Experiences from the pilot implementation of the Package of Essential Non-communicable Disease Interventions (PEN) in Myanmar, 2017-18: A mixed methods study.

Lwin Lwin Aye,Ko Ko,Myo Minn Oo,Kyaw Kan Kaung,Thae Maung Maung,Hlaing Moh Moh Thu,Mya Lay Nwe,Jaya Prasad Tripathy,Kamal Gholipour

doi:10.1371/journal.pone.0229081

Abstract

Background and objectivesMyanmar adopted the World Health Organization (WHO) Package for Essential Non-Communicable Disease Interventions (PEN) in 20 pilot townships in 2017. This study was conducted to assess the implementation of PEN, its effectiveness and understand the facilitators and barriers in its implementation.MethodsMixed methods design involving a quantitative component (retrospective study analysing both aggregate and individual patient data from PEN project records; cross-sectional facility survey using a structured checklist) and a descriptive qualitative component.ResultsA total of 152,446 individuals were screened between May 2017-December 2018 comprising of current smokers (17.5%), tobacco chewers (26.3%), Body Mass Index ≥25 kg/m2 (30.6%), raised blood pressure i.e. ≥ 140/90 mmHg (35.2%) and raised blood sugar i.e. Random Blood Sugar >200 mg/dl, Fasting Blood Sugar >126 mg/dl (17.1%). Nearly 14.8% of those screened had Cardiovascular Disease (CVD) risk score ≥20%, 34.6% had CVD risk not recorded. Of 663 patients registered with diabetes and/or hypertension in 05 townships, 27 (4.1%) patients made three follow-up visits after the baseline visit, of whom, CVD risk assessment, systolic blood pressure and blood sugar measurement was done in all visits in 89.0%, 100.0% and 78.0% of cases respectively. Health facility assessment showed 64% of the sanctioned posts were filled; 90% of those appointed been trained in PEN; key essential medicines for PEN were available in half of the facilities surveyed. Confidence of the health care staff in managing common NCD and perceived benefits of the project were some of the strengths.ConclusionHigh loss to follow up, poor recording of CVD risk score, lack of essential medicines and equipments were the key challenges identified that need to be addressed before further expansion of PEN project to other townships.

Highlights

Non-communicable diseases (NCDs) accounted for nearly 72% of all deaths in 2016 with three quarters of these deaths occurring in low- and middle-income countries (LMICs) [1]
Of 663 patients registered with diabetes and/or hypertension in 05 townships, 27 (4.1%) patients made three follow-up visits after the baseline visit, of whom, cardiovascular disease (CVD) risk assessment, systolic blood pressure and blood sugar measurement was done in all visits in 89.0%, 100.0% and 78.0% of cases respectively
While death rates have significantly declined in some developed countries, morbidity and mortality due to NCDs have increased at an alarming rate in the LMICs [2]

Summary

Introduction

Non-communicable diseases (NCDs) accounted for nearly 72% of all deaths in 2016 with three quarters of these deaths occurring in low- and middle-income countries (LMICs) [1]. To curb the rising epidemic in the LMICs, the World Health Organization (WHO) developed a Package of Essential Non-Communicable (PEN) Disease Interventions for lowresource primary care settings. PEN is a set of cost-effective interventions, both populationwide and individual level, including health education, promotion of healthy behaviours, early diagnosis of NCDs and their risk factors. It employs inexpensive technologies, affordable medications for prevention and treatment of cardiovascular disease (CVD), stroke, diabetes, hypertension, cancer and asthma, regular follow-up and referral [3]. Myanmar adopted the World Health Organization (WHO) Package for Essential Non-Communicable Disease Interventions (PEN) in 20 pilot townships in 2017. This study was conducted to assess the implementation of PEN, its effectiveness and understand the facilitators and barriers in its implementation

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