Conference abstract
Effect of structured self-management education on cardiometabolic disease outcomes in sub-Saharan Africa: a systematic review
Pan African Medical Journal - Conference Proceedings. 2024:22(110).25
Nov 2024.
doi: 10.11604/pamj-cp.2024.22.110.2691
Archived on: 25 Nov 2024
Contact the corresponding author
Keywords: Cardiometabolic disease, outcomes, sub-Saharan Africa
Poster
Effect of structured self-management education on cardiometabolic disease outcomes in sub-Saharan Africa: a systematic review
Stephen Tetteh Engmann1, Roberta Lamptey1,&, Babbel Agbinko-Djobalar1, Stephen Aguadze1, Nana Akosua Darko1, Leonard Baatiema1
1Department of Family Medicine, Korle Bu Teaching Hospital, Accra, Ghana
&Corresponding author
Introduction: globally at least one in every two adults aged 60 or more has at least two chronic conditions. The true prevalence of chronic cardiometabolic diseases in sub-Saharan Africa is unknown. However, the disease burden is highest among young adults less than 30 years old. Furthermore, the age-adjusted total disability-adjusted life years due to non-communicable diseases in Sub-Saharan Africa has risen by over the past three decades by 67% and over the next two decades the highest rise in prevalence of diabetes, a major non-communicable disease, will in this same region, if current trends persist. Structured self-management education remains pivotal in managing chronic long-term conditions including when multiple conditions cluster in individuals. Structured self-management education programs have improved disease outcomes in some high-income settings. In low-income settings like in Sub-Saharan Africa where 80% of the world’s poorest billion people live and where 80% of people living with non-communicable diseases reside, structured self-management education programs are an obvious necessity. The effect of these structured self-management education programs on outcomes of chronic long-term conditions in such resource-constrained contexts has not been synthesized. The aim is to describe the effect of structured self-management education interventions on cardiometabolic disease outcomes in Sub-Saharan Africa.
Methods: a systematic review of controlled trials that assessed the effect of structured self-management education interventions on cardiometabolic disease outcomes was conducted. We included studies conducted in Sub-Saharan Africa in adults aged 18 or older, which reported outcomes such as HbA1c, blood pressure, and quality of life. We search across PubMed, CINAHL, and Cochrane Library from inception to 23rd May 2024. Data retrieval, appraisal, and extraction were done mainly by a team of four of the authors with covidence. Data extraction involved key study characteristics, and the risk of bias was assessed using the Cochrane Risk-of-Bias tool. Registration: The review is registered on PROSPERO CRD42024539490.
Results: in total 1821 studies were identified. Of these 19 studies involving 6344 participants from eight sub-Saharan countries were included. The review found that in six out of 14 studies, structured self-management education intervention significantly improved glycaemic control in patients with type 2 diabetes. However, evidence regarding blood pressure control was limited, with only five studies reporting relevant outcomes, two of which showed statistically significant improvements. Overall, 68% (n=13) of the studies had either high risk or some risk of bias.
Conclusion: the existing evidence on the effect of structured self-management education interventions on cardiometabolic disease outcomes in Sub-Saharan Africa is unfortunately limited and checkered. Larger and more robust controlled trials are urgently needed to guide policy, and clinical practice and hopefully reverse current epidemiological trends. The strengths of this review include methodological rigor and objective eligibility criteria. Our findings are limited by the small number of included studies, the majority being at high risk of bias.
Effect of structured self-management education on cardiometabolic disease outcomes in sub-Saharan Africa: a systematic review
Stephen Tetteh Engmann1, Roberta Lamptey1,&, Babbel Agbinko-Djobalar1, Stephen Aguadze1, Nana Akosua Darko1, Leonard Baatiema1
1Department of Family Medicine, Korle Bu Teaching Hospital, Accra, Ghana
&Corresponding author
Introduction: globally at least one in every two adults aged 60 or more has at least two chronic conditions. The true prevalence of chronic cardiometabolic diseases in sub-Saharan Africa is unknown. However, the disease burden is highest among young adults less than 30 years old. Furthermore, the age-adjusted total disability-adjusted life years due to non-communicable diseases in Sub-Saharan Africa has risen by over the past three decades by 67% and over the next two decades the highest rise in prevalence of diabetes, a major non-communicable disease, will in this same region, if current trends persist. Structured self-management education remains pivotal in managing chronic long-term conditions including when multiple conditions cluster in individuals. Structured self-management education programs have improved disease outcomes in some high-income settings. In low-income settings like in Sub-Saharan Africa where 80% of the world’s poorest billion people live and where 80% of people living with non-communicable diseases reside, structured self-management education programs are an obvious necessity. The effect of these structured self-management education programs on outcomes of chronic long-term conditions in such resource-constrained contexts has not been synthesized. The aim is to describe the effect of structured self-management education interventions on cardiometabolic disease outcomes in Sub-Saharan Africa.
Methods: a systematic review of controlled trials that assessed the effect of structured self-management education interventions on cardiometabolic disease outcomes was conducted. We included studies conducted in Sub-Saharan Africa in adults aged 18 or older, which reported outcomes such as HbA1c, blood pressure, and quality of life. We search across PubMed, CINAHL, and Cochrane Library from inception to 23rd May 2024. Data retrieval, appraisal, and extraction were done mainly by a team of four of the authors with covidence. Data extraction involved key study characteristics, and the risk of bias was assessed using the Cochrane Risk-of-Bias tool. Registration: The review is registered on PROSPERO CRD42024539490.
Results: in total 1821 studies were identified. Of these 19 studies involving 6344 participants from eight sub-Saharan countries were included. The review found that in six out of 14 studies, structured self-management education intervention significantly improved glycaemic control in patients with type 2 diabetes. However, evidence regarding blood pressure control was limited, with only five studies reporting relevant outcomes, two of which showed statistically significant improvements. Overall, 68% (n=13) of the studies had either high risk or some risk of bias.
Conclusion: the existing evidence on the effect of structured self-management education interventions on cardiometabolic disease outcomes in Sub-Saharan Africa is unfortunately limited and checkered. Larger and more robust controlled trials are urgently needed to guide policy, and clinical practice and hopefully reverse current epidemiological trends. The strengths of this review include methodological rigor and objective eligibility criteria. Our findings are limited by the small number of included studies, the majority being at high risk of bias.
