Non-communicable Diseases Clinics Research Articles

Telemedicine in non-communicable chronic diseases care during the COVID-19 pandemic: exploring patients' perspectives.

This study aimed to explore challenges facing patients using Telemedicine consultations in non-communicable chronic disease clinics in primary care settings and to evaluate their satisfaction and willingness to use this service in the future. This is an analytical cross-sectional study enrolling participants who were randomly selected from representative primary care centers in Bahrain and providing Telemedicine consultations. A semi-structured questionnaire permitted data collection using telephone interviews. A total of 251 individuals participated in the study of whom the majority were Bahraini (90.04%), and the mean age was 54.48 ± 10.78 years. Most of the participants 231 (92.03%) were satisfied with the Telemedicine consultation while only 142 (56.80%) were willing to use this service in the future. The main perceived challenges related to Teleconsultations were the lack of physical examination, inadequate time of TM consultation, fear of medical errors, and lack of privacy. The willingness to use TM consultation in the future was mainly determined by the degree of comfort to tell private information (p < 0.01) and to less extent the ease of the communication tool (p = 0.005) on multivariate analysis. TM consultations could be a good complement to conventional consultation formats in the future. The sustainability of this innovative healthcare delivery tool requires addressing acceptability by users, ease of use, patient-centeredness, and technological advances to ensure privacy.

Assessing socioeconomic vulnerability and COVID-19 infection risk among NCD patients in rural Sierra Leone: a cross-sectional study

BackgroundIn Sierra Leone, non-communicable diseases (NCDs) are an increasingly important source of mortality and morbidity. However, Sierra Leonean NCD patients’ experience of direct exposure to COVID-19-related risks and indirect effects of the COVID-19 pandemic on socioeconomic determinants of health has not been described.MethodsWe conducted a cross-sectional telephone survey among adult (≥ 18 years) hypertensive, diabetic, and heart failure patients receiving treatment at the NCD clinic at Koidu Government Hospital (KGH) in rural Sierra Leone. We described patient demographics, COVID-19 related knowledge, and practice of infection prevention measures. Patients were categorized into nationally representative wealth quintiles using an asset-based wealth index and measures of social vulnerability were reported by clinical program and wealth category.ResultOf the 400 respondents, 80.5% were between 40 and 69 years old and 46.1% were male. The majority of patients (> 90%) knew utilizing masks, social distancing, isolation from positive cases, and avoiding hand shaking were effective COVID-19 prevention measures. However, only 27.3% of the population had access to adequate handwashing facilities, 25.5% had attended crowded events in the past two weeks, and only 5.8% always used face masks. Compared with the national distribution of wealth, 33.0% of our population belonged in the richest quintile, 34.8% in the second-richest quintile, and 32.2% in the bottom 3 poorest-middle quintiles. Socioeconomic vulnerability was high overall with significant disparities between wealth categories. In the 30 days before the interview, almost 60% of the poorest-middle categories experienced one barrier to essential health services, 87.4% used at least one emergency coping mechanism to cover food, housing, or health care, and 98.4% were worried about having food. In the richest category, the proportion of patients experiencing these challenges was 32.3%, 39.5% and 81.6%, respectively.ConclusionOur patients had good knowledge of COVID-19 prevention measures; however, we found substantial discrepancies between patients’ self-reported knowledge and practices. Although our population was wealthier than the national average, the NCD patients were still exposed to unacceptable levels of socioeconomic vulnerability, reflecting a high absolute poverty in Sierra Leone. Furthermore, wealth-based disparities in access to essential resources persist among NCD patients.

Assessment of Medication Adherence and Associated Factors Among Patients With Diabetes Attending a Non-communicable Disease Clinic in a Community Health Centre in Eastern India.

Background Non-adherence to medication represents a modifiable risk factor for patients with type 2 diabetes mellitus (T2DM). Identification of patients with poor adherence can have a significant impact on clinical and socio-economic outcomes in the management of diabetes. This study aimed to assess medication adherence and its associated factors among patients with T2DM attending a non-communicable disease (NCD) clinic in a rural community health centre (CHC) in eastern India. Methods The study was a facility-based study that included 207 study participants with an age greater than 18 years. A structured questionnaire was used to collect data on socio-demographic characteristics, health-seeking behaviour, self-care practices, risk factors, clinical information on diabetes, prescription practices, and medication practices. The Hill-Bone Medication Adherence Scale (HB-MAS) has been used to assess medication adherence among study participants. Results The study found that the medication adherence rate among the study participants was 67.1%. On multivariate analysis, subjects with social insurance (adjusted odds ratio (AOR) = 2.73, 95% confidence interval (CI) = 1.01-7.38, p-value = 0.047), current smoking status (AOR = 5.47, 95% CI = 1.55-19.23, p-value = 0.008), anxiety (AOR= 3.52, 95% CI= 1.62- 7.61, p-value= 0.001), polypharmacy (AOR= 3.79, 95% CI= 1.25- 11.45, p-value= 0.018), and using alternative medicine (AOR= 5.82, 95% CI= 1.58 - 21.39, p-value= 0.008), were found to have a significantly higher chance of non-adherence. On the other hand, patients practising regular physical activity (AOR = 0.31, 95% CI= 0.12-0.79, p-value = 0.015) and with deprescription (AOR = 0.12, 95% CI= 0.03-0.47, p-value = 0.002) were found to have less chance of non-adherence as compared to their counterparts. Conclusion The study highlights the need to identify patients with poor medication adherence and develop interventions according to their requirements through a holistic approach. The study contributes to the existing literature on medication adherence among diabetes patients in rural healthcare settings in eastern India.

Estimating the Cost of Delivering Tobacco Cessation Intervention Package at Noncommunicable Disease Clinics in Two Districts of North India.

Integrated care is likely to improve outcomes in strained healthcare systems while limiting costs. NCD clinics were introduced under the "National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke" (NPCDCS) in India; however, there is limited literature on the costs of delivering tobacco cessation interventions within NPCDCS. One of the study's objectives was to estimate the cost of delivering a culturally specific patient-centric behavioral intervention package in two district-level NCD clinics in Punjab, India. Costing was undertaken using the health systems perspective. A top-down or financial costing approach and a bottom-up or activity-based approach were employed at each step of development and implementation. The opportunity cost was used to include the cost of human resources, infrastructure, and capital resources used. All infrastructure and capital costs were annualized using a 3% annual discount rate. Four additional scenarios were built up concerning three major components to reduce costs further when rolled out on a large scale. The cost of intervention package development, human resource training, and unit cost of implementation were estimated to be INR 6,47,827 (USD 8,874); INR 134,002 (USD 1810); and INR 272 (USD 3.67), respectively. Based on our sensitivity analysis results, the service delivery cost varied from INR 184 (USD 2.48) to INR 326 (USD 4.40) per patient. The development costs of the intervention package accounted for the majority proportion of the total cost. Of the total unit cost of implementation, the telephonic follow-up, human resources, and capital resources were the major contributory components. The current study aims to fill gaps by estimating the unit-level health systems cost of a culturally sensitive, disease-specific, and patient-centric tobacco cessation intervention package delivered at the outpatient settings of NCD clinics at the secondary level hospital, which represents a major link in the health care system of India. Findings from this study could be used to provide supportive evidence to policymakers and program managers for rolling out such interventions in established NCD clinics through the NPCDCS program of the Indian Government.

Evaluating the validity of depression-related stigma measurement among diabetes and hypertension patients receiving depression care in Malawi: A mixed-methods analysis.

Mental illness stigma research is sparse in Malawi. Our team previously analyzed the reliability and statistical validity of a quantitative tool to measure depression-related stigma among participants with depressive symptoms using quantitative psychometric methods. This analysis aims to further evaluate the content validity of the stigma tool by comparing participants' quantitative responses with qualitative data. The SHARP project conducted depression screening and treatment at 10 noncommunicable disease clinics across Malawi from April 2019 through December 2021. Eligible participants were 18-65 years with depressive symptoms indicated by a PHQ-9 score ≥5. Questionnaires at each study timepoint included a vignette-based quantitative stigma instrument with three thematic domains: disclosure carryover (i.e., concerns about disclosure), treatment carryover (i.e., concerns about external stigma because of receiving depression treatment), and negative affect (i.e., negative attitudes about people having depression). Sub-scores were aggregated for each domain, with higher scores indicating greater stigma. To better understand participants' interpretation of this quantitative stigma questionnaire, we asked a subset of six participants a parallel set of questions in semi-structured qualitative interviews in a method similar to cognitive interviewing. Qualitative responses were linked with participants' most recent quantitative follow-up interviews using Stata 16 and NVivo software. Participants with lower quantitative stigma disclosure sub-scores had qualitative responses that indicated less stigma around disclosure, while participants with higher quantitative stigma sub-scores had qualitative responses indicating greater stigma. Similarly, in the negative affect and treatment carryover domains, participants had parallel quantitative and qualitative responses. Further, participants identified with the vignette character in their qualitative interviews, and participants spoke about the character's projected feelings and experiences based on their own lived experiences. The stigma tool was interpreted appropriately by participants, providing strong evidence for the content validity of the quantitative tool to measure these stigma domains.

Feasibility of tobacco cessation intervention at non-communicable diseases clinics: A qualitative study from a North Indian State.

One of the 'best buys' for preventing Non-Communicable Diseases (NCDs) is to reduce tobacco use. The synergy scenario of NCDs with tobacco use necessitates converging interventions under two vertical programs to address co-morbidities and other collateral benefits. The current study was undertaken with an objective to ascertain the feasibility of integrating a tobacco cessation package into NCD clinics, especially from the perspective of healthcare providers, along with potential drivers and barriers impacting its implementation. A disease-specific, patient-centric, and culturally-sensitive tobacco cessation intervention package was developed (published elsewhere) for the Health Care Providers (HCPs) and patients attending the NCD clinics of Punjab, India. The HCPs received training on how to deliver the package. Between January to April 2020, we conducted a total of 45 in-depth interviews [medical officers (n = 12), counselors (n = 13), program officers (n = 10), and nurses (n = 10)] within the trained cohort across various districts of Punjab until no new information emerged. The interview data wereanalyzed deductively based on six focus areas concerning feasibility studies (acceptability, demand, adaptation, practicality, implementation, and integration) using the 7- step Framework method of qualitative analysis and put under preset themes. The respondent's Mean ± SD age was 39.2± 9.2 years, and years of service in the current position were 5.5 ± 3.7 years. The study participants emphasized the role of HCPs in cessation support (theme: appropriateness and suitability), use of motivational interviewing, 5A's & 5R's protocol learned during the training & tailoring the cessation advice (theme: actual use of intervention activities); preferred face-to-face counseling using regional images, metaphors, language, case vignettes in package (theme: the extent of delivery to intended participants). Besides, they also highlighted various roadblocks and facilitators during implementation at four levels, viz. HCP, facility, patient, and community (theme: barriers and favorable factors); suggested various adaptations to keep the HCPs motivated along with the development of integrated standard operating procedures (SOPs), digitalization of the intervention package, involvement of grassroots level workers (theme: modifications required); the establishment of an inter-programmatic referral system, and a strong politico-administrative commitment (theme: integrational perspectives). The findings suggest that implementing a tobacco cessation intervention package through the existing NCD clinics is feasible, and it forges synergies to obtain mutual benefits. Therefore, an integrated approach at the primary & secondary levels needs to be adopted to strengthen the existing healthcare systems.

The Role of Noncommunicable Disease Clinics in Improving Control of Hypertension and Diabetes Among Adults Residing in Rural Ballabgarh, Haryana.

Introduction High systolic blood pressure (SBP) and raised plasma glucose are major attributable and preventable causes of death worldwide. The objective of this study was to estimate the control rates and identify determinants of control of hypertension and diabetes among adults. Methods A longitudinal follow-up study was conducted among all the adults registered at the noncommunicable disease (NCD) clinics under the national program at two primary health centers in Faridabad, Haryana. Data were collected every month from the individual booklet generated for registered adults. Two monthly visits in three months and four in six months were considered adequate follow-ups at the NCD clinic. Results In the study, 495 (82.2%) adults had hypertension, and 242 (40.2%) had diabetes. The control rates at the third and sixth months were 37.1% (95% confidence interval (CI): 31.4-42.7) and 53.6% (95% CI: 43.4-59.8) among hypertensives and 28.7% (95% CI: 21.7-35.7) and 35.9% (95% CI: 27.5-44.4) among diabetics. Among hypertensives, six-month control status was associated with adequate follow-up at the NCD clinic (adjusted odds ratio (AOR) 2.3; 95% CI: 1.4-4.0; p-value: 0.002), male sex (AOR 0.5; 95% CI: 0.3-0.9; p-value: 0.02) and high SBP (AOR 0.5; 95% CI: 0.3-0.9; p-value: 0.017). Conclusions Control status was achieved in half of the adults with hypertension and one-third of adults with diabetes after six months of regular follow-up. Adequate follow-up at the NCD clinic, male sex, and raised SBP emerged as determinants of control among hypertensives.

Knowledge, attitude and practices regarding diabetes management and complications among Type 2 Diabetic patients

Introduction: Diabetes initially causes generalized or nonspecific symptoms that are often unimportant. Patients require healthcare attention to reduce the comorbidities that may develop in future. Since diabetes is prevalent in India, there is a National Programme for Diabetes that provides free diagnostics, drugs, and health promotion through behavior change, but patients still develop complications. Objectives: The aim of the study was to assess participants' awareness of the diabetic diet,foot care, regular eye checkup, and complications of diabetes, as well as adherence to a diabetic diet, physical exercises, drug therapy, and timely follow-ups. Methods: A descriptive cross-sectional study was conducted among 156 Diabetic individuals who had at least three previous visits to the Non-Communicable Disease clinic. Seriously ill patients were excluded. A pretested semi-structured questionnaire was used. The data collected was documented in MS Excel and analyzed using Epi Info v7.2.5. Results: Of the 156 participants, the mean age was 57.1 years, and 48.7% had diabetes for &gt; 5 years. Almost 85.9% of participants had low awareness of self-care and complications. Half (49.4%) of the participants had lightheadedness as their initial reason that led to the investigation of diabetes, and 14.1% were diagnosed during regular check-ups. About 39.1% of participants did regular physical exercises, and 32.7% followed the diabetic diet. About 45.5% and 73.1% of the participants were overweight and had hypertension, respectively. About 36.5% missed one or two doses of medication, and 19.2% had changed medication dosage on their own. About 78.9% made their follow-up visits on the recommended dates. Conclusion: Most participants' adherence to drug therapy and timely follow-up was high. But the participants had low awareness of self-care and complications, as well as low adherence to diet and exercise. This highlights the need to improve healthcare attention among people with diabetes.

Faith-based health screenings for Marshallese adults living in the Republic of the Marshall Islands: Study design and results.

Striking health disparities exist in the Republic of the Marshall Islands (RMI). The RMI has one of the highest age-adjusted type 2 diabetes mellitus (T2DM) rates in the world (23.0%) compared to global (9.3%) and United States (US; 13.3%) rates. We conducted health screenings including clinical indicators of T2DM and hypertension among Marshallese in the RMI. Screenings were conducted at 20 churches on Majuro Atoll. Participants completed questionnaires and biometric data collection assessing glycated hemoglobin (HbA1c), blood pressure, and body mass index. Screenings included 528 participants and showed a high prevalence of T2DM, obesity, and hypertension. One-third of participants were referred to the non-communicable disease clinic. The percent of adults in this study with T2DM-indicative HbA1c (48.5%) is higher than observed at the national level (23.0%). Results highlight the need for non-communicable disease-related programs in the RMI.

Quality of life and its determinants among ambulatory diabetic patients attending NCD prevention clinic: A cross sectional study from Eastern India

IntroductionIndia is experiencing an upward spiral in diabetic population. With the impact of diabetes on physical, social, psychological components of individual's life, a holistic view in terms of Quality of Life (QoL) is being increasingly recognized as an essential component of diabetes care and management. The objective of this study was to evaluate the QoL in ambulatory diabetic patients and factors affecting it in a tertiary care medical institution in eastern India. Material and methodsIn this cross-sectional study, 103 adult diabetic ambulatory patients were recruited by systematic random sampling from a Non-Communicable Disease (NCD) Clinic of a tertiary care hospital of Eastern India. The QoL of patients were accessed by the validated Odia version of WHO-QoL BREF questionnaire. Bivariate analysis was performed to compare the effect of sociodemographic and clinical parameters on QoL scores. ResultsThe maximum domain wise score was in social (65.98 ± 13.89) followed by environmental (61.73 ± 16.27) domain. Overall, 64% of the respondents perceived as their QoL as good. Males, urban residents, persons aged less than 60 years and overweight individuals reported a better QoL than their counterparts. Gender and residence were found to be significantly associated with QoL, across domains. ConclusionsQoL assessment is pivotal as an outcome measure in diabetes care and management. Policy makers ought to consider quality adjusted life years while evaluating health outcomes in patients of chronic diseases like diabetes.

Estimating the effect of anticipated depression treatment-related stigma on depression remission among people with noncommunicable diseases and depressive symptoms in Malawi.

While mental health stigma research is sparse in Malawi, research in other settings suggests that stigma represents a barrier to mental health treatment and recovery. Accordingly, we conducted an analysis to understand the role of treatment-related stigma in depression care in Malawi by estimating the effect of patients' baseline anticipated treatment-related stigma on their 3-month probability of depression remission when newly identified with depression. We conducted depression screening and treatment at 10 noncommunicable disease (NCD) clinics across Malawi from April 2019 through December 2021. Eligible cohort participants were 18-65 years with depressive symptoms indicated by a PHQ-9 score ≥5. Questionnaires at the baseline and 3-month interviews included a vignette-based quantitative stigma instrument that measured treatment-related stigma, i.e., concerns about external stigma because of receiving depression treatment. Using inverse probability weighting to adjust for confounding and multiple imputation to account for missing data, this analysis relates participants' baseline levels of anticipated treatment stigma to the 3-month probability of achieving depression remission (i.e., PHQ-9 score < 5). Of 743 included participants, 273 (37%) achieved depression remission by their 3-month interview. The probability of achieving depression remission at the 3-month interview among participants with high anticipated treatment stigma (0.31; 95% Confidence Interval [CI]: 0.23, 0.39)) was 10 percentage points lower than among the low/neutral stigma group (risk: 0.41; 95% CI: 0.36, 0.45; RD: -0.10; 95% CI: -0.19, -0.003). In Malawi, a reduction in anticipated depression treatment-related stigma among NCD patients initiating depression treatment could improve depression outcomes. Further investigation is necessary to understand the modes by which stigma can be successfully reduced to improve mental health outcomes and quality of life among people living with depression.

Champion and audit and feedback strategy fidelity and their relationship to depression intervention fidelity: A mixed method study

BackgroundGlobally, mental health disorders rank as the greatest cause of disability. Low and middle-income countries (LMICs) hold a disproportionate share of the mental health burden, especially as it pertains to depression. Depression is highly prevalent among those with non-communicable diseases (NCDs), creating a barrier to successful treatment. While some treatments have proven efficacy in LMIC settings, wide dissemination is challenged by multiple factors, leading researchers to call for implementation strategies to overcome barriers to care provision. However, implementation strategies are often not well defined or documented, challenging the interpretation of study results and the uptake and replication of strategies in practice settings. Assessing implementation strategy fidelity (ISF), or the extent to which a strategy was implemented as designed, overcomes these challenges. This study assessed fidelity of two implementation strategies (a ‘basic’ champion strategy and an ‘enhanced’ champion ​+ ​audit and feedback strategy) to improve the integration of a depression intervention, measurement based care (MBC), at 10 NCD clinics in Malawi. The primary goal of this study was to assess the relationship between the implementation strategies and MBC fidelity using a mixed methods approach. MethodsWe developed a theory-informed mixed methods fidelity assessment that first combined an implementation strategy specification technique with a fidelity framework. We then created corresponding fidelity indicators to strategy components. Clinical process data and one-on-one in-depth interviews with 45 staff members at 6 clinics were utilized as data sources. Our final analysis used descriptive statistics, reflexive-thematic analysis (RTA), data merging, and triangulation to examine the relationship between ISF and MBC intervention fidelity. ResultsOur mixed methods analysis revealed how ISF may moderate the relationship between the strategies and MBC fidelity. Leadership engagement and implementation climate were critical for clinics to overcome implementation barriers and preserve implementation strategy and MBC fidelity. Descriptive statistics determined champion strategy fidelity to range from 61 to 93% across the 10 clinics. Fidelity to the audit and feedback strategy ranged from 82 to 91% across the 5 clinics assigned to that condition. MBC fidelity ranged from 54 to 95% across all clinics. Although correlations between ISF and MBC fidelity were not statistically significant due to the sample of 10 clinics, associations were in the expected direction and of moderate effect size. A coefficient for shared depression screening among clinicians had greater face validity compared to depression screening coverage and functioned as a proximal indicator of implementation strategy success. ConclusionFidelity to the basic and enhanced strategies varied by site and were influenced by leadership engagement and implementation climate. Champion strategies may benefit from the addition of leadership strategies to help address implementation barriers outside the purview of champions. ISF may moderate the relationship between strategies and implementation outcomes.

Implementation of self-monitoring of blood glucose for patients with insulin-dependent diabetes at a rural non-communicable disease clinic in Neno, Malawi.

Self-monitoring of blood glucose (SMBG) is a widely accepted standard of practice for management of insulin-dependentdiabetes, yet is largely unavailable in rural sub-Saharan Africa (SSA). This prospective cohort study is the first known report ofimplementation of SMBG in a rural, low-income country setting. To evaluate adherence and change in clinical outcomes with SMBG implementation at two rural hospitals in Neno, Malawi. Forty-eight patients with type 1 and insulin-dependent type 2 diabetes were trained to use glucometers and logbooks. Participantsmonitored preprandial glucose daily at rotating times and overnight glucose once a week. Healthcare providers were trained to evaluateglucose trends, and adjusted insulin regimens based on results. Adherence was measured as the frequency with which patients checked anddocumented blood glucose at prescribed times, while clinical changes were measured by change in glycated haemoglobin (HbA1c) over a6-month period. Participants brought their glucometers and logbooks to the clinic 95 - 100% of the time. Adherence with measuring glucose valuesand recording them in logbooks eight times a week was high (mean (standard deviation) 69.4% (15.7) and 69.0% (16.6), respectively). MeanHbA1c decreased from 9.0% (75 mmol/mol) at enrolment to 7.8% (62 mmol/mol) at 6 months (mean difference 1.2% (95% confidenceinterval (CI) 0.6 - 2.0; p=0.0005). The difference was greater for type 1 diabetes (1.6%; 95% CI 0.6 - 2.7; p=0.0031) than for type 2 diabetes(0.9%; 95% CI 0.1 - 1.9; p=0.0630). There was no documented increase in hypoglycaemic events, and no hospitalisations or deaths occurred. SMBG is feasible for patients with insulin-dependent diabetes in a rural SSA population, and may be associated with improvedHbA1c levels. Despite common misconceptions, all patients, regardless of education level, can benefit from SMBG. Further research onlong-term retention of SMBG activities and the benefits of increasing frequency of monitoring is warranted.

Study of Depression and Its Associated Factors Among Patients of Diabetes Mellitus (DM) and Hypertension (HTN) Attending a Primary Health Center (PHC) in a Rural Area of New Delhi, India.

Depression is among the most common mental disorders which is a leading cause of disability and is a negative prognostic indicator in many non-communicable chronic diseases such as diabetes mellitus (DM) and hypertension (HTN). Depression among these patients can further worsen their disease condition. Existing information on this topic has mostly come from tertiary care hospital setting. Hence, present study was done among patients attending a primary health center (PHC) in New Delhi. This was a cross-sectional study conducted among 210 participants having diabetes and/or hypertension attending the non-communicable diseases (NCD) clinic at PHC, Fatehpur Beri, New Delhi. Simple random sampling was done and a pre-designed, semi-structured, interview-based questionnaire was used. Depression was assessed using a Patient Health Questionnaire-9 (PHQ-9). Data were analyzed using SPSS software version 21.0 (IBM Corp., Armonk, NY). The overall prevalence of depression was found to be 49% (n=103), out of which most had moderate depression (23.8%), 16.2% had moderately severe depression, and 9% had severe depression. Multivariate analysis results revealed the odds of having depression to be significantly higher among those who belonged to lower socioeconomic class (adjusted odds ratio, aOR=2.9, confidence interval, CI=1.2-7.4); had uncontrolled diabetes mellitus/hypertension (DM/HTN) (adjusted odds ratio, aOR=2.5, CI=1.1-6.1); had associated comorbidities (aOR=5.9, CI=2.4-15); sedentary lifestyle(aOR=7.8, CI=2.4-25.1); who had past history of coronavirus disease 2019 (COVID-19) infection (aOR=14.7, CI=5.4-39.6); and those who lost family member(s) due to COVID-19 (aOR=10.1, CI=1.3-79.4). Prevalence of depression in patients with DM/HTN was found to be significantly high and various factors were found to be significant. Therefore, every such patient should be screened for depression; and periodic follow ups should also be conducted to prevent future complications and improve prognosis of the disease.

Integrated Care for Type 1 Diabetes: The West Bengal Model.

A structured dedicated health programme for Type 1 diabetes mellitus (T1DM) has been initiated in the state of West Bengal, India. The aim is to provide comprehensive healthcare to all children, adolescents and young adults living with T1DM, along with the provision of free supply of insulin, glucose measuring devices, blood glucose test strips, and other logistics. The strategic framework for programme implementation is to utilise the infrastructure and manpower of the already existing non-communicable disease (NCD) clinic under National Health Mission. Establishing dedicated T1DM clinics in each district hospital by utilising existing healthcare delivery systems, intensive training and hand-holding of named human resources; providing comprehensive healthcare service and structured diabetes education to all T1DM patients; and building an electronic registry of patients are important components of the programme. T1DM clinics run once a week on the same day throughout the state. All T1DM patients are treated with the correct dose of insulin, both human regular insulin and glargine insulin. Patients are routinely monitored monthly to ensure good glycaemic control and prevent complications of the disease. Routine anthropometric examination and required laboratory investigations are conducted in the set-up of the already existing NCD clinic. Ongoing monitoring and evaluation of the T1DM programme are being conducted in terms of glycated haemoglobin (HbA1c) values, growth and development, complication rates, psychological well-being, quality of life, and direct and indirect expenditure incurred by families. Through this programme, any bottlenecks or gaps in service delivery will be identified and corrective measures will be adopted to ensure better health outcomes for those living with T1DM.

Exercise habits and perception of physical exercise among residents of an island in the Western Pacific Region.

[Purpose] The current study aimed to validate the exercise habits and perception of physical exercise among residents of an island in the Western Pacific Region, where the high prevalence of noncommunicable diseases is a serious health issue. [Participants and Methods] Semi-structured interviews were conducted with one doctor, three nurses, and six patients from a noncommunicable disease clinic on one island of the Kingdom of Tonga. The questions focused on the patients' exercise habits and perception of physical exercise. Their comments were structured using the KJ method. [Results] Structuring of the comments revealed that the exercise habits of the island residents had three unique features: variations in thinking and behavior toward exercise, variations in the amount of daily exercise, and the presence of key persons in the community who affect their exercise habits. [Conclusion] Exercise programs suitable for countries in the Western Pacific Region that consider environmental and cultural factors should be developed and disseminated in the future.

Prevalence of Self-care Practices among Type 2 Diabetes Mellitus Patients and its Effect on Glycemic Control: A Cross-sectional Study in Secondary and Tertiary Health-care Centers in Lucknow.

Globally, prevalence of diabetes is 10.5%, and in 2019, approximately 463 million adults were living with diabetes by 2045; this will increase to 700 million (10.9%). India is a diabetic capital of world, prevalence of diabetes in India is 8.3%. This study aimed to assess self-care practices (SCPs) among type 2 diabetes mellitus (T2DM) patients, its predictors, and effect of SCP on glycemic control. A cross-sectional hospital-based study was conducted among 300 known T2DM patients in the age group of 18-60 years attending noncommunicable diseases clinic at Secondary and Tertiary Care Hospitals of Lucknow, Uttar Pradesh, selected using two-stage purposive sampling method. Data were collected using a predesigned and pretested semi-structured questionnaire. Data were collected from consenting respondents on the sociodemographic profile (about their residence, gender, marital status, type of family, educational status, family income, employment status, etc.). SCP was assessed using Summary of Diabetes Self-Care Activities. Data were analyzed using SPSS. Among 300 patients with a mean age 50 ± 8.9 years, the prevalence of good SCPs was 37%. Out of 189 T2DM patients with poor SCPs, 66.4% had uncontrolled blood sugar level (285.4 ± 67 mg/dL). Out of 73 T2DM patients with poor SCPs, 65.7% had uncontrolled glycated hemoglobin level (8.4% ± 2%), and this was statistically significant. The practice of self-care was found to be suboptimal among patients with T2DM in the study.

The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi.

Depressive disorders are a leading cause of global morbidity and remain disproportionately high in low- and middle-income settings. Stressful life events (SLEs) are known risk factors for depressive episodes and worsened depressive severity, yet are under-researched in comparison to other depression risk factors. As depression is often comorbid with hypertension, diabetes, and other noncommunicable diseases (NCDs), research into this relationship among patients with NCDs is particularly relevant to increasing opportunities for integrated depression and NCD care. This study aims to estimate the cross-sectional association between SLEs in the three months preceding baseline interviews and baseline depressive severity among patients with at least mild depressive symptoms who are seeking NCD care at 10 NCD clinics across Malawi. SLEs were measured by the Life Events Survey and depressive severity (mild vs. moderate to severe) was measured by the Patient Health Questionnaire-9. The study population (n = 708) was predominately currently employed, grand multiparous (5-8 children) women with a primary education level. Two thirds (63%) had mild depression while 26%, 8%, and 3% had moderate, moderately severe, and severe depression, respectively. Nearly all participants (94%) reported at least one recent SLE, with the most common reported SLEs being financial stress (48%), relationship changes (45%), death of a family member or friend (41%), or serious illness of a family member or friend (39%). Divorce/separation, estrangement from a family member, losing source of income, and major new health problems were significant predictors of greater (moderate or severe) depressive severity compared to mild severity. Having a major new health problem or experiencing divorce/separation resulted in particularly high risk of more severe depression. After adjustment, each additional SLE was associated with a 9% increased risk of moderate or worse depressive severity compared to mild depressive severity (RR: 1.09; (95% CI: 1.05, 1.13), p<0.0001). Among patients with NCDs with at least mild depressive symptoms, SLEs in the prior 3 months were associated with greater depressive severity. While many SLEs may not be preventable, this research suggests that assessment of SLEs and teaching of positive coping strategies when experiencing SLEs may play an important role in integrated NCD and depression treatment models.

Prevalence of SARS-CoV-2 antibodies after the Omicron surge, Kingston, Jamaica, 2022

A cross-sectional SARS-CoV-2 serosurvey was conducted after the Omicron surge in Jamaica using 1,540 samples collected during March - May 2022 from persons attending antenatal, STI and non-communicable diseases clinics in Kingston, Jamaica. SARS-CoV-2 spike receptor binding domain (RBD) and/or nucleocapsid IgG antibodies were detected for 88.4% of the study population, with 77.0% showing evidence of previous SARS-CoV-2 infection. Of persons previously infected with SARS-CoV-2 and/or with COVID-19 vaccination, 9.6% were negative for spike RBD IgG, most of which were unvaccinated previously infected persons. Amongst unvaccinated previously infected people, age was associated with testing spike RBD IgG negative. When considering all samples, median spike RBD IgG levels were 131.6 BAU/mL for unvaccinated persons with serological evidence of past infection, 90.3 BAU/mL for vaccinated persons without serological evidence of past infection, and 896.1 BAU/mL for vaccinated persons with serological evidence of past infection. Our study of the first reported SARS-CoV-2 serosurvey in Jamaica shows extensive SARS-CoV-2 population immunity, identifies a substantial portion of the population lacking spike RBD IgG, and provides additional evidence for increasing COVID-19 vaccine coverage in Jamaica.

Impact of COVID-19 on non-communicable disease management services at selected government health centers in Addis Ababa, Ethiopia.

The global pandemic of COVID-19 forced the world to divert resources and asked the public to shelter-in-place, so the diagnosis surveillance system and management of non-communicable diseases has become more challenging. To identify the impact of COVID-19 on non-communicable diseases management services at government health centers in Addis Ababa, Ethiopia. Health facility based cross-sectional study was conducted from August to September, 2020. A total of 30 health centers were included in this study. Bivariate and multiple logistic regression models were used to assess association between the outcome and independent variables. The majority, 24 (80%), of the study participants perceived that the COVID-19 pandemic severely disrupted the non-communicable disease management services. There was a statistically significant association between a decrease in outpatient volume at non communicable disease (NCD) management services (25 (83.3%), P-value: 0.006), closure of population level screening programs of NCDs (22 (73.3%), P-value: 0.007), and closure of disease specific NCD clinics and the occurrence of the COVID-19 pandemic (23 (76.7%), P-value: 0.013). The most critical health-care services for non-communicable diseases management were severely disrupted by the COVID-19 pandemic. Therefore, during public health emergencies, policymakers should ensure continuation of critical clinical services and inform the public about proper service utilization.