Journal Article > CommentaryFull Text
Lancet. 2011 July 16; Volume 378 (Issue 9787); 282-4.; DOI:10.1016/S0140-6736(10)62303-3
Schouten EJ, Jahn A, Midiani D, Makombe SD, Mnthambala A, et al.
Lancet. 2011 July 16; Volume 378 (Issue 9787); 282-4.; DOI:10.1016/S0140-6736(10)62303-3
Journal Article > ResearchFull Text
Public Health Action. 2016 June 21; Volume 6 (Issue 2); 60-65.; DOI:10.5588/pha.16.0003
Manjono RC, Mwagomba B, Ade S, Ali E, Ben-Smith A, et al.
Public Health Action. 2016 June 21; Volume 6 (Issue 2); 60-65.; DOI:10.5588/pha.16.0003
SETTING
Patients with chronic non-communicable diseases attending a primary health care centre, Lilongwe, Malawi.
OBJECTIVE
Using an electronic medical record monitoring system, to describe the quarterly and cumulative disease burden, management and outcomes of patients registered between March 2014 and June 2015.
DESIGN
A cross-sectional study.
RESULTS
Of 1135 patients, with new registrations increasing each quarter, 66% were female, 21% were aged 65 years, 20% were obese, 53% had hypertension alone, 18% had diabetes alone, 12% had asthma, 10% had epilepsy and 7% had both hypertension and diabetes. In every quarter, about 30% of patients did not attend the clinic and 19% were registered as lost to follow-up (not seen for 1 year) in the last quarter. Of those attending, over 90% were prescribed medication, and 80–90% with hypertension and/or diabetes had blood pressure/blood glucose measured. Over 85% of those with epilepsy had no seizures and 60–75% with asthma had no severe attacks. Control of blood pressure (41–51%) and diabetes (15–38%) was poor.
CONCLUSION
It is feasible to manage patients with non-communicable diseases in a primary health care setting in Malawi, although more attention is needed to improve clinic attendance and the control of hypertension and diabetes.
Patients with chronic non-communicable diseases attending a primary health care centre, Lilongwe, Malawi.
OBJECTIVE
Using an electronic medical record monitoring system, to describe the quarterly and cumulative disease burden, management and outcomes of patients registered between March 2014 and June 2015.
DESIGN
A cross-sectional study.
RESULTS
Of 1135 patients, with new registrations increasing each quarter, 66% were female, 21% were aged 65 years, 20% were obese, 53% had hypertension alone, 18% had diabetes alone, 12% had asthma, 10% had epilepsy and 7% had both hypertension and diabetes. In every quarter, about 30% of patients did not attend the clinic and 19% were registered as lost to follow-up (not seen for 1 year) in the last quarter. Of those attending, over 90% were prescribed medication, and 80–90% with hypertension and/or diabetes had blood pressure/blood glucose measured. Over 85% of those with epilepsy had no seizures and 60–75% with asthma had no severe attacks. Control of blood pressure (41–51%) and diabetes (15–38%) was poor.
CONCLUSION
It is feasible to manage patients with non-communicable diseases in a primary health care setting in Malawi, although more attention is needed to improve clinic attendance and the control of hypertension and diabetes.
Journal Article > CommentaryFull Text
PLOS Med. 2010 August 10; Volume 7 (Issue 8); DOI:10.1371/journal.pmed.1000319
Douglas GP, Gadabu OJ, Joukes S, Mumba S, McKay MV, et al.
PLOS Med. 2010 August 10; Volume 7 (Issue 8); DOI:10.1371/journal.pmed.1000319
Journal Article > Short ReportFull Text
Public Health Action. 2014 June 21; Volume 4 (Issue 2); DOI:10.5588/pha.13.0103
Harries AD, Jahn A, Ben-Smith A, Gadabu OJ, Douglas GP, et al.
Public Health Action. 2014 June 21; Volume 4 (Issue 2); DOI:10.5588/pha.13.0103
Journal Article > ReviewFull Text
J Int AIDS Soc. 2011 July 6; Volume 14; DOI:10.1186/1758-2652-14-S1-S4
Schouten EJ, Jahn A, Ben-Smith A, Makombe SD, Harries AD, et al.
J Int AIDS Soc. 2011 July 6; Volume 14; DOI:10.1186/1758-2652-14-S1-S4
The number of people receiving antiretroviral treatment (ART) has increased considerably in recent years and is expected to continue to grow in the coming years. A major challenge is to maintain uninterrupted supplies of antiretroviral (ARV) drugs and prevent stock outs. This article discusses issues around the management of ARVs and prevention of stock outs in Malawi, a low-income country with a high HIV/AIDS burden, and a weak procurement and supply chain management system. This system for ARVs, paid for by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and bypassing the government Central Medical Stores, is in place, using the United Nations Children’s Fund’s (UNICEF’s) procurement services. The system, managed by a handful of people who spend limited time on supply management, is characterized by a centrally coordinated quantification based on verified data from all national ART clinics, parallel procurement through UNICEF, and direct distribution to ART clinics. The model worked well in the first years of the ART programme with a single first-line ARV regimen, but with more regimens becoming available (e.g., alternative first-line, second-line and paediatric regimens), it has become more difficult to administer. Managing supplies through a parallel system has the advantage that weaknesses in the national system have limited influence on the ARV procurement and supply chain management system. However, as the current system operates without a central warehouse and national buffer stock capacity, it diminishes the ability to prevent ARV stock outs. The process of ordering ARVs, from the time that estimates are made to the arrival of supplies in health facilities, takes approximately one year. Addressing the challenges involved in maintaining ARVs through an efficient procurement and supply chain management system that prevents ARV stock outs through the establishment of a dedicated procurement team, a central warehouse and/or national buffer stock is a priority.