Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: a systematic review protocol

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Abstract Type 2 diabetes remains a major global public health challenge particularly in the African region. Though evidence exists on pharmacological agents and non-pharmacological interventions in maintaining blood glucose concentration, the health systems ability in meeting patients’ needs may be inadequate. However, the management of non-communicable diseases particularly diabetes, have been postulated to depend largely on functioning health systems. This systematic review will therefore, summarize the current evidence on existing health systems interventions in primary health settings for type 2 diabetes care and health outcomes in West Africa and would explore the impact of these system-level interventions on service availability, accessibility and quality, as well as individualized outcomes such as glycemic control, disease awareness and treatment adherence. The review will be conducted in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The health system framework by Witter et al, 2019 will guide the system-level interventions and the search strategy to be explored in this review. This framework was designed to integrate the six building blocks of the World health’s organization (WHO) health systems framework and delineates how they work synergistically to improve specific health outcomes. We will search the following databases PubMed, Google scholar and Cumulated Index to Nursing and Allied Health Literature (CINAHL) between January 2000 to June 2023 and Car.info from inception to June 2023. The Cochrane Collaboration tool for assessing Risk of Bias will be implemented on each included study to assess for risk of bias. We will conduct a narrative synthesis and make comparisons across findings using Excel generated tables. The main limitation of this study is that we are likely to miss out on studies not conducted in English or French since our search would be conducted in English and French only. In Conclusion, this systematic review will outline the existing system-level interventions that aim to or already improve type 2 diabetes services in primary health facilities in West Africa and would allow for strengthening and co-production of successful interventions that can be generalized to the entire sub-region.

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