Integrating the Prevention and Control of Rheumatic Heart Disease into Country Health Systems: A Systematic Review and Meta-Analysis.
Integrating the Prevention and Control of Rheumatic Heart Disease into Country Health Systems: A Systematic Review and Meta-Analysis.
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DOI：
10.5334/gh.874
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发表时间：
2020-09-14
期刊：
影响因子：
3.7
通讯作者：
Engel ME
中科院分区：
文献类型：
--
作者：
Abrams J;Watkins DA;Abdullahi LH;Zühlke LJ;Engel ME
最近已就风湿性心脏病（一种在资源匮乏国家流行的可预防的心脏病）作出国家和国际政治承诺。为了为最佳实践提供信息并确定证据差距，我们评估了RHD预防和控制规划的有效性以及将其纳入地方卫生系统的程度和性质。我们使用先前发表的方案进行了系统回顾和荟萃分析，该方案包括对1990年1月至2019年7月期间发表的关于链球菌性咽炎、风湿热和/或RHD风险人群预防和控制规划的研究进行电子和手动检索。我们根据先前发布的框架和使用结果链框架的计划有效性分析了计划整合。我们使用随机效应模型对二级预防依从性进行meta分析。采用同行评议清单（CASP和PRISM）评估研究质量。普洛斯彼罗注册号：CRD42017076307。5项观察性研究符合纳入标准。在纳入卫生系统的范围和性质上，研究是相似的；没有方案是完全整合或不整合的。一项关于方案影响的研究报告。二级预防依从性在部分整合的RHD方案中得到改善（RR, 1.18 [95% CI， 1.03至1.36]，3项研究，n = 618）。两项研究的偏倚风险较低，其余三项研究的偏倚风险不确定。有证据表明，部分整合的RHD规划有利于一系列中期健康结果。这篇综述概述了目前整合的最佳做法，并确定了知识方面的主要差距，为未来RHD计划的设计和实施提供了一个起点。南非国家研究基金会。
National and international political commitments have been made recently on rheumatic heart disease (RHD), a preventable heart condition that is endemic in low-resource countries. To inform best practice and identify evidence gaps, we assessed the effectiveness of RHD prevention and control programmes and the extent and nature of their integration into local health systems. We conducted a systematic review and meta-analysis using a previously published protocol that included electronic and manual searches for studies published between January 1990 and July 2019 reporting on prevention and control programmes for populations at risk for streptococcal pharyngitis, rheumatic fever, and/or RHD. We analysed programme integration according to a previously published framework and programme effectiveness using a results-chain framework. We meta-analysed secondary prophylaxis adherence using random-effects models. Study quality was assessed using peer-reviewed checklists (CASP and PRISM). PROSPERO registration: CRD42017076307. Five observational studies met with the inclusion criteria. Studies were similar in extent and nature of integration into health systems; no programme was completely integrated or non-integrated. A single study reported on programme impact. Secondary prophylaxis adherence improved among partially integrated RHD programmes (RR, 1.18 [95% CI, 1.03 to 1.36], 3 studies, n = 618). Risk of bias was low in two studies, and indeterminable in the remaining three studies. There is evidence that partially integrated RHD programmes are beneficial for a range of intermediate health outcomes. This review provides a starting point for the design and implementation of future RHD programmes by outlining current best practice for integration and identifying key gaps in knowledge. National Research Foundation of South Africa.
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