NCD Control Research Articles

Readiness of primary care centres for a community-based intervention to prevent and control noncommunicable diseases in the Caribbean: A participatory, mixed-methods study.

Epidemiological transition to NCDs is a challenge for fragile health systems in the Caribbean. The Congregations Taking Action against NCDs (CONTACT) Study intervention proposes that trained health advocates (HAs) from places of worship (PoWs), supervised by nurses at nearby primary healthcare centres (PHCs), could facilitate access to primary care among vulnerable communities. Drawing on participatory and systems thinking, we explored the capacity of local PHCs in three Caribbean countries to support this intervention. Communities in Jamaica (rural, urban), Guyana (rural) and Dominica (Indigenous Kalinago Territory) were selected for CONTACT because of their differing socio-economic, cultural, religious and health system contexts. Through mixed-method concept mapping, we co-developed a list of perceived actionable priorities (possible intervention points ranked highly for feasibility and importance) with 48 policy actors, healthcare practitioners and civic society representatives. Guided in part by the concept mapping findings, we assessed the readiness of 12 purposefully selected PHCs for the intervention, using a staff questionnaire and an observation checklist to identify enablers and constrainers. Concept mapping illustrated stakeholder optimism for the intervention, but revealed perceptions of inadequate primary healthcare service capacity, resources and staff training to support implementation. Readiness assessments of PHCs identified potential enablers and constrainers that were consistent with concept mapping results. Staff support was evident. Constraints included under-staffing, which could hinder supervision of HAs; and inadequate essential NCD medicines, training in NCDs and financial and policy support for embedding community interventions. Despite a history of socio-political disadvantage, the most enabling context was found in the Kalinago Territory, where ongoing community engagement activities could support joint development of programmes between churches and PHCs. Multi-sectoral stakeholder consultation and direct PHC assessments revealed viability of the proposed POW-PHC partnership for NCD prevention and control. However, structural and policy support will be key for implementing change.

Content analysis of policy documents related to non-communicable diseases prevention and control in Sri Lanka: a developing country in the South-East Asia.

Health policies form the foundation for provisioning best level care and are important for all stakeholders including patients and healthcare providers. Health policy analysis and evaluation allows policy makers to improve an existing policy, terminate a non-effective policy and to successfully implement future policies.The objective was to assess the coherence between the two local policy documents on NCD prevention and control in Sri Lanka, the national NCD policy (NCD policy) and the multisectoral action plan (MSAP), and to assess the consistency of MSAP with the global action plan for NCDs. The content analysis of the NCD policy and MSAP of Sri Lanka was conducted based on the modified criteria developed to the 'Analysis of determinants of policy impact' model, by two reviewers independently. Coherence between MSAP and the global NCD action plan were also assessed by two reviewers independently. Consensus for discrepancy was achieved through discussion. Accessibility was the strongest criteria for the NCD policy, while, resources and obligations were the weakest. Goals and monitoring and evaluation criteria were the strongest in the MSAP. Requirement for improvement were identified in policy background, goals, monitoring and evaluation, and public opportunities for the NCD policy. Accessibility, policy background, resources, public opportunities and obligations require further improvement in the MSAP. The MSAP is well coherent with the global road map for NCD prevention and control. Policy documents related to NCD prevention and control in Sri Lanka are coherent with the global action plan, while, there are areas within the local policy documents that need to be improved to enhance the coherence between the local documents. Lessons learnt by this activity need to be utilized by Sri Lanka and other countries to improve the uniformity between the NCD policy documents within the country as well as internationally.

Projection of diabetes morbidity and mortality till 2045 in Indonesia based on risk factors and NCD prevention and control programs

Diabetes Mellitus is one of the biggest health problems in Indonesia but the research on the disease’s projection is still limited. This study aimed to make a projection model of prevalence and mortality of diabetes in Indonesia based on risk factors and NCD programs. The study was a quantitative non-experimental study through multiple linear regression models and system dynamics. The baseline projection was created by 2018 data and projections until 2045 involved the dynamization of risk factors and programs, population, and case fatality rate. The model was created from 205 districts data. This study used secondary data from Basic Health Research, BPJS Kesehatan, NCD programs, and Ministry of Health. The prevalence of diabetes in Indonesia is estimated to increase from 9.19% in 2020 (18.69 million cases) to 16.09% in 2045 (40.7 million cases). The prevalence will be lower to 15.68% (39.6 million) if interventions of programs were carried out, and to 9.22% (23.2 million) if the programs were added with prevention of risk factors. The projected number of deaths due to diabetes increases from 433,752 in 2020 to 944,468 in 2045. Deaths due to stroke among diabetes increases from 52,397 to 114,092 in the same period. Deaths from IHD among diabetes increase from 35,351 to 76,974, and deaths from chronic kidney disease among diabetes increase from 29,061 to 63,279. Diabetes prevalence and mortality in Indonesia rise significantly in Indonesia and can be reduced by intervention of several programs and risk factors. This study findings could be source of planning and evaluation of Diabetes prevention and control program at national and provincial level in the future related to risk factors control and program development.

Impact of simultaneous heart procurement on outcomes of donation after circulatory death lung transplantation

Donation after circulatory death (DCD) heart procurement is done using either direct procurement (DP) or thoracoabdominal normothermic machine perfusion (TA-NRP). Both approaches could impact lung transplant outcomes with combined heart and lung procurements from the same donor. The impact of such practice on DCD lung transplant remains unstudied. We performed a retrospective analysis using the United Network for Organ Sharing (UNOS) dataset, identifying DCD lung transplants where the donor also donated the heart (cardia lung donor [CD]). A cohort of noncardiac DCD lung donors (noncardiac lung donor [NCD]) from the same era, matched for donor and recipient characteristics, was used as a comparison group. Both immediate and long-term outcomes were examined. A subanalysis was performed comparing the distinct impact of DP or TA-NRP on DCD lung transplant outcomes. Overall graft survival did not significantly differ between CD and NCD. However, recipients in the CD group trended toward a lower P/F ratio at 72 hours (CD vs NCD: 284 vs 3190; P = .054). In the subanalysis, we identified 40 DP donors and 22 TA-NRP donors. We found the both cohorts had lower P/F ratio at 72 hours than the NCD control (P = .04). Overall, 1-year graft survival was equivalent among the TA-NRP, DP, and NCD cohorts.

Integrated primary care using a life course approach for prevention and control of non-communicable diseases: Indonesia’s perspective

An integrated primary care using a life course approach for preventing and controlling NCDs in Indonesia is the right policy decision. It strives to be holistic, addressing NCDs with a long-term vision across the critical stages where modifications can be made to minimise risks of developing NCDs. This policy direction is inherently complex mandating multi-sectoral and/or inter-sectoral approaches, as well as multi-disciplinary teams. Additionally, existing evidence suggests the intricate connections between health, social, economic, and environmental across the lifespan7. Taking a life course approach also means the governments must extend the NCD prevention and control measures beyond health sector alone. This means that effective implementation of an integrated primary care using a life course approach require long-term strategies to strengthening multi-sectoral partnerships to promote a life course approach across all government sectors and community systems.

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).

A Comprehensive SSA Report Current Status of Cancer Control in Belize

Background: Belizeans have been severely affected by cancer, noted by the rising mortality rates. Health disparities, health inequities and issues with systemic health access are some of the pre-existing problems. One of the significant issues in small countries is often the downplay of cancer control and the lack of a cancer continuum of care through a national cancer control plan. It has been estimated that over 80% of countries have developed national cancer control plans. However, the central issue that presented a significant barrier was the successful launch of implementing the plan. There is a great need to assess and evaluate those implementation barriers to overcome this impediment. Objective: 1. To determine what critical government plans and policies are in place to gear towards the country’s specific barriers to reducing cancer incidence. An assessment of the latter was conducted. 2. To determine whether the multisectoral approach was present within Belize’s governance structure for cancer control. Methodology: With the use of 2 approaches that were complementary to each other. 1st Approach: Questionnaire-grid: ‘snap-shot’ of the government responses to cancer in Belize. 2nd Approach: EOH’S APPROACH TO STAKEHOLDER ENGAGEMENT Detailed Case Study: Policy response to cancer explored via in-depth, semi-structured interviews EOH’S approach includes: 1. An inclusive approach 2. Materiality 3. Responding Interviews were conducted with key informants from a range of backgrounds: 1. Representatives of the private sectors 2. Specialists 3. Public sectors 3rd Approach: Archival Research to identify prior and current policy documents throughout the years within the MOHW. Together these approaches were cross-linked to enable a detailed analysis of formulated policy and mechanism of assessment of what type of cancer control/surveillance is being used in the delivery of health care for cancer in Belize. In addition, to evaluate if all policies were implemented and successfully launched. This will help to avoid redundancies in cancer control planning and to accelerate the process of launching respective cancer control mechanisms in Belize. Results: This article finds that twenty different types of plans and policies were found in efforts to contribute toward NCD control. Nevertheless, very few policies directly target cancer mortality and morbidity in Belize. There seem to have been issued in implementing these policies(failure to launch successfully) and some procedures that were not explicitly addressing the root issues of the prevalence of cancer. No cancer surveillance system was activated to measure the progress of all Belizeans with cancer. Thus, this is because no national cancer registry was functionally started to capture the various modalities, variables and risk factors of cancer. Conclusion: This stakeholder and situational analysis highlight the disparities in Belize’s healthcare system that disproportionately impacts Belizeans once diagnosed with cancer. This article elucidates the perspective of Belize’s national response to cancer. It highlights the deficiencies or barriers that inhibit successful cancer mitigation—recognizing a great need for cancer control mitigation in Belize through NCCP that provides a continuum of care. To address the country-specific cancer burden, reliable, evidence-based data is needed. Cancer surveillance is the most efficient way of achieving optimum cancer management in the delivery of the cancer healthcare system in Belize

Sociodemographic predictors of non-communicable diseases risk-related knowledge and behaviours: a cross-sectional study of in-school adolescents in a southern Nigerian State.

the adolescence period is a significant phase in development of non-communicable diseases. Public health interventions that reduce risky behaviors among adolescents are beneficial across the life course. This study assessed the level of non-communicable diseases (NCDs´) risk-related knowledge, the prevalence of NCDs´ risk behavior, and the sociodemographic predictors of NCDs´ risk-related knowledge and behaviors among in-school adolescents in a Southern Nigerian State. a cross-sectional study design was employed to assess the NCDs´ risk-related knowledge and behaviors among a random multistage sample of 607 students age between 10 and 19 years. Data were collected using an interviewer-administered semi-structured questionnaire adapted from the WHO STEPS questionnaire. Descriptive and inferential analyses of data collected were carried out using the IBM SPSS version 22 software. the mean age of the students was 14.7 (SD=1.52) years, 57.2% (n=347) of which were females, and 42.8% (n=260) were males. The proportion of students with good overall NCDs risk-related knowledge was 22.7% (n=138). Age, place of residence, family's socioeconomic status, and mother's level of education were significant sociodemographic predictors of good overall NCD risk-related knowledge. Among the students, 66.2% (n=402) self-report inadequate physical activity, 65.7% (n=399) self-report consumption of unhealthy diets, 29.2% (n=177) self-report current alcohol use, and 3.3% (n=20) self-report they were current cigarette smokers. a significant proportion of the surveyed students had poor overall NCDs risk-related knowledge and engaged in NCDs risk behaviors. The relevant stakeholders concern with prevention of NCDs in government and non-governmental organizations should target adolescents in NCD control strategies in the study setting.

Sustaining capacity building and evidence-based NCD intervention implementation: Perspectives from the GRIT consortium.

Implementation science has been primarily focused on adoption of evidence-based interventions, and less so on sustainability, creating a gap in the field. The Global Research on Implementation and Translation Science (GRIT) Consortium is funded by the National Heart Lung and Blood Institute (NHBLI) to support the planning, implementation, and sustainability of Late-Stage Phase 4 Translational Research (T4TR) and capacity building for NCD prevention and control in eight low-and middle-income countries (LMICs). This paper highlights perspectives, including barriers, facilitators, opportunities, and motivators for sustaining capacity building and evidence-based hypertension interventions within LMICs. Guided by the Capacity, Opportunity, Motivation, Behavior (COM-B) Model, this study surveyed GRIT consortium members on the barriers, facilitators, key motivators, and opportunities for sustaining capacity building and evidence-based hypertension interventions in LMICs. Thematic analysis was used to identify themes and patterns across responses. Twenty-five consortium members across all eight sites and from various research levels responded to the survey. Overarching themes identifying facilitators, key motivators and opportunities for sustainability included: (1) access to structured and continuous training and mentorship; (2) project integration with existing systems (i.e., political systems and health systems); (3) adaption to the local context of studies (i.e., accounting for policies, resources, and utilizing stakeholder engagement); and (4) development of interventions with decision makers and implementers. Barriers to sustainability included local policies and lack of infrastructure, unreliable access to hypertension medications, and lack of sufficient staff, time, and funding. Sustainability is an important implementation outcome to address in public health interventions, particularly as it pertains to the success of these initiatives. This study provides perspectives on the sustainability of NCD interventions with a focus on mitigating their NCD burden in LMICs. Addressing multilevel factors that influence the sustainability of capacity building and interventions will have notable implications for other global NCD efforts going forward. Current and future studies, as well as consortium networks, should account for sustainability barriers outlined as it will strengthen program implementation, and long-term outcomes.

Readiness of Health Professionals, Undergraduate Medical Curriculum and on-the-job Training on Noncommunicable Diseases in Bangladesh to achieve Program Objectives- an Operational Research Study

Health professionals need competency in the assessment and outcome evaluation of several health behaviors related to NCDs and their risk factors. Assessment of the curricula in health professional education programs with respect to health promotion competencies is a compelling and potentially costeffective initial means of preventing and reversing the trend of non-communicable diseases. Learning evidence-based health promotion competencies within an inter-professional context would help students maximize the use of nonpharmacologic/ non-surgical approaches and the contribution of each member of the health team. This operational research study was initiated by Noncommunicable Disease Control Program (NCDC) of GOB to assess the readiness of the medical graduates to achieve the primary program objective “to reduce premature (40-69 years age group) death by 33% by the year 2030”. The program also wanted to review the existing undergraduate curriculum to determine the need for a change to achieve program objectives. The activity was delegated to Bangladesh College of Physicians & Surgeons (BCPS), to develop the recommendations for the NCD program. The study was designed as a cross-sectional mixed-method study adopting both quantitative and qualitative methods. Quantitative data were obtained from new graduates (12 medical colleges’ public & private) and older graduates from the existing public healthcare services. In-depth interviews (IDI), Key informant interviews (KII) & opinion gathering workshops were adopted to collect qualitative data. Senior medical teachers teaching NCD subjects were included in the qualitative process. Quantitative data were analyzed by using SPSS 20.0. Qualitative data was audio-recorded and transcribed by the anthropologist team. The curriculum review was done manually by using content analysis of the whole curriculum. The total number of respondents for the quantitative survey was 678, new graduates 348 (51%), older graduates 330 (49%). Among older graduates, 178 (54%) had no previous training, and 152 (46%) received some form of on-the-job training on NCDs by the program. The 12 IDI, 7 KII and 4 workshops participated by 88 senior teachers participated in recommendations development. The knowledge of 4 major NCDs, four major risk factors, PEN, and contribution of death from major NCDs was incorrect, suggesting a lack of conceptual and contextual understanding of the NCD prevention and control program. Qualitative investigation & opinion of the teachers suggested a lack of awareness of teachers regarding the control program, revealing a lack of communication and coordination between the program and academia, and the present curriculum is inadequate for NCD learning by the students. It can be concluded that the existing curriculum is inadequate in terms of program orientation and necessary skills to achieve the program objectives. A structured training program using a training module covering the concept and content on prevention and control of NCDs in a country perspective is essential for the current graduates. Major NCD education in the existing curriculum requires to be urgently updated and could be best offered by using a teaching-learning module on major NCDs. J Bangladesh Coll Phys Surg 2022; 40: 95-105

Prevalence of risk factors of non-communicable diseases in the Sultanate of Oman: STEPS survey 2017.

BackgroundNon-communicable diseases (NCD) represent a major public health issue and currently cause 185.75 deaths per 100,000 population in Oman. Hence, there is a need for comprehensive, up-to-date and internationally comparable data on NCD risk factors in order to evaluate the effectiveness of ongoing public health policies and to develop further NCD prevention and control interventions. The aim of the study was to provide evidence-based, up-to-date, extensive, and reliable baseline data on the behavioural and biological risk factors of NCDs in the Sultanate of Oman.MethodsA cross‐sectional, prospective, observational community‐based survey designed to be nationally representative of the Sultanate of Oman was conducted based on the WHO STEPwise approach to Surveillance (STEPS). Multi-stage stratified random sampling according to geographical distribution selected a total of 9053 households (Omani nationals and non-Omani residents). Cluster sampling was used to randomly select equal clusters from each governorate. 823 households were randomly selected from the list of all households in all selected clusters from each governorate and one eligible adult selected from each household randomly accounting for 6582 consenting participants. The survey used demographic and behavioural information questionnaires along with physical and biochemical measurements among adults aged 18 years and above.ResultsThe prevalence of behavioural risk factors such as tobacco use was 9%, alcohol consumption was 2%, insufficient fruit or vegetable intake was 61%, and insufficient physical activity was 39%. The prevalence of biological risk factors such as overweight and obesity was 66%, raised blood pressure was 33%, raised blood glucose was 16%, and raised blood cholesterol was 36%. The prevalence of multiple risk factors was also determined and 95% of the population were found to have more than one risk factor. Three or more risk factors were found among 33% of population aged 18 years and above and 45% of the population aged 45 years and above.ConclusionA high prevalence of various NCD risk factors was found which needs to be addressed through health promotion, education, and policy. The findings are important to support the formulation and implementation of NCD-related policies and action plans that improve health status and prevent mortality due to NCDs in Oman.

9.D. Skills building seminar: Community based NCD prevention and control: what can we learn from research in South East Asia?

Abstract Non-communicable diseases (NCDs) are increasing worldwide. Especially in low- and middle-income countries the disease burden of NCDs is quickly increasing. The recent COVID-19 pandemic exposed increased risk of complications due to comorbidity with obesity, cardio-vascular diseases, chronic lung diseases and diabetes. To reduce the burden of NCDs worldwide prevention, early detection and treatment is crucial. The research project Scaling Up NCD interventions in South East Asia (SUNI SEA) in Indonesia, Myanmar and Vietnam, aims at introducing an effective and cost-effective approach in community-based health promotion, screening and primary healthcare (PHC)-based diagnosis and treatment of NCDs. The study builds of internationally accepted interventions (e.g. WHO manuals), and on experiences from countries and regions with community- and PHC-based interventions. In the SUNI-SEA project we learned that it is necessary to customise community-based and PHC-based activities to local culture, socio-economic and health services-related factors, in order to achieve optimal effectiveness. Based on this finding, the team developed methodologies and activities for this adaption process. During this workshop these methodologies and activities will be shared and participants will be invited to mutual learning. The workshop concentrates on three elements of customisation: Developing culturally sensitive and responsive capacity building materials and programs for health promotion and screening by community volunteers and community groups; Identifying relevant contextual factors in the communities which contribute to an enabling environment for health promotion and screening; Identifying effective and cost-effective patient journeys for identifying individuals with high risks for developing NCDs, early treatment and lifestyle interventions, which fit in local cultures and health systems. The workshop will start with three brief introductions, after a brief explanation of the theory of change underpinning the NCD prevention and control interventions. The three elements of contextually adapted capacity building, enabling environment and patient journeys will be explained and methodologies presented. Each introduction will end with an open question for debate. The debate following the introductions will apply the fishbowl approach, whereby panellists and workshop participants can switch places to share their views and experiences. This enhances participation and mutual learning. The workshop will be closed with formulating one recommendation per element, on how to enhance adaptation of interventions to local conditions. Key messages A global knowledge base is developed for community-based NCD prevention and control. The SUNI-SEA project developed tools for customisation of culturally sensitive and cost-effective interventions. Stronger community organisations and better collaboration between community groups and primary healthcare facilities enhances prevention and control of hypertension and diabetes.

Evaluation on the quality of 236 National Demonstration Areas for comprehensive prevention and control of chronic diseases betweem 2017 and 2019

Objective: To evaluate the quality of the National Demonstration Area for Comprehensive Prevention and Control of NCDs (referred to as "the Demonstration Area"). Methods: Based on the evaluation scores of the Demonstration Area field survey from 2017 to 2019, we counted the scores of each indicator, comparing the scores among indicators and regions. x±s was used to describe the scores. The 95%CI of the score was used to test the statistical difference among regions. Each score was converted into a hundred-mark system to compare the scores among indicators. Results: Of 236 Demonstration Areas, the total score was 83.5. The scores of the first-level indicator listed from high to low appeared as Integrating System of NCD Prevention and Control (92.8), Policy Perfection (90.3), Building Supportive Environment for NCD Prevention and Control (88.4), Implementation of Health Education and Health Promotion (87.4), Whole-course Management of NCDs (78.1), Innovation and Guidance (76.5), Surveillance and Evaluation (75.1). Total scores were higher in the east (259.2±18.8) comparing to the middle (243.2±15.2) or the west (245.4±19.7) regions. Conclusions: Substantial variations on the quality in the Demonstration Area existed across different regions in China. These disparities are important to the government when developing health policies and allocating resources. Whole-course Management of NCDs, Surveillance and Evaluation, and Innovation and Guidance in the Demonstration Area also needs to be improved.

Towards understanding power and agency in policy implementation: A stakeholder analysis of a primary care NCD policy in the Philippines

Abstract The growing NCD burden of demands collective action from many stakeholders. This is often difficult to achieve, largely due to the limited understanding of how actors interact and shape policy processes, especially in LMICs. CVD accounts for a third of deaths in the Philippines, where a national primary care policy for NCD control has been enacted. We describe how we assessed the capacities, power and level of stakeholder engagement in implementing the programme within the Philippine health system and identified ways to support implementation. A scoping review developed an analytical framework for stakeholder analysis, peer reviewed by health policy experts. Four characteristics were identified: level of knowledge, interest, power, and position of stakeholders. Interviews and a consensus building exercise were used to operationalize it. Respondents were purposively sampled via document review and a snowball technique. National government has high power but offers moderate support for implementation. Decentralized local governments also have high power but offer varying degrees of support for implementation given competing priorities and limited resources. Frontline health workers and civil society are both supportive but have little power. Professional societies have only moderate power but are an important conduit to reach private providers. The capacities of some actors are not fully mobilized. Understanding of the power and capacity of actors facilitates approaches to control NCDs in the Philippines. Engagement with national and local governments must be strengthened to improve uptake of the NCD control policy. Frontline health workers, if empowered, can make a key contribution to policy implementation. Professional societies can play an important facilitating and convening role to build collaborations across public and private sectors. Finding the optimal balance and synergies between these diverse roles may be critical for NCD programme implementation.

Gender Responsiveness of NCD and tobacco control policies

Abstract Sarah Hawkes will discuss recent analyses of the gender-responsiveness of NCD policies in general in 6 European countries and tobacco-control policies in particular in a further 4 LMICs. Tobacco use is the world's leading preventable cause of illness and death and the most important risk factor for NCDs and thus developing effective and transformative tobacco control policies remains a pressing priority. Evidence for the sex-disaggregated burden of disease will be supplemented with gendered and intersectional analysis that explains why differences in health outcomes persist, and discussions will centre on how policies and programmes to address NCDs, including those specifically linked to tobacco, can be made more responsive to gender and its intersections.

Gender responsive health promotion and NCD prevention – challenges and solutions in Kyrgyzstan

Abstract Reaching men is one of the challenges related to targeted health promotion. Societal factors, concepts of masculinities, and gender norms have a strong influence on preventive and health behavior of men. Targeted health promotion and prevention has to consider gender-specific differences in language and information sources to spread preventive messages but often fail to be effective. In Kyrgyzstan, non-communicable diseases account for 80% of mortality, including cardiovascular diseases, and raised blood pressure is the second most common disease for men. The NCD prevention and control project in Kyrgyzstan, funded by the Swiss Agency for Development and Cooperation (SDC), aims to facilitate behavioral change towards healthier lifestyles by taking a gender-responsive approach to support the utilization of NCD related primary health care services for men. The gender-responsive intervention considers gender roles, norms, and inequalities, understands men's health needs, and pattern of preventive behavior to develop interventions. Data from project studies yielded that for men family members were the primary source of information about NCDs, risk factors and prevention. An assets-based approach is taken, building on the male role in a life-course perspective and a positive approach to the role of men as fathers. In 2019, an intervention, combining a school competition for children with a voucher system for preventive services for fathers and male relatives was conducted. In total, 80,416 males were reached and visited primary health facilities for preventive services (which averaged 20% of the male population over 18 years old); 18,364 (23%) men were newly detected with high blood pressure. Medical workers were made available during special hours to provide men with a consultation. During their visits, all men were screened for risk factors and received a consultation based on PEN protocol 1 and 2. Lessons on gender sensitivity have been learned from this experience.

Readiness of primary health-care facilities for the management of non-communicable diseases in rural Bangladesh: a mixed methods study

BackgroundNon-communicable diseases (NCDs) account for 67% of all deaths in Bangladesh. Several programmes are being implemented at the primary health-care level for NCD control in rural Bangladesh. This study aimed to assess the readiness for NCD health services provision in primary health-care facilities in rural Bangladesh, and explore health-care providers' perceptions about NCD care provision at the facilities. MethodsThis study was conducted in the Parbatipur sub-district of Bangladesh using an embedded mixed method design. We used the modified WHO Service Availability and Readiness Assessment tool to assess primary health-care facilities and completed in-depth interviews with health-care providers (community health workers, nurses, and doctors with experience in management of NCDs). We used descriptive statistics to analyse quantitative data and mean domain score was based on the availability of the items as a percentage for each facility type. Service readiness score for each NCD was calculated across facility types as the mean score of all domains of service readiness (management guideline, trained staff, equipment, medicine). Higher scores indicated better service readiness. Thematic analysis was used for qualitative data. FindingsBetween Nov 18 and Dec 3, 2018, we assessed 24 primary health-care facilities and completed 15 in-depth interviews. Of the 24 facilities surveyed, 23 were government-owned and one was a non-governmental organisation facility. Overall readiness score was highest for cardiovascular disease (22·6% [SD 28·8]) followed by diabetes (17·2% [25·0]) and asthma (13·2% [12·2]). Health-care providers mentioned lack of training, unavailability of medicine, and inadequate supervision as barriers to achieving readiness for NCD services. InterpretationThat functions and resources required for NCD care such as management guidelines, medicine, equipment, and trained staff were unavailable in the primary health-care facilities suggests a need to integrate NCD services into the Essential Services Package in government facilities. A limitation of the study is that the small sample size did not allow analysis to assess differences in service readiness between facility types. FundingMasters dissertation funded by BRAC James P Grant School of Public Health, BRAC University.

Opportunities and challenges for delivering non-communicable disease management and services in fragile and post-conflict settings: perceptions of policy-makers and health providers in Sierra Leone

BackgroundThe growing burden of non-communicable diseases in low- and middle-income countries presents substantive challenges for health systems. This is also the case in fragile, post-conflict and post-Ebola Sierra Leone, where NCDs represent an increasingly significant disease burden (around 30% of adult men and women have raised blood pressure). To date, documentation of health system challenges and opportunities for NCD prevention and control is limited in such settings. This paper aims to identify opportunities and challenges in provision of NCD prevention and care and highlight lessons for Sierra Leone and other fragile states in the battle against the growing NCD epidemic.MethodsThis paper focuses on the case of Sierra Leone and uses a combination of participatory group model building at national and district level, in rural and urban districts, interviews with 28 key informants and review of secondary data and documents. Data is analysed using the WHO’s health system assessment guide for NCDs.ResultsWe highlight multiple challenges typical to those encountered in other fragile settings to the delivery of preventive and curative NCD services. There is limited government and donor commitment to financing and implementation of the national NCD policy and strategy, limited and poorly distributed health workforce and pharmaceuticals, high financial barriers for users, and lack of access to quality-assured medicines with consequent high recourse to private and informal care seeking. We identify how to strengthen the system within existing (low) resources, including through improved clinical guides and tools, more effective engagement with communities, and regulatory and fiscal measures.ConclusionOur study suggests that NCD prevention and control is of low but increasing priority in Sierra Leone; challenges to addressing this burden relate to huge numbers with NCDs (especially hypertension) requiring care, overall resource constraints and wider systemic issues, including poorly supported primary care services and access barriers. In addition to securing and strengthening political will and commitment and directing more resources and attention towards this area, there is a need for in-depth exploratory and implementation research to shape and test NCD interventions in fragile and post-conflict settings.

Using the right to health framework to tackle non-communicable diseases in the era of neo-liberalism in Uganda

The main objective of this article is to reflect on how the right to health framework may be used to tackle non-communicable diseases in the era of neo-liberalism in Uganda. NCDs, also known as chronic or lifestyle diseases, cause many deaths. The risk factors for NCDs include the harmful use of alcohol, physical inactivity, salt intake, tobacco use, raised blood pressure, diabetes, obesity, as well as ambient and household air pollution. The article moves beyond the recognition of these important risk factors and interrogates the contribution of neo-liberalism to the prevalence of NCDs. The article argues that neo-liberalism, which emphasises the role of market forces in dealing with socio-economic questions, significantly contributes to the NCDs challenge in Uganda. The article concludes that the right to health can and should play a critical role in tackling the challenge of NCDs in Uganda. Unless policy challenges associated with neo-liberalism are tackled, current NCD prevention, control and management efforts that focus on individual behaviour or lifestyle approaches and place the burden of responsibility on the individual may not achieve the desired results.

Methylenetrahydrofolate Reductase Gene C677T Polymorphism and Diabetic Retinopathy: a Meta-Analysis.

Objective To investigate the association between the methylenetetrahydrofolate reductase gene C677T (MTHFR C677T) polymorphism and diabetic retinopathy (DR). Methods A total of 6971 subjects including 2707 DR patients and 4264 controls from 23 studies were enrolled in the study. A random-effects model was applied to estimate the overall effects and the stratified effects of the MTHFR C677T polymorphism on the risk of DR, and study quality was also assessed. Results Strong associations were observed between the MTHFR C677T polymorphism and DR. The carries of MTHFR C677T were more likely to be found in the DR group in relative to the healthy control group with odds ratio 1.68, 2.55, and 2.31 respectively in allele contrast model (T vs. C, 95%CI: 1.29-2.18, P<0.001, I 2=78.4%), homozygous model (TT vs. CC, 95%CI: 1.70-3.83, P=0.008, I 2=54.4%) and dominant model (TT+CT vs. CC, 95%CI: 1.62-3.29, P<0.001, I 2=74.7%). This association can also be found in contrast to the Ncd (non-complicated diabetic mellitus) group (allele contrast, OR=1.50, 95%CI: 1.07-2.11, P=0.032, I 2=62.1%; homozygous, OR=2.39, 95%CI: 1.06-5.38, P=0.017, I 2=66.7%; dominant, OR=1.59, 95%CI: 0.97-2.62, P=0.056, I 2=56.5%). For the heterozygous model (CT vs. CC), the association was significant in contrast to the healthy control group (OR=1.46, 95%CI: 1.64-3.69, P=0, I 2=77.3%), while in contrast to the Ncd control group the association was not statistically meaningful (OR=1.38, 95%CI: 0.87-2.18, P=0.131, I 2=43.7%). For the recessive model, 1.92-fold increased risk was found only in contrast to the Ncd control group (95%CI: 1.07-3.43, P=0.064, I 2=55.0%). There was no significant association found in the models in contrast to the DM control group. Conclusion In this meta-analysis, we found an association between the MTHFR C677T polymorphism and DR, especially in contrast to the Ncd control group. Further studies are required to establish more definite relationship.