Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jan 6;13(1):e062009.
doi: 10.1136/bmjopen-2022-062009.

Acceptability and feasibility of tuberculosis and diabetes mellitus bidirectional screening and joint treatment services in Malawi: a cross-sectional study and a policy document review

John Lz Nyirenda  1   2   3 , Erasmo Mbemba  2 , Marumbo Chirwa  2 , Balwani Mbakaya  2 , Bagrey Ngwira  4 , Dirk Wagner  5 , Ingrid Toews  3 , Berit Lange  6   7
Affiliations
Review

Acceptability and feasibility of tuberculosis and diabetes mellitus bidirectional screening and joint treatment services in Malawi: a cross-sectional study and a policy document review

John Lz Nyirenda et al. BMJ Open. .

Abstract

Objectives: A cross-sectional and a policy document review study was performed to investigate perceived acceptability and feasibility to implementing different integration measures for tuberculosis (TB) and diabetes mellitus (DM) healthcare among healthcare workers (HCWs) and health managers, and to describe policy influence through a policy documents review in Malawi.

Setting: The survey was performed at eight hospitals, ministry of health offices and 10 non-governmental organisations. We collected data in March and April 2021.

Participants: Of 95 HCWs and health managers invited; 92 participated. 21/92 (23%) were female, and 17/92 (18%) participants were from clinics that piloted the integrated care for TB and DM.

Outcome measures: We described awareness levels on TB/DM comorbidity, perceptions and experiences in TB/DM care. Furthermore, development processes and contents of included documents were analysed.

Results: 16/17 (94%) of HCWs from clinics piloting integrated care and 65/75 (86%) HCWs from hospitals that do not use integrated care for TB and DM responded that integrated care was acceptable and feasible. In qualitative data, shortage of resources, inadequate information sharing were common themes. We included seven relevant documents for the analysis. On development process and content, six of seven documents were scored ≥70%. In these documents, DM is a recognised risk factor for TB, and integration of healthcare services for infectious diseases and non-communicable diseases is recommended, however, these documents lacked information specifically on integrated care for TB and DM.

Conclusion: In this study, we identified inadequate information sharing, and lack of resources as major factors impeding implementation of integration of services, however, awareness on TB/DM comorbidity was high.

Keywords: General diabetes; Health policy; Organisation of health services; PRIMARY CARE; PUBLIC HEALTH; Tuberculosis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

References

    1. Harries AD, Satyanarayana S, Kumar AMV, et al. Epidemiology and interaction of diabetes mellitus and tuberculosis and challenges for care: a review [Review article]. Public Health Action 2013;3:3–9. 10.5588/pha.13.0024 - DOI - PMC - PubMed
    1. Ruslami R, Aarnoutse RE, Alisjahbana B, et al. Implications of the global increase of diabetes for tuberculosis control and patient care. Trop Med Int Health 2010;15:1289–99. 10.1111/j.1365-3156.2010.02625.x - DOI - PubMed
    1. Berman J, Mitambo C, Matanje-Mwagomba B, et al. Building a knowledge translation platform in Malawi to support evidence-informed health policy. Health Res Policy Syst 2015;13:73. 10.1186/s12961-015-0061-4 - DOI - PMC - PubMed
    1. Jørgensen ME, Faurholt-Jepsen D. Is there an effect of glucose lowering treatment on incidence and prognosis of tuberculosis? A systematic review. Curr Diab Rep 2014;14:505. 10.1007/s11892-014-0505-1 - DOI - PubMed
    1. World Health Organisation . World Heal Organ. In: Global action plan for the prevention and control of noncommunicable diseases 2013-2020. 102, 2013.

Publication types