Abstract
BackgroundMany patients on antiretroviral therapy (ART) in Malawi have or will develop non-communicable diseases (NCDs). The current capacity of ART sites to provide care for NCDs is not known.AimThis study aimed to assess the capacity of ART sites to provide care for hypertension and diabetes in rural Malawi.SettingTwenty-five health centres and five hospitals in two rural districts in northern Malawi.MethodsA cross-sectional survey was performed between March and May 2014 at all facilities. Qualitative interviews were held with three NCD coordinators.ResultsTreatment of hypertension and diabetes was predominantly hospital-based. Sixty percent of hospitals had at least one clinician and one nurse trained in NCD care, whereas 5% of health centres had a clinician and 8% had a nurse trained in NCD care. Hundred percent of hospitals and 92% of health centres had uninterrupted supply of hydrochlorothiazide in the previous 6 months, but only 40% of hospitals and no health centres had uninterrupted supply of metformin. Hundred percent of hospitals and 80% of health centres had at least one blood pressure machine, and 80% of hospitals and 32% of health centres had one glucometer. Screening for hypertension amongst ART patients was only conducted at one hospital and no health centres. At health centres, integrated NCD and ART care was more common, with 48% (12/25) providing ART and NCD treatment in the same consultation.ConclusionsThe results reflect the status of the initial stages of the Malawi NCD programme at sites currently providing ART care.
Highlights
Non-communicable diseases (NCDs) are the largest cause of mortality in the world accounting for 63% of the 57 million deaths globally.[1]
This study aimed to examine the current capacity of the NCD programme, using hypertension and diabetes services as tracer conditions, in two rural districts in northern Malawi, and to explore the extent of integration with the HIV and antiretroviral therapy (ART) care
The study was performed under the umbrella of the Extending Quality Improvement for HIV/AIDS in Malawi (EQUIP) project - a USAID funded HIV programme aimed at improving care in hospitals and health centres in these two districts
Summary
Non-communicable diseases (NCDs) are the largest cause of mortality in the world accounting for 63% of the 57 million deaths globally.[1] Of these deaths, 80% occur in low- and middle-income countries. In 2011, Malawi included NCDs in the Essential Health Package[6] and followed this with the development of a National NCD Action Plan.[7] This plan focuses on cardiovascular disease, diabetes, chronic kidney disease, chronic respiratory disease, cancers, epilepsy, mental health and injuries. A National NCD Unit at the Ministry of Health was established. Many patients on antiretroviral therapy (ART) in Malawi have or will develop non-communicable diseases (NCDs). The current capacity of ART sites to provide care for NCDs is not known
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