Treating Syrian refugees with diabetes and hypertension in Shatila refugee camp, Lebanon: Médecins Sans Frontières model of care and treatment outcomes

Abstract

Background Médecins Sans Frontières (MSF) has been providing primary care for non-communicable diseases (NCDs), which have been increasing in low to middle-income countries, in the Shatila refugee camp, Beirut, Lebanon, using a comprehensive model of care to respond to the unmet needs of Syrian refugees. The objectives of this study were to: 1) describe the model of care used and the Syrian refugee population affected by diabetes mellitus (DM) and/or hypertension (HTN) who had ≥ one visit in the MSF NCD clinic in Shatila in 2017, and 2) assess 6 month treatment outcomes. Methods A descriptive retrospective cohort study using routinely collected program data for a model of care for patients with DM and HTN consisting of four main components: case management, patient support and education counseling, integrated mental health, and health promotion. Results Of 2644 Syrian patients with DM and/or HTN, 8% had Type-1 DM, 30% had Type-2 DM, 30% had HTN and 33% had DM + HTN. At intake, patients had a median age of 53, were predominantly females (63%), mostly from outside the catchment area (70%) and diagnosed (97%) prior to enrollment. After 6 months of care compared to intake: 61% of all patients had controlled DM (HbA1C < 8%) and 50% had controlled blood pressure (BP: < 140/90 mmHg) compared to 29 and 32%, respectively ( p < 0.001). Compared to intake, patients with Type-1 DM reached an HbA1C mean of 8.4% versus 9.3% ( p = 0.022); Type-2 DM patients had an HbA1C mean of 8.1% versus 9.4% ( p = 0.001); and those with DM + HTN reached a mean HbA1C of 7.7% versus 9.0%, ( p = 0.003). Reflecting improved control, HTN patients requiring ≥3 medications increased from 23 to 38% (p < 0.001), while DM patients requiring insulin increased from 21 to 29% (p < 0.001). Loss-to-follow-up was 16%. Conclusions The MSF model of care for DM and HTN operating in the Shatila refugee camp is feasible, and showed promising outcomes among enrolled individuals. It may be replicated in similar contexts to respond to the increasing burden of NCDs among refugees in the Middle-East and elsewhere.

Prevalence of Non-Communicable Diseases and Associated Medication Use Among Syrian Refugees in Lebanon: An Analysis of Country-Wide Data from the Sijilli Electronic Health Records Database

“…The burden of NCDs is growing swiftly among Syrian refugees in Lebanon and the region (43). Previous studies found a high prevalence of reported hypertension, diabetes, CVDs and other NCDs amongst Syrian refugees in Lebanon (43,44), and prevalence was most pronounced among adults above 40 (45). One study indicated that the prevalence rates reached 21% for hypertension, 11% for CVDs and 10% for diabetes (46).…”

“…Although the prevalence of NCDs among the Syrian refugee population in Lebanon has reached alarming rates and regardless of the presence of healthcare actors to respond to the needs of the refugee population, very little is being done to control and manage these costly diseases which remain to be a heavy burden within this population (44).…”

“…Given the large caseload of Syrian refugees with NCDs in Lebanon coupled with the high costs of providing NCD care, implications on the Lebanese healthcare system are substantial (56). In light of this, the Lebanese Ministry of Public Health (MoPH) and the UNHCR undertook measures in response to the Syrian crisis to provide primary healthcare services for Syrian refugees through the primary healthcare centers (PHCs) across the country's governorates at subsidized costs (44,45,57). The UNHCR pays 75% or up to 100% of hospitalization costs for the most vulnerable refugees and for those who need life-saving (9).…”

“…However, due to limited funding, the UNHCR has insu cient capacities to provide health coverage for chronic conditions such as renal failures, diabetes and certain cancers, except for life-threating cases (9,58). In parallel to the Lebanese MoPH system, international non-governmental agencies have been providing free-of-charge primary care for Syrian refugees with NCDs, including diabetes and hypertension, in both North Lebanon and in the Bekaa valley since early 2012 (57,59), and in South of Beirut since 2013 (44).…”

“…Comparable ndings were reported with regards to NCD-associated medication use (60,61); however, interval discontinuation of medications was documented (19,62). Nonetheless, despite the reportedly high rates of healthcare seeking, Syrian refugees in Lebanon declared that they faced complications in seeking healthcare to manage their NCDs (44). The primary obstacle that limited these populations from seeking NCDs healthcare in Lebanon was the costs of NCDs treatment.…”