Non-communicable Diseases Clinics Research Articles

Relationship between proxy behavior in clinic attendance and disease control among persons with hypertension and diabetes at a rural primary health center: A cohort analysis in South India

ABSTRACT Aims: Among persons with hypertension and diabetes on treatment for at least 1 year at the Rural Health Centre (RHC) noncommunicable disease (NCD) clinic, 1. To determine the control status for hypertension and diabetes. 2. To assess the relationship between proxy behavior for collection of medications and the control status. Settings and Design: Rural Health Centre, Ramanathapuram, Puducherry, India; record-based retrospective observational study. Methods and Material: The study employed a universal sampling of 396 eligible persons with diabetes and hypertension who had been on medication for over a year at the RHC NCD clinic and had recorded blood pressure and glucose values within the last 4 months. Case sheets of these patients were retrieved from the Medical Registration Department, and data from the past 12 months were collected and analyzed to assess proxy behaviors and absenteeism. Statistical Analysis Used: Data were entered from the case sheets in Epicollect5 and analyzed using Stata v17. Results: Among hypertensive patients, 48.01% were aged 60 and above, with 55.63% being female. Fifty-six percent of hypertensive patients had their condition controlled. For diabetic patients, 40.88% were aged 45–59 years, with 59.75% being female. Only 18.24% of diabetic patients had their condition controlled. The multivariable analysis examined factors associated with the control status of hypertension and diabetes. Those aged 30–44 (aRR: 1.47, 95% CI: 1.01–2.15) and 45–59 (aRR: 1.37, 95% CI: 1.03–1.82) had a higher risk of uncontrolled hypertension compared to those aged 60 and above. Gender did not show significant associations with hypertension control status. Regarding attendance status, patients who had both proxy and missed visits (RR: 1.46, 95% CI: 1.02–2.07) had a higher risk of uncontrolled hypertension. There was also a significant association with patients having more than three proxies (aRR: 1.51, 95% CI: 1.10–2.17) exhibiting a higher risk of uncontrolled hypertension. Absenteeism status showed that those absent for 1–3 visits had a higher relative risk (RR: 1.37, 95% CI: 1.03–1.82) of uncontrolled hypertension compared to those with no absenteeism. Conclusion: Proxy behavior affects the control status of persons with hypertension and diabetes. A longitudinal study is warranted to assess the relationship between proxy visits and control status.

Adherence to Medication Among Diabetic Patients Attending the Non-communicable Disease Clinic of a Secondary Care Center in North Kerala, India

Adherence to Medication Among Diabetic Patients Attending the Non-communicable Disease Clinic of a Secondary Care Center in North Kerala, India

Awareness And Practices Of Diabetic Retinopathy Among Diabetic Patients Attending Non-Communicable Disease Clinic At Tertiary Health Care Centre - A Facility Based Cross Sectional Study.

Awareness And Practices Of Diabetic Retinopathy Among Diabetic Patients Attending Non-Communicable Disease Clinic At Tertiary Health Care Centre - A Facility Based Cross Sectional Study.

Perceptions and Satisfaction of E-Health Applications: An Analytical Cross-Sectional Study in a Rural Health Center at Tiruvallur District, Tamil Nadu.

Introduction E-health, defined as the utilization of information and communication technologies for health services, has become integral in enhancing healthcare delivery and accessibility. This study focuses on user satisfaction and perceptions of e-health applications in rural health centers, with special focus on Tamil Nadu, India. E-health technologies have proven to be effective in addressing challenges to healthcare accessibilityand improving patient outcomes, at reduced costs. Despite these benefits, there is a need to understand user experiences in rural settings to optimize the implementation of e-health solutions. Methods A cross-sectional study was conducted among 383 patients registered in a non-communicable disease(NCD) clinic and specialty clinic in the rural health center of a tertiary care hospital in Tiruvallur district. Participants were selected using a consecutive sampling method from the NCD and specialty clinic registers. A semi-structured questionnaire was used to collect data on their perception and satisfaction with e-health applications. Data was entered in (Microsoft) MS Excel (Microsoft Corporation, Redmond, Washington, United States) and analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Results The overall mean age was 49.45 ± 7 years. Among the study participants, females constituted 57.3% compared to males who constituted 42.7%. 58.3% of the participants had comorbid conditions. More than half of the study participants were educated up to the high school level. According to BG Prasad's classification, 86.9 % of the participants belonged tomiddle class and below. Among the study participants, more than half of them use their smartphones as devices for internet access to use e-health applications. The study participants who had no co-morbid conditions were 3.3 times the odds of having poor perception and satisfaction when compared to the other categories (OR = 3.3, CI = 2.1 - 5.1) in using e-health applications, and this difference was found to be statistically significant (p = 0.01). Conclusion This study's findings reveal that gender, socio-economic status, occupation, and the presence of comorbid illnesses play significant roles in shaping users' perceptions and satisfaction levels. This study's findings underscore the importance of tailored e-health interventions to address these barriers and enhance healthcare delivery in rural areas.

Catastrophic out-of-pocket payments related to non-communicable disease multimorbidity and associated factors, evidence from a public referral hospital in Addis Ababa Ethiopia

BackgroundIn low and middle-income countries (LMICs), non-communicable diseases (NCDs) are on the rise and have become a significant cause of mortality. Unfortunately, accessing affordable healthcare services can prove to be challenging for individuals who are unable to bear the expenses out of their pockets. For NCDs, the treatment costs are already high, and being multimorbid further amplifies the economic burden on patients and their families. The present study seeks to bridge the gap in knowledge regarding the financial risks that come with NCD multimorbidity. It accomplishes this by examining the catastrophic out-of-pocket (OOP) expenditure levels and the factors that contribute to it at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia.MethodsA facility-based cross-sectional study was conducted at Tikur Anbesa Specialized Hospital between May 18 and July 22, 2020 and 392 multimorbid patients participated. The study participants were selected from the hospital’s four NCD clinics using systematic random sampling. Patients’ direct medical and non-medical out-of-pocket (OOP) expenditures were recorded, and the catastrophic OOP health expenditure for NCD care was estimated using various thresholds as cutoff points (5%, 10%, 15%, 20%, 25%, and 40% of both total household consumption expenditure and non-food expenditure). The collected data was entered into Epi Data version 3.1 and analyzed using STATA V 14. Descriptive statistics were utilized to present the study’s findings, while logistic regression was used to examine the associations between variables.ResultsA study was conducted on a sample of 392 patients who exhibited a range of socio-demographic and economic backgrounds. The annual out-of-pocket spending for the treatment of non-communicable disease multimorbidity was found to be $499.7 (95% CI: $440.9, $558.6) per patient. The majority of these expenses were allocated towards medical costs such as medication, diagnosis, and hospital beds. It was found that as the threshold for spending increased from 5 to 40% of total household consumption expenditure, the percentage of households facing catastrophic health expenditures (CHE) decreased from 77.55 to 10.46%. Similarly, the proportion of CHE as a percentage of non-food household expenditure decreased from 91.84 to 28.32% as the threshold increased from 5 to 40%. The study also revealed that patients who traveled to Addis Ababa for healthcare services (AOR = 7.45, 95% CI: 3.41–16.27), who were not enrolled in an insurance scheme (AOR = 4.97, 95% CI: 2.37, 10.4), who had more non-communicable diseases (AOR = 2.05, 95% CI: 1.40, 3.01), or who had more outpatient visits (AOR = 1.46, 95%CI: 1.31, 1.63) had a higher likelihood of incurring catastrophic out-of-pocket health expenditures at the 40% threshold.Conclusion and recommendationThis study has revealed that patients with multiple non-communicable diseases (NCDs) frequently face substantial out-of-pocket health expenditures (CHE) due to both medical and non-medical costs. Various factors, including absence from an insurance scheme, medical follow-ups necessitating travel to Addis Ababa, multiple NCDs and outpatient visits, and utilization of both public and private facilities, increase the likelihood of incurring CHE. To mitigate the incidence of CHE for individuals with NCD multimorbidity, an integrated NCD care service delivery approach, access to affordable medications and diagnostic services in public facilities, expanded insurance coverage, and fee waiver or service exemption systems should be explored.

“Intensified Case Finding of Tuberculosis among Diabetes Mellitus Patients attending Non-Communicable Disease Clinic in a Tertiary Care Hospital – An Implementation Research”

BackgroundFor ending the epidemic of TB by the year 2030, along in line with Sustainable Development Goals, it is essential to address the TB associated co-morbidities. Prevalence of diabetes influencing TB incidence and mortality is higher when compared to other co-morbidities like HIV infection, cigarette smoking, alcohol use and under-nutrition. Therefore, this study was conducted with the following objectives: 1.To evaluate the effectiveness of the intervention on implementation of TB-DM collaborative activity using four symptom complex strategy and to explore the patient and health providers related factors that contribute to implementation of activity. Material and MethodsThe present study was undertaken by Department of Community Medicine, Sri Manankula Vinayagar Medical College and Hospital, Puducherry for a period of 18 months in the Out Patient Departments of General Medicine, General Surgery, Obstetrics and Gynecology, Orthopedics, DOTS center and Designated Microscopy Centre. It was an embedded sequential experimental study, done among the health care professionals (CRRI, Postgraduates and staff nurse) who were involved in process of 4s complex screening for DM patients and the stakeholders who were involved in implementation of NTEP activity. The study was conducted in three phases. Phase I: baseline survey and identification of intervention strategies, Phase II: implementation of the intervention and Phase III: end line survey. Data entry and analysisManual content analysis was done for Qualitative data. The Quantitative data were entered into Epi Info software (version 7.2.2.6) and analyzed in SPSS software (version 24). Comparison of knowledge among the health care professionals before and after sensitization was calculated using Mc nemar test. It was considered statistically significant when the p value was <0.005. The analysis of free list and pile sort data was undertaken using Anthropac 4.98.1/X software. ResultsChallenges obtained from stakeholders in implementing the activity were categorized as patient related factor, health care professional related factor and screening and reporting related factor. Suggested solutions were generating awareness at patient level, display of IEC tools, periodical sensitization for the staff, inter-departmental co-ordination, monitoring and re-enforcing the activity in core-committee meetings. After sensitization, the knowledge on joint TB-DM collaborative activity was significantly improved among the health care professionals. By implementing the four symptom complex screening activity in NCD clinic, 6480 DM patients were screened and 176 (2.7%) presumptive TB cases were identified. Of which, 136 of them reached DMC for sputum examination. Among them 44 (35.4%) had active TB infection. The Number Needed to Screen to yield a case of TB was 147. Conclusionand recommendations: We found improvement in identification of TB cases using ICF approach with minimal resources. Thus, we recommend a support group to maintain and strengthen the ongoing activity. The challenges and solutions identified may help in optimizing the screening process. Implementing the activity in special clinics like oncology OPDs, nephrology OPDs, antenatal clinics can be recommended.

Diabetes Self-Efficacy on Glycemic Control and Well-Being of Patients With Type 2 Diabetes Mellitus: An Analytical Cross-Sectional Study.

Diabetes mellitus is a major, chronic, and progressive lifestyle disease. It adversely affects patients' quality of life, effectiveness, and well-being. Self-care practices are universally recognized as imperative to keep the illness under control and prevent complications. Self-efficacy is one of the factors involved in the successful self-care of diabetic patients. The primary objective of the study was to estimate the proportion of diabetes self-efficacy and to assess the correlation ofdiabetes self-efficacy with glycemic control, and the well-being of patients with type 2 diabetes mellitus (T2DM). The secondary objective was to assess the factors associated with diabetes self-efficacy. An analytical cross-sectional study was conducted among T2DM patients attending the non-communicable disease clinic in the outreach centers of Government Medical College, Thiruvananthapuram, Kerala, India. Four hundred patients with T2DM were included in the study.Diabetes self-efficacy was assessed by the Stanford Diabetes Self-Efficacy Scaleand the WHO-5 index scale was used to assess wellbeing. Glycemic control was determinedby HbA1C estimation, with ≤7% as good control. Among 400 patients with T2DM, 51.25 % (95% CI: 46.2-56.2) had high diabetes self-efficacy. A significantly negative correlation was found between HbA1C and self-efficacy (r =- 0.208, p = 0.01), and a positive correlation was shown between well-being and self-efficacy (r = 0.418, p = 0.01). Logistic regression analysis found that factors associated with diabetes self-efficacy were upper socioeconomic status (OR = 8.53, 95% CI: 3.06-13.82), family support (OR = 1.97, 95% CI: 1.10-3.54), participation in diabetes education classes (OR = 1.95, 95% CI: 1.10-3.54), diet compliance (OR = 4.74, 95% CI: 2.80-8.01), glycemic control (OR = 1.69, 95% CI: 1.01-2.84), and overall wellbeing (OR = 6.7, 95% CI: 3.84-11.64). The proportion of high diabetes self-efficacy was 51.25% (95% CI: 46.2-56.2). The factors associated with diabetes self-efficacy were family support, participation in diabetes education classes, high socioeconomic status, absence of complications, good glycemic control, and well-being. The study findings depicted that high self-efficacy was significantly correlated with good glycemic control and well-being of patients with T2DM.

Assessment of Quality of Life Among Type 2 Diabetes Mellitus Patients in an Urban Health Center of Tiruvallur District, Tamil Nadu.

Introduction Diabetes mellitus (DM) is one of the leading causes of death and disability, in addition to its rapidly increasing prevalence in developing countries. The key element of managing diabetes is quality of life (QoL). It is a factor that is positively related to treatment adherence, and QoLmotivates the patient to manage their disease and achieve health and happiness in the long term. We undertook this study in a district of South India among patients with type 2 diabetes mellitus(T2DM) to assess their QoL. Methodology A cross-sectional study was conducted among T2DM patientsregistered in a noncommunicable disease (NCD) clinic in an urban health center in Tiruvallur District, Tamil Nadu. Participants were selected using a systematic random sampling method from the NCD clinic register. Sociodemographic details of the participants were collected using a pretested, semistructured questionnaire, following which the World Health Organization Quality of Life-Brief Version Scale (WHOQOL-BBREF) questionnaire was used to assess the QoL. Data was entered in MS Excel (Microsoft Corporation, Redmond, Washington, United States) and analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). Results The mean age of the study participants was 53.5 ± 9.2 years. Females constituted 63.81% of the study population compared to males (36.19%). Domain-wise, 55.83% had good physical QoL, 49.1% had good psychological QoL, 49.69% had good social QoL, and 57.1% had good environmental QoL. Overall, 52.8% had a good QoLacross all the domains. Conclusion The current study found that patients with diabetes had a good QoLwith the exception in educational category. However, it is essential to create an awareness among the diabetic patients about the QoL and also the measures that they can practice to improve their QoL, which should be emphasized through health education, information education communication (IEC), and counselling in NCD clinics.

Unravelling the obesity maze in diabetic patients: A comparative analysis of classification methods.

Obesity is a significant health concern among individuals with type 2 diabetes mellitus (T2DM). Emerging evidence suggests that alternative measures, such as abdominal girth (AG) and body fat percentage (BF%), can provide a more accurate reflection of obesity-related metabolic risks in diabetic populations. This study aimed to compare the accuracy of different obesity classification methods, including BMI, AG, and BF%, among individuals with T2DM. This was an observational cross-sectional study conducted among T2DM patients who came to the non-communicable diseases clinic of GG Govt Hospital, Jamnagar, Gujarat during the period of March-April 2023. Demographic and anthropometric information was collected. Body fat analysis was done using a validated Omron fat analyzer. The study found the sensitivity of BMI in males and females as 41.6% and 45% against BF%, respectively. It also showed that the sensitivity of BMI in males and females was 38% and 40.7%, respectively, against AG. The present study also found a moderate positive correlation (r = 0.575) between AG and BF% in individuals with T2DM. The findings indicate that BF% and AG provide valuable insights into adiposity, surpassing the limitations of BMI as a measure of body composition. BF% is an indicator of body fat content, whereas AG serves as a proxy for central adiposity. The correlations between BF% and AG suggest that excess abdominal fat accumulation signifies increased body fat. By incorporating measures such as BF% and AG alongside BMI, clinicians can obtain a more comprehensive understanding of body composition and its relationship with metabolic abnormalities.

Factors associated with oral health care behavior of people with type 2 diabetes mellitus: A hospital-based, cross-sectional study.

Oral healthcare behavior determines oral health status and the incidence of oral diseases. People with type 2 diabetes mellitus (T2DM) are at-risk of having low oral healthcare behavior and disease-related oral health. To investigate the oral health status and factors associated with oral healthcare behavior among people with T2DM in Thailand. In total, 401 people with T2DM participated in the study based on their attendance at a non-communicable disease clinic at sub-district health promotion hospitals in Bueng Kan, a north-eastern province in Thailand. A structured questionnaire was used to obtain variables of interest. Linear regression analysis at the 95% confidence interval (CI) was applied. The majority of participants were female (73.8%). More than three-quarters had more than 20 permanent teeth (77.6%), a decay missing filling tooth index was 10.6 teeth/person. Many participants had four permanent occlusal pairs (69.6%), had tooth decay (74.6%), and some participants had tooth filling (32.2%). Statistically significant factors associated with oral healthcare behavior were: having complications associated with diabetes mellitus (Beta = -0.097, 95%CI = -1.653, -0.046), oral health literacy (Beta = 0.119, 95%CI = 0.009, 0.150), educational level (Beta = 0.123, 95%CI = 0.103, 0.949), oral healthcare attitude (Beta = 0.258, 95%CI = 0.143, 0.333), and oral health services (Beta = 0.430, 95%CI = 0.298, 1.408). People with T2DM had good oral health status. People with T2DM with low oral health literacy, low attitude, and low level of oral health services were at a higher risk of poor oral healthcare behavior.

Population Based Electronic Surveillance Tool to Identify Risk Factors for Developing Cervical Cancer- A Study Protocol

Background: Cervical cancer remains a significant global health concern, with well-established risk factors. Population-based electronic surveillance tools offer a promising avenue for identifying risk factors associated with cervical cancer development way before it becomes an actual concern for a woman. The objective of this study is to understand and to support the app- based decision-making tool for identifying risk factors of cervical cancer for the women between 30-60 years of age. Method: The study will be conducted in the selected Sampoorna Non-Communicable Diseases (NCD) clinics at Lucknow, Uttar Pradesh (UP). A rigorous review of database was conducted to summarize the evidence on informatics available for early identification of cervical cancer app. An app-based decision- making tool will be developed to identify and detect the high- risk population developing cervical cancer. The app then will be shared with health workers at Sampoorna clinics and will be capacitated for using it to collect real time data. Conclusion: The utilization of a population-based electronic surveillance tool will facilitate the identification of various risk factors contributing to cervical cancer development. The methodology process will help to comprehend the analysis providing the insights. This approach has the potential to enhance targeted interventions, public health policies, and personalized screening programs to mitigate the burden of cervical cancer. The objective of this paper is to understand and to support the design of dashboards for creating transparency and accountability.

Investigating the Prevalence and Predictors of Uncontrolled Hypertension: A Cross-Sectional Study in Gujarat, India.

Uncontrolled hypertension is a major public health concern that contributes significantly to cardiovascular morbidity and mortality. Treatment of hypertension prevents and reduces cardiovascular morbidity, notably a 40% reduction in risk of stroke and a 15% reduction in risk of myocardial infarction. Understanding the prevalence and predictors of uncontrolled hypertension is crucial for developing targeted interventions. This study aimed to determine the prevalence of uncontrolled hypertension and identify potential predictors among patients attending the Non-Communicable Disease (NCD) clinic of a tertiary care center in Gujarat, India. A cross-sectional study involving 732 adult patients with hypertension was conducted. Sociodemographic data, lifestyle factors, anthropometric measurements, and comorbidities were assessed. Blood pressure was measured using standardized protocols, and uncontrolled hypertension was defined as a systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Univariate and multivariate logistic regression analyses were performed to identify predictors of uncontrolled hypertension. The prevalence of uncontrolled hypertension was 60.2% (95% CI: 56.7%-63.7%). In the multivariate analysis, increasing age (adjusted OR: 1.21, 95% CI: 1.05-1.39), increased body mass index (adjusted OR: 1.49, 95% CI: 1.27-1.75), diabetes (adjusted OR: 1.68, 95% CI: 1.20-2.35), chronic kidney disease (adjusted OR: 2.11, 95% CI: 1.22-3.65), and current smoking status (adjusted OR: 1.83, 95% CI: 1.14-2.93) were identified as independent predictors of uncontrolled hypertension. This study revealed a high prevalence of uncontrolled hypertension in this tertiary care setting. Age, obesity, diabetes, chronic kidney disease, and smoking were identified as significant predictors. Targeted interventions addressing these modifiable risk factors and comorbidities are crucial for improving blood pressure control and reducing the burden of hypertension-related complications.

IJCM_195A: Prevalence of Drug Adherence Among Hypertensive Patients attending Primary Health Centre - A Cross sectional Study

Background: There is an increase in prevalence of hypertension 31.5% in urban and 26.2% in rural dwellers of Tamil Nadu (ICMR-INDIAB study). Adherence to hypertension medication is very important for improving the quality of life and preventing complications. In this study we aim to estimate the drug adherence among hypertensive patients using Morisky Medication Adherence Scale. Objectives: To estimate the prevalence of drug adherence and its influencing factors among hypertensive patients in Rural Health Training Centre areas of Madras Medical College. Methodology: 180 Hypertensive patients attending Non-Communicable Disease clinic from two rural health centres 90 patients from each Padiyanallur PHC and Medavakkam PHC were recruited for the study. In this study we have used The Morisky Scale MMAS-4 to address medication adherence. Results: Study results showed that 32.62% of hypertensive patients had high adherence to antihypertensive medications,53.48% patients had medium adherence whereas 13.9% patients had low adherence. Adherence to drug is higher among females (36.9%) than males (29.1%). Patients with low to medium adherence to antihypertensive drugs are having more than 10% risk of developing cardiovascular disease (OR – 3.6, 95% CI – 1.86 to 6.75) than their counterpart. Patients with good knowledge (42%) had high adherence than people with poor knowledge (24.2%) Conclusion: The study reported only 32.62% were found to be adherent to antihypertensive medications. To ensure high level of control among hypertensive sustained and focussed interventions should be implemented at all levels of health care.

A randomised controlled trial to evaluate the effectiveness of a culture and disease-specific, patient-centric multi-component tobacco cessation intervention package for the patients attending non-communicable disease clinics in Punjab, India

Background Developing an infrastructure to support tobacco cessation through existing systems and resources is crucial for ensuring the greatest possible access to cessation services. The present study aims to evaluate the effectiveness of a newly developed multi-component cessation among tobacco users in Non- Communicable Disease (NCD) clinics, functioning under the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases, & Stroke (NPCDCS) of the Government of India. Methods The intervention package consisting of culture- and disease-specific four face-to-face counselling sessions, pamphlets, and short text messages (bilingual) with follow-ups at 3rd, 6th, and 9th months with an endline assessment at 12th months was delivered to the intervention arm of the two-arm- parallel group randomised controlled trial at two selected NCD clinics. Self-reported seven-day abstinence, frequency of use, expenditure in seven days at each follow-up, FTND score, stage of change and plasma cotinine values were assessed at baseline, follow-ups, and endline (using Liquid Chromatography –Mass Spectrometry), as applicable. Results The intervention arm reported a significantly more reduction in self-reported frequency of tobacco use at 6 months (mean: 13.6, 95% CI (7.8–19.4)), 9 months (mean: 20.3, 95% CI (12.2–28.4)) and 12 months (mean: 18.7, 95% CI (8.7–28.7)). The plasma cotinine concentration at endline in the intervention arm was statistically significantly lower than the baseline concentration. Conclusion Strengthening existing health systems is crucial for offering cessation support in the resource-restraint setting of LMICs to assist in quitting sustainably.

Cardiovascular Risk Profiling Using the Globorisk Calculator among Noncommunicable Disease Patients Attending Primary Health Centers of a Tertiary Care Teaching Hospital in South India: A Cross-Sectional Analytical Study.

Cardiovascular diseases (CVDs) account for over three-quarters of all deaths taking place in developing nations. The present study aims to stratify noncommunicable disease (NCD) patients using the Globorisk chart for predicting their 10-year risk of a major (fatal or nonfatal) CVD event and to estimate the level of agreement between this country-specific chart and the existing World Health Organization (WHO)/International Society of Hypertension (ISH) risk strata. A record-based cross-sectional analytical study was conducted in 2018 among adults attending the NCD clinic of one rural and one urban primary health center in Puducherry. Laboratory and office risk calculators of the Globorisk chart were used to calculate the risk. The median age (interquartile range (IQR)) of the 760 study participants was 58 (50-65) years. When calculated using the Globorisk prediction chart, 22.1% (n = 168) of the participants had a <10% risk for any CVD event in the next 10 years, whereas the same risk was found in 71.1% (n = 540) by using the WHO/ISH risk chart. There was no agreement found between the two risk charts (k = 0.0174; P-value = 0.26). The Globorisk chart was found to identify more patients as belonging to the higher risk category as compared to WHO/ISH charts.

The longitudinal association of stressful life events with depression remission among SHARP trial participants with depression and hypertension or diabetes in Malawi.

Depressive disorders are leading contributors to morbidity in low- and middle-income countries and are particularly prevalent among people with non-communicable diseases (NCD). Stressful life events (SLEs) are risk factors for, and can help identify those at risk of, severe depressive illness requiring more aggressive treatment. Yet, research on the impact of SLEs on the trajectory of depressive symptoms among NCD patients indicated for depression treatment is lacking, especially in low resource settings. This study aims to estimate the longitudinal association of SLEs at baseline with depression remission achievement at three, six, and 12 months among adults with either hypertension or diabetes and comorbid depression identified as being eligible for depression treatment. Participants were recruited from 10 NCD clinics in Malawi from May 2019-December 2021. SLEs were measured by the Life Events Survey and depression remission was defined as achieving a Patient Health Questionaire-9 (PHQ-9) score <5 at follow-up. The study population (n = 737) consisted predominately of females aged 50 or higher with primary education and current employment. At baseline, participants reported a mean of 3.5 SLEs in the prior three months with 90% reporting ≥1 SLE. After adjustment, each additional SLE was associated with a lower probability of achieving depression remission at three months (cumulative incidence ratio (CIR) 0.94; 95% confidence interval: 0.90, 0.98, p = 0.002), six months (0.95; 0.92, 0.98, p = 0.002) and 12 months (0.96; 0.94, 0.99, p = 0.011). Re-expressed per 3-unit change, the probability of achieving depression remission at three, six, and 12 months was 0.82, 0.86, and 0.89 times lower per 3 SLEs (the median number of SLEs). Among NCD patients identified as eligible for depression treatment, recent SLEs at baseline were associated with lower probability of achieving depression remission at three, six, and 12 months. Findings suggest that interventions addressing SLEs during integrated NCD and depression care interventions (e.g., teaching and practicing SLE coping strategies) may improve success of depression treatment among adult patient populations in low-resource settings and may help identify those at risk of severe and treatment resistant depression.

Implementation strategies to build mental health-care capacity in Malawi: a health-economic evaluation

Depression is a major contributor to morbidity and mortality in sub-Saharan Africa. Due to low system capacity, three in four patients with depression in sub-Saharan Africa go untreated. Despite this, little attention has been paid to the cost-effectiveness of implementation strategies to scale up evidence-based depression treatment in the region. In this study, we investigate the cost-effectiveness of two different implementation strategies to integrate the Friendship Bench approach and measurement-based care in non-communicable disease clinics in Malawi. The two implementation strategies tested in this study are part of a trial, in which ten clinics were randomly assigned (1:1) to a basic implementation package consisting of an internal coordinator acting as a champion (IC-only group) or to an enhanced package that complemented the basic package with quarterly external supervision, and audit and feedback of intervention delivery (IC + ES group). We included material costs, training costs, costs related to project-wide meetings, transportation and medication costs, time costs related to internal champion activities and depression screening or treatment, and costs of external supervision visits if applicable. Outcomes included the number of patients screened with the patient health questionnaire 2 (PHQ-2), cases of remitted depression at 3 and 12 months, and disability-adjusted life-years (DALYs) averted. We compared the cost-effectiveness of both packages to the status quo (ie, no intervention) using a micro-costing-informed decision-tree model. Relative to the status quo, IC + ES would be on average US$10 387 ($1349-$17 365) more expensive than IC-only but more effective in achieving remission and averting DALYs. The cost per additional remission would also be lower with IC + ES than IC-only at 3 months ($119 vs $223) and 12 months ($210 for IC + ES; IC-only dominated by the status quo at 12 months). Neither package would be cost-effective under the willingness-to-pay threshold of $65 per DALY averted currently used by the Malawian Ministry of Health. However, the IC + ES package would be cost-effective in relation to the commonly used threshold of three times per-capita gross domestic product per DALY averted. Investing in supporting champions might be an appropriate use of resources. Although not currently cost-effective by Malawian willingness-to-pay standards compared with the status quo, the IC + ES package would probably be a cost-effective way to build mental health-care capacity in resource-constrained settings in which decision makers use higher willingness-to-pay thresholds. National Institute of Mental Health.

Dietary Practices Among Type 2 Diabetes Patients Visiting a Non-communicable Disease (NCD) Clinic in a District of Western India: A Cross-Sectional Study.

Diabetes is becoming a major public health problem in the country. One of the most important lifestyle modifications necessary for diabetic patients is maintaining healthy dietary choices. These modifications in dietary practices are supposed to be followed lifelong, along with medication, for better glycemic control. Despite understanding the importance of dietary control and physical activity in the management of diabetes, adherence to these practices is poor. This study aimed to assess the dietary practices of type 2 diabetes mellitus (T2DM) patients and various factors that determine adherence to these healthy dietary practices. The secondary objective was to find the perceptions of participants about the role of diet in controlling diabetes and to find the perception-practice gap among study participants. It was a hospital-based cross-sectional study conducted among 450 T2DM patients visiting the non-communicable disease (NCD) clinics of tertiary care hospitals and community health centres (CHCs) of the study district. Dietary practice was assessed using a modified UK Diabetes and Diet Questionnaire (UKDDQ), considering the food patterns in the study area. Statistical tests like chi-square and ordinal logistic regression were applied using Jamovi software for univariate and multivariate analyses. The healthiest food choices were abstinence from alcohol consumption (100%), avoiding processed meat (92.21%), high-fibre breakfast (70.4%), and daily consumption of vegetables (68.2%). Improper dietary practices were regular sugary drinks (38%) and high-glycemic-index food items (22.4%). The mean (SD) of the composite score was 68.02 (8.7) and the median score (interquartile range (IQR)) was 69 (60-76). Tertile analysis of the composite score revealed that with the increase in age, patients were less likely to be in the intermediate or upper tertile score (β = -0.0219, p = 0.016). Being female (odds ratio (OR) =0.603, CI: 0.395-0.917, p = 0.019) and living in a three-generation family made the patients less likely to be in the upper tertile score. Nearly half of the participants had an overall healthy score. Dietary practices were healthy among the participants of lower ages, males, and those living in nuclear and joint families. The highest perception-practice gap was seen for fruit and rice consumption.

Sickle cell disease in Cameroon: Taking out the "neglect" and highlighting key opportunities for sustainable control.

Sickle Cell Disease (SCD) is a serious genetic disorder with astounding regional differences in childhood survival. Alarmingly, over 90% of children with SCD in SSA die before their fifth birthday. In Cameroon, approximately 7,000 children are born with SCD annually; however, most of them go undiagnosed until their fourth birthday, resulting into untold pain and suffering. Despite this, little is known about the barriers to optimal care and treatment for SCD in Cameroon. Here, we assess these barriers, and consider opportunities that could be leveraged, for a sustainable control of SCD in Cameroon. We conducted a qualitative study, with documentary analysis of key national and international policy documents related to SCD management in Cameroon; semi-structured interviews; and focus group discussions, used for data collection. Key informants were selected purposively, and met at the central level of the health system (in Yaoundé) and the operational level (Mfou health district). These were policy makers, health workers, parents with SCD children and teenagers with SCD. Several critical gaps exist which hinder SCD control in Cameroon. These include lack of a national sickle cell disease strategy, no proportional allocation of funds for SCD in the national budget, and gaps in service delivery. These are translated into healthcare providers having little knowledge on SCD, absence of SCD-specific indicators in the health information system, challenges accessing essential medicines, and limited awareness raising in communities on SCD. Still, several opportunities exist which could be leveraged for improving SCD care in Cameroon. These include the possibility of integrating SCD screening and care into well-established primary healthcare services like vaccination, antenatal care, and non-communicable disease clinics. In the light of such limited resource settings, considering opportunities for integration in existing health programs could go a long way to reduce morbidities and mortalities from SCD over the coming years.

The Hidden Battle Within: Shedding Light on the Co-existence of Sarcopenia and Sarcopenic Obesity among Participants with Type 2 Diabetes in a Tertiary Care Hospital, Gujarat.

Type 2 diabetes (T2DM) is characterised by chronic hyperglycaemia due to abnormal insulin secretion and/or utilisation. Currently, sarcopenia has emerged as a new complication of T2DM, which increases the risk of physical disability, and even death. The study aims to estimate the prevalence of sarcopenia and sarcopenic obesity (SO) as well as their association with various other factors related to T2DM. The study was an observational hospital-based cross-sectional study conducted among diabetic patients who came to the non-communicable diseases (NCD) clinic of a tertiary care hospital in Gujarat, India, from April 2023 to June 2023. Adult patients with T2DM attending follow-ups were included, with a diagnosis of T2DM for at least 1 year from the date of their electronic medical records, regardless of their mode of therapeutic treatment. They were on regular medical reviews with two or more visits to the study site in the past 1 year. Then a self-structured standard questionnaire was used to collect the data, containing socio-demographic characteristics, clinical profiles, anthropometric assessment (comprising weight, height and body mass index [BMI]), bio-impedance indices like body fat%, skeletal muscle% and handgrip by hand dynamometer. In the study, a total of 404 participants participated. Their mean age was 55 ± 13.5 years and their mean body fat (BF) % was 30 ± 7.4%. BF%-defined obesity was found in 260 (64.4%) participants. A total of 362 (89.6%) had possible sarcopenia, 183 (45.3%) had sarcopenia and 124 (30.7%) had SO. Age (OR: 2.6, CI: 1.7-3.9), duration of diabetes for more than 7 years (OR: 7.5, CI: 3.65-15.4) and BF%-defined obesity (OR: 2.2, CI: 3.6-15) were statistically associated with Sarcopenia, in similar pattern age (OR: 2.4, CI: 1.5-3.7), and duration of diabetes more than 7 years (OR: 18.9, CI: 5.7-62) were associated with SO (P < 0.05). Older age, longer diabetes duration and BF%-defined obesity are associated with an increased likelihood of developing sarcopenia and sarcopenic obesity. Healthcare providers should prioritise regular screening for sarcopenia and SO in elderly individuals with diabetes to facilitate early detection and intervention.