An Integrated Management System for Noncommunicable Diseases Program Implementation in a Sub-Saharan Setting.

Maria Agata Miselli,Monica Rizzi,Bruno Ndunguru,Simone Conte,Stefano Taddei,Samwel Marwa,Giulia Ciccarelli,Gaetano Azzimonti,Giovanni Putoto,Rehema John Itambu,Katunzi Mutalemwa,Giovanni Fernando Torelli,Francesco Cavallin

doi:10.3390/ijerph182111619

Abstract

Morbidity and mortality due to noncommunicable diseases (NCDs) are growing exponentially across Tanzania. The limited availability of dedicated services and the disparity between rural and urban areas represent key factors for the increased burden of NCDs in the country. From March 2019, an integrated management system was started in the Iringa District Council. The system implements an integrated management of hypertension and diabetes between the hospital and the peripheral health centers and introduces the use of paper-based treatment cards. The aim of the study was to present the results of the first 6 months’ roll-out of the system, which included 542 patients. Data showed that 46.1% of patients returned for the reassessment visit (±1 month), more than 98.4% of patients had blood pressure measured and were checked for complication, more than 88.6% of patients had blood sugar tested during follow-up visit, and blood pressure was at target in 42.8% of patients with hypertension and blood sugar in 37.3% of diabetic patients. Most patients who were lost to follow-up or did not reach the targets were those without medical insurance or living in remote peripheries. Our findings suggest that integrated management systems connecting primary health facilities and referral hospitals may be useful in care and follow-up of patients with hypertension and diabetes.

Highlights

Noncommunicable diseases (NCDs) represent a group of chronic conditions, including cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes, which account for 71% of all deaths worldwide, equivalent to 41 million people each year [1,2]
The link between illness and poverty is well documented, as it is the role played by noncommunicable diseases (NCDs) and injuries (NCDIs) in the suffering and death of the poorest populations [4,5,6]
An update of the study over a longer time span is warranted to provide more reliable data on follow-up and complications, and to assess the effect of further developments. These results confirm that gaps in the control of noncommunicable diseases are still large in Tanzania

Summary

Introduction

Noncommunicable diseases (NCDs) represent a group of chronic conditions, including cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes, which account for 71% of all deaths worldwide, equivalent to 41 million people each year [1,2]. A large proportion of these deaths occur in low- and middle-income countries (LMICs), where about 700 million people still experience extreme levels of poverty [2,3]. The link between illness and poverty is well documented, as it is the role played by NCDs and injuries (NCDIs) in the suffering and death of the poorest populations [4,5,6]. In Tanzania, the burden of NCDIs has doubled in the past 25 years and accounts for. While 80% of the global NCDIs burden 4.0/).

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