819条引文，在删除重复项和我们的纳入/排除标准后，只有41篇论文符合纳入审查的条件。26个国家的代表参加了这次审查，其中肯尼亚和尼日利亚在审查可持续性的现有研究中最具代表性。研究时间从1996年到2015年。值得注意的是，这些研究中的大多数(30%)发表于2014年。使用的最常见框架是可持续性框架，其中四项研究对此进行了讨论。在41项研究中，19项(46%)报告了可持续成果，重点是传染病，艾滋病毒和艾滋病在大多数研究中占主导地位，其次是疟疾。在41项研究中，只有21项对可持续性有明确的定义。许多经审查的研究认为，社区自主权和动员是干预措施实施初期和实施后的干预可持续性的关键促进者，而社会和生态条件以及社会动乱是影响撒哈拉以南非洲干预措施持续的障碍。考虑到疾病、卫生保健人员短缺、卫生系统薄弱和资源有限的双重负担，在撒哈拉以南非洲实施的卫生干预措施的可持续性是不可避免的。我们提出了一个概念框架，提请注意可持续性是该区域实施的干预措施整个生命周期的核心组成部分。
Sub-Saharan Africa (SSA) is facing a double burden of disease with a rising prevalence of non-communicable diseases (NCDs) while the burden of communicable diseases (CDs) remains high. Despite these challenges, there remains a significant need to understand how or under what conditions health interventions implemented in sub-Saharan Africa are sustained. The purpose of this study was to conduct a systematic review of empirical literature to explore how health interventions implemented in SSA are sustained. We searched MEDLINE, Biological Abstracts, CINAHL, Embase, PsycInfo, SCIELO, Web of Science, and Google Scholar for available research investigating the sustainability of health interventions implemented in sub-Saharan Africa. We also used narrative synthesis to examine factors whether positive or negative that may influence the sustainability of health interventions in the region. The search identified 1819 citations, and following removal of duplicates and our inclusion/exclusion criteria, only 41 papers were eligible for inclusion in the review. Twenty-six countries were represented in this review, with Kenya and Nigeria having the most representation of available studies examining sustainability. Study dates ranged from 1996 to 2015. Of note, majority of these studies (30 %) were published in 2014. The most common framework utilized was the sustainability framework, which was discussed in four of the studies. Nineteen out of 41 studies (46 %) reported sustainability outcomes focused on communicable diseases, with HIV and AIDS represented in majority of the studies, followed by malaria. Only 21 out of 41 studies had clear definitions of sustainability. Community ownership and mobilization were recognized by many of the reviewed studies as crucial facilitators for intervention sustainability, both early on and after intervention implementation, while social and ecological conditions as well as societal upheavals were barriers that influenced the sustainment of interventions in sub-Saharan Africa. The sustainability of health interventions implemented in sub-Saharan Africa is inevitable given the double burden of diseases, health care worker shortage, weak health systems, and limited resources. We propose a conceptual framework that draws attention to sustainability as a core component of the overall life cycle of interventions implemented in the region.