School of Geosciences, University of Edinburgh , Edinburgh, UK.
Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, University of Aberdeen , Aberdeen, UK.
Glob Health Action. 2021 Jan 1;14(1):1852781. doi: 10.1080/16549716.2020.1852781.
: NCDs are non-infectious, long-term conditions that account for 40 million deaths per annum. 87% of premature NCD mortality occurs in low- and middle-income countries. : The aims were:develop methods to provide integrated biosocial accounts of NCD mortality; and explore the practical utility of extended mortality data for the primary health care system. : We drew on data from research programmes in the study area. Data were analysed in three steps: [a]analysis of levels, causes and circumstances of NCD mortality [n = 4,166] from routine census updates including Verbal Autopsy and of qualitative data on lived experiences of NCDs in rural villages from participatory research; [b] identifying areas of convergence and divergence between the analyses; and [c]exploration of the practical relevance of the data drawing on engagements with health systems stakeholders. : NCDs constituted a significant proportion of mortality in this setting [36%]. VA data revealed multiple barriers to access in end-of-life care. Many deaths were attributed to problems with resources and health systems [21%;19% respectively]. The qualitative research provided rich complementary detail on the processes through which risk originates, accumulates and is expressed in access to end-of-life care, related to chronic poverty and perceptions of poor quality care in clinics. The exploration of practical relevance revealed chronic under-funding for NCD services, and an acute need for robust, timely data on the NCD burden. : VA data allowed a significant burden of NCD mortality to be quantified and revealed barriers to access at and around the time of death. Qualitative research contextualised these barriers, providing explanations of how and why they exist and persist. Health systems analysis revealed shortages of resources allocated to NCDs and a need for robust research to provide locally relevant evidence to organise and deliver care. Pragmatic interdisciplinary and mixed method analysis provides relevant renditions of complex problems to inform more effective responses.
非传染性疾病是非传染性、长期存在的疾病，每年导致 4000 万人死亡。87%的过早非传染性疾病死亡发生在中低收入国家。：目的是：开发提供非传染性疾病死亡率综合生物社会核算的方法；并探索扩展死亡率数据在初级卫生保健系统中的实际效用。：我们借鉴了研究区域内研究计划的数据。数据分三步进行分析：[a] 分析常规人口普查更新中（包括死因推断）非传染性疾病死亡率的水平、原因和情况[n=4166]，以及参与式研究中农村村庄中关于非传染性疾病生活经历的定性数据；[b] 确定分析之间的趋同和分歧领域；[c] 利用与卫生系统利益攸关方的接触情况，探索数据的实际相关性。：在这种情况下，非传染性疾病在死亡率中占相当大的比例[36%]。死因推断数据显示，临终关怀存在多种获取障碍。许多死亡归因于资源和卫生系统方面的问题[分别为 21%和 19%]。定性研究提供了有关风险起源、积累和在临终关怀中表现的过程的丰富详细信息，与慢性贫困以及对诊所护理质量差的看法有关。对实际相关性的探索表明，慢性病服务长期资金不足，急需关于慢性病负担的可靠、及时数据。：死因推断数据允许定量确定非传染性疾病死亡的巨大负担，并揭示了接近死亡时获取服务的障碍。定性研究使这些障碍具有背景，提供了有关其存在和持续存在的原因和方式的解释。卫生系统分析表明，分配给非传染性疾病的资源短缺，需要进行强有力的研究，以提供当地相关证据来组织和提供护理。实用的跨学科和混合方法分析为更有效的应对措施提供了复杂问题的相关版本。
