Hinneh Thomas, Mensah Bernard, Boakye Hosea, Ogungbe Oluwabunmi, Commodore-Mensah Yvonne
Johns Hopkins School of Nursing, Baltimore, MD, USA.
Yale School of Nursing, New Haven, CT, USA.
Glob Heart. 2024 Dec 5;19(1):92. doi: 10.5334/gh.1375. eCollection 2024.
Hypertension and diabetes are leading causes of adult hospital admissions and mortality across health facilities in Ghana. Timely screening and diagnosis at primary health facilities are crucial to initiate treatment and avert complications. This study explored service availability and readiness of health systems for managing hypertension and diabetes in selected district hospitals in Ghana.
We adapted the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) tool to assess hypertension and diabetes management practices between June and July 2022 in four district hospitals in Ghana. Domain scores of service readiness were calculated based on the mean score of tracer item availability, transformed into percentages, and stratified by facility ownership. The mean readiness index was based on basic clinical logistics and equipment, diagnostic capacity, and first-line medications. Service availability was based on the core health workforce and specific service arrangements for the management of hypertension and diabetes. Facilities were considered 'ready' for services at a cut-off readiness score of 70%.
All facilities (n = 4, 100%) provided hypertension and diabetes services, with a median of 118 nurses (IQR 103-140) and 5 physicians (IQR 2-8). Only one facility (n = 1, 25%) had conducted cardiovascular disease training in the past year. All basic equipment (weighing scales, stethoscopes, glucometers, and blood pressure monitors) were available in all 4 facilities. Antihypertensives, including ACE inhibitors (n = 3; 75%), calcium channel blockers (n = 4; 100%), centrally acting agents (n = 4; 100%), and thiazides (n = 4; 100%), were available, as were antidiabetic medications like metformin (n = 4; 100%) and insulin (n = 2; 50%). Only two facilities (n = 2; 50%) could perform the required test (Hemoglobin A1c, full blood count, renal function, serum creatinine, blood urea, electrolytes, and blood lipid tests). Overall readiness score was 75.5%, essential medications (83.5%), basic equipment (78%), clinical guidelines for the management of cardiovascular disease management (75%), and diagnostic capacity (65.5%). Mission facilities had a higher readiness score (96%) and government facilities (55%).
Facilities demonstrated high readiness for basic hypertension and diabetes care, with higher availability of some essential medications and basic clinical logistics and equipment. Limited diagnostic capacity and cardiovascular disease training, highlight areas of improvement to strengthen hypertension and diabetes services in Ghana.
高血压和糖尿病是加纳各医疗机构成人住院和死亡的主要原因。在初级卫生机构进行及时筛查和诊断对于启动治疗及避免并发症至关重要。本研究探讨了加纳部分地区医院卫生系统管理高血压和糖尿病的服务可及性及准备情况。
我们采用世界卫生组织（WHO）的服务可及性和准备情况评估（SARA）工具，于2022年6月至7月对加纳4家地区医院的高血压和糖尿病管理实践进行评估。服务准备情况的领域得分基于示踪项目可及性的平均得分计算得出，转换为百分比，并按机构所有权进行分层。平均准备指数基于基本临床后勤和设备、诊断能力及一线药物。服务可及性基于核心卫生人力以及高血压和糖尿病管理的特定服务安排。当准备得分达到70%的临界值时，机构被认为“准备好”提供服务。
所有机构（n = 4，100%）均提供高血压和糖尿病服务，护士中位数为118名（四分位间距103 - 140），医生中位数为5名（四分位间距2 - 8）。过去一年中只有一家机构（n = 1，25%）开展了心血管疾病培训。所有4家机构均配备了所有基本设备（体重秤、听诊器、血糖仪和血压计）。抗高血压药物均有供应，包括血管紧张素转换酶抑制剂（n = 3；75%）、钙通道阻滞剂（n = 4；100%）、中枢作用药物（n = 4；100%）和噻嗪类药物（n = 4；100%），抗糖尿病药物如二甲双胍（n = 4；100%）和胰岛素（n = 2；50%）也有供应。只有两家机构（n = 2；50%）能够进行所需检测（糖化血红蛋白、全血细胞计数、肾功能、血清肌酐、血尿素、电解质和血脂检测）。总体准备得分是75.5%，基本药物（83.5%）、基本设备（78%）、心血管疾病管理临床指南（75%）和诊断能力（65.5%）。教会机构的准备得分较高（96%），而政府机构为（55%）。
各机构在基本高血压和糖尿病护理方面表现出较高的准备程度，一些基本药物以及基本临床后勤和设备的可及性较高。诊断能力和心血管疾病培训有限，凸显了加纳加强高血压和糖尿病服务需改进的领域。
