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Diabetes is a significant public health issue that affects approximately one in 10 adults globally, with type 2 diabetes accounting for 90–95% of cases. This chronic condition causes considerable morbidity and mortality and is growing in impact, with cases projected to rise from 537 million in 202
...
1 to 784 million by 2045.1 As cases rise, it is imperative to ensure the healthcare workforce is prepared to care for affected individuals. However, there is a growing global shortage of healthcare workers, which was estimated, pre pandemic, to reach 15 million by 2030.2 Therefore, all of the healthcare workforce will need to be utilised to their fullest potential in order to address the growing global burden of diabetes. Pharmacists will continue to be essential in this endeavour.
more
The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults 2021
Flood, D.; Seiglie, J.A.; Dunn, M.; et al.
The Lancet Healthy Longevity Volume 2, Issue 6e340-e351June 2021
(2021)
CC2
Approximately 80% of the 463 million adults worldwide with diabetes live in low-income and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the scarce availability of nationally representative data on the current patterns
...
of treatment coverage. The objectives of this study were to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment; and to describe country-level and individual-level characteristics that are associated with treatment.
more
Since the discovery of insulin nearly 100 years ago, advances in diabetes treatments and therapies have transformed the lives of people
with diabetes (PwD), notably reducing the daily burden of its management.
Newer technologies, including those driven by artificial intelligence, have the potentia
...
l to further improve the quality of life of PwD and help
identify and diagnose people at risk of developing Type 2 diabetes and diabetes-related complications early. However, medical and technological advances alone are not enough to fix the diabetes challenge. It is also critical to acknowledge the complexity and the seriousness of diabetes, its impact on the quality of life and well-being of over 32 million PwD in the EU and the financial burden it represents for health systems and society at large.
more
It is now evident that we are living in a world of diabetes pandemic—despite the scientifically sound estimates, worldwide diabetes prevalence has been exceeding even the most pessimistic projections from the past. If we go back in history, it was estimated in 2004 that diabetes prevalence in 2030
...
would reach 366 million people. What actually happened was that the prevalence of 366 million people with diabetes was already reached in 2011, 19 years earlier than initially predicted. According to the latest projections, there would be 578 million people with diabetes in 2030, almost 60% more of what was estimated 15 years ago.
more
The document "Management of Type 2 Diabetes Mellitus" provides comprehensive guidelines for the diagnosis, prevention, and treatment of type 2 diabetes in adults. It emphasizes the importance of individualized glycemic targets, lifestyle interventions like diet and exercise, and the use of medicatio
...
ns such as metformin, SGLT2 inhibitors, and GLP1 receptor agonists to manage blood sugar levels and reduce long-term complications. The document also discusses the screening and management of comorbidities such as hypertension, hyperlipidemia, and diabetic complications like retinopathy, neuropathy, and nephropathy. It highlights the role of diabetes self-management education and support in improving adherence to treatment and patient outcomes. The guidelines are evidence-based and aim to reduce morbidity and mortality associated with type 2 diabetes.
more
Diabetes is a significant public health issue that affects approximately one in 10 adults globally, with type 2 diabetes accounting for 90–95% of cases. This chronic condition causes considerable morbidity and mortality and is growing in impact, with cases projected to rise from 537 million in 202
...
1 to 784 million by 2045. As cases rise, it is imperative to ensure the healthcare workforce is prepared to care for affected individuals. However, there is a growing global shortage of healthcare workers, which was estimated, pre pandemic, to reach 15 million by 2030. Therefore, all of the healthcare workforce will need to be utilised to their fullest potential in order to address the growing global burden of diabetes. Pharmacists will continue to be essential in this endeavour.
more
Summary of National Priorities - Malawi
Community Health Roadmap
United States Agency for International Development; Bill & Melinda Gates Foundation; The Rockefeller Foundation; World Bank Group; community health acceleration partnership; unicef
(2021)
CC
Malawi’s first National Community Health Strategy (NCHS, 2017-2022) defines a new community health system in which community health cadres, both formal and non-formal, deliver services of the Essential Health Package, with a focus on child and maternal health. It envisages an integrated approach t
...
o service delivery and is embedded in Malawi’s Health Sector Strategic Plan (HSSPII).
more
Exploring equity and inclusion in Malawi’s National Disability Mainstreaming Strategy and Implementation Plan
Ebuenyi, I.D.; Smith, E.M.; Munthali, A. et al.
International Journal for Equity in Health
(2021)
CC
Background
Equity and inclusion are important principles in policy development and implementation. The aim of this study is to explore the extent to which equity and inclusion were considered in the development of Malawi’s National Disability Mainstreaming Strategy and Implementation Plan.
Met
...
hods
We applied an analytical methodology to review the Malawi’s National Disability Mainstreaming Strategy and Implementation Plan using the EquIPP (Equity and Inclusion in Policy Processes) tool. The EquIPP tool assesses 17 Key Actions to explore the extent of equity and inclusion.
Results
The development of the Malawi National Disability Mainstreaming Strategy and Implementation Plan was informed by a desire to promote the rights, opportunities and wellbeing of persons with disability in Malawi. The majority (58%) of the Key Actions received a rating of three, indicating evidence of clear, but incomplete or only partial engagement of persons with disabilities in the policy process. Three (18%) of the Key Actions received a rating of four indicating that all reasonable steps to engage in the policy development process were observed. Four (23%) of the Key Actions received a score five indicating a reference to Key Action in the core documents in the policy development process.
Conclusions
The development of disability policies and associated implementation strategies requires equitable and inclusive processes that consider input from all stakeholders especially those whose wellbeing depend on such policies. It is pivotal for government and organisations in the process of policy or strategy development and implementation, to involve stakeholders in a virtuous process of co-production – co-implementation – co-evaluation, which may strengthen both the sense of inclusion and the effectiveness of the policy life-cycle.
more
Follow-up care is crucial but challenging for disease management particularly in rural areas with limited healthcare resources and clinical capacity, yet few studies have been conducted from the perspective of rural primary care physicians (PCPs). We assessed the frequency of follow-up care delivere
...
d by rural PCPs for hypertension and type 2 diabetes – the two most common long-term conditions.
more
Chronic kidney disease (CKD) is an important contributor to mortality from noncommunicable diseases. No decrease has been seen for CKD mortality contrary to many other important non-communicable diseases (e.g., cardiovascular disease). The prevalence of CKD and kidney failure are increasing all over
...
the world – and thereby also the need for dialysis. Unfortunately, the prevalence increases most rapidly in lowand middle-income countries. Globally, there are great inequities in access and quality of management of kidney failure. Many low- and middle-income countries cannot meet the increased need for dialysis. If the patients receive dialysis, it might only be for a limited period due to the out-of-pocket expenses. There are global disparities in CKD mortality reflecting the disparities in access to care. Lack of access to dialysis is an important cause of the increased CKD mortality in low- and middle-income countries.
more
"Tackling Noncommunicable Diseases (NCDs), risk factors and mental health during the time of COVID-19" is a series of high-level strategic discussions on transforming the approach to noncommunicable diseases, its risk factors and mental health as a result of the pandemic in terms of strengthening he
...
alth systems and services, responding to emergencies, investing to transform the NCD, RF and MH agenda, optimizing partnerships, among others, with a focus on big picture thought leadership.
more
The article "Asthma in South African adolescents: a time trend and risk factor analysis over two decades" investigates the prevalence and risk factors for asthma in Cape Town adolescents from 2002 to 2017. The study finds that while the overall prevalence of asthma remained similar, the severity of
...
the condition increased significantly. Risk factors for asthma and severe cases include smoking, pet exposure, outdoor pollution, and living in informal housing. Despite these trends, underdiagnosis remains a concern, as only one-third of adolescents with current or severe asthma had been formally diagnosed. The article emphasizes the need for better public health strategies to address environmental exposures and improve asthma diagnosis and treatment.
more
The article "Barriers and determinants of asthma control in children and adolescents in Africa: a systematic review" analyzes factors contributing to poor asthma control in African youth. Based on studies conducted between 2014 and 2019 in Nigeria, Uganda, and South Africa, the review identifies key
...
challenges such as limited access to asthma diagnosis, inadequate use of inhaled corticosteroids, and environmental and socio-economic factors. It finds that urban living, older age, and concurrent allergic conditions significantly affect asthma management. The study emphasizes the need for improved diagnostic tools, better access to treatment, and tailored public health interventions to enhance asthma outcomes in African children.
more
Lung health in Africa: challenges and opportunities in the context of COVID-19
Ozho, O.B.; Mbatchou Ngahane, B.H.; Zar, H.J.; et al.
American Journal of Physiology - Lung Cellular and Molecular Physiology
(2021)
CC2
The article discusses the challenges and opportunities for lung health in Africa in the context of the COVID-19 pandemic. It highlights the strain on healthcare systems, the increase in chronic respiratory diseases like asthma and COPD, and the limited resources for managing these conditions. The pa
...
ndemic has exacerbated issues like delayed diagnosis and treatment, while also impacting child lung health and increasing risks for those with tuberculosis. It emphasizes the importance of leveraging global partnerships and strategies to improve healthcare infrastructure and response in Africa.
more
Chronic obstructive pulmonary disease (COPD) is a complex disease that requires differential diagnosis and proper classification to identify appropriate therapy. Nonpharmacologic therapy and preventative measures should be utilized to prevent worsening of disease, symptoms, and complications. The Gl
...
obal Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines classify a patient’s COPD and provide recommendations for first-line treatment. The 2021 update included information regarding the use of e-cigarettes as nicotine replacement, triple therapy, and how the SARS-CoV-2 virus impacted patients with COPD. This article will focus on the diagnosis, classification, and treatment of COPD, as well as recently updated information regarding the use of e-cigarettes and the impact of COVID-19.
more
PATS and ERS
Paediatric Webinar Series
Air pollution and the lung in children:
the evidence for exposure and prevention measures
PATS & ERS
Paediatric Webinar Series
Non- CF Bronchiectasis: Diagnostic Approach and Management
Background
Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced a
...
sthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.
Methods
We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.
Results
Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.
Discussion
Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.
more
Severe and difficult asthma in a low- and middle-income country (LMIC) can relate to lack of availability of basic medications; potentially reversible factors such as poor adherence or comorbidities such as obesity inhibiting a good response to treatment; and (rarely) true severe, therapy-resistant
...
asthma. However, definitions of severity should encompass not merely doses of prescribed medication, but also underlying risk. The nature of asthmatic airway disease shows geographical variation, and LMIC asthma should not be assumed to be phenotypically the same as that in high-income countries (HICs). The first assessment step is to ensure another diagnosis is not being missed. Largely, political action is needed if children with asthma are to get access to basic medications. If a child is apparently not responding to low dose, simple medications, the next step is not to increase the dose but perform a detailed assessment of what factors (for example co-morbidities such as obesity, or social factors like poor adherence) are inhibiting a treatment response; in most cases, an underlying reason can be found. An assessment of risk of future severe asthma attacks, side-effects of medication and impaired lung development is also important. True severe, therapy-resistant asthma is rare and there are multiple underlying molecular pathologies. In HICs, steroid-resistant eosinophilia would be treated with omalizumab or mepolizumab, but the cost of these is prohibitive in LMICs, the biomarkers of successful therapy are likely only relevant to HICs. In LMICs, a raised blood eosinophil count may be due to parasites, so treating asthma based on the blood eosinophil count may not be appropriate in these settings.
more
