Abstract
BackgroundIndia accounts for more than two-third of mortality due to non-communicable diseases (NCDs) in south-east Asia. The burden is high in Karnataka, one of the largest states in southern India. There is a need for integration of disease prevention, health promotion, treatment and care within the national program at primary level. A public-private partnership initiative explored evidence gaps to inform a health system based, integrated NCD programme across care continuum with a focus on hypertension and diabetes.MethodsThe study was conducted during 2017–18 in urban parts of Mysore city, covering a population of 58,000. Mixed methods were used in the study; a population-based screening to estimate denominators for those with disease and at risk; cross-sectional surveys to understand distribution of risk factors, treatment adherence and out of pocket expenses; facility audits to assess readiness of public and private facilities; in-depth interviews and focus group discussions to understand practices, myths and perceptions in the community. Chi-square tests were used to test differences between the groups. Framework analysis approach was used for qualitative analysis.ResultsTwelve and 19% of the adult population had raised blood sugar and blood pressure, respectively, which increased with age, to 32 and 44% for over 50 years. 11% reported tobacco consumption; 5.5%, high alcohol consumption; 40%, inadequate physical activity and 81%, inappropriate diet consumption. These correlated strongly with elderly age and poor education. The public facilities lacked diagnostics and specialist services; care in the private sector was expensive. Qualitative data revealed fears and cultural myths that affected treatment adherence. The results informed intervention design across the NCD care continuum.ConclusionsThe study provides tools and methodology to gather evidence in designing comprehensive NCD programmes in low and middle income settings. The study also provides important insights into public-private partnership driving effective NCD care at primary care level.
Highlights
India accounts for more than two-third of mortality due to non-communicable diseases (NCDs) in south-east Asia
World Health Organization (WHO) estimates that more than a third of 40 million deaths occurring due to Non-Communicable Diseases (NCDs) globally, are premature deaths
The sustainable development goal (SDG) 3.4 aims to reduce the premature mortality due to NCDs by a third [6] and absence of timely and effective intervention at this juncture may leave the hope of achieving the SDG unrealized
Summary
India accounts for more than two-third of mortality due to non-communicable diseases (NCDs) in south-east Asia. A public-private partnership initiative explored evidence gaps to inform a health system based, integrated NCD programme across care continuum with a focus on hypertension and diabetes. World Health Organization (WHO) estimates that more than a third of 40 million deaths occurring due to Non-Communicable Diseases (NCDs) globally, are premature deaths. With around 5.87 million deaths annually, India shares more than two-third of the mortality due to NCDs in the South-East Asia Region1 [2]. Burden of NCDs in India is expected to worsen in the future; diabetics will increase from 40.9 million to 69.9 million by 2025 and obesity will affect 52.1 million by 2030 [4, 5]. The sustainable development goal (SDG) 3.4 aims to reduce the premature mortality due to NCDs by a third [6] and absence of timely and effective intervention at this juncture may leave the hope of achieving the SDG unrealized
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