Abstract
BackgroundAs Mozambique faces a double burden of diseases, with a rise of Non Communicable Diseases (NCD) superimposed to uncontrolled communicable diseases (CD), routine disease surveillance system does not include NCD. The objectives of our study were to i) upgrade of the current surveillance system by adapting the data collection tools to NCD; ii) describe the occurrence and profile of selected NCD using these data collection tools.MethodsWorkshops were implemented in a first referral urban hospital of Mozambique to train clinical staff, administrative workers and nurses on NCD surveillance, as well as select conditions to be prioritized. Based on the WHO Global Action Plan and Brazaville Declaration for NCD prevention and control, we selected arterial hypertension, diabetes, stroke, chronic respiratory diseases, mental illness and cancers. Data collection tools used for CD were changed to include age, gender, outcome and visit type. Between February/2014 and January/2015 we collected data at an urban hospital in Mozambique’s capital.ResultsOver 12 months 92,018 new patients were assisted in this hospital. Data was missing or diagnosis was unreadable in 2637 (2.9%) thus only 89,381 were used for analysis; of these 6423 (median age 27 years; 58.4% female) had at least one selected NCD as their primary diagnosis: arterial hypertension (2397;37.31%), mental illness (1497;23.30%), asthma (1495;23.28%), diabetes (628;9.78%), stroke (299;4.66%), chronic obstructive pulmonary disease 61 (0.95%) and cancers 46 (0.72%). Emergency transfers were needed for 76 patients (1.2%), mainly due to hypertensive emergencies (31; 40.8%) and stroke (18;23.7%). Twenty-four patients died at entry points (0.3%); 10 of them had hypertensive emergencies.ConclusionChanges in existing surveillance tools for communicable diseases provided important data on the burden and outcomes of the selected NCD helping to identify priority areas for training and health care improvement. This information can be used to design the local NCD clinics and to strengthen the health information system in resource-limited settings in a progressive and sustainable way.
Highlights
As Mozambique faces a double burden of diseases, with a rise of Non Communicable Diseases (NCD) superimposed to uncontrolled communicable diseases (CD), routine disease surveillance system does not include non-communicable disease (NCD)
Consultations performed by doctors and clinical officers are registered in books from where nurses and administrative workers routinely extract data on CD targeted by national programs, to produce weekly reports that are centralized at the Ministry of Health (MoH)
This study provided a model to incorporate NCD surveillance into an existing health information system (HIS) directed to CD
Summary
As Mozambique faces a double burden of diseases, with a rise of Non Communicable Diseases (NCD) superimposed to uncontrolled communicable diseases (CD), routine disease surveillance system does not include NCD. A combination of broad and localized environmental factors, infectious disease and lifestyle behaviors determine the occurrence of deadly and disabling forms of communicable and non-communicable disease (NCD) in Africa. Mozambique, a low-income country in southern Africa, faces this double burden of disease characterized by uncontrolled endemic infections such as malaria, tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and neglected parasitic diseases, as well as high prevalence of risk factors for NCD [1,2,3]. Of 651 patients with new stroke events (mean age 59.1 ± 13.2 years and 53% men) 561 patients (86.2%) had prior hypertension; 28-day case-fatality was 49.6% (72.3% for hemorrhagic stroke), and 64.4% of 370 survivors at 28 days had moderate-to-severe disability [2]
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