Mulure Nathan, Hewadmal Hewad, Khan Zahid
Public Health, Kenya Medical Research Institute (KEMRI), Nairobi, KEN.
Internal Medicine, Desert Valley Hospital, Victorville, USA.
Cureus. 2024 Jul 27;16(7):e65516. doi: 10.7759/cureus.65516. eCollection 2024 Jul.
The incidence of cardiovascular diseases (CVDs) in low- and middle-income countries (LMICs) has greatly increased. Previously dominated by infectious diseases, LMICs are the new epicentre of CVDs. CVD is a common problem amongst the population in the African continent; however, many countries in LMICs lack the resources to stem the rise of CVDs. A systematic review was conducted between March and July 2023 to assess barriers to the primary prevention of CVDs in studies conducted in LMICs. Online databases, such as Embase, Cochrane, Scopus, and MEDLINE, were consulted. Keywords included primary prevention, cardiovascular diseases, diabetes, weight loss, and physical fitness, all of which focused on LMICs. To enrich the literature review, efforts were made to check other listed references and more papers were retrieved. The inclusion criteria were countries in LMICs, CVD, full-text, and peer-reviewed journals. Qualitative and quantitative studies were included. Exclusion criteria included high-income countries, secondary prevention, and research unrelated to CVDs, such as barriers in oncology or mental health. A total of 1089 papers were retrieved from the search engines. After applying the exclusion criteria for LMICs, only 186 papers were retained. A further search for quality, relevance, and duplicity reduced the qualifying number to 50 papers. Further efforts to retrieve the data and examine the quality of the studies resulted in 18 final selected studies. Three categories emerged based on the type of barriers: physician barriers, patient barriers, and health system barriers. Evidently, in several LMICs, guidelines for CVD prevention were lacking, and too much emphasis was placed on secondary prevention at the expense of primary prevention, a lack of human resources, and inadequate infrastructure. Overworked healthcare providers were unable to allocate adequate time to the patients. There was no shared decision-making process. Patient barriers included lack of motivation, no symptoms, low level of education, no insurance, long physical distances to the facilities, and inadequate medication or stock out. Some of the major barriers included closing and opening hours, poor operating space, inadequate funding from the government or donors, and lack of electronic medical services. There are many barriers to accessing primary prevention services for CVDs. These barriers can be divided into patient, physician, or health system barriers. More research needs to be conducted in LMICs to address the increasing risk factors for CVDs. Greater investment is required by national governments to provide more resources. Task shifting and shared decision-making are some of the quick wins.
低收入和中等收入国家（LMICs）心血管疾病（CVDs）的发病率大幅上升。LMICs此前主要受传染病困扰，如今却成为了心血管疾病的新中心。心血管疾病在非洲大陆的人群中是一个常见问题；然而，许多LMICs国家缺乏阻止心血管疾病发病率上升的资源。2023年3月至7月进行了一项系统综述，以评估在LMICs开展的研究中，心血管疾病一级预防的障碍。查阅了Embase、Cochrane、Scopus和MEDLINE等在线数据库。关键词包括一级预防、心血管疾病、糖尿病、体重减轻和身体健康，所有这些都聚焦于LMICs。为丰富文献综述，还查阅了其他列出的参考文献并检索到了更多论文。纳入标准为LMICs国家、心血管疾病、全文以及同行评审期刊。纳入了定性和定量研究。排除标准包括高收入国家、二级预防以及与心血管疾病无关的研究，如肿瘤学或心理健康方面的障碍。从搜索引擎中总共检索到1089篇论文。在应用LMICs的排除标准后，仅保留了186篇论文。进一步筛选质量、相关性和重复性后，符合条件的论文数量减少到50篇。进一步检索数据并检查研究质量后，最终选定了18项研究。根据障碍类型出现了三类：医生障碍、患者障碍和卫生系统障碍。显然，在几个LMICs国家，缺乏心血管疾病预防指南，过于强调二级预防而牺牲了一级预防，人力资源短缺，基础设施不足。工作过度劳累的医疗服务提供者无法为患者分配足够的时间。没有共同决策过程。患者障碍包括缺乏动力、无症状、教育水平低、没有保险、到医疗机构的距离远以及药物不足或缺货。一些主要障碍包括营业时间、操作空间差、政府或捐助者资金不足以及缺乏电子医疗服务。获得心血管疾病一级预防服务存在许多障碍。这些障碍可分为患者、医生或卫生系统障碍。LMICs需要开展更多研究以应对心血管疾病日益增加的风险因素。各国政府需要加大投资以提供更多资源。任务转移和共同决策是一些立竿见影的成效。
