Health system performance for people with diabetes in 28 low- and middle-income countries : a cross-sectional study of nationally representative surveys

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dc.contributor.authorManne-Goehler, Jenniferen_ZA
dc.contributor.authorGeldsetzer, Pascalen_ZA
dc.contributor.authorAgoudavi, Kokouen_ZA
dc.contributor.authorAndall- Brereton, Glennisen_ZA
dc.contributor.authorAryal, Krishna K.en_ZA
dc.contributor.authorBicaba, Brice Wilfrieden_ZA
dc.contributor.authorBovet, Pascalen_ZA
dc.contributor.authorBrian, Garryen_ZA
dc.contributor.authorDorobantu, Mariaen_ZA
dc.contributor.authorGathecha, Gladwellen_ZA
dc.contributor.authorGurung, Mongal Singhen_ZA
dc.contributor.authorGuwatudde, Daviden_ZA
dc.contributor.authorMsaidie, Mohameden_ZA
dc.contributor.authorHouehanou, Corineen_ZA
dc.contributor.authorHouinato, Dismanden_ZA
dc.contributor.authorJorgensen, Jutta Mari Adelinen_ZA
dc.contributor.authorKagaruki, Gibson B.en_ZA
dc.contributor.authorKarki, Khem B.en_ZA
dc.contributor.authorLabadarios, Demetreen_ZA
dc.contributor.authorMartins, Joao S.en_ZA
dc.contributor.authorMayige, Mary T.en_ZA
dc.contributor.authorMcClure, Roy Wongen_ZA
dc.contributor.authorMwalim, Omaren_ZA
dc.contributor.authorMwangi, Joseph Kibachioen_ZA
dc.contributor.authorNorov, Bolormaaen_ZA
dc.contributor.authorQuesnel-Crooks, Sarahen_ZA
dc.contributor.authorSilver, Bahendeka K.en_ZA
dc.contributor.authorSturua, Lelaen_ZA
dc.contributor.authorTsabedze, Lindiween_ZA
dc.contributor.authorWesseh, Chea Stanforden_ZA
dc.contributor.authorStokes, Andrewen_ZA
dc.contributor.authorMarcus, Majaen_ZA
dc.contributor.authorEbert, Caraen_ZA
dc.contributor.authorDavies, Justine I.en_ZA
dc.contributor.authorVollmer, Sebastianen_ZA
dc.contributor.authorAtun, Rifaten_ZA
dc.contributor.authorBarnighausen, Till W.en_ZA
dc.contributor.authorJaacks, Lindsay M.en_ZA
dc.date.accessioned2021-09-29T08:57:09Z
dc.date.available2021-09-29T08:57:09Z
dc.date.issued2019
dc.descriptionCITATION: Manne-Goehler, J., et al. 2019. Health system performance for people with diabetes in 28 low- and middle-income countries : a cross-sectional study of nationally representative surveys. PLoS Medicine, 16(3):e1002751, doi:10.1371/journal.pmed.1002751.
dc.descriptionThe original publication is available at https://journals.plos.org/plosmedicine
dc.description.abstractBackground: The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. Methods and findings: We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given (“treated”), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%–9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%–5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%–78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. Conclusions: The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.en_ZA
dc.description.abstractA Boyce 2021-09
dc.description.urihttps://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002751
dc.description.versionPublisher's version
dc.format.extent21 pagesen_ZA
dc.identifier.citationManne-Goehler, J., et al. 2019. Health system performance for people with diabetes in 28 low- and middle-income countries : a cross-sectional study of nationally representative surveys. PLoS Medicine, 16(3):e1002751, doi:10.1371/journal.pmed.1002751
dc.identifier.issn1549-1676 (online)
dc.identifier.issn1549-1277 (print)
dc.identifier.otherdoi:10.1371/journal.pmed.1002751
dc.identifier.urihttp://hdl.handle.net/10019.1/123098
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectDiabetesen_ZA
dc.subjectHealth planning -- Developing countriesen_ZA
dc.subjectDiabetes -- Treatmenten_ZA
dc.subjectDiabetes researchen_ZA
dc.titleHealth system performance for people with diabetes in 28 low- and middle-income countries : a cross-sectional study of nationally representative surveysen_ZA
dc.typeArticleen_ZA
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