Management Of NCDs Research Articles

Primary Healthcare Services and Health-Related Quality of Life of Older Persons with Non-Communicable Diseases: A Narrative Literature Review

In response to the rising burden of non-communicable disease (NDC), the World Health Organization (WHO) developed tools to enable early detection and management of NCDs in Primary Healthcare centers (PHC). Globally, the prevalence of NCDs remains alarmingly high with 41 million deaths annually. Of these, 17 million people die before the age of 70, and 86% of these premature deaths occur in low-and middle-income countries. This narrative review aimed to assess the effect of PHC services on health-related quality of life (HRQoL) of older persons with NCDs, to critically analyze the potential of the existing literature in informing improvements in PHC services. We searched various databases (PubMed, Springer, Scopus, and ScienceDirect) for relevant literature. Peer-reviewed articles on the influence of PHC services on HRQoL among older persons with NCDs written and published in English between January 2013 and May 2024 were considered. The review indicates that effective PHC services are linked to good HRQoL. However, PHC services are sub-optimal and poor in low- and middle-income countries, hence more health interventions are essential to improve PHC services to enhance HRQoL of older persons.

High free sugars, insulin resistance, and low socioeconomic indicators: the hubs in the complex network of non-communicable diseases in adolescents

BackgroundNoncommunicable diseases (NCDs) predominantly affect adults, but pathophysiological changes begin decades earlier, as a continuum, with initial events apparent in adolescence. Hence, early identification and intervention are crucial for the prevention and management of NCDs. We investigated the complex network of socioeconomic, behavioral, and metabolic factors associated with the presence of NCD in Brazilian adolescents.MethodsWe conducted a cross-sectional study nested within the São Luís segment of the Ribeirão Preto, Pelotas, and São Luís (RPS) cohort’s consortium, focusing on 18–19-year-olds (n = 2515). Data were collected prospectively, from which we constructed a complex network with NCD-related factors/indicators as nodes and their co-occurrences as edges. General and sex-based models analyzed: socioeconomic status, behavioral (smoking, alcohol, and other drugs use, unhealthy diet, poor sleep, physical inactivity), and metabolic factors (overweight/obesity, elevated blood pressure, poor lipid profile). We also looked for NCDs in adolescence like asthma, abnormal spirometry, depression, suicide risk, and poor oral health. The network was characterized by degree, betweenness, eigenvector, local transitivity, Shannon entropy, and cluster coefficient.ResultsThe adolescents had an average age of 18.3 years, 52.3% were female and 47.7% male. 99.8% of them have a diet rich in free sugars, 15% are overweight/obese and 72.3% had an elevated TyG index. High free sugar emerged as the central hub, followed by high TyG index (an early marker of insulin resistance) and low socioeconomic class. In males, low fiber intake and a high triglycerides/HDL ratio highlighted cardiometabolic concerns; in females, sedentary behavior and poor sleep marked metabolic and psychological challenges, along with caries in both sexes.ConclusionsOur findings provide insights into central health challenges during adolescence, such as high free sugars, insulin resistance, and low socioeconomic indicators, suggesting that interventions targeted at these central hubs could have a significant impact on their NCD network.

O25 ARE COMMUNITY HEALTH WORKERS EFFECTIVE IN MANAGING HYPERTENSION AND DIABETES SIMULTANEOUSLY? A SYSTEMATIC REVIEW AND META-ANALYSIS

Background and objective: To evaluate and summarise the effectiveness of community health worker (CHW)-led interventions to manage risk factors for NCDs. We further assessed whether CHWs could simultaneously manage hypertension and diabetes. Methods: We searched six different databases for randomised controlled trials and cluster randomised trials. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. We used random effects models to assess the sample average mean difference between intervention and control groups. The primary outcomes for this review were net mean differences in systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose (HbA1c and fasting blood glucose), blood lipids (low-density lipoprotein (LDL) and triglycerides) and obesity (body mass index (BMI) ≥ 25 kg/m2). Results: Among 10,508 potential articles identified, 68 were included in the systematic review, and 43 for meta-analysis (11223 participants) after excluding studies not meeting the inclusion criteria. Interventions undertaken by CHWs were effective in reducing SBP [-2.94 mmHg (95% CI, -4.28 to -1.59); I2=73%], DBP [-1.63 mmHg (95% CI, -2.60 to -0.66); I2=81%], HbA1c% [-0.30 (95% CI, -0.45 to -0.16), I2=54%], and triglycerides [-8.32 mg/dl (95%. CI, -13.54 to -3.10)]. Greater reductions in SBP were observed in low- and middle-income countries (LMICs) than in high-income countries (HICs). No detectable difference was observed in the change in HbA1c% in LMICs (only three studies). Interventions targeting diabetes as the primary outcome not only reduced HbA1c% but were also effective in reducing SBP by -2.03 mmHg (95% CI, -3.85 to -0.21). There was no evidence that these interventions improved body mass index or LDL Conclusions: We demonstrate that CHW-led interventions are effective in reducing SBP, DBP, HbA1c% and triglycerides, thus reinforcing the importance of engaging CHWs in the management of NCDs. This study represents an important step towards expanding the role of CHWs in addressing multiple risk factors in LMICs and marginalised groups in HICs. Figure 1: Effect of CHW-delivered intervention on primary and secondary outcomes of systolic blood pressure

Mid-level healthcare workers knowledge on non-communicable diseases in Tanzania: a district-level pre-and post-training assessment

IntroductionOver the past two decades, Tanzania’s burden of non-communicable diseases has grown disproportionately, but limited resources are still prioritized. A trained human resource for health is urgently needed to combat these diseases. However, continuous medical education for NCDs is scarce. This paper reports on the mid-level healthcare workers knowledge on NCDs. We assessed the knowledge to measure the effectiveness of the training conducted during the initiation of a Package for Essential Management of Severe NCDs (PEN Plus) in rural district hospitals in Tanzania.MethodsThe training was given to 48 healthcare employees from Dodoma Region’s Kondoa Town Council District Hospital. For a total of five (5) days, a fundamental course on NCDs featured in-depth interactive lectures and practical workshops. Physicians from Tanzania’s higher education institutions, tertiary university hospitals, research institutes, and medical organizations served as trainers. Before and after the training, a knowledge assessment comprising 28 questions was administered. Descriptive data analysis to describe the characteristics of the specific knowledge on physiology, diagnosis and therapy of diabetes mellitus, rheumatic fever, heart disease, and sickle cell disease was done using Stata version 17 (STATA Corp Inc., TX, USA).ResultsComplete assessment data for 42 out of the 48 participants was available. Six participants did not complete the training and the assessment. The mean age of participants was 36.9 years, and slightly above half (52%) were above 35 years. Two-thirds (61.9%) were female, and about half (45%) were nurses. The majority had the experience of working for more than 5 years, and the average was 9.4 years (+/- 8.4 years). Overall, the trainees’ average scores improved after the training (12.79 vs. 16.05, p < 0.0001) out of 28 possible scores. Specifically, trainees’ average scores were better in treatment than in diagnosis, except for sickle cell disease (1.26 vs. 1.83). Most were not able to diagnose rheumatic heart disease (47.6% able) compared to diabetes mellitus (54.8% able) or sickle cell disease (64.3% able) at baseline. The proportion of trainees with adequate knowledge of the treatment of sickle cell disease and diabetes mellitus was 35% and 38.1%, respectively, and there was a non-statistical difference after training. Those working for less than 5 years had a higher proportion of adequate knowledge (30.8%) compared to their more experienced colleagues (6.9%). After the training, participants’ knowledge of NCDs increased by three times (i.e., aPR 3, 95% CI = 1.1, 1.5, and 6.0).Conclusion and recommendationsPEN Plus training improved the knowledge of healthcare workers at Kondoa Town Council District Hospital. Training is especially needed among nurses and those with a longer duration of work. Continuing education for human resources for health on the management of NCDs is highly recommended in this setting.

The Effectiveness of Mobile Health Utilization to Prevent Non-Communicable Diseases at the Group of Majlis Taklim

Background: Mobile health application is a technological innovation that has proven effective use for the prevention and management of NCDs in other countries. However, there has been no test on the use of mobile health applications that have been launched in Indonesia, including the Halodoc application. The majlis taklim group is a target group in increasing community empowerment in the family order. Aims: This study was to examine Halodoc application in preventing noncommunicable diseases. Methods: The population is the member of the majlis taklim who was active in the last three months. The sample was respondents who were identified as having knowledge and bad behavior in NCD prevention efforts, 45 people. Descriptive analysis on respondents' characteristics and level of knowledge. While analytical analysis consists of dependent T tests to determine the difference in effectiveness before and after utilizing the application, the next test is the CBAM-Stage of Concern test, which is to assess respondents' perceptions through the level of respondents' concern for halodoc innovation. Results: Univariate analysis found that most respondents were poorly educated, namely 35 respondents (78%), as IRT 30 respondents (67%), family history of NCD disease 30 respondents (67%), and history of NCD disease in themselves 10 respondents (22%). The level of knowledge on the pretest was low at 23 respondents (51%), and the knowledge on the posttest was mostly high at 31 respondents (69%). Conclusion: The result of the dependent T test obtained a value of 0.000 means that statistically there is a significant difference in knowledge before and after the use of Halodoc for the prevention and management of NCDs. The test results with the Stage of Use Consern Questionnaire (SoC) analysis, obtained information on the percentage of respondents' perception of the highest acceptance of innovation before being given the Halodoc intervention (pretest) at the personal level, which is 60%. However, after utilizing Halodoc, most respondents' perceptions were at the level of unconcern, which was 81%.

Abstract

Yoga as a mind-body intervention being used for wellness is increasingly used as an add-on therapy in the management of several NCDs. The first RCT on Yoga on hypertension, published by Dr Chandra Patel in the Lancet in 1975, laid the foundation for vigorous research into the practice of yoga as a therapy. Yoga a wellness and fitness fad started moving from studios and home environments to hospitals in the late 90s. There has been an increasing trend for research publications in Yoga since International Day of Yoga was declared by UN in the year 2014. There has been an increase in publications on Yoga by 143% and meditation by 172% in the last 9 years. Putting together yoga and meditation keywords account for more than 18000 articles on PubMed. The US is the leading contributor, followed by India in terms of publications. Regarding clinical trials as registered on the WHO International clinical trials registry platform, we have India as a leading country in registered clinical trials in yoga. However, in comparison to the number of publications, the number of RCT publications is quite low. Very few articles are published in high-impact factor journals (Above 8.0). Most of the publications and studies have small sample sizes and are hypotheses generated. There is a need for large multicentric studies in Yoga. Though Yoga studies have found their way in some guideline documents in oncology and cardiology, a lot needs to be done to generate level 1 evidence to have Yoga incorporated as an integrative medicine in management of various clinical conditions. This presentation will highlight the journey where we stand today and what needs to be done in the future.

Adaptability of Integrated Community Care models in Moldova to overcome compounded crisis, including supporting refugees.&amp;nbsp;

Introduction: The Healthy Life Project in Moldova works and collaborates with local authorities across all sectors, including civil society organisations, community members and NCD patients to promote integrated, person-centered care. The aim is to ensure vulnerable people, including refugees, have access to health and social care. Overall, Moldova has received nearly 698,000 Ukrainian refugees, of which 96,646 currently remain in the country.&#x0D; Methods: Through intersectoral capacity building community teams developed local integrated care work plans, including joint assessments of people with NCDs and coordinated individual care across different sectors and community resources. The plans also involved a focus on responding to the needs of Ukrainian refugees. Within this continued implementation support, the project included questions of access to health and social care along the migratory cycle to maintain management of chronic conditions. Around 97% of refugees are residing in the host community, most of them require particular support in accessing their rights in practice, being women (59%), children (48%) and the elderly (21%).&#x0D; Results: Request for health care services from refugees (28,30%) is one of the forms of assistance expected in addition to cash handouts (76,84%) and in-kind support (35,79%). Therefore, in addition to building capacities for monitoring and management of NCDs, and the application of integrated care, the project considered specific actions for refugees. Training on managing NCDs within the refugee crisis was provided to Primary Health Care (PHC), hospital, Public Health, and emergency care management teams in 20 districts. To support and ensure mobility of PHC practitioners in responding to increased community needs due to hosted refugees, 835 medical kits were purchased and distributed, alongside protective equipment and disinfectants for both the health and social workers. A guide for community social workers on supporting refugees was developed in partnership with the National Social Assistance Agency and has since been embedded in the curricula of the social assistance faculty within the State Pedagogical University. &#x0D; During 2022, 20 integrated community care centers have reached 8,464 persons with NCDs, with 77% having their wellbeing jointly assessed by a community nurse and social worker. As a result, most of them were included in preventive measures and supported to manage NCDs (7851 persons). The most vulnerable were identified and assisted, including 15% of NCD patients (675 persons) and supported to gain access to social benefits, while people with complex needs (663 persons) received access to home health and social care. Considerable progress has been made to promote integrated working locally, between health and social care. As everywhere, collaboration is reliant on personal motivation and local relationship building, and some teams take longer than others.&#x0D; Conclusions: Such community approaches are playing an important role in coordination of efforts to support the most vulnerable, as Moldova continues to face a refugee crisis. This continuous support to build capacity and ensure implementation of common approaches, facilitated by a jointly held normative framework supports a more integrated approach to service provision at community level, coordinated by local authorities thus making more efficient use of scarce resources.&#x0D;

A situational analysis of human resource and non-communicable diseases management for community health workers in Chengdu, China: a cross-sectional study

BackgroundNon-communicable diseases (NCDs) pose a major challenge to health economic cost and residents’ health status. Community health workers (CHWs) are the gatekeeper of primary health care.ObjectiveThis study aimed to conduct a situational analysis of current human resource and requirements of NCDs-related training among CHWs in Chengdu with regard to address to understand the suggestions for improvement of challenges and barriers.MethodsA descriptive online cross-sectional survey was conducted among CHWs (doctors and nurses) from 23 districts and counties in Chengdu. Sociodemographic and NCDs-related variables were collected. Univariate analysis and multiple response analysis were used to describe the characteristics of these variables.Results711 doctors and 637 nurses completely responded. There were significant differences among gender, age, educational levels, professional title, working year, type of institution, urban circle and registration in general practice between doctors and nurses (P < 0.001). 60.6% of doctors were female, compared to 98.0% for nurses. 58.2% of doctors held a bachelor’s degree compared with 45.4% of nurses, while 48.3% of nurses held a junior college degree compared with 25.7% of doctors. Higher levels of professional title and registration in general practice were found in doctors compared with nurses. The proportions of NCDs’ category, NCDs-related roles and tasks, NCDs-related training contents and forms that CHWs have attend and hoped to gain more were significantly different between doctors and nurses (P < 0.001). In general, the proportions in nurses were much lower than those of doctors (P < 0.05). The top five diseases managed by CHWs were hypertension, diabetes, cerebrovascular disease, chronic respiratory diseases and mental diseases. The five most reported roles performed among doctors included the distribution of health education (91.4%), following up (85.9%), establishing archives (71.3%), medicine adjustment (64.7%) and treatment implementation (52.0%). The top three diseases managed by nurses were same with doctors. The top four and five tasks were contact with patients or health services (39.6%) and referral (16.6%) in nurses. Most CHWs had received primary and common diseases-related trainings, but they had few opportunities to study in a tertiary hospital (40.4% in doctors and 20.9% in nurses, respectively), attend domestic academic conferences (26.9% in doctors vs. 9.7% in nurses), and take part in training courses (44.9% in nurses). CHWs hoped that the above-discussed training contents and forms could be provided more in the future. Besides basic skills related trainings, some specific skills related trainings should be strengthened.ConclusionThe qualifications in doctors were much better than those of nurses. The roles performed by CHWs in NCDs management are varied form common and frequent disease management to subsequent follow up and supervision. CHWs hope to receive more desired and oriented trainings. There is a need for building capacity of CHWs, optimizing and defining CHWs’ role, facilitating postgraduate medical education support and strengthening multidisciplinary collaboration would be effective in NCDs management.

Ageing and non-liver comorbidities in population with chronic hepatitis B infection in the western pacific region from 1990 to 2019.

Objectives: This study examined the age structure and burden of non-liver noncommunicable diseases in population with chronic hepatitis B virus (HBV) infection in the Western Pacific Region (WPR) from 1990 to 2019. Methods: We estimated ageing trends and the prevalence of non-liver NCDs among the HBV-infected population and the general population in 31 countries/areas in the Western Pacific Region from 1990 to 2019 based on the Global Burden of Disease 2019 dataset. Results: The proportion of individuals aged 60 or older among the HBV-infected population has increased at a faster rate compared to the general population, whereas the proportion of individuals younger than 19years has decreased rapidly over the past three decades. Among the HBV-infected population, the prevalence of most (29/31) NCDs increased from 1990 to 2019, with the top three most significant increases found for non-Hodgkin's lymphoma (789.94% increase), prostate cancer (512.40% increase), and kidney cancer (411.34% increase). The prevalence of NCDs among the HBV-infected population increased faster than in the general population over the past three decades, especially in countries with rapid population ageing. Conclusion: This study highlights the increasing burden of non-liver comorbidities among the HBV-infected population. The integrated management of non-liver NCDs among this population should be implemented.

Availability and readiness of primary healthcare facilities for the management of non-communicable diseases in different districts of Punjab, Pakistan.

Non-communicable diseases (NCDs) and their effects are rising quickly. NCDs such as cardiovascular illnesses, diabetes, cancer, and chronic lung diseases cause 60% of global deaths; of which, 80% occur in developing countries. In established health systems, primary healthcare handles most of the NCD care. This is a mixed-method study conducted to analyze the health service availability and readiness toward NCDs using the SARA tool. It included 25 basic health units (BHUs) of Punjab, which were selected through random sampling. Quantitative data were collected using the SARA tools, while qualitative data were collected through in-depth interviews with healthcare providers working at the BHUs. There was a problem of load shedding of both electricity and water in 52% of the BHUs, which leads to the poor availability of healthcare services. Only eight (32%) out of 25 BHUs provide the diagnosis or management of NCDs. The service availability was the highest for diabetes mellitus (72%), followed by cardiovascular disease (52%) and then chronic respiratory disease (40%). No services were available for cancer at the BHU level. This study raises issues and questions about the primary healthcare system in Punjab in two areas: first, the overall performance system, and second, the readiness of basic healthcare institutions to treat NCDs. The data show that there are many persisting primary healthcare (PHC) deficiencies. The study found a major training and resource deficit (guidelines and promotional materials). Therefore, it is important to include NCD prevention and control training in district training activities. NCDs are underrecognized in primary healthcare (PHC).

Exploration of NIMART-trained nurses’ experiences in the implementation of integrated management of HIV and NCDs in Limpopo Province, South Africa

Exploration of NIMART-trained nurses’ experiences in the implementation of integrated management of HIV and NCDs in Limpopo Province, South Africa

Prevention and control of non-communicable diseases in antenatal, intrapartum, and postnatal care: a systematic scoping review of clinical practice guidelines since 2011

BackgroundNon-communicable diseases (NCDs) are a leading cause of maternal mortality and morbidity worldwide. The World Health Organization is developing new recommendations focusing on the management of NCDs for pregnant, intrapartum, and postnatal women. Thus, to support the development of new guidelines and recommendations, we aimed to determine the availability, focus, and scope of recommendations of current guidelines for the management of NCDs during pregnancy, intrapartum, and postnatal period.MethodsPubMed, Global Index Medicus, TRIP, and Guideline International Network databases were searched on 31 May 2021, to identify any NCD-related guidelines published between 2011 and 2021 with no language or country restrictions. Websites of 165 professional organizations were also searched. Characteristics of included guidelines were analyzed, and recommendations were extracted from guidelines of five high-priority NCD conditions (diabetes, chronic hypertension, respiratory conditions, hemoglobinopathies and sickle cell disease, and mental and substance use disorders).ResultsFrom 6026 citations and 165 websites, 405 guidelines were included of which 132 (33%) were pregnancy-specific and 285 (88%) were developed in high-income countries. Among pregnancy-specific guidelines, the most common conditions for which recommendations were provided were gestational diabetes, circulatory diseases, thyroid disorders, and hypertensive disorders of pregnancy. For the five high-priority conditions, 47 guidelines were identified which provided 1834 recommendations, largely focused on antenatal care interventions (62%) such as early detection, screening tools, pharmacological treatment, and lifestyle education. Postnatal recommendations largely covered postnatal clinical assessments, lifestyle education, and breastfeeding. Health system recommendations largely covered multidisciplinary care teams and strengthening referral pathways.ConclusionsThis study provides a robust assessment of currently available guidelines and mapping of recommendations on NCD management within maternal health services, which will inform the scope of the World Health Organization’s future guideline development activities. This study identified a need to develop guidelines that consider NCDs holistically, with an integrated approach to antenatal, intrapartum, and postnatal care, and that are relevant for resource-limited contexts. Any such guidelines should consider what interventions are most essential to improving outcomes for women with NCDs and their newborns, and how variations in quality of NCD-related care can be addressed.

Perceptions and experiences of people living with non-communicable diseases during covid pandemic-a cross sectional study

Background: COVID pandemic has been more challenging to people living with non-communicable diseases, (NCD) regarding availability of medicines, physician consultation etc. In the absence of effective public interventions, socioeconomically vulnerable groups are likely to develop complications. Diseases like cardiovascular diseases, chronic respiratory disease, cancers and diabetes, contribute to about 82% of all NCD deaths in India. Present study was conducted with aim to identify the challenges faced and perceptions in the management of NCDs during COVID pandemic.Methods: A cross-sectional study was conducted between March to June 2022 by the department of community medicine, SVS medical college, Mahabubnagar. A pre-tested questionnaire was used on was used to collect data, which included demographic details of individuals and the information regarding their experiences and perceptions in the management of NCDs during the pandemic. The calculations were performed with SPSS program, version 23.Results: In the present study it was found that about 37.5% had decrease in the physical activity, 43.8% changed their dietary habits, 45.2% population has gained weight and 41.4% had increase in stress, anxiety and sleeping disorder during the pandemic.Conclusions: In the present study it was found that majority had change in the lifestyle behaviors, Challenges faced included non-availability of bed in the hospital and non-availability of medication. Half of the participants received guidance from the healthcare professionals.

Readiness of health facilities to deliver non-communicable diseases services in Kenya: a national cross-sectional survey

BackgroundNon-communicable diseases (NCDs) account for an estimated 71% of all global deaths annually and nearly 80% of these deaths occur in low- and middle-income countries. This study aimed to assess the readiness of existing healthcare systems at different levels of health care in delivering NCDs management and prevention services in Kenya.MethodsA cross-sectional survey of 258 facilities was conducted between June 2019 and December 2020 using multistage sampling, examining facility readiness based on the availability of indicators such as equipment, diagnostic capacity, medicines and commodities, trained staff and guidelines for NCDs management. Readiness scores were calculated as the mean availability of tracer items expressed as a percentage and a cut-off threshold of ≥ 70% was used to classify facilities as “ready” to manage NCDs. Descriptive and bivariate analyses were performed to assess the readiness of facilities by type, level, and location settings. Logistic regressions were used to identify factors associated with the readiness of facilities to provide disease-specific services.ResultsOf the surveyed facilities, 93.8% offered chronic respiratory disease (CRD) diagnosis and/or management services, 82.2% diabetes mellitus, 65.1% cardiovascular disease (CVD), and only 24.4% cervical cancer screening services. The mean readiness scores for diabetes mellitus (71%; 95% CI: 67–74) and CVD (69%; 95% CI: 66–72) were relatively high. Although CRD services were reportedly the most widely available, its mean readiness score was low (48%; 95% CI: 45–50). The majority of facilities offering cervical cancer services had all the necessary tracer items available to provide these services. Modeling results revealed that private facilities were more likely to be “ready” to offer NCDs services than public facilities. Similarly, hospitals were more likely “ready” to provide NCDs services than primary health facilities. These disparities in service readiness extended to the regional and urban/rural divide.ConclusionsImportant gaps in the current readiness of facilities to manage NCDs in Kenya at different levels of health care were revealed, showing variations by disease and healthcare facility type. A collective approach is therefore needed to bridge the gap between resource availability and population healthcare needs.

The determinants of the quality of clinical management among diabetic and hypertensive patients in a context of fragility: A cross-sectional survey from Lebanon.

IntroductionThe management of NCDs is a growing challenge in low- and middle-income settings with the increasing prevalence and the associated demands that such conditions make on health systems. Fragile settings both exacerbate the risk of NCDs and undermine systems capacity. Lebanon is a setting where strategies to address rising NCDs burden have faced particularly acute contextual challenges.MethodsWe conducted a cross-sectional survey with patients accessing non-communicable disease across 11 primary care centers within the Greater Beirut and Beqaa areas. Response were received from 1,700 patients. We generated a Clinical Management Index Score as a measure of quality of care, and scores related to a range of socio-demographic characteristics and other context specific variables.ResultsSignificantly higher clinical management index scores (better quality of care) were associated with patients living in the semi-urban/rural context of Beqaa (compared to Greater Beirut), having health insurance coverage, aged above 60, having high levels of educational attainment, and making partial or full payment for their treatment. Relatively lower index scores (poorer quality of care) were associated with Syrian nationality (compared to Lebanese) and with patients suffering from diabetes or hypertension (compared to comorbid patients).ConclusionThe study identified a wide margin for improving quality of NCDs care in fragile contexts with particular gaps identified in referral to ophthalmology, accessing all prescribed medication and receiving counseling for smoking cessation. Additionally, findings indicate a number of predictors of comparatively poor quality of care that warrant attention, notably with regard to Syrian nationality/legal status, lack of health coverage, seeking free health provision and lower educational attachment. Although these are all relevant risk factors, the findings call on donor agencies, NGOs and provider institutions to design targeted programs and activities that especially ensure equitable delivery of services to diabetic and hypertensive patients with compounded vulnerability as a result of a number of these factors.

Impact of a Group-Based Video and Interactive Group Session Addressing Diarrheal Disease, Helminthic and Schistosomiasis Infections, Hypertension and Diabetes on Short and Long-Term Improvement in Knowledge and Healthy Behaviors in Seroconcordant HIV-Negative Zambian Couples

Non-communicable and neglected tropical diseases (NCD and NTD) contribute to high morbidity and mortality in Zambia. While the public health importance of NTD has long been recognized, prevalence of disease remains high. NCD are emerging as causes of morbidity and mortality. Knowledge of risk factors, diagnosis, management, and prevention of NCDs and NTDs in the general population is poor and as a result, low-cost commodities are insufficiently used.

Noncommunicable diseases and health system responses in Saudi Arabia: focus on policies and strategies. A qualitative study

BackgroundNoncommunicable diseases (NCDs) are responsible for an increasing disease and economic burden in Saudi Arabia, particularly those due to chronic diseases such as diabetes and cardiovascular disease. Efforts are being made to improve chronic disease control through greater prevention and disease management. This research examines the scope, comprehensiveness and perceived effectiveness of Saudi Arabia’s national policies and strategies to prevent and control NCDs and their risk factors.MethodsSemi-structured interviews were conducted with 25 managers of the Ministry of Health in Saudi Arabia. The interviewees were public health leaders, national programme directors and programme implementation staff. The interviews were transcribed and coded into key themes.ResultsInterviewee responses indicated a belief that Ministry of Health programmes for the prevention and control of NCDs have achieved initial success, but have not yet been adequately evaluated. Interviewees reported faster development and implementation of policies for tobacco, sugar-sweetened drinks and obesity than for physical activity. Major challenges identified included inefficient programme management and low community awareness. There was a reported need for greater emphasis on health promotion and improving the effectiveness of existing multisectoral coordination.ConclusionEffective national NCD policies and strategies have a critical role to play in the control of chronic disease epidemics. In Saudi Arabia, opportunities exist to improve the policy and strategies in response to NCDs by establishing a comprehensive surveillance system and linking epidemiological surveillance with health programme evaluation, as well as using a multisectoral and integrated approach. For better management and control of NCDs, a cohesive multisectoral collaboration with a comprehensive surveillance programme and adequate evaluation is urgently needed.

Non-Communicable Diseases

NCDs such as Diabetes mellites, cardiac disorders, cardiac failure, obesity, renal diseases, lung disease, dyslipidemia and stroke are among the few. NSDs have become a primary health concern and a major cause of mortality and morbidity around the globe. These diseases are progressive, asymptomatic and chronic and patient do not realize until the complications arise and symptoms appear. World Health Organization (WHO) reported in 2016 that 86% death from NCDs and 16% of premature deaths were in the age range of 30-70 years worldwide. Among these NSDs, 49% contribution was from cardiovascular diseases alone, 12% from caner, 5% from respiratory diseases and 5% from diabetes [1].&#x0D; Disease burden of NCDs can be assessed by several indicators e.g. the disability adjusted life years (DALYs) which is the equivalent of losing one year in good and healthy life due to early death or any illness including disability [2]. NCDs were recognized as public health concern by United Nations and hence, policies were devised, Sustainable Development Goals (SDGs) for the prevention and management of NCDs by 2030 were also planned [3]. The global NCDs action plan by WHO was initiated and implemented from 2013-2020 aiming to attain the set goals and priorities by 2025. The main goal which comprises of 25%, is to reduce the premature deaths from NCDs by 2025 [4].&#x0D; Currently, the world is going through COVID-19 pandemic which has changed the whole world in terms of health, economics, psyphy and behaviours adversely. Although COVID-19 is a communicable disease but it has been observed that the patients who already have been contracted with NCDs such as heart, renal or lung disease are at much higher risk for COVID-19 infection as compared to others. Therefore, it is suggested that every one should get proper health screening at regular intervals even if you are healthy. Annual visit for checkups and screening should be conducted after the age of 40 years and after every 6 months is appreciated if you are above 50 years of age. A better governance and implementation of the Global strategy by WHO and United Nations is an urgent need of the recent times.

Unhealthy Dietary Habits and Obesity: The Major Risk Factors Beyond Non-Communicable Diseases in the Eastern Mediterranean Region.

There are 22 countries in the Eastern Mediterranean Region (EMR) expanding from Morocco in the west to Pakistan and Afghanistan in the east, containing a population of 725,721 million in 2020. In the previous 30 years, the illness burden in the EMR has transmitted from communicable diseases to non-communicable diseases such as diabetes, cardiovascular diseases, and cancer. In 2019, cardiovascular mortality in the EMR was mostly attributed to ischemic heart disease, the first reason for mortality in 19 countries in the region. Stroke was the second reason for death in nine countries followed by diabetes, which was ranked as the second reason for death in two countries. The prominent nutrition-related NCDs risk factors in EMR include obesity, hypertension, high fasting plasma glucose, and upregulated unhealthy diet consumption. Most of the EMR population are unaware of their NCDs risk factor status. These risk factors, even if treated, are often poorly controlled, therefore, inhibiting their existence by changing the lifestyle to proper dietary habits and sufficient physical activity is mandatory. In this review, the epidemiology and nutrition-related risk factors of NCDs in the EMR will be discussed and illustrated, aiming to scale up action and support decision-makers in implementing cost effective strategies to address obesity and NCDs prevention and management in the region.

Improving healthcare systems and services in the face of population ageing: policy considerations for low- and middle-income countries.

Worldwide, the proportion and absolute numbers of over 60-year-olds in the population is rising: it was 1 billion in 2019 and is expected to get to 1.4 billion in 2030 and 2.1 billion by 2050, with the progression being more pronounced in developing countries. Degenerative and non-communicable diseases are more common with ageing, which means they would become the major disease problems for countries. Long-term care poses financial risks to individuals/families and governments. These warrant urgent policy and structural adjustments of health systems in low- and middle-income countries to cater for the probable change in health needs and make their society more age-sensitive. There is the need for policymakers to begin to change focus from traditional models of healthcare delivery and give more attention to aged care and create separate financing mechanisms/programmes for the elderly, most of whom are already unemployed, to protect them from the effects of cream-skimming by private health insurers. Informed decisions on healthcare purchasing can be made using Economic Evaluation, as well as Programme Budgeting and Marginal Analysis, a presentation of discrete categories of healthcare expenditure (specialties, disease-groups, etc.) and the resources appropriated to each as an aid to reviewing subsequent resource allocation. Reforms in healthcare financing should pay particular attention to the elderly considering that technical efficiency concerns of the private sector may mean that they are discriminated against. There is need for retraining/reorientation of health workers on identification and comprehensive management of NCDs, including palliative care, in a culturally competent way, on the essence of shifting from an acute care model to a chronic care model, and on providing services to people within defined catchment areas.