Early Experiences in the Integration of Noncommunicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo

Abstract

Background: Health services in humanitarian crises increasingly integrate the management of non-communicable diseases into primary care. As there is little description of such programs, this case study aims to describe the initial implementation of non-communicable disease management within emergency primary care in the conflict-affected Beni Region of Democratic Republic of the Congo (DRC). Objectives: We implemented and evaluated a primary care approach to hypertension and diabetes management to assess the feasibility of patient monitoring, early clinical and programmatic outcomes, and costs, after seven months of care. Methods: We designed clinical and programmatic modules for diabetes and hypertension management for clinical officers and the use of patient cards and community health workers to improve adherence. We used cohort analysis (April to October 2018), time-trend analysis, semi-structured interviews, and costing to evaluate the program. Findings: Increases in consultations for hypertension (incidence rate ratio [IRR] 13.5, 95% CI 5.8–31.5, p < 0.00) and diabetes (IRR 3.6, 95% CI 1–12.9, p < 0.05) were demonstrated up to the onset of violence and an Ebola epidemic in August 2018. Of 833 patients, 67% were women of median age 56. Nearly all were hypertensives (88.7%) and newly diagnosed (95.9%). Treatment adherence, defined as attending ≥2 visits in the seven month period, was demonstrated by 45.4% of hypertension patients. Community health workers had contact with 3.2–3.8 patients per month. Respondents stated that diabetes care remained fragmented with insulin and laboratory testing located outside of primary care. Program and management costs were 115 USD per person per treatment course. Conclusions: In an active conflict setting, we demonstrated that non-communicable disease care can be well-organized through clinical training and cohort analysis, and adherence can be addressed using patient-held cards and monitoring by community health workers. Nearly all diagnoses were new, emphasizing the need to establish self-management. Insecurity reduced access for patients but care continued for a subset of patients during the Ebola epidemic.

Health System Determinants of Hypertension Care and Outcomes in Sub-Saharan Africa: A Systematic Review

“…Half of the studies (21/39) [32–36, 38–41, 43, 46–49, 53, 55, 57–59, 61] across 13 countries explored the impact of healthcare provider knowledge of or adherence to hypertension treatment guidelines and decision support system on hypertension outcomes (Table 3). Generally, higher provider knowledge of or better adherence to guidelines and availability of decision-making support systems correlated with better hypertension care outcomes.…”

“…Eighteen percent (7/39) of the included studies [42, 49, 55, 56, 62, 65, 68] explored the impact of health facility type and capacity on hypertension care and outcomes. The studies highlighted the significant yet inconsistent differences in hypertension outcomes associated with receiving care at either community health post (closer to the community - offering one or very few primary healthcare services), community health center (serving a slightly bigger size of the community - offers the whole package of primary care services), general referral hospital, or specialized clinics.…”

“…A quarter (10/39) of the studies [36, 39–41, 48, 49, 55, 66, 67, 69] across eight countries explored the availability of equipment and consumables involved in hypertension management and impact on BP outcomes. The procurement of drugs and consumables and improvement in the supply chain implemented in the experimental studies and quality improvement project was in combination with other interventions such as providers’ training in Cameroon, Kenya, and Zambia [36, 39, 40], and better data management in Botswana [69].…”

The reality of managing asthma in sub-Saharan Africa – Priorities and strategies for improving care

“…In some SSA countries, the few available health workers have reported low competency in managing patients with chronic respiratory diseases. [12,13] While some progress has been made toward understanding how to integrate non-communicable diseases such as diabetes mellitus and hypertension into primary care, important gaps exist for chronic respiratory diseases such as asthma. [13] In this review, we discuss the diagnosis and treatment of asthma in children, adolescents, and adults in SSA.…”

“…[12,13] While some progress has been made toward understanding how to integrate non-communicable diseases such as diabetes mellitus and hypertension into primary care, important gaps exist for chronic respiratory diseases such as asthma. [13] In this review, we discuss the diagnosis and treatment of asthma in children, adolescents, and adults in SSA. We review the literature describing how asthma is diagnosed and treated in SSA and place current practice within the context of African national, regional, and selected international recommendations for asthma diagnosis and treatment from the World Health Organization (WHO), the International Union Against Tuberculosis (TB) and Lung Disease (The Union), and the Global Initiative for Asthma (GINA).…”