The reported impact of non-communicable disease investment cases in 13 countries.

Non-communicable diseases (NCDs) are a leading health and development challenge worldwide. Since 2015, WHO and the United Nations Development Programme have provided support to governments to develop national NCD investment cases to describe the socioeconomic dimensions of NCDs. To assess the impact of the investment cases, semistructured interviews and a structured process for gathering written feedback were conducted between July and October 2022 with key informants in 13 countries who had developed a national NCD investment case between 2015 and 2020. Investment cases describe: (1) the social and economic costs of NCDs, including their distribution and projections over time; (2) priority areas for scaled up action; (3) the cost and returns from investing in WHO-recommended measures to prevent and manage NCDs; and (4) the political dimensions of NCD responses. While no country had implemented all the recommendations set out in their investment case reports, actions and policy changes attributable to the investment cases were identified, across (1) governance; (2) financing; and (3) health service access and delivery. The pathways of these changes included: (1) stronger collaboration across government ministries and partners; (2) advocacy for NCD prevention and control; (3) grounding efforts in nationally owned data and evidence; (4) developing mutually embraced 'language' across health and finance; and (5) elevating the priority accorded to NCDs, by framing action as an investment rather than a cost. The assessment also identified barriers to progress on the investment case implementation, including the influence of some private sector entities on sectors other than health, the impact of the COVID-19 pandemic, and changes in senior political and technical government officials. The results suggest that national NCD investment cases can significantly contribute to catalysing the prevention and control of NCDs through strengthening governance, financing, and health service access and delivery.

Hypertension among persons living with HIV-Zambia, 2021; A cross-sectional study of a national electronic health record system.

Hypertension is a major risk factor for cardiovascular disease, which is a common cause of death in Zambia. Data on hypertension prevalence in Zambia are scarce and limited to specific geographic areas and/or populations. We measured hypertension prevalence among persons living with HIV (PLHIV) in Zambia using a national electronic health record (EHR) system. We did a cross-sectional study of hypertension prevalence among PLHIV aged ≥18 years during 2021. Data were extracted from the SmartCare EHR, which covers ~90% of PLHIV on treatment in Zambia. PLHIV with ≥2 clinical visits in 2021 were included. Hypertension was defined as ≥2 elevated blood pressure readings (systolic ≥140 mmHg/diastolic ≥90 mmHg) during 2021 and/or on anti-hypertensive medication recorded in their EHR ≤5 years. Logistic regression was used to assess for associations between hypertension and demographic characteristics. Among 750,098 PLHIV aged ≥18 years with ≥2 visits during 2021, 101,363 (13.5%) had ≥2 recorded blood pressure readings. Among these PLHIV, 14.7% (95% confidence interval [CI]: 14.5-14.9) had hypertension. Only 8.9% of PLHIV with hypertension had an anti-hypertensive medication recorded in their EHR. The odds of hypertension were greater in older age groups compared to PLHIV aged 18-29 years (adjusted odds ratio [aOR] for 30-44 years: 2.6 [95% CI: 2.4-2.9]; aOR for 45-49 years: 6.4 [95% CI: 5.8-7.0]; aOR for ≥60 years: 14.5 [95% CI: 13.1-16.1]), urban areas (aOR: 1.9 [95% CI: 1.8-2.1]), and on ART for ≥6-month at a time (aOR: 1.1 [95% CI: 1.0-1.2]). Hypertension was common among PLHIV in Zambia, with few having documentation of treatment. Most PLHIV were excluded from the analysis because of missing BP measurements. Strengthening integrated management of non-communicable diseases in HIV clinics might help to diagnose and treat hypertension in Zambia. Addressing missing data of routine clinical data (like blood pressure) could improve non-communicable diseases surveillance in Zambia.

Estimation of the completeness of road traffic mortality data in Zambia using a three source capture recapture method.

BACKGROUND: Accurate and reliable data are essential for tracking progress and evaluating the effectiveness of road safety intervention measures. However, in many low- and medium-income countries, good quality data on road traffic crashes are often difficult to obtain. This situation has led to an underestimation of the severity of the problem and distortions in trends when the reporting changes over time. This study estimates the completeness of road traffic crash fatality data in Zambia. METHODS: Data from the police, hospitals, and the civil registration and vital statistics (CRVS) databases was collected for the period 1st January to 31st December 2020 and analyzed using a three-source capture-recapture technique. RESULTS: A total of 666 unique records on mortalities as a result of road traffic crashes were collected from the three data sources during the period under review. The capture-recapture technique estimated the completeness of police, hospital, and CRVS databases to be 19%, 11% and 14% respectively. The combination of the three data sets was found to increase completeness to 37%. Based on this completion rate, we estimate that the actual number of people who died as a result of road traffic crashes in Lusaka Province in the year 2020 was approximately 1,786 (95% CI [1,448-2,274]). This corresponds to an estimated mortality rate of around 53 deaths per 100,000 population. CONCLUSIONS: There is no single database contains complete data to provide a comprehensive picture of Lusaka province and by extension the country's road traffic injury burden. This study has shown how capture and recapture method can address this problem. It shows the need for the continuous review of the data collection processes and procedures in order to identify gaps and bottlenecks, improve efficiency, and increase the quality and completeness of road traffic data on injuries and fatalities. Based on the findings of this study, it is recommended that the city of Lusaka province and Zambia as a whole utilize more than one database for official reporting of road traffic fatalities to increase completeness.