Abstract
Assessing Diabetes Knowledge & Prevalence in Nevis, West Indies: A Mixed Method Surveillance Initiative with the Ministry of Health
Jeanita W. Richardson, PhD1, Corinne Conn, graduate student1, Aejari Browne, MHIRT Scholar2, Shakira King, MHIRT Scholar3, Michelle Crawford-Johnson, MHIRT Scholar1, Ahisha Herbert, MHIRT Scholar4, Deega Omar, MHIRT Scholar1, Noellissa Swabe, MHIRT Scholar2, Yolande Tchuisseu, MHIRT Scholar1 and Andrew Wills, MHIRT Scholar5
(1)University of Virginia, Charlottesville, VA, (2)Nevis Sixth Form College, Charlottesville, VA, (3)Haverford College, Charlottesville, VA, (4)Clarence Fitzroy Bryant College, Charlottesville, VA, (5)New York City College of Technology, Charlottesville, VA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Objective: A multi-university team investigated the prevalence of type 2 diabetes (DM) and its risk factors in Nevis, WI, the second leading cause of death in the country, to support the Ministry of Health's commitment to evidenced-based interventions.
Methods: We used a mixed methodological approach of randomized chart reviews and surveys. The randomized chart review of the six publicly funded health centers yielded 439 examined charts (4% of the island population). Metabolic screenings, medical history and general health information were analyzed using descriptive statistics. The World Health Organization's STEPwise instrument was used to survey 110 Nevis residents (~1% of the island's population) focusing on diabetes knowledge, risk factors (such as diet, exercise, risk-factors), and open-ended questions targeting perceived DM risk.
Results: Approximately 17% of the clinical records noted a diabetes diagnosis. Diabetes was more prevalent among females and those in the 50 – 75 year old age cohort. Risk factors of hypertension, elevated cholesterol and fasting blood glucose were prevalent in non-diabetics and as comorbidities in patients with diabetes. Participants believe diet primarily contributed to diabetes (78%), but not exercise (13%). While the severity of DM was clear to respondents (e.g. potential amputations), over 1/3 of respondents were not aware of the DM support services offered by the Ministry of Health.
Conclusions: Survey results suggest there are low-cost risk screenings that if implemented systematically may reveal an under-representation of DM risk. In addition, educational materials and interventions targeting DM risk factors would be beneficial if they were more widely advertised. Persons in this study also confirmed the MOH's suspicions that type 2 diabetes prevention, early detection and management is a population health concern.
Assessment of individual and community needs for health education Public health or related research
Abstract
Strengthening the health workforce in developing countries through a global public health management program: Factors for selection of target countries
Lynnette Ametewee, MA LLM MBA PhD Student Epidemiology, Zahid Samad, MD, MPH, MBA and Erika Willacy, MPH
Centers for Disease Control and Prevention, Atlanta, GA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Introduction
Strengthening the public health workforce in developing countries with limited resources and weak health infrastructure is key to improving health systems. Few global health training programs focus on building the capacity of mid-level public health managers in developing countries. The Centers for Diseases Control and Prevention's Improving Public Health Management through Action (IMPACT) program focuses on providing public health management training to mid-level managers in low-resource countries. Few studies examine the process for selecting target countries for participation in a global health training program. Following an assessment of developing countries, Kenya and Bangladesh were selected as demonstration countries for this novel program.
Methods
Cross-sectional surveys were conducted with 46 countries. Sixty-three percent of countries expressed a need for public health management training and interest in IMPACT. Six countries were targeted for country readiness assessments. Criteria used included level of commitment and evidence that IMPACT could be prioritized by the Ministry of Health academic.
Results
Preliminary analysis highlighted that all countries need public health management training but four of the countries did not meet all of the criteria for readiness. Only Kenya and Bangladesh clearly demonstrated the commitment to work with partners to implement the program.
Conclusion
A holistic approach to strengthening health systems in low-resource countries is needed to effectively address public health problems and emergencies in the 21st century. Our assessment reinforced the need for countries to have targeted training for public health managers. However, many countries need more targeted support to effectively implement global health management programs.
Administration, management, leadership Public health or related education
Abstract
Has Democracy Failed the Poor or is the Jury still out - an analysis of health system strengthening in South Africa since democracy
Eric Buch, Professor
University of Pretoria, Pretoria, South Africa
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Under apartheid the health system focus was to advance racial disparity. The advent of democracy in 1994 and the associated Bill of Rights committed to the progressive realization of the right to health care. Yet, 20 years into democracy, inequity of access remains the defining feature of the South African Health System. This paper traces health system developments in South Africa, from the injustices of apartheid, through the removal of structural racism to health system strengthening measures taken over the past 21 years and assesses the extent to which these have made a difference. The paper then turns its attention to the White Paper on the National Health Insurance System (NHI) introduced this year by the Minister of Health. The paper analyses the prospects and implications of the proposed NHI and its proposals for health systems strengthening and raises the question of whether democracy will continue to fail the poor in the attainment of universal access to quality health care, or if the proposed NHI means that the jury is still out. What prospects does eh NHI hold for improved efficiency? The implications of the dual public-private health system are considered as are the path from AIDS denialism to the largest HIV treatment program in the world is woven into the analysis as is the need to take bold decisions on rationing in the face of a heavy burden of disease.
Administration, management, leadership Provision of health care to the public Public health administration or related administration
Abstract
Health system efficiency and achievement of Millennium Development Goals (MDGs) in low and middle income countries: Lesson for health related Sustainable Development Goals (SDGs)
Yohannes Kinfu, PHD, MPHIL. MA, B.Econ1 and Monika Sawhney, PhD, MSW2
(1)yohannes.kinfu@canberra.edu.au, Canberra, Australia, (2)Marshall University, Huntington, WV
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
As the world community moves towards Sustainable Development Goals (SDGs) it is imperative to take stock of past achievements, develop strategies for newly identified targets and identify mitigating measures for future potential challenges. This study explores connections between health system performance, efficiency, and achievements of MDGs among countries that met the MDGs targets for key health indicators, countries that achieved well below targets, and countries that made substantial progress but didn't reach stipulated targets. Purpose of this study includes estimating health system efficiency at national and sub-national levels for countries which had achieved the MDG targets and those which failed to meet them and identifying barriers and enabling factors associated with health system performance. Our analyses focus on sub-national units within these countries and combines data on health inputs, health achievements/outcomes and on determinants of efficiency. Health achievements will be measured using under-five, maternal and adult mortality rates. Health system inputs will be measured using per-capita public expenditure on health, health work force density, and health-facility-to-population ratio. Furthermore, three indicators: wealth index, female literacy and urbanization will be introduced to explore their enabling effect on a country's health system efficiency. Preliminary results suggest that achievement of MDGs appears to be correlated not only with the level of input but also with the efficiency with which they are combined in the system. Findings from the proposed study will contribute to this understanding by exploring those exogenous factors that can enhance health system efficiency and ultimately improve a nation's health outcome.
Biostatistics, economics Planning of health education strategies, interventions, and programs Program planning Provision of health care to the public Public health or related organizational policy, standards, or other guidelines Public health or related public policy