Diagnostic testing for hypertension, diabetes, and hypercholesterolaemia in low-income and middle-income countries: a cross-sectional study of data for 994 185 individuals from 57 nationally representative surveys
In this study, Sophie Ochmann, Isabelle von Polenz, Dr. Maja Marcus, Michaela Theilmann, Rifat Atun, and co-authors quantified and characterized diagnostic testing for hypertension, diabetes, and hypercholesterolemia in low-income and middle-income countries.
Testing for the risk factors of cardiovascular disease, which include hypertension, diabetes, and hypercholesterolaemia, is important for timely and effective risk management. Yet few studies have diagnostic testing performance for hypertension, diabetes, and hypercholesterolaemia in low-income and middle-income countries (LMICs) with respect to sociodemographic inequalities. This study aimed to address this knowledge gap.
According to the testing criteria in the WHO package of essential noncommunicable disease interventions for primary care (PEN) guidelines, all adults below 40 with a BMI above 30 kg/m² or adults aged 40 years or older with a BMI above 25 kg/m² should be tested for cardiovascular disease risk factors.
The sample included data from around 994 000 adults from 57 surveys from different world regions. The study found that 19·1% (95% CI 18·5–19·8) people in the hypertension sample met the WHO PEN criteria for diagnostic testing, of whom 78·6% (77·8–79·2) were tested; 23·8% (23·4–24·3) people in the diabetes sample met the WHO PEN criteria for diagnostic testing, of whom 44·9% (43·7–46·2) were tested; and 27·4% (26·3–28·6) people in the hypercholesterolaemia sample met the WHO PEN criteria for diagnostic testing, of whom 39·7% (37·1–2·4) were tested.
Women were more likely than men to be tested for hypertension and diabetes, and people in higher wealth quintiles compared with those in the lowest wealth quintile were more likely to be tested for all three risk factors, as were people with at least secondary education compared with those with less than primary education. The study shows opportunities for health systems in LMICs to improve the targeting of diagnostic testing for cardiovascular risk factors and adherence to diagnostic testing guidelines. Risk-factor-based testing recommendations rather than sociodemographic characteristics should determine which individuals are tested.
Learn more about the findings here.
Health system resilience: a critical review and reconceptualisation
This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neglect of equity and of who is bearing the costs of resilience strategies. Resilience depends crucially on relationships between system actors and components, and—as amply shown during the COVID-19 pandemic—relationships with wider systems (eg, economic, political, and global governance structures). Resilience is therefore connected to power imbalances, which need to be addressed to enact the transformative strategies that are important in dealing with more persistent shocks and stressors, such as climate change. We discourage the framing of resilience as an outcome that can be measured; instead, we see it emerge from systemic resources and interactions, which have effects that can be measured. We propose a more complex categorisation of shocks than the common binary one of acute versus chronic, and outline some of the implications of this for resilience strategies. We encourage a shift in thinking from capacities towards capabilities—what actors could do in future with the necessary transformative strategies, which will need to encompass global, national, and local change. Finally, we highlight lessons emerging in relation to preparing for the next crisis, particularly in clarifying roles and avoiding fragmented governance.
Learn more about the findings here.