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

Abstract

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...

Challenges faced by the patients in the management of risk factors of non-communicable diseases in a government primary health care setting of Puducherry

“…3 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 and focusing on management of risk factors. 4 India's current approach for intervention is more in terms of screening blood sugar testing and putting the same patients on anti-glycemic agents, indeed for cutting down the burden of type-2 diabetes, there is intervention for the prevention of risk factors such as sugar intake and salt intake which needs a different approach. Indeed for addressing other issues such as healthy eating practices, reduction of alcohol, and complete ban on tobacco consumption, separate health education program is needed for effective intervention of NCDs.…”

Non-communicable diseases in the Western Area District, Sierra Leone, before and during the Ebola outbreak

“…This is already being done in other African countries, 7,8 and the lessons learnt need to be shared and taken up. Finally, more research is needed as to why there were sex differences and increases in reports of PUD between the pre-Ebola and Ebola periods.…”

“…7,8 As PUD requires endoscopy for a definitive diagnosis, which is not possible at most health-care levels …”

“…Consideration should also be given to electronic medical records, which have been successfully deployed and used for chronic NCDs at peripheral heath centres in Africa and elsewhere. 8,21,22 The private sector needs to be included in plans and implementation.…”

“…7,8 In Sierra Leone, NCDs are also generally managed at tertiary and secondary level hospitals. Peripheral health units (PHUs), however, have increasingly begun to take on this workload with established referral mechanisms to ensure that patients with selected NCDs (e.g., diabetes, epilepsy) or severe complications from hypertension or peptic ulcer disease can be referred from primary health care level to secondary or tertiary care facilities.…”