TY - JOUR
T1 - Urban-rural disparities in chronic obstructive pulmonary disease management and access in Uganda
AU - Robertson, Nicole M.
AU - Nagourney, Emily M.
AU - Pollard, Suzanne L.
AU - Siddharthan, Trishul
AU - Kalyesubula, Robert
AU - Surkan, Pamela J.
AU - Hurst, John R.
AU - Checkley, William
AU - Kirenga, Bruce J.
N1 - Funding Information:
Abbreviations: chronic obstructive pulmonary disease, COPD; low-and middle-income countries, LMIC; non-communicable disease, NCD; tuberculosis, TB; chronic respiratory disease, CRD; Global initiative for chronic Obstructive Lung Disease, GOLD Funding Support: This research was funded by the Medical Research Council Grant MR/P008984/1 under the Global Excellence in COPD Outcomes study and the Irvin F. and Alice S. Etscorn International Summer Research Award. Date of Acceptance: July 16, 2018 Citation: Robertson NM, Nagourney EM, Pollard SL, et al. Urban-rural disparities in chronic obstructive pulmonary disease management and access in Uganda. Chronic Obstr Pulm Dis. 2019;6(1):17-28. doi: https://doi.org/10.15326/jcopdf.6.1.2018.0143
Funding Information:
We greatly acknowledge the health care providers who volunteered their time and made this study possible. A special thanks to the study sites— Nakaseke District Hospital, LifeCare Clinic, HCII Kigegge, HCII Bukyare, HCII Biddabuggya, Nakaseke Private Pharmacy, MRB Drug Shop, Mulago National Referral Hospital, and Makerere University Lung Institute—for allowing us to conduct interviews at their facilities with their providers. We would also like to acknowledge Dr. Patricia Alupo, Faith Nassali, and our research assistant Rebecca Akello for their involvement in this study. This research was generously funded by the Irvin F. and Alice S. Etscorn International Summer Research Award and the Medical Research Council Grant MR/P008984/1 under the Global Excellence in COPD study.
Publisher Copyright:
© 2019.
PY - 2019
Y1 - 2019
N2 - Introduction: Almost 90% of chronic obstructive pulmonary disease (COPD) deaths occur in low- and middleincome countries (LMICs), where there are large rural populations and access to health care for COPD is poor. The purpose of this study was to compare urban-rural provider experiences regarding systemic facilitators and barriers to COPD management and treatment access. Methods: We conducted a qualitative study using direct observations and in-depth semi-structured interviews with 16 and 10 health care providers in urban Kampala and rural Nakaseke, Uganda, respectively. We analyzed interviews by performing inductive coding using generated topical codes. Results: In both urban and rural districts, exposure to evidence-based practices for COPD diagnosis and treatment was limited. The biomedical definition of COPD is not well distinguished in rural communities and was commonly confused with asthma and other respiratory diseases. Urban and rural participants alike described low availability of medications, limited access to diagnostic tools, poor awareness of the disease, and lack of financial means for medical care as common barriers to seeking and receiving care for COPD. While there was greater access to COPD treatment in urban areas, rural populations faced more pronounced barriers in access to diagnostic equipment, following standard treatment guidelines, and training medical personnel in non-communicable disease (NCD) management and treatment. Conclusion: Our results suggest that health system challenges for the treatment of COPD may disproportionately affect rural areas in Uganda. Implementation of diagnostic and treatment guidelines and training health professionals in COPD, with a special emphasis on rural communities, will assist in addressing these barriers.
AB - Introduction: Almost 90% of chronic obstructive pulmonary disease (COPD) deaths occur in low- and middleincome countries (LMICs), where there are large rural populations and access to health care for COPD is poor. The purpose of this study was to compare urban-rural provider experiences regarding systemic facilitators and barriers to COPD management and treatment access. Methods: We conducted a qualitative study using direct observations and in-depth semi-structured interviews with 16 and 10 health care providers in urban Kampala and rural Nakaseke, Uganda, respectively. We analyzed interviews by performing inductive coding using generated topical codes. Results: In both urban and rural districts, exposure to evidence-based practices for COPD diagnosis and treatment was limited. The biomedical definition of COPD is not well distinguished in rural communities and was commonly confused with asthma and other respiratory diseases. Urban and rural participants alike described low availability of medications, limited access to diagnostic tools, poor awareness of the disease, and lack of financial means for medical care as common barriers to seeking and receiving care for COPD. While there was greater access to COPD treatment in urban areas, rural populations faced more pronounced barriers in access to diagnostic equipment, following standard treatment guidelines, and training medical personnel in non-communicable disease (NCD) management and treatment. Conclusion: Our results suggest that health system challenges for the treatment of COPD may disproportionately affect rural areas in Uganda. Implementation of diagnostic and treatment guidelines and training health professionals in COPD, with a special emphasis on rural communities, will assist in addressing these barriers.
KW - COPD
KW - Chronic obstructive pulmonary disease
KW - Low and middle-income countries
KW - Treatment access
KW - Uganda
KW - Urban-rural health disparities
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U2 - 10.15326/JCOPDF.6.1.2018.0143
DO - 10.15326/JCOPDF.6.1.2018.0143
M3 - Article
AN - SCOPUS:85064921964
SN - 2372-952X
VL - 6
SP - 17
EP - 28
JO - Chronic Obstructive Pulmonary Diseases
JF - Chronic Obstructive Pulmonary Diseases
IS - 1
ER -