TY - JOUR T1 - What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries JF - BMJ Open JO - BMJ Open DO - 10.1136/bmjopen-2021-052105 VL - 12 IS - 7 SP - e052105 AU - Stephen Mulupi AU - Irene Ayakaka AU - Rachel Tolhurst AU - Nicole Kozak AU - Elizabeth Henry Shayo AU - Elhafiz Abdalla AU - Rashid Osman AU - Uzochukwu Egere AU - Stellah G Mpagama AU - Martha Chinouya AU - Kingsley Rex Chikaphupha AU - Asma ElSony AU - Helen Meme AU - Rose Oronje AU - Nyanda Elias Ntinginya AU - Angela Obasi AU - Miriam Taegtmeyer A2 - , Y1 - 2022/07/01 UR - http://bmjopen.bmj.com/content/12/7/e052105.abstract N2 - Objectives Chronic respiratory diseases (CRD) are among the top four non-communicable diseases globally. They are associated with poor health and approximately 4 million deaths every year. The rising burden of CRD in low/middle-income countries will strain already weak health systems. This study aimed to explore the perspectives of healthcare workers and other health policy stakeholders on the barriers to effective diagnosis and management of CRD in Kenya, Malawi, Sudan, Tanzania and Uganda.Study design Qualitative descriptive study.Settings Primary, secondary and tertiary health facilities, government agencies and civil society organisations in five sub-Saharan African countries.Participants We purposively selected 60 national and district-level policy stakeholders, and 49 healthcare workers, based on their roles in policy decision-making or health provision, and conducted key informant interviews and in-depth interviews, respectively, between 2018 and 2019. Data were analysed through framework approach.Results We identified intersecting vicious cycles of neglect of CRD at strategic policy and healthcare facility levels. Lack of reliable data on burden of disease, due to weak information systems and diagnostic capacity, negatively affected inclusion in policy; this, in turn, was reflected by low budgetary allocations for diagnostic equipment, training and medicines. At the healthcare facility level, inadequate budgetary allocations constrained diagnostic capacity, quality of service delivery and collection of appropriate data, compounding the lack of routine data on burden of disease.Conclusion Health systems in the five countries are ill-equipped to respond to CRD, an issue that has been brought into sharp focus as countries plan for post-COVID-19 lung diseases. CRD are underdiagnosed, under-reported and underfunded, leading to a vicious cycle of invisibility and neglect. Appropriate diagnosis and management require health systems strengthening, particularly at the primary healthcare level.Data are available upon reasonable request. No additional data available. ER -