Novel approaches to screening for noncommunicable diseases: Lessons from Neno, Malawi

Abstract

BackgroundAs Malawi continues to suffer from a large burden of noncommunicable diseases (NCDs), models for NCD screening need to be developed that do not overload a health system that is already heavily burdened by communicable diseases. Methods This descriptive study examined 3 screening programmes for NCDs in Neno, Malawi, that were implemented from June 2015 to December 2016. The NCD screening models were integrated into existing platforms, utilising regular mass screening events in the community, patients awaiting to be seen in a combined NCD and HIV clinic, and patients awaiting treatment at outpatient departments (OPDs). Focusing on hypertension and diabetes, we screened all adults 30 years and above for hypertension using a single blood pressure cut-off of 160/110 mmHg, as well as adults 40 years and above for diabetes, measuring either random blood sugar (RBS) or fasting blood sugar (FBS), with referral criteria of FBS > 126 mg/dL and RBS > 200 mg/dL. Data were collected on specifically designed screening registers, then entered and analysed in Excel. Results Over 14,000 adults (≥ 12 years old) were screened for an array of common conditions at community screening events. Of these adults, 58% (n = 8133) and 29% (n = 4016) were screened for hypertension and diabetes, respectively. Nine percent (n = 716) and 3% ( n = 113) were referred for further hypertension and diabetes assessment respectively. At one OPD, 5818 patients (60%) had their blood pressures measured, and among adults 30 years and above, 168 eligible adults were referred for further hypertension assessment. Since the initiation of the screening programmes, the number of patients ever enrolled for NCD care every 3 months has nearly tripled, from 40 to 114. ConclusionsThe screening models have shown that it is not only feasible to introduce NCD screening into a public system, but screening may have also contributed to increased enrolment in NCD care in Neno, Malawi.

Expanding access to non-communicable disease care in rural Malawi: outcomes from a retrospective cohort in an integrated NCD–HIV model

“…Patients were diagnosed using predefined NCD protocols, set by the IC3 team and HIV protocols from central MOH. 50 Patients enrolled in IC3 were seen at the health facility nearest to their home at regular intervals. Patients with a complex diagnosis or those starting care had a scheduled visit every month, while most other patients visited every 3 months.…”

Quality of primary care from patients’ perspective: a cross sectional study of outpatients’ experience in public health facilities in rural Malawi

“…Recent studies from Neno show better health outcomes in maternal and child mortality [ 13 ], HIV care [ 14 , 15 ], Kaposi sarcoma and palliative care [ 16 ], and financial risk protection for vulnerable patients [ 17 ]. In addition, innovative primary care approaches have been implemented in non-communicable diseases [ 18 , 19 ]and an extensive structure of community health workers is supporting the health system [ 20 ].…”

Feasibility of integrated, multilevel care for cardiovascular diseases (CVD) and HIV in low- and middle-income countries (LMICs): A scoping review

“…Additionally, only 5% of selected studies (n = 1) was a randomized controlled trial (RCT)—a pragmatic cluster RCT [19]. Most studies were either descriptive, cross sectional studies (n = 8) [20, 21, 22, 23, 24, 25, 26, 27] or observational cohort studies (n = 6) [21, 28, 29, 30, 31] (See S1 Dataset )…”