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dc.rights.licenseAttribution 4.0 International (CC BY 4.0)
dc.contributor.authorSaleh, Shadi
dc.contributor.authorMuhieddine, Dina
dc.contributor.authorHamadeh, Randa
dc.contributor.authorDimassi, Hani
dc.contributor.authorDiaconu, Karin
dc.contributor.authorArakelyan, Stella
dc.contributor.authorAger, Alastair
dc.contributor.authorAlameddine, Mohamad
dc.identifierdoi: 10.3389/fpubh.2022.844864
dc.identifier.citationSaleh, S., Muhieddine, D., Hamadeh, R., Dimassi, H., Diaconu, K., Arakelyan, S., Ager, A. and Alameddine, M. (2022) ‘The determinants of the quality of clinical management among diabetic and hypertensive patients in a context of fragility: A cross-sectional survey from Lebanon’, Frontiers in Public Health, 10, p. 844864. Available at:
dc.descriptionFrom Frontiers via Jisc Publications Router
dc.descriptionHistory: collection 2022, received 2022-01-26, accepted 2022-07-04, epub 2022-07-25
dc.descriptionPublication status: Published
dc.descriptionStella Arakelyan - ORCID: 0000-0003-0326-707X
dc.descriptionAlastair Ager - ORCID: 0000-0002-9474-3563
dc.description.abstractIntroduction: The management of NCDs is a growing challenge in low- and middle-income settings with the increasing prevalence and the associated demands that such conditions make on health systems. Fragile settings both exacerbate the risk of NCDs and undermine systems capacity. Lebanon is a setting where strategies to address rising NCDs burden have faced particularly acute contextual challenges. Methods: We conducted a cross-sectional survey with patients accessing non-communicable disease across 11 primary care centers within the Greater Beirut and Beqaa areas. Response were received from 1,700 patients. We generated a Clinical Management Index Score as a measure of quality of care, and scores related to a range of socio-demographic characteristics and other context specific variables. Results: Significantly higher clinical management index scores (better quality of care) were associated with patients living in the semi-urban/rural context of Beqaa (compared to Greater Beirut), having health insurance coverage, aged above 60, having high levels of educational attainment, and making partial or full payment for their treatment. Relatively lower index scores (poorer quality of care) were associated with Syrian nationality (compared to Lebanese) and with patients suffering from diabetes or hypertension (compared to comorbid patients). Conclusion: The study identified a wide margin for improving quality of NCDs care in fragile contexts with particular gaps identified in referral to ophthalmology, accessing all prescribed medication and receiving counseling for smoking cessation. Additionally, findings indicate a number of predictors of comparatively poor quality of care that warrant attention, notably with regard to Syrian nationality/legal status, lack of health coverage, seeking free health provision and lower educational attachment. Although these are all relevant risk factors, the findings call on donor agencies, NGOs and provider institutions to design targeted programs and activities that especially ensure equitable delivery of services to diabetic and hypertensive patients with compounded vulnerability as a result of a number of these factors.
dc.publisherFrontiers Media S.A.
dc.rightsLicence for this article:
dc.rights© 2022 Saleh, Muhieddine, Hamadeh, Dimassi, Diaconu, Arakelyan, Ager and Alameddine. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
dc.sourceeissn: 2296-2565
dc.subjectPublic Health
dc.subjectNon-communicable diseases
dc.titleThe determinants of the quality of clinical management among diabetic and hypertensive patients in a context of fragility: A cross-sectional survey from Lebanon
qmu.authorDiaconu, Karin
qmu.authorArakelyan, Stella
qmu.authorAger, Alastair
qmu.centreInstitute for Global Health and Development

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Attribution 4.0 International (CC BY 4.0)
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