Carlson Selma, Duber Herbert C, Achan Jane, Ikilezi Gloria, Mokdad Ali H, Stergachis Andy, Wollum Alexandra, Bukhman Gene, Roth Gregory A
Division of Cardiology, University of Washington, Seattle, Washington, USA.
Institute for Health Metrics and Evaluation, Seattle, Washington, USA.
Heart. 2017 Dec;103(23):1874-1879. doi: 10.1136/heartjnl-2016-310913. Epub 2017 May 10.
Heart failure is a major cause of disease burden in sub-Saharan Africa (SSA). There is an urgent need for better strategies for heart failure management in this region. However, there is little information on the capacity to diagnose and treat heart failure in SSA. We aim to provide a better understanding of the capacity to diagnose and treat heart failure in Kenya and Uganda to inform policy planning and interventions.
We analysed data from a nationally representative survey of health facilities in Kenya and Uganda (197 health facilities in Uganda and 143 in Kenya). We report on the availability of cardiac diagnostic technologies and select medications for heart failure (β-blockers, ACE inhibitors and furosemide). Facility-level data were analysed by country and platform type (hospital vs ambulatory facilities).
Functional and staffed radiography, ultrasound and ECG were available in less than half of hospitals in Kenya and Uganda combined. Of the hospitals surveyed, 49% of Kenyan and 77% of Ugandan hospitals reported availability of the heart failure medication package. ACE inhibitors were only available in 51% of Kenyan and 79% of Ugandan hospitals. Almost one-third of the hospitals in each country had a stock-out of at least one of the medication classes in the prior quarter.
Few facilities in Kenya and Uganda were prepared to diagnose and manage heart failure. Medication shortages and stock-outs were common. Our findings call for increased investment in cardiac care to reduce the growing burden of heart failure.
心力衰竭是撒哈拉以南非洲地区疾病负担的主要原因。该地区迫切需要更好的心力衰竭管理策略。然而，关于撒哈拉以南非洲地区心力衰竭诊断和治疗能力的信息却很少。我们旨在更好地了解肯尼亚和乌干达心力衰竭的诊断和治疗能力，为政策规划和干预措施提供依据。
我们分析了来自肯尼亚和乌干达具有全国代表性的医疗机构调查数据（乌干达197家医疗机构，肯尼亚143家）。我们报告了心脏诊断技术的可用性以及用于治疗心力衰竭的选定药物（β受体阻滞剂、血管紧张素转换酶抑制剂和呋塞米）。按国家和平台类型（医院与门诊设施）对机构层面的数据进行分析。
肯尼亚和乌干达的医院中，不到一半同时具备功能正常且配备人员的放射成像、超声和心电图设备。在接受调查的医院中，49%的肯尼亚医院和77%的乌干达医院报告有心力衰竭药物组合。血管紧张素转换酶抑制剂仅在51%的肯尼亚医院和79%的乌干达医院有供应。每个国家近三分之一的医院在前一季度至少有一类药物缺货。
肯尼亚和乌干达准备好诊断和管理心力衰竭的机构很少。药物短缺和缺货情况很常见。我们的研究结果呼吁增加对心脏护理的投资，以减轻日益增长的心力衰竭负担。
