Applying lessons learnt from the ‘DOTS’ Tuberculosis Model to monitoring and evaluating persons with diabetes mellitus in Blantyre, Malawi

Allain, Theresa J.; Oosterhout, Joep J. van; Douglas, Gerald P.; Joukes, Sabine; Gadabu, Oliver Jintha; Darts, Christopher; Kapur, Anil; Harries, Anthony

doi:10.1111/j.1365-3156.2011.02808.x

Cited by 69 publications

(77 citation statements)

References 12 publications

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“…There is no paper-based record system EMR In the clinic, an EMR has been set up in a way similar to those being used in the antiretroviral therapy clinics throughout the country and the diabetic clinics in Blantyre, Zomba and Lilongwe, as previously described. 14,15 These use a touch screen, point-of-care electronic system that has data fields for NCDs and their management. Demographic, clinical and treatment information for the patient is collected during registration and entered in real time into the EMR.…”

Section: Discussionmentioning

confidence: 99%

Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi

Manjomo

Mwagomba

Adè

et al. 2016

public health action

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KEY WORDS operational research; SORT IT; non-communicable disease; electronic medical record system; Malawi Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi R. C. Manjomo, 1 B. Mwagomba, 2 S. Ade, 3,4 E. Ali, 5 A. Ben-Smith, 6 P. Khomani, 1 P. Bondwe, 1 D. Nkhoma, 1 G. P. Douglas, 7 K. Tayler-Smith, 5 L. Chikosi, 8 A. D. Harries,3,9 O. J. Gadabu 1 C hronic non-communicable diseases (NCDs) are now the world's leading cause of mortality, with a significant and rapidly growing impact in low-and middle-income countries (LMICs). 1,2 In 2010, there were 34.5 million deaths (two of every three deaths globally) due to NCDs, with cancer, ischaemic heart disease, stroke and diabetes being the predominant causes. 3 Despite the increasing burden of disease and associated mortality, access to prevention, care and treatment remains out of reach for most people in LMICs, and as a result there have been calls for action to improve the situation. 4,5 In September 2011, the United Nations convened a high-level meeting on NCDs, and agreement was reached on a goal to reduce NCD deaths by 25% by 2025 in people aged 30-70 years. 6,7 This was taken forward into the Sustainable Development Goals (SDG), with SDG 3.4 aiming to reduce premature mortality from NCDs by one third by 2030. 8 The targets selected to achieve this goal include reducing elevated blood pressure, smoking cessation, reducing salt intake and increasing physical activity. While there is increasing agreement about the upstream policies required to combat NCDs and reduce NCD mortality, far less is known downstream about how to deliver and monitor quality services for the prevention, care and treatment of chronic disease for the millions of people in need.In LMICs, patients with NCDs are usually managed in tertiary or secondary level hospitals, but there is an urgent and important need to know how to decentralise and integrate the management of NCDs into primary health care and how to monitor the incidence and prevalence of disease, treatment outcomes and associated morbidity and mortality in this setting. A recent study from Kenya reported on the integrated management of patients with hypertension and/or diabetes in a primary health care setting supported by Médecins Sans Frontières (MSF), with encouraging results. 9 There is little information, however, about how this could work at the peripheral level in government settings in other LMICs.In Malawi, a nationwide World Health Organization (WHO) STEPwise approach to Surveillance (STEPS) survey showed that in 2009 respectively 33% and 6% of the population surveyed had hypertension and diabetes mellitus (DM); 10 as a result, a Non-Communicable Diseases Management Unit was established within the Ministry of Health. A national strategy and action plan for NCDs has been developed, including the roll-out of the concept of a 'chronic care clinic'. Currently, most patients with NCDs such as hypertension, DM, asthma and epilepsy are managed in one of the four national te...

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Section: Discussionmentioning

confidence: 99%

Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi

Manjomo

Mwagomba

Adè

et al. 2016

public health action

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“…First, it endorses the use of e-Health and cohort analysis for monitoring and managing patients with DM and hypertension, and adds to the growing body of literature supporting the use of this method in Jordan and other countries for NCDs. 19,20 Second, e-Health also enforces adherence to UNRWA technical guidelines, as it is impossible to move from the current to the next screening page without completing the requested assignments, and we feel that this is partly responsible for the excellent performance of disease control measurements seen in Q2 2013. Nevertheless, it needs to be asked whether PPBG is the best monitoring method or whether this could be replaced by glycated haemoglobin, which is more convenient and reliable as a measure of diabetes control, although more costly.…”

Section: Public Health Action Cohort Analysis For Patients With Diabementioning

confidence: 99%

Diabetes mellitus and treatment outcomes in Palestine refugees in UNRWA primary health care clinics in Jordan

Khader

Ballout

Shahin

et al. 2013

public health action

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decision was made to improve the practice and recording of routine clinic measurements and to expand the use of cohort analysis to other PHC clinics that already had e-Health.The aim of the present study was to use the principle of cohort analysis to report on the burden of DM and treatment outcomes of patients with DM registered at six PHC clinics in Jordan. Specific objectives were to report on 1) the number and characteristics of new patients with DM registered in the second quarter (Q2) of 2013 and of all patients with DM ever registered up to the end of June 2013; and 2) the treatment outcomes of patients ever registered up to the end of June 2013, along with measures of disease control and cumulative burden of disease-related complications, stratified by sex. METHODS Study designThis was a descriptive study of a quarterly and cumulative cohort of patients monitored using an e-Health record system. SettingThe study was conducted in six PHC clinics in Jordan, a country of 6 million inhabitants that also houses 2 million registered Palestine refugees, of whom 17% live in 10 official camps. UNRWA has 24 PHC clinics in Jordan, and in 2012 served a population of 1 175 021 refugees. The six PHC clinics (Nuzha, Taybeh, Marka, South Baqaa, Baqaa and Suf) situated in or near Amman, the capital city, served 302 539 (26%) refugees in 2012. Each clinic is staffed by up to four doctors and a variable number of nurses; all services are provided free of charge. Persons with diabetes mellitus and their managementPalestine refugees who attend the clinic are screened annually for DM and 6-monthly for hypertension if they are aged ⩾40 years, at risk of non-communicable diseases (NCDs) or are pre-conception or pregnant women. DM screening is performed by measuring random blood glucose on attendance at the clinic; if it is ⩾126 mg/dl (⩾7.0 mmol/l), then two fasting blood glucose (FBG) measurements are performed within a week, both of which must be ⩾126 mg/dl for diagnostic confirmation of DM. 3,4 Those with FBG between 100 and 125 mg/dl (6.0-6.9 mmol/l) are further screened for DM using an oral glucose tolerance test. 5 50% and 47%, respectively. In Q2 2013, 9740 (78%) patients attended a clinic, with >99% having undergone disease control measures: of these, 72% had postprandial blood glucose ⩽ 180 mg/dl, 71% had blood cholesterol < 200 mg/dl, 82% had blood pressure < 140/90 and 40% had body mass index < 30 kg/m 2 . Late-stage complications were present in 1130 (11.6%) patients who attended a clinic, with cardiovascular disease and stroke being the most common. Several differences in outcomes were found between males and females. International Union Against Tuberculosis and Lung Disease Conclusion:There is a high burden of disease due to DM at primary health care clinics in Jordan. Cohort analysis using e-Health is a vital way to assess management and follow-up.

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“…By 2030, this number is expected to reach 438 million (16). Diabetic non-healing wounds, such as diabetic foot ulcer (DFU), are a major cause of morbidity in diabetic patients, often leading to infection, suffering and a poor quality of life.…”

Section: Discussionmentioning

confidence: 99%

Akt/hypoxia-inducible factor-1α signaling deficiency compromises skin wound healing in a type 1 diabetes mouse model

Jing

2015

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to investigate the mechanisms for impaired skin wound healing in subjects with diabetes. Type 1 diabetes (T1DM) was induced in BALB/c mice using streptozotocin. One month after the establishment of the T1DM mouse model, a wound was formed on the back of the mice, and tissues from the wounds and the margins were collected on days 0, 3, 7 and 10. Protein levels of cluster of differentiation 31 (CD31) were detected using immunohistochemistry, and the mRNA levels of Akt, hypoxia-inducible factor-1α (Hif-1α), vascular endothelial growth factor (Vegf ), VEGF receptor 2 (Vegfr2), stromal cell-derived growth factor-1α (Sdf-1α) and CXC chemokine receptor 4 (Cxcr4) were determined using reverse transcription-quantitative polymerase chain reaction analysis. The corresponding protein levels were determined using western blotting. The skin wound healing rate in the T1DM mice was significantly lower than that in the control mice, and the protein level of CD31 in the wounded skin of the T1DM mice was significantly decreased. Furthermore, the overall mRNA levels of Akt, Vegf, Vegfr2, and Cxcr4 in the T1DM mice were significantly lower than those in the control mice, and similar trends were observed in the protein levels. In conclusion, skin wound healing was impaired in the T1DM mice, and this may have been caused by a deficiency of Akt/HIF-1α and downstream signaling, as well as delayed angiogenesis. IntroductionDiabetes mellitus is a chronic disease threatening the health of individuals worldwide (1). There are multiple, often serious, complications associated with diabetes mellitus, one of which is impaired healing, which can lead to a reduction in physical activity and, in certain cases, chronic wounds and limb amputation (1,2). An imbalance between the pro-and anti-inflammatory mediators accentuates diabetic vascular complications and impedes proper wound healing (3). Other factors that contribute to deficient healing in patients with diabetes include altered host responses; attenuated antibacterial defenses; prolonged inflammation; changes in protease activity; insufficient cell production for rapid and robust healing; angiogenic disorders; decreased production of growth factors; inadequate extracellular matrix production; and changes in apoptosis (1-5).Wound healing is a complex process involving inflammation, granulation tissue formation, the production of new structures and tissue remodeling (2). The process is dependent upon a series of interactions between a variety of cell types, cytokine mediators and the extracellular matrix (1). In order for wound healing to be successful, a sufficient number of cells must be generated to participate in the repair (2,6,7). Processes that have a negative effect on the generation of an adequate cell number, such as inappropriately high levels of fibroblast apoptosis, may limit healing (6,7).Hypoxia-inducible factor (HIF)-1 is a master regulator of oxygen homeostasis and is comprised of HIF-1α, a finely regulated subunit, and HIF-1β (also ...

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Applying lessons learnt from the ‘DOTS’ Tuberculosis Model to monitoring and evaluating persons with diabetes mellitus in Blantyre, Malawi

Cited by 69 publications

References 12 publications

Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi

Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi

Diabetes mellitus and treatment outcomes in Palestine refugees in UNRWA primary health care clinics in Jordan

Akt/hypoxia-inducible factor-1α signaling deficiency compromises skin wound healing in a type 1 diabetes mouse model

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