Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey.
Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey.
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DOI：
10.1016/s2214-109x(14)70033-6
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发表时间：
2014-05
影响因子：
34.3
通讯作者：
Kapiga, Saidi
中科院分区：
文献类型：
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作者：
Peck, Robert;Mghamba, Janneth;Vanobberghen, Fiona;Kavishe, Bazil;Rugarabamu, Vivian;Smeeth, Liam;Hayes, Richard;Grosskurth, Heiner;Kapiga, Saidi
历史上，撒哈拉以南非洲的卫生设施主要管理急性传染病。关于非洲卫生设施为应对日益流行的慢性非传染性疾病做好准备的数据很少。我们评估了坦桑尼亚西北部卫生机构的非传染性疾病负担，并调查了卫生系统的优势以及在选定的非传染性疾病初级保健管理方面需要改进的领域。在2012年11月至2013年5月期间，我们对坦桑尼亚城市和农村的24个公共和非营利卫生设施（4家医院、8个卫生中心和12个药房）的代表性样本进行了横断面调查。我们对设施管理人员进行了结构化访谈，检查了资源，并对335名卫生保健工作者进行了自填问卷调查。我们将重点放在高血压、糖尿病和艾滋病毒（用于比较）上。我们的主要研究成果涉及服务提供、指南和用品的可用性、管理和培训系统以及人力资源的准备。在医院的成人门诊中，58%是慢性病，而保健中心的这一比例为20%，药房的这一比例为13%。在许多设施中，用于非传染性疾病初级保健的指南、诊断设备和一线药物治疗不足，管理、培训和报告系统薄弱。艾滋病毒服务占慢性病就诊的大多数，似乎比非传染性疾病服务更强大。10个（42%）设施有艾滋病毒指南，3个（13%）设施有非传染性疾病指南。261名（78%）卫生工作者对艾滋病毒有一定了解，而198名（59%）卫生工作者对高血压有一定了解，187名（56%）卫生工作者对糖尿病有一定了解。一般来说，较低级别设施的卫生系统较弱。一线卫生保健工作者（如非医生临床医生和护士）不具备非传染性疾病的知识和经验。例如，150名护士中只有74名（49%）对糖尿病护理至少有一定的了解，而150名高血压护士中有85名（57%），150名艾滋病毒护士中有119名（79%），150名护士中只有31名（21%）在过去3个月内见过5名以上糖尿病患者，而150名高血压护士中有50名（33%），150名艾滋病毒护士中有111名（74%）。坦桑尼亚非传染性疾病的大多数门诊服务是在医院提供的，尽管目前的政策规定保健中心和诊所应提供这种服务。我们确定了卫生系统中应该考虑的关键弱点（和优势），以改善非洲非传染性疾病的初级保健，并确定了艾滋病毒规划可以作为这些改进的模型和结构平台的方式。英国医学研究理事会。
Historically, health facilities in sub-Saharan Africa have mainly managed acute, infectious diseases. Few data exist for the preparedness of African health facilities to handle the growing epidemic of chronic, non-communicable diseases (NCDs). We assessed the burden of NCDs in health facilities in northwestern Tanzania and investigated the strengths of the health system and areas for improvement with regard to primary care management of selected NCDs. Between November, 2012, and May, 2013, we undertook a cross-sectional survey of a representative sample of 24 public and not-for-profit health facilities in urban and rural Tanzania (four hospitals, eight health centres, and 12 dispensaries). We did structured interviews of facility managers, inspected resources, and administered self-completed questionnaires to 335 health-care workers. We focused on hypertension, diabetes, and HIV (for comparison). Our key study outcomes related to service provision, availability of guidelines and supplies, management and training systems, and preparedness of human resources. Of adult outpatient visits to hospitals, 58% were for chronic diseases compared with 20% at health centres, and 13% at dispensaries. In many facilities, guidelines, diagnostic equipment, and first-line drug therapy for the primary care of NCDs were inadequate, and management, training, and reporting systems were weak. Services for HIV accounted for most chronic disease visits and seemed stronger than did services for NCDs. Ten (42%) facilities had guidelines for HIV whereas three (13%) facilities did for NCDs. 261 (78%) health workers showed fair knowledge of HIV, whereas 198 (59%) did for hypertension and 187 (56%) did for diabetes. Generally, health systems were weaker in lower-level facilities. Front-line health-care workers (such as non-medical-doctor clinicians and nurses) did not have knowledge and experience of NCDs. For example, only 74 (49%) of 150 nurses had at least fair knowledge of diabetes care compared with 85 (57%) of 150 for hyptertension and 119 (79%) of 150 for HIV, and only 31 (21%) of 150 had seen more than five patients with diabetes in the past 3 months compared with 50 (33%) of 150 for hypertension and 111 (74%) of 150 for HIV. Most outpatient services for NCDs in Tanzania are provided at hospitals, despite present policies stating that health centres and dispensaries should provide such services. We identified crucial weaknesses (and strengths) in health systems that should be considered to improve primary care for NCDs in Africa and identified ways that HIV programmes could serve as a model and structural platform for these improvements. UK Medical Research Council.