Mobile messaging support versus usual care for people with type 2 diabetes in sub-Saharan Africa: a protocol for a multicentre randomized controlled trial (StAR2D) (Preprint)

2018 ◽  
Author(s):  
Andrew Farmer ◽  
Kirsten Bobrow ◽  
Natalie Leon ◽  
Nicola Williams ◽  
Enita Phiri ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Health Outcomes ◽  
Usual Care ◽  
Text Messaging ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
The Impact ◽  
Sms Text Messaging

UNSTRUCTURED Background: Health outcomes for people treated for type 2 diabetes could be substantially improved in sub-Saharan Africa. Failure to take medicines regularly to treat diabetes has been identified as a major problem. Resources to identify and support patients who are not making best use of medicine in low and middle-income settings are scarce. Mobile phones are widely available in these settings including among people with diabetes, and linked technologies such as SMS-text messaging have shown promise in delivering low-cost interventions efficiently. However, evidence that these interventions will work when carried out at a larger scale, and of the extent to which they will improve health outcomes when added to usual care is limited. Methods: We will carry out a randomised clinical trial in two contrasting settings in sub-Saharan Africa, Cape Town in South Africa and Lilongwe in Malawi, to provide information about the impact of sending brief automated messages via SMS text-messaging. The messages will advise people about the benefits of their diabetes treatment and offer motivation and encouragement around lifestyle and use of medication. We will allocate patients using a randomly-generated assignment plan to receive either intervention messages, or an active control. We will follow up people for twelve months measuring important risk factors for poor health outcomes and complications in diabetes so we can estimate potential health benefits, including HbA1c as a marker for long-term blood glucose control and blood pressure control, We will record the costs of doing this, and estimate cost-effectiveness. We will also capture collection of medication and assess the reception of the intervention by participants and health care workers. Discussion: The knowledge gained will have wide application and advance the evidence base for effectiveness of mobile-phone based brief text-messaging on clinical outcomes and in large-scale, operational settings. It will provide evidence for cost-effectiveness that will further inform policy development and decision-making. We will work with a wide network that includes patients, clinicians, academics, industry, and policy makers to help us identify opportunities for informing people about the work and raise awareness of what is being developed and studied. Trial Registration: ISRCTN70768808 (Registered on 3 August 2015)

scholarly journals The impact and cost‐effectiveness of community‐basedHIVself‐testing in sub‐Saharan Africa: a health economic and modelling analysis

2019 ◽  
Vol 22 (S1) ◽  
pp. e25243 ◽  
Author(s):  
Valentina Cambiano ◽  
Cheryl C Johnson ◽  
Karin Hatzold ◽  
Fern Terris‐Prestholt ◽  
Hendy Maheswaran ◽  
...  
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Sub Saharan Africa ◽  
Modelling Analysis ◽  
Sub Saharan ◽  
The Impact

scholarly journals Examining the impact of mental disease on type 2 diabetes outcomes: results from the EpiChron Cohort

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Guerrero Fernández de Alba ◽  
A Gimeno-Miguel ◽  
B Poblador Plou ◽  
K Bliek Bueno ◽  
J Carmona Pirez ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Substance Abuse ◽  
Early Detection ◽  
Health Outcomes ◽  
Emergency Room ◽  
Mental Disease ◽  
Emergency Room Visits ◽  
Mental Diseases ◽  
The Impact

Abstract Background Type 2 diabetes mellitus (T2D) is often accompanied by other chronic diseases, including mental diseases (MD). This work aimed at studying MD prevalence in T2D patients and analyse its impact on T2D health outcomes. Methods Retrospective, observational study of individuals of the EpiChron Cohort aged 18 and over with prevalent T2D at baseline (2011) in Aragón, Spain (n = 63,365). Participants were categorized by the existence or absence of MD, defined as the presence of depression, anxiety, schizophrenia or substance abuse. MD prevalence was calculated, and a logistic regression model was performed to analyse the likelihood of the four studied health outcomes (4-year all-cause mortality, all-cause hospitalization, T2D-hospitalization, and emergency room visits) based on the presence of each type of MD, after adjusting by age, sex and number of comorbidities. Results Mental diseases were observed in 19% of T2D patients, with depression being the most frequent condition, especially in women (20.7% vs. 7.57%). Mortality risk was significantly higher in patients with MD (odds ratio -OR- 1.24; 95% confidence interval -CI- 1.16-1.31), especially in those with substance abuse (OR 2.18; 95% CI 1.84-2.57) and schizophrenia (OR 1.82; 95% CI 1.50-2.21). The presence of MD also increased the risk of T2D-hospitalization (OR 1.51; 95% CI 1.18-1.93), emergency room visits (OR 1.26; 95% CI 1.21-1.32) and all-cause hospitalization (OR 1.16; 95% CI 1.10-1.23). Conclusions The high prevalence of MD among T2D patients, and its association with health outcomes, underscores the importance of providing integrated, person-centred care and early detection of comorbid mental diseases in T2D patients to improve disease management and health outcomes. Key messages Comprehensive care of T2D should include specific strategies for prevention, early detection, and management of comorbidities, especially mental disorders, in order to reduce their impact on health. Substance abuse was the mental disease with the highest risk of T2D-hospitalization, emergency room visits and all-cause hospitalization.

scholarly journals Cost-Effectiveness Analysis of a Mobile-Based Intervention for Patients with Type 2 Diabetes Mellitus

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Jing Li ◽  
Li Sun ◽  
Yabing Hou ◽  
Liming Chen
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Usual Care ◽  
Usual Care Group ◽  
Management Mode ◽  
Care Group

Objective. The aim of this study was to evaluate the cost effectiveness of a mobile-based intervention for patients with type 2 diabetes mellitus (T2DM) and compare it with the usual management mode. Method. A total of 215 patients with T2DM in a tertiary-care hospital specific to diabetes were selected as the study population. This study was conducted from January 1, 2019 to January 1, 2020. Of the 215 patients, 130 were randomly assigned to the mHealth group and 85 were assigned to the usual care group. IBM SPSS 25.0 software was used for descriptive statistics, t tests, chi-square tests, and correlation analyses. Haemoglobin A1c (HbA1c) was the effectiveness parameter adopted. Cost-effectiveness analyses were performed, and incremental cost-effectiveness ratios (ICERs) were calculated. Results. Of the 215 patients with T2DM, the proportion of male patients was 66.0%. The mean age of the patients was 47.2 (SD 9.95). Differences in baseline information were not statistically significant between the two groups ( P > 0.05 ). At the 3-, 6-, and 12-month follow-ups, the mHealth group reported higher control rates of HbA1c than the usual care group, 67.9% versus 46.2% ( P < 0.001 ), 72.4% versus 45.4% ( P < 0.001 ), and 74.6% versus 47.1% ( P < 0.001 ), respectively. The value of HbA1c was positively related to total patient cost, material fee, Western medicine fee, and hospitalization expenses ( P < 0.05 ), with correlation coefficients of 0.202, 0.200, 0.172, and 0.183, respectively. The costs of the mHealth group and usual care group were CNY¥ 1169.76 and CNY¥ 1775.44 per patient/year, respectively. The incremental cost of the mHealth intervention was CNY¥ −605.68 per patient/year. The ICER was CNY¥ −22.02 per patient/year. Conclusion. Compared with the usual care mode, the mHealth management model for patients with T2DM improved the control rate of HbA1c, and the mHealth management mode had better cost effectiveness.

scholarly journals "My wife's mistrust. That's the saddest part of being a diabetic": A qualitative study of sexual well-being in men with Type 2 diabetes in sub-Saharan Africa

PLoS ONE ◽  
2018 ◽  
Vol 13 (9) ◽  
pp. e0202413 ◽  
Author(s):  
Sara Cooper ◽  
Natalie Leon ◽  
Hazel Namadingo ◽  
Kirsten Bobrow ◽  
Andrew J. Farmer
Keyword(s):  
Type 2 Diabetes ◽  
Qualitative Study ◽  
Well Being ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Experiences of type 2 diabetes in sub-Saharan Africa: a scoping review

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Mikaela Zimmermann ◽  
Christopher Bunn ◽  
Hazel Namadingo ◽  
Cindy M. Gray ◽  
John Lwanda
Keyword(s):  
Type 2 Diabetes ◽  
Scoping Review ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals The Impact of Suboptimal Diet on Type 2 Diabetes at Global, Regional, National, and Sub-National Levels: A Comparative Risk Assessment Analysis

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 877-877
Author(s):  
Meghan O'Hearn ◽  
Gitanjali Singh ◽  
Frederick Cudhea ◽  
Victoria Miller ◽  
Jianyi Zhang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Risk Assessment ◽  
Whole Grains ◽  
Dietary Factors ◽  
Sub Saharan Africa ◽  
Sensitivity Analyses ◽  
Comparative Risk Assessment ◽  
Comparative Risk ◽  
The Impact

Abstract Objectives To prioritize dietary factors for reducing the growing burden of type 2 diabetes (T2D) worldwide, we estimated the impact of suboptimal diet on T2D incidence at global, regional, national, and subnational levels between 1990 and 2015. Methods A comparative risk assessment framework estimated T2D incidence attributable to suboptimal diet in strata jointly stratified by year, nation, age, and sex, across 185 countries. We estimated direct (dietary composition) etiologic effects of 8 factors including nuts/seeds, whole grains, yogurt, processed meats, unprocessed red meats, glycemic load (estimated from refined grains), sugar-sweetened beverages (SSBs) and potatoes. Population demographics were from the United Nations; stratum-specific mean dietary intakes and distributions from Global Dietary Database (GDD), diet-T2D etiologic effects from meta-analyses of prospective cohort studies; and T2D incidence from the Global Burden of Disease study. These inputs and their uncertainties were used to calculate the stratum-specific population attributable fraction (PAF) and then absolute attributable cases, with joint effects estimated using multiplicative PAFs. Results In 2015, suboptimal intakes of these 8 factors were jointly estimated to cause 10.9 million T2D cases (95% UI 7.2–15.3), representing 59.6% of all cases (39.3–83.3%) among adults age 25 + y globally. Low intake of whole grains (3.6 million cases (3.4–3.8)) followed by high intake of SSBs (2.7 million cases (2.5–2.9)) had the largest estimated attributable burdens. Across 7 world regions, highest diet-attributable burdens of T2D were in High Income Countries (2516 cases per million (2115, 2870)) and Former Soviet Union (2341 cases per million (1465, 2970)); and lowest in Sub-Saharan Africa (797 cases per million (333, 1435)). The proportion of T2D attributable to suboptimal diet was generally greater in males vs. females and in younger vs. older age groups. Results for specific countries, trends over time, and further sensitivity analyses will be presented. Conclusions These novel findings provide the most updated estimates of diet-attributable T2D globally, helping to inform priorities for targeted healthcare system, policy, industry and public health interventions to reduce T2D. Funding Sources Gates Foundation.

Does economic freedom improve health outcomes in sub-Saharan Africa?

2020 ◽  
Vol 47 (12) ◽  
pp. 1633-1649
Author(s):  
Anand Sharma
Keyword(s):  
Mortality Rate ◽  
Life Expectancy ◽  
Health Outcomes ◽  
Economic Freedom ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Content Type ◽  
The World ◽  
Sub Saharan ◽  
The Impact

PurposeThe purpose of this study is to examine the impact of economic freedom on four key health indicators (namely, life expectancy, infant mortality rate, under-five mortality rate and neonatal mortality rate) by using a panel dataset of 34 sub-Saharan African countries from 2005 to 2016.Design/methodology/approachThe study obtains data from the World Development Indicators (WDI) of the World Bank and the Fraser Institute. It uses fixed effects regression to estimate the effect of economic freedom on health outcomes and attempts to resolve the endogeneity problems by using two-stage least squares regression (2SLS).FindingsThe results indicate a favourable impact of economic freedom on health outcomes. That is, higher levels of economic freedom reduce mortality rates and increase life expectancy in sub-Saharan Africa. All areas of economic freedom, except government size, have a significant and positive effect on health outcomes.Research limitations/implicationsThis study analyses the effect of economic freedom on health at a broad level. Country-specific studies at a disaggregated level may provide additional information about the impact of economic freedom on health outcomes. Also, this study does not control for some important variables such as education, income inequality and foreign aid due to data constraints.Practical implicationsThe findings suggest that sub-Saharan African countries should focus on enhancing the quality of economic institutions to improve their health outcomes. This may include policy reforms that support a robust legal system, protect property rights, promote free trade and stabilise the macroeconomic environment. In addition, policies that raise urbanisation, increase immunisation and lower the incidence of HIV are likely to produce a substantial improvement in health outcomes.Originality/valueExtant economic freedom-health literature does not focus on endogeneity problems. This study uses instrumental variables regression to deal with endogeneity. Also, this is one of the first attempts to empirically investigate the relationship between economic freedom and health in the case of sub-Saharan Africa.

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