Periodic Reporting for period 3 - CEAD (Contextualizing Evidence for Action on Diabetes in low-resource Settings: A mixed-methods case study in Quito and Esmeraldas, Ecuador.)
Reporting period: 2022-01-01 to 2023-06-30
The relentless rise in diabetes is one of the greatest global health emergencies of the 21st century. The rise is most pronounced in low and middle income countries where today three quarters of people with diabetes live and over 80% of the deaths attributed to non-communicable diseases occur. Most major international organizations call for the adoption healthy public policies to improve diets and increase physical activity, as well as initiatives to strengthening existing health systems for diabetes management. Unfortunately, implementation of recommended action remains limited in many settings.
In project CEAD we explore the challenges to implementation in two low-resource areas in Ecuador (one rural and one urban) and engage local stakeholders in the development of context-led innovations for diabetes prevention and care. The overarching objective is to explore the process by which global recommendations can be translated into context-specific, evidence-informed action for diabetes prevention and care in low-resource settings.
In project CEAD we explore the challenges to implementation in two low-resource areas in Ecuador (one rural and one urban) and engage local stakeholders in the development of context-led innovations for diabetes prevention and care. The overarching objective is to explore the process by which global recommendations can be translated into context-specific, evidence-informed action for diabetes prevention and care in low-resource settings.
The first 30 months of the project have been dedicated to refining protocols, achieving ethics approval, ministry of health authorisation, recruiting and training staff, and commencing fieldwork.
To summarise the work performed, we can consider two main areas. 1) work related to the contextualisation of healthy public policies 2) work related to strengthening the health system for diabetes care.
1) Healthy public policies:
We have started two cross-sectional population surveys to estimate the prevalence of diabetes, impaired glucose tolerance, and non-communicable disease risk factors in two carefully selected health districts in Ecuador (one rural, one urban). There has been some delays caused by movement restrictions due to the COVID-19 pandemic, but both surveys are well underway and expected to be completed this year. We have also carried out a scoping review on evidence-based policy actions that are recommended by global public health institutions and can be implemented at local level to improve diet and promote physical activity. The findings from both these actions will be discussed with local stakeholders to analyse the contextual relevance and applicability of different policy actions.
2) Health system strengthening:
We have published a systematic review on the barriers and facilitators of diabetes management in Latin America and the Caribbean. We have validated a questionnaire for exploring quality of life among people with diabetes in Ecuador. We have initiated the recruitment of two longitudinal studies looking at the care received by patients with type 2 diabetes in the two setting in Ecuador. In Esmeraldas (the rural setting) recruitment and data collection is well underway. In Quito (the urban setting), recruitment has been delayed due to the COVID pandemic, and we have been forced to collect information by telephone interview.
To complement the data obtained here (and in light of the current health emergency) we have also completed 20 semi-structured interviews exploring patients experiences of diabetes care during the pandemic.
To summarise the work performed, we can consider two main areas. 1) work related to the contextualisation of healthy public policies 2) work related to strengthening the health system for diabetes care.
1) Healthy public policies:
We have started two cross-sectional population surveys to estimate the prevalence of diabetes, impaired glucose tolerance, and non-communicable disease risk factors in two carefully selected health districts in Ecuador (one rural, one urban). There has been some delays caused by movement restrictions due to the COVID-19 pandemic, but both surveys are well underway and expected to be completed this year. We have also carried out a scoping review on evidence-based policy actions that are recommended by global public health institutions and can be implemented at local level to improve diet and promote physical activity. The findings from both these actions will be discussed with local stakeholders to analyse the contextual relevance and applicability of different policy actions.
2) Health system strengthening:
We have published a systematic review on the barriers and facilitators of diabetes management in Latin America and the Caribbean. We have validated a questionnaire for exploring quality of life among people with diabetes in Ecuador. We have initiated the recruitment of two longitudinal studies looking at the care received by patients with type 2 diabetes in the two setting in Ecuador. In Esmeraldas (the rural setting) recruitment and data collection is well underway. In Quito (the urban setting), recruitment has been delayed due to the COVID pandemic, and we have been forced to collect information by telephone interview.
To complement the data obtained here (and in light of the current health emergency) we have also completed 20 semi-structured interviews exploring patients experiences of diabetes care during the pandemic.
The findings will support the global endeavour to bridge the global “know-do” gap, one of the most important public health challenges this century and a great opportunity for strengthening health systems and achieving health equity.