The prevalence of diabetes is estimated to increase from 415 million in 2015 to 642 million by 2040, resulting in a public healthcare crisis worldwide [1]. The steep increase of primarily type 2 diabetes (T2D) can be attributed to urbanisation, changing diets and decreasing physical activity [2, 3]. Untreated T2D has serious physical, psychological and social consequences [4, 5]. Individuals, families and communities suffer financial hardship [4] and health systems are put under pressure [6].
Diabetes disproportionally affects low- and middle-income countries (LMICs). More than 70% of cases [7] and 80% of deaths caused by diabetes [5] are expected to take place in LMICs by 2030. Health systems based on comprehensive and community oriented primary health care (PHC) are better equipped to face the growing burden of T2D [8]. However, PHC lacks comprehensiveness in most LMICs where it is focused on episodic treatment, especially of infectious disease and maternal and child health [9]. Concurrently, the lion’s share of evidence on comprehensive diabetes programs in PHC comes from high-income countries [10], making it less pertinent for LMICs [11, 12].
Bạn đang xem: Needs and resources of people with type 2 diabetes in peri-urban Cochabamba, Bolivia: a people-centred perspective
Xem thêm : Center for Regional Food Systems
Previous studies on improving diabetes management at the PHC level in LMICs were identified with following Boolean operators: (“community health service*” OR “rural health service*” OR “community health centre*” OR “community health nursing” OR “Primary health centre” OR “primary health care centre”) AND “diabetes”, including studies in LMICs on management of T2D published until December 2019. The 23 studies, from 15 different LMICs, found, mainly focused on isolated interventions like the training of formal or informal healthcare providers [12,13,14,15], pharmacological follow-up [16] or patient education and counselling [14, 17,18,19,20,21,22]. Despite their seemingly positive short-term effects, managing chronic conditions requires a comprehensive strategy which involves more than performing a series of disconnected interventions [23, 24]. To identify what can work within the local context, and to promote community ownership, engaging individuals with T2D, their families and communities in the design and implementation of prevention and treatment solutions are to be considered [25,26,27,28,29,30]. This type of healthcare design is known as ‘People-Centred Health Care’, defined as ‘an approach to care that consciously adopts individuals’, caregivers’, families’ and communities’ perspectives as participants in, and beneficiaries of, trusted health systems that respond to their needs and preferences in humane and holistic ways’ [31]. No studies were found that thoroughly explored the needs and resources of people living with T2D in Bolivia.
Bolivia is a LMIC with a human development index of 0.70 in 2018, ranked as 15th of the 20 countries in Latin-America [32]. It is characterised by a high prevalence of chronic disease and a weak PHC system [33] with a long history of selective programs and a biomedical hospital centric focus [34]. Notwithstanding the introduction in 2008 [35] of a public health care model based on intercultural community family health, encouraging broad participation while incorporating both Western and indigenous (traditional) medicines, progress has not been evaluated [36, 37]. The prevalence of T2D in the main urban regions was estimated at around 7.2% in 2001, with no later studies on country level prevalence available [38]. The department of Cochabamba has tropical lowlands, semi-arid valleys and highlands. This study was performed in Sacaba (172,466 inhabitants) and Quillacollo (137,182 inhabitants), the second and third largest municipalities situated at both sides of the urbanised valley of Cochabamba. They are the fastest growing municipalities with population growths of respectively 150 and 100% since 1992, reaching a population density of 83.14 and 59.7 inhabitants/km2 and poverty levels of 36.3% (72.56% in 1992) and 28.3% (62.88% in 1992) [39]. In both municipalities, over 60% of the population identified themselves as Quechua, received a median of 8 years of schooling with 10% illiteracy [40]. While traditionally working in agriculture [40, 41], they now predominantly work in transport and trade. In Quillacollo and Sacaba respectively, 50.7 and 63.5% of the population access the public health system, 29.2 and 22.8% access private health services, 23 and 18.7% access a social health insurance service, 10.4 and 12.5% consult a traditional healer while half of the population uses home remedies or self-medicates [39]. To be able to design an inclusive, efficient and acceptable diabetes program for people living with T2D, it is necessary to grasp their current resources, how these can be bolstered and which needs are unmet. The aim of this study was threefold (1) to obtain an extensive set of perspectives on what people who live with T2D in the recently urbanised region of Cochabamba, Bolivia rely on, (2) to explore what they need to maintain their health, and (3) to structure these elements in a people-centred diabetes care plan.
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