Protocol for the evaluation of a pilot implementation of essential interventions for the prevention of cardiovascular diseases in primary healthcare in the Republic of Moldova

Collins, Dylan; Ciobanu, Angela; Laatikainen, Tiina; Curocichin, Ghenadie; Șalaru, Virginia; Zatic, Tatiana; Anisei, Angela; Farrington, Jill

doi:10.1136/bmjopen-2018-025705

Cited by 14 publications

(17 citation statements)

References 4 publications

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“…Part of this pledge is to continue on the awareness campaigns already in place and to establish a comprehensive strategy involving legal measures, mandatory reformulation, nutritional labelling, efficient enforcement and good leadership [28]. Furthermore, a feasibility study of implementation and evaluation of essential interventions for the prevention of CVD in primary healthcare is currently under way in the Republic of Moldova, with a view towards a national scale-up [51].…”

Section: Impact and Policy Implicationsmentioning

confidence: 99%

Sodium, Potassium and Iodine Intake, in a National Adult Population Sample of the Republic of Moldova

et al. 2019

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In the Republic of Moldova, more than half of all deaths due to noncommunicable diseases (NCDs) are caused by cardiovascular disease (CVD). Excess salt (sodium) and inadequate potassium intakes are associated with high CVD. Moreover, salt iodisation is the preferred policy to prevent iodine deficiency and associated disorders. However, there is no survey that has directly measured sodium, potassium and iodine consumption in adults in the Republic of Moldova. A national random sample of adults attended a screening including demographic, anthropometric and physical measurements. Sodium, potassium and iodine intakes were assessed by 24 h urinary sodium (UNa), potassium (UK) and iodine (UI) excretions. Knowledge, attidues and behaviours were collected by questionnaire. Eight-hundred and fifty-eight participants (326 men and 532 women, 18–69 years) were included in the analysis (response rate 66%). Mean age was 48.5 years (SD 13.8). Mean UNa was 172.7 (79.3) mmoL/day, equivalent to 10.8 g of salt/day and potassium excretion 72.7 (31.5) mmoL/day, equivalent to 3.26 g/day. Only 11.3% met the World Health Organization (WHO) recommended salt targets of 5 g/day and 39% met potassium targets (>90 mmoL/day). Whilst 81.7% declared limiting their consumption of processed food and over 70% not adding salt at the table, only 8.8% looked at sodium content of food, 31% still added salt when cooking and less than 1% took other measures to control salt consumption. Measures of awareness were significantly more common in urban compared to rural areas. Mean urinary iodine was 225 (SD: 152; median 196) mcg/24 h, with no difference between sexes. According to WHO criteria, 41.0% had adequate iodine intake. Iodine content of salt table was 21.0 (SD: 18.6) mg/kg, lower in rural than urban areas (16.7, SD = 18.6 vs. 28.1, SD = 16.5 mg/kg, p < 0.001). In most cases participants were not using iodised salt as their main source of salt, more so in rural areas. In the Republic of Moldova, salt consumption is unequivocally high, potassium consumption is lower than recommended, both in men and in women, whilst iodine intake is still inadequate in one in three people, although severe iodine deficiency is rare. Salt consumed is often not iodised.

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Section: Impact and Policy Implicationsmentioning

confidence: 99%

Sodium, Potassium and Iodine Intake, in a National Adult Population Sample of the Republic of Moldova

et al. 2019

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“…We therefore hope that by mapping our six key lessons to validated CFIR domains, this will help national governments to predict and plan around factors known to be influential for the improving access to quality essential health services. While Member States in the region are at various stages of implementation, several are currently conducting pragmatic cluster randomised trials to generate local evidence for health policy that will help add to the implementation science evidence base 21 22. As this work expands, greater engagement with peer-to-peer sharing of contextual wisdom, sharing of resources and publishing methodology and results and development of region-specific resources is planned.…”

Section: Resultsmentioning

confidence: 99%

Implementing essential interventions for cardiovascular disease risk management in primary healthcare: lessons from Eastern Europe and Central Asia

2020

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Globally, non-communicable diseases (NCDs) are the leading cause of morbidity and mortality, including in the WHO European region. Within this region, the Member States with the greatest cardiovascular disease (CVD) burden are also some of the lowest resourced. As the need for technical support for the implementation of essential CVD/NCD interventions in primary healthcare (PHC) in these regions grew urgent, the WHO Regional Office for Europe has been directly supporting national governments in the development, assessment, scale-up and quality improvement of large scale PHC interventions for CVD. Herein, we synthesise the key learnings from providing technical support to national governments under the auspices of the WHO across the European region and share these learnings as a resource for public health professionals to consider when increasing coverage of quality essential health services. Based on our experience providing technical support to a diversity of Member States in the European Region (eg, Tajikistan, Republic of Moldova, Ukraine and Uzbekistan), we have identified six key lessons: prioritising NCDs for public health intervention, identifying and mapping existing resources, engaging key stakeholders, tailoring interventions to the local health system, generating local evidence and ensuring quality improvement while mainstreaming. Common challenges across all phases of implementation include multiple and inconsistent international toolkits and guidance, lack of national capacity for evidence-based healthcare, limited access to essential medicines and technologies, inconsistent national guidelines and limited experience in evaluation methodology, clinical epidemiology and guideline implementation. We map the lessons to the Consolidated Framework for Implementation Research and highlight key learnings and challenges specific to the region. Member States in the region are at various stages of implementation; however, several are currently conducting pragmatic clinical trials to generate local evidence for health policy. As this work expands, greater engagement with peer-to-peer sharing of contextual wisdom, sharing of resources, publishing methodology and results and development of region-specific resources is planned.

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“…We previously published our study protocol which describes the methodology in detail. (Collins et al, 2019) The one-year follow-up data are published in the European Journal of Public Health, along with additional methodological information. (Laatikainen et al, 2020) In short, we conducted a feasibility study of a cluster randomized controlled trial of primary health care facilities (n = 20) which were randomly allocated to intervention (n = 10) or control (n = 10) ( Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…Thus, the a priori outcomes were assessed again at second year using the previously described methodology. (Collins et al, 2019;Laatikainen et al, 2020) Herein, we report the second-year follow-up data from the aforementioned feasibility study.…”

Section: Introductionmentioning

confidence: 99%

Implementing a package of noncommunicable disease interventions in the Republic of Moldova: two-year follow-up data

Collins

Inglin

Laatikainen

et al. 2020

Prim Health Care Res Dev

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SUMMARY Noncommunicable diseases (NCDs) are a growing challenge in the Republic of Moldova. A previously reported pilot cluster randomized controlled trial aimed to determine the feasibility of implementing and evaluating essential interventions for NCDs (e.g. cardiovascular risk scoring, hypertension management, statin treatment, etc.) in primary health care in the Republic of Moldova, with a view toward national scale up. One-year follow-up data (previously published) demonstrated modest improvements in NCD risk factor identification and management could be achieved. Herein, we report the second-year follow-up data and conclude that sustainable improvements in NCD risk factor control (e.g. hypertension control) can be achieved in primary health care in low resource settings by adapting existing resources (e.g. WHO PEN) and conducting focused clinical training and support. If scaled to a national level, these improvements in risk factor control could significantly translate to reductions in premature mortality from NCDs.

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Protocol for the evaluation of a pilot implementation of essential interventions for the prevention of cardiovascular diseases in primary healthcare in the Republic of Moldova

Cited by 14 publications

References 4 publications

Sodium, Potassium and Iodine Intake, in a National Adult Population Sample of the Republic of Moldova

Sodium, Potassium and Iodine Intake, in a National Adult Population Sample of the Republic of Moldova

Implementing essential interventions for cardiovascular disease risk management in primary healthcare: lessons from Eastern Europe and Central Asia

Implementing a package of noncommunicable disease interventions in the Republic of Moldova: two-year follow-up data

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