MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
Trop Med Int Health. 2010 Feb;15(2):176-81. doi: 10.1111/j.1365-3156.2009.02438.x. Epub 2009 Dec 9.
With non-communicable diseases (NCDs) projected to become leading causes of morbidity and mortality in developing countries, research is needed to improve the primary care response, especially in sub-Saharan Africa. This region has a particularly high double burden of communicable diseases and NCDs and the least resources for an effective response. There is a lack of good quality epidemiological data from diverse settings on chronic NCD burden in sub-Saharan Africa, and the approach to primary care of people with chronic NCDs is currently often unstructured. The main primary care research needs are therefore firstly, epidemiological research to document the burden of chronic NCDs, and secondly, health system research to deliver the structured, programmatic, public health approach that has been proposed for the primary care of people with chronic NCDs. Documentation of the burden and trends of chronic NCDs and associated risk factors in different settings and different population groups is needed to enable health system planning for an improved primary care response. Key research issues in implementing the programmatic framework for an improved primary care response are how to (i) integrate screening and prevention within health delivery; (ii) validate the use of standard diagnostic protocols for NCD case-finding among patients presenting to the local health facilities; (iii) improve the procurement and provision of standardised treatment and (iv) develop and implement a data collection system for standardised monitoring and evaluation of patient outcomes. Important research considerations include the following: selection of research sites and the particular NCDs targeted; research methodology; local research capacity; research collaborations; ethical issues; translating research findings into policy and practice and funding. Meeting the research needs for an improved health system response is crucial to deliver effective, affordable and equitable care for the millions of people with chronic NCDs in developing countries in Africa.
随着非传染性疾病（NCDs）预计成为发展中国家发病率和死亡率的主要原因，需要进行研究以改善初级保健应对措施，特别是在撒哈拉以南非洲地区。该地区传染病和非传染性疾病的双重负担特别高，而应对措施所需的资源最少。撒哈拉以南非洲地区缺乏关于慢性非传染性疾病负担的不同环境下的高质量流行病学数据，目前对慢性非传染性疾病患者的初级保健方法通常是无组织的。因此，主要的初级保健研究需求首先是进行流行病学研究，以记录慢性非传染性疾病的负担，其次是进行卫生系统研究，以提供针对慢性非传染性疾病患者的结构化、计划性、公共卫生方法，需要记录不同环境和不同人群中慢性非传染性疾病及相关危险因素的负担和趋势，以便为改善初级保健应对措施进行卫生系统规划。在实施改善初级保健应对措施的计划性框架方面，关键的研究问题是如何：(i) 将筛查和预防纳入卫生服务；(ii) 验证在当地卫生机构就诊的患者中使用标准诊断方案进行非传染性疾病病例发现的有效性；(iii) 改善标准化治疗的采购和供应；(iv) 制定和实施标准化监测和评估患者结果的数据收集系统。重要的研究考虑因素包括以下几点：研究地点和目标特定非传染性疾病的选择；研究方法；当地研究能力；研究合作；伦理问题；将研究结果转化为政策和实践以及资金。满足改善卫生系统应对措施的研究需求对于为数百万患有慢性非传染性疾病的发展中国家的人提供有效、负担得起和公平的护理至关重要。
