A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa.
BACKGROUND
Chronic diseases, primarily cardiovascular disease, respiratory disease, diabetes and cancer, are the leading cause of death and disability worldwide. In sub-Saharan Africa (SSA), where communicable disease prevalence still outweighs that of non-communicable disease (NCDs), rates of NCDs are rapidly rising and evidence for primary healthcare approaches for these emerging NCDs is needed.


METHODS
A systematic review and evidence synthesis of primary care approaches for chronic disease in SSA. Quantitative and qualitative primary research studies were included that focused on priority NCDs interventions. The method used was best-fit framework synthesis.


RESULTS
Three conceptual models of care for NCDs in low- and middle-income countries were identified and used to develop an a priori framework for the synthesis. The literature search for relevant primary research studies generated 3759 unique citations of which 12 satisfied the inclusion criteria. Eleven studies were quantitative and one used mixed methods. Three higher-level themes of screening, prevention and management of disease were derived. This synthesis permitted the development of a new evidence-based conceptual model of care for priority NCDs in SSA.


CONCLUSIONS
For this review there was a near-consensus that passive rather than active case-finding approaches are suitable in resource-poor settings. Modifying risk factors among existing patients through advice on diet and lifestyle was a common element of healthcare approaches. The priorities for disease management in primary care were identified as: availability of essential diagnostic tools and medications at local primary healthcare clinics and the use of standardized protocols for diagnosis, treatment, monitoring and referral to specialist care.
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. jjbkane@gmail.com.
Jennifer
http://orcid.org/0000-0003-3822-1071
J
Kane
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.|Dignitas International, 2 Adelaide Street West, Suite 200, Toronto, M5H 1L6, Canada.
Megan
M
Landes
Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield Regent Court, Regent Street, Sheffield, S1 4DA, UK.
Christopher
C
Carroll
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Amy
A
Nolen
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.|Dignitas International, 2 Adelaide Street West, Suite 200, Toronto, M5H 1L6, Canada.
Sumeet
S
Sodhi
D017954:Africa South of the Sahara; D002908:Chronic Disease / Q000628:therapy; D003906:Developing Countries; D019468:Disease Management; D005260:Female; D006295:Health Resources / Q000191:economics*; D006801:Humans; D007182:Income; D008297:Male; D008962:Models, Theoretical; D000073296:Noncommunicable Diseases / Q000453:epidemiology* / Q000628:therapy*; D011315:Preventive Medicine / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D018570:Risk Assessment; D012959:Socioeconomic Factors
Non-communicable diseases; Prevention; Primary healthcare; Sub-Saharan Africa; Systematic review; Treatment