Browsing by Author "Werfalli, Mahmoud"

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    Informing the development of a self-management care programme for older people with type 2 diabetes attending community health centres in Cape Town, South Africa
    (2019) Werfalli, Mahmoud; Levitt, Naomi; Kalula, Sebastiana Z
    Diabetes is a growing problem globally, with the major impact being experienced in low and middle-income countries. In 2017, there were an estimated 122.8 million people over the age of 65 years living with diabetes globally, with a prevalence of 18.8% and 3.2 million deaths at this age. If the trends continue, the number of people living with diabetes over the age of 65 years will be 253.4 million in 2045.This is being driven by demographic changes including the ageing of the population. In South Africa, diabetes is a major cause of morbidity and mortality and a burden to the overstretched health services, community, family and people with the disease. Self- care management is a cornerstone of diabetes care. The purpose of this thesis is to inform the development of a self-care management programme for older people attending public sector primary health care services in Cape Town, South Africa by using the PRECEDE planning model. This model provides an eight-phase framework for health care professionals to determine, develop, implement and assess health promotion programmes, as well as the application of health promotion theories systematically within such programmes. The thesis incorporates five interlinked studies, presented as five publications, two published and three in review: The first was a systematic review of studies that assessed the prevalence of type 2 diabetes mellitus among older people in African countries conducted between 2000 and 2015 with the objective of providing data for the monitoring of future trends. This demonstrates that type 2 diabetes is not rare in individuals aged 55 years and older across Africa – the overall prevalence of diabetes was 13.7% (95% CI 11·3–16·3) and was twofold higher in studies based on the oral glucose tolerance test than in those using fasting plasma blood glucose. The second is a secondary analysis of the Study on global AGEing and adult health (SAGE) South Africa Wave 1 data that examined the prevalence of self-reported diabetes and the association between diabetes and each of health-related quality of life and disability amongst South Africa’s older adults. The results were that diabetes was associated with lower quality of life and greater disability: it represented not only a risk factor for disability but was associated with a range of impairments and co-morbidities predisposing to loss of autonomy. The third, a cross-sectional survey, examines the knowledge of older people with diabetes attending primary care clinics in Cape Town, South Africa, about living with and managing their diabetes; and aims to determine the relationship of social support, especially that of family and friends with their self-management. Its major finding is that there was a lack of knowledge about the complications of diabetes, suggesting that the available diabetes educational opportunities have not been effective. Importantly, however, social support was positively associated with both knowledge and a number of self-care aspects. The fourth is a qualitative study consisting of documentary review and individual interviews with key informants to investigate the current policies, programmes and any other interventions as they relate to older people with diabetes. This found that generally older persons face numerous barriers in managing their condition. Further, there are multiple efforts to re-orientate the healthcare system to focus more effectively on non-communicable diseases for the population which would benefit older patients with diabetes. Finally, the study includes a systematic review of peer and non-professional health worker-led diabetes self-management programmes (COMP-DSMP) in low and middle-income country primary health care settings, and also examines the implementation strategies and associated diabetes-related health outcomes This found equivocal evidence supporting the use of COMP-DSMP for people with diabetes in these countries and suggested that the models of a peer/CHW-led programme need to be further explored, especially given the inevitability of a professional healthcare workforce shortage in LMICs. In conclusion, this research study has described the extent of the need for developing and evaluating education programmes that focus on older people with diabetes and emphasises the role of family and friends. Whilst there have been some significant policy interventions pertaining to the protection of the health and welfare of older persons in SA, the needs of this vulnerable group remain relatively low on the list of priorities in terms of focus and resource allocation. In this context, older people, as a distinct group, are also not a strong focus in current health policy relating to the provision of NCD care. This thesis alerts policymakers and clinicians to some of the specific issues considered to be pertinent and important in the care and management of older persons with diabetes. Many of these would also be applicable to older individuals with other chronic conditions.
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    N-acetylcysteine for non-paracetamol drug-induced liver injury: a systematic review protocol
    (BioMed Central Ltd, 2015) Chughlay, Mohamed; Kramer, Nicole; Werfalli, Mahmoud; Spearman, Wendy; Engel, Mark E; Cohen, Karen
    BACKGROUND: Drug-induced liver injury (DILI) refers to acute or chronic liver injury that may occur as a consequence of using drugs and herbal or dietary supplements. Specific therapies for DILI are limited. There is considerable evidence for efficacy and safety of N-acetylcysteine (NAC) in management of paracetamol-induced liver injury. More recently, research has explored the use of NAC in non-paracetamol drug-induced liver injury. It is important to summarise the evidence of NAC for non-paracetamol DILI to determine if NAC may be considered a therapeutic option in this condition.METHODS/DESIGN:We will conduct a systematic review of the benefit and harm of NAC in non-paracetamol drug-induced liver injury. Primary and secondary outcomes of interest are pre-specified. Primary outcomes include all-cause mortality, mortality due to DILI, time to normalisation of liver biochemistry (e.g. return of alanine transaminase to <100 U/l and/or international normalized ratio (INR) <1.5) and adverse events. Secondary outcomes include transplantation rate, time to transplantation, transplant-free survival and duration of hospitalisation. We will include randomized controlled trials (RCTs) and prospective cohort studies. RCTs will contribute to the evaluation of safety and efficacy of NAC, whereas, the cohort studies will contribute exclusively to the evaluation of safety. We will search several bibliographic databases (including PubMed, Scopus, CINAHL, CENTRAL), grey literature sources, conference proceedings and ongoing trials. Following data extraction and assessment of the risk of bias, we will conduct a meta-analysis if feasible, as well as subgroup analyses. We will assess and explore clinical and statistical heterogeneity.DISCUSSION:The aim of this review is to provide evidence on the effectiveness and safety of NAC in non-paracetamol DILI. We anticipate that the results could aid health care practitioners, researchers and policymakers in the decision-making regarding the use of NAC in patients with non-paracetamol DILI.SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42014008771
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    The effectiveness of peer and community health worker-led self-management support programs for improving diabetes health-related outcomes in adults in low- and-middle-income countries: a systematic review
    (2020-06-06) Werfalli, Mahmoud; Raubenheimer, Peter J; Engel, Mark; Musekiwa, Alfred; Bobrow, Kirsten; Peer, Nasheeta; Hoegfeldt, Cecilia; Kalula, Sebastiana; Kengne, Andre P; Levitt, Naomi S
    Objective Community-based peer and community health worker-led diabetes self-management programs (COMP-DSMP) can benefit diabetes care, but the supporting evidence has been inadequately assessed. This systematic review explores the nature of COMP-DSMP in low- and middle-income countries’ (LMIC) primary care settings and evaluates implementation strategies and diabetes-related health outcomes. Methods We searched the Cochrane Library, PubMed-MEDLINE, SCOPUS, CINAHL PsycINFO Database, International Clinical Trials Registry Platform, Clinicaltrials.gov, Pan African Clinical Trials Registry (PACTR), and HINARI (Health InterNetwork Access to Research Initiative) for studies that evaluated a COMP-DSMP in adults with either type 1 or type 2 diabetes in World Bank-defined LMIC from January 2000 to December 2019. Randomised and non-randomised controlled trials with at least 3 months follow-up and reporting on a behavioural, a primary psychological, and/or a clinical outcome were included. Implementation strategies were analysed using the standardised implementation framework by Proctor et al. Heterogeneity in study designs, outcomes, the scale of measurements, and measurement times precluded meta-analysis; thus, a narrative description of studies is provided. Results Of the 702 records identified, eleven studies with 6090 participants were included. COMP-DSMPs were inconsistently associated with improvements in clinical, behavioural, and psychological outcomes. Many of the included studies were evaluated as being of low quality, most had a substantial risk of bias, and there was a significant heterogeneity of the intervention characteristics (for example, peer definition, selection, recruitment, training and type, dose, and duration of delivered intervention), such that generalisation was not possible. Conclusions The level of evidence of this systematic review was considered low according to the GRADE criteria. The existing evidence however does show some improvements in outcomes. We recommend ongoing, but well-designed studies using a framework such as the MRC framework for the development and evaluation of complex interventions to inform the evidence base on the contribution of COMP-DSMP in LMIC.