Non-communicable Diseases Clinics Research Articles

A study to evaluate the magnitude of understanding on harm’s way associated with heart disease among clients attending NCD clinic at nemam PHC

Non-communicable Disease (NCD), almost completely heart diseases, malignancy, diabetes and chronic obstructive pulmonary diseases are the main source of demise worldwide killing additional human beings further wise entire further sources merge. In 2008 nearly two-thirds of the demises were due to NCD, a 36 million out of 57. Out of this almost completely 80% of demise happens in little and medium earnings nation with over 50% of them happening amid human beings completely amount 70 years old and 29% under 60 years of age. At current heart diseases (CVD) are the numeral single sources of demise worldwide with little and medium earning nations existence pretentious uneven. So the current research is ready to evaluate the magnitude of understanding on harm’s way associated with heart disease among clients attending NCD clinic at nemam PHC. A descriptive research design was chosen to evaluate the magnitude of understanding on harm’s way associated with heart disease among clients attending NCD clinic at nemam PHC 100 samples are included within our study. Prospective sampling techniques method was utilized in selecting the samples. A self-arranged questionnaire was utilized to gather statistics. The evaluate the magnitude of understanding on harm’s way associated with heart disease among clients attending NCD clinic at nemam PHC are Inadequate knowledge: 23%Moderate knowledge: 56% Adequate knowledge: 21%. The study concludes that there is moderation risk factors associated with heart disease among clients attending NCD clinic at Nemam PHC.

P3417Comparison of cardiometabolic profile and left ventricular systolic dysfunction amongst outpatients in a low-income Sub-Saharan African versus high-income European population; the MTIMA I study

Abstract Background Most of the information on modifiable risk factors linked to cardiac dysfunction comes from high income countries and/or hospitalized patients. We sought to evaluate the challenge of non-communicable diseases (NCDs) in the community setting in Malawi, and to compare the cardiometabolic profile of these patients with age, sex and diabetes matched European participants. Methods MTIMA I is a prospective, observational, cohort study of community dwelling patients attending a NCD clinic in Malawi together with age, sex and diabetes matched European participants. All consenting patients were evaluated for clinical history, blood pressure, heart rate, body mass index (BMI), fasting glucose, left ventricular ejection fraction and medications. Results Amongst 251 sub-Saharan African patients and 502 age, sex and diabetes matched European patients, the average age was 61.8±10.6 years, 31% were male and 53% had diabetes and the majority had hypertension (80.0% and 70.7% in the African and European cohorts respectively, p=NS). The African population had poorer pressure control (147/90±21/13 mmHg vs 137/82±19/11 mmHg, p<0.0001) and higher heart rates (80.73±17.0 bpm vs 72.7±12.5 bpm, p<0.0001) than the European cohort. Use of antihypertensive agents per patient was lower in the African population (0.96±0.05 vs 1.22±0.05, p<0.001) and there was lower usage of renin-angiotensin-aldosterone-system modifying therapies. Reported smoking rates were lower in the African cohort (3% vs 16%, p<0.0001). Only 78 of the African cohort had lipids evaluated compared with all the European cohort and in this subset, while total cholesterol was lower (4.4±1.2, vs. 4.6±0.5 mmol/L, p<0.01), it was due to lower HDL (0.99±0.5 vs 1.3±0.2 mmol/L, p<0.001) as LDL cholesterol was similar (2.6±1.0, vs 2.5±0.5 mmol/L, p=ns). Statin usage was lower in the African cohort (1.6% vs 61.5%, p<0.0001). Surprisingly, the average body mass index did not differ between the populations (28.9±0.3 vs 29.2±1.5 kg/m2, p=NS) and there were similar proportions of obesity (31.1% vs 33.7%). Plasma glucose was higher in the African population (10.3±0.4 vs. 7.4±0.1 mmol/L, p<0.0001) despite similar usage of antidiabetic therapies. Average ejection fraction was significantly lower in the African cohort (49.8±8.6% vs 66.5±3.5%, p<0.0001). Left ventricular systolic dysfunction (<40%) was significantly more prevalent in the African cohort (21% vs 0.4%, p<0.0001). Conclusions The profile of cardiovascular risk factors, medications and cardiac dysfunction is different in community dwelling African and European patients with chronic cardiovascular disease. One in 5 African patients in our study has undiagnosed left ventricular systolic dysfunction reflecting the need for increased focus on non-communicable diseases and cardiovascular prevention. Further work on the pathophysiology of the high rate of LVSD noted and prevention strategies are required

Non-communicable disease clinics in rural Ethiopia: why patients are lost to follow-up.

Providing medical care for non-communicable diseases (NCDs) in rural sub-Saharan Africa has proved to be difficult because of poor treatment adherence and frequent loss to follow-up (LTFU). The reasons for this are poorly understood. To investigate LTFU among patients with two different but common NCDs who attended rural Ethiopian health centres. The study was based in five health centres in southern Ethiopia with established NCD clinics run by nurses and health officers. Patients with epilepsy or hypertension who were lost to follow-up and non-LTFU comparison patients were identified and traced; a questionnaire was administered enquiring about the reasons for LTFU. Of the 147 LTFU patients successfully located, 62 had died, moved away or were attending other medical facilities. The remaining 85 patients were compared with 211 non-LFTU patients. The major factors associated with LTFU were distance from the clinic, associated costs and a preference for traditional treatments, together with a misunderstanding of the nature of NCD management. The delivery of affordable care closer to the patients' homes has the greatest potential to address the problem of LTFU. Also needed are increased levels of patient education and interaction with traditional healers to explain the nature of NCDs and the need for life-long management.

Magnitude and Determinants of Patients at Risk of Developing Obstructive Sleep Apnea in a Non-Communicable Disease Clinic.

Background and Objective: Obstructive sleep apnea (OSA) is a common chronic disorder worldwide, which can adversely affect the cardiovascular system among non-communicable disease (NCD) patients. It is underdiagnosed—or rather not diagnosed—in primary care settings due to the costly diagnostic techniques involved. This study aimed to assess the number of study participants at risk of developing OSA and to assess and quantify the risk factors associated with this disorder. Materials and Methods: A cross-sectional study was performed in an NCD clinic of a rural health training center, Karikalampakkam, Puducherry of South India from August 2018 to October 2018. A Modified Berlin Questionnaire (MBQ) was used to screen the study participants at risk for OSA. Four-hundred-and-seventy-three people aged 18 years and above were included in the study, using systematic random sampling. Respondents’ socio-demographic and morbidity characteristics, as well as clinical and anthropometric parameters including body weight, height, blood pressure, neck, hip and waist circumference were collected. Data was captured using Epicollect5 and analyzed using SPSS version 20.0. Results: One-fourth (25.8%) of the respondents were at high risk of developing OSA. In terms of gender, 27.9% of the men and 23.8% of the women were at high risk for OSA. In univariate analyses, the risk of developing OSA was significantly associated with a history of diabetes mellitus, hypertension, dyslipidemia and gastro-esophageal reflux disease, weight, body mass index, neck, waist and hip circumference, waist–hip ratio, and systolic and diastolic blood pressure. Multivariate logistic regression analysis showed that a history of dyslipidemia (aOR, 95% CI = 2.34, 1.22–4.48), body mass index (aOR, 95% CI = 1.15, 1.06–1.22) and waist circumference (aOR, 95% CI = 1.10, 1.07–1.14) emerged as significant predictors of risk for OSA. Conclusions: A considerable proportion of NCD patients with easily detectable attributes are at risk of developing OSA, but still remain undiagnosed at a primary health care setting. The results obtained using MBQ in this study were comparable to studies performed using polysomnography. Dyslipidemia, body mass index and waist circumference were independent risk factors for predicting a risk of developing OSA. Prospective studies are needed to confirm whether a reduction in these risk factors could reduce the risk for OSA.

Strategies for Stakeholder Engagement and Uptake of New Intervention: Experience From State-Wide Implementation of mHealth Technology for NCD Care in Tripura, India

BackgroundAppropriate strategies and key stakeholder engagement are the keys to successful implementation of new health care interventions. ObjectivesThe study sought to articulate the key strategies used for scaling up a research-based intervention, mPower Heart electronic Clinical Decision Support System (e-CDSS), for state-wide implementation at health facilities in Tripura. MethodsMultiple strategies were used for statewide implementation of mPower Heart e-CDSS at noncommunicable diseases clinics across the government health facilities in Tripura: formation of a technical coordination-cum-support unit, change management, enabling environment, adapting the intervention with user focus, and strengthening the Health Information System. ResultsThe effective delivery of a new health system intervention requires engagement at multiple levels including political leadership, health administrators, and health professionals, which can be achieved by forming a technical coordination-cum-support unit. It is important to specify the role and responsibilities of existing manpower and provide a structured training program. Enabling environment at health facilities (providing essential equipment, space and time, etc.) is also crucial. Successful implementation also requires that patients, health care providers, the health system, and leadership recognize the immediate and long-term benefits of the new intervention and have a buy-in in the intervention. With constant encouragement and nudge from administrative authorities and by using multiple strategies, 40 government health facilities adopted the mPower Heart e-CDSS. From its launch in May 2017 until November 20, 2018, a total of 100,810 eligible individuals were screened and enrolled, with 35,884 treated for hypertension, 9,698 for diabetes, and 5,527 for both hypertension and diabetes. ConclusionsMultiple strategies, based on implementation principles, are required for successful scaling up of research-based interventions.

Nutritional Knowledge and Practice among Patients with Non-communicable Diseases Attending Mbale Regional Referral Hospital in Eastern Uganda: A Cross Sectional Study

Aim: To determine nutritional knowledge and practices among patients with Non-Communicable Diseases (NCD) attending Mbale Regional Referral hospital, in Eastern Uganda.
 Study Design: A mixed methods cross sectional study design was used.
 Place and Duration of Study: Mbale Regional Referral Hospital among patients attending the NCD clinic from May to July 2017.
 Methodology: Two hundred sixty clients were recruited for the study. Quantitative data was collected through structured administered questionnaires. Quantitative data was analyzed at univariate, bivariate and multivariate levels. Chi square test and logistic regression were used to determine the association between nutrition knowledge and utilization. Qualitative data was coded first and summarized according to the themes.
 Results: The mean age of the respondents was 55 years (SD= 14) and hospital was the main source of nutrition information (n=156, 60%). Most respondents (n=156, 60%) had a high level of nutrition knowledge, however only 48.8% (n=127) were utilizing the knowledge. Those who had attained secondary level of education were 2.308 more likely to utilize the nutrition knowledge than those who had never studied P value of .028, 95CI (1.093-4.874). Those with tertiary education were even 9.261 times more likely to utilize the knowledge P value <.001 95CI (2.721-31.522). Those with adequate knowledge were about 1.6 times most likely to utilize the nutrition knowledge compared to those with inadequate knowledge level, however, with the adjusted odd ratio of 1.573 at 95% CI (0.923- 2.868) the results were not statistically significant (P value .098).
 Conclusion: NCD patients had adequate knowledge, with a few of them utilizing the knowledge. High education level was associated with better nutrition practices.

Cost of integrated chronic care for severe non-communicable diseases at district hospitals in rural Rwanda

BackgroundIntegrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the...

Challenges faced by the patients in the management of risk factors of non-communicable diseases in a government primary health care setting of Puducherry

Background: India’s current approach for intervention in non-communicable diseases (NCDs) is more in terms of early diagnosis and treatment. The focus should also be on the management of risk factors in the diseased individuals. The objectives of the study are to measure the risk factors of NCDs, lifestyle modification followed by them and to assess the challenges in reducing the risk factors of NCDs faced by the study population.Methods: The study was conducted between March and June 2017 in 2 government primary health centres (PHCs) in Puducherry. Based on systematic random sampling, 200 patients enrolled in NCD clinic with diabetes mellitus, hypertension, Stroke and myocardial infarction were selected for the study. After obtaining written informed consent, data was collected.Results: Out of 200 participants, majority of them were in the age group of 51-70 years (60%), females (71%) and living in nuclear family (83%). Among 200 participants, 23.5% of them had diabetes mellitus, 42% had hypertension and 24% had diabetes with hypertension. The risk factors that many of the participants had were excessive salt and sugar intake, overweight and obesity, less vegetable and fruits intake and alcohol consumption. Out of 200 participants, the major challenges in reducing the salt and sugar intake were lack of awareness and no family support.Conclusions: Most of the participants were oldest females who had diabetes or hypertension. The most common NCD they were suffering from were diabetes and hypertension. The major challenge in the management of NCDs is lack of awareness.

Drug utilization study and adverse drug reactions of oral anti diabetics among type 2 diabetes mellitus patients in tertiary care hospital

Background: The aim was to evaluate the drug utilization pattern of oral antidiabetic drugs in type 2 diabetes mellitus outpatients and monitor adverse drug reactions (ADRs) associated with oral antidiabetic drugs.Methods: A retrospective observational study was carried out by collecting the data of type 2 diabetes mellitus patients visiting outpatient department of noncommunicable disease clinic of a tertiary care hospital for a period of one year. The data of demographic, drug utilization pattern and adverse drug reactions of patients on oral antidiabetic drugs was collected and entered in a proforma.Results: Total number of patients in this study were 39 out of which 21 (53.85%) patients were females and 18 (46.15%) patients were males. Majority of patients were in the age group 51-70 years (66.6%). Metformin was the most commonly prescribed drug 76.9% followed by Glibenclamide 17.9%. About 7.7% of patients who were taking oral antidiabetic drugs later switched over to insulin as their blood glucose levels were not controlled. Out of 18 (46.15%) patients, hypertension (38.5%) was the most common comorbid condition and a concomitant drug was prescribed was amlodipine 25.6%. Among all the adverse drug reactions observed, diarrhoea was the most common adverse drug reaction reported 76.9%.Conclusions: Metformin was the most commonly used oral antidiabetic drug. Diarrhoea was the common adverse drug reaction reported.

The validity of the patient health Questionnaire-9 to screen for depression in patients with type-2 diabetes mellitus in non-communicable diseases clinics in Malawi

BackgroundDepression is a global problem, affecting populations worldwide, but is too often under-diagnosed. The identification of depression among patients with diabetes is important because depression is prevalent in this group and can complicate diabetes management.ObjectivesThe aim of the study was to determine the sensitivity and specificity of the PHQ-9 in the detection of depression among patients with type-2 diabetes mellitus attending non-communicable diseases (NCD) clinics in Malawi.MethodsWe conducted a validation study of the Patient Health Questionnaire (PHQ-9) among 323 patients with type-2 diabetes mellitus who attended two NCD clinics in one of the 28 districts of Malawi. The participants were screened consecutively using the nine-item PHQ-9 in Chichewa by a research assistant and completed a diagnostic interview using the Structured Clinical Interview for DSM-IV (SCID) for depression with a mental health clinician. We evaluated both content validity based on expert judgement and criterion validity of the Patient Health Questionnaire (PHQ-9) based on performance against the SCID. The PHQ-9 cutpoint that maximized sensitivity plus specificity was selected to report test characteristics.ResultsUsing the SCID for depression, the prevalence of minor or major depression was 41% (133/323). The internal consistency estimate for the PHQ-9 was 0.83, with an area under the receiver operator curve (AUC) of 0.93 (95% CI, [0.91–0.96]). Using the optimal cut-point of ≥9, the PHQ-9 had a sensitivity of 64% and a specificity of 94% in detecting both minor and major depression, with likelihood ratio-positive = 10.1 and likelihood ratio negative =0.4 as well as overall correct classification (OCC) rate of 81%.ConclusionsThis is the first validation study of the PHQ-9 in NCD clinics in Malawi. Depression was highly prevalent in this sample. The PHQ-9 demonstrated reasonable accuracy in identifying cases of depression and is a useful screening tool in this setting. Health care workers in NCD clinics can use the PHQ-9 to identify depression among their patients with those having a positive screen followed up by additional diagnostic assessment to confirm diagnosis.Trial registrationPACTR201807135104799. Retrospectively registered on 12 July 2018.

Drug utilization pattern in type II diabetes mellitus patients attending non-communicable disease clinic in a tertiary care hospital

Background: Diabetes mellitus is a metabolic disorder. Early institution of treatment is necessary to prevent complications. Since treatment of diabetes requires lifetime therapy; this study is designed to understand the prescription trends at Non Communicable Disease clinic set up and to provide rationale.Methods: This cross-sectional, observational study was conducted over a period of 2 months (May 2017- June 2017). Details of demographic data, duration and family history of diabetes, antidiabetic medications prescribed, history of comorbid diseases and drugs prescribed by physician for the treatment of comorbid diseases were collected in a structured format. Height and weight were recorded, and body mass index was calculated.Results: Study population included 294 patients and patients in the age groups of 40-59 years formed the bulk. 39% patients were overweight and 19.39% were obese. 93.20% patients were prescribed with metformin. 37 patients received insulin injection. 64.29% received more than one antidiabetic drug. Hypertension (82.05%) was the most common comorbid disease. Amlodipine was the most commonly prescribed antihypertensive drug.Conclusions: Metformin was the most commonly prescribed antidiabetic drug. Utilization of newer antidiabetic drug is inferior. Use of rationale fixed dose combination improves patient compliance.

Effectiveness of a new multi-component smoking cessation service package for patients with hypertension and diabetes in northern Thailand: a randomized controlled trial (ESCAPE study)

BackgroundSmoking cessation is an achievable behavioral change, which reduces the risks of cardiovascular diseases, cancers and tobacco-related diseases. There is a need for an effective smoking cessation service for low and middle income country settings where the smoking rate is generally very high whilst a cessation service is not usually accessible. This study devised a new smoking cessation service package and assessed its effectiveness in the primary health care setting of northern Thailand.MethodsThis randomized controlled trial was centered at Maetha district hospital, Lampang province, Thailand, and its network of mobile non-communicable disease clinics at seven primary care units. A total of 319 eligible patients who consented to participate in the study, were randomly allocated to an intervention arm (160) and a control arm (159), applying block randomization. The multi-component intervention service consisted of:regular patient motivation by the same nurse over a 3-month period;a monthly piCO+ Smokerlyzer test for 3 months;continual assistance from a trained family member, using a smoking-cessation- diary; andoptional nicotine replacement chewing gum therapy.The control group received the routine service comprising of brief counseling and casual follow-up. Smoking cessation, confirmed by six months of abstinence and the piCo+ Smokerlyzer breath test, was compared between the two services after a year follow-up.The trial is registered as an international current control trial at the ISRCTN registry. ISRCTN89315117.ResultsThe median age of the participants was 64 years, with females constituting 28.84%. Most of the participants smoke hand-rolled cigarettes (85%). The intervention arm participants achieved a significantly higher smoking cessation rate than the control arm 25.62% vs 11.32%, with an adjusted odd ratio of 2.95 and 95% confidence interval 1.55–5.61.ConclusionIn relation to accessing smoking cessation services within the primary health care setting, participants who received the evidence-based intervention package were about three times more likely to succeed in giving up smoking than those who received the routine service. Utilizing community resources as major intervention components, the evidence from this trial may provide a useful and scalable smoking cessation intervention for low and middle income countries.Trial registrationCurrent controlled trials ISRCTN89315117.WHO international clinical trial identifier number: U1111–1145-6916; 3/2013.

Incorporating selected non-communicable diseases into facility-based surveillance systems from a resource-limited setting in Africa

BackgroundAs Mozambique faces a double burden of diseases, with a rise of Non Communicable Diseases (NCD) superimposed to uncontrolled communicable diseases (CD), routine disease surveillance system does not include NCD. The objectives of our study were to i) upgrade of the current surveillance system by adapting the data collection tools to NCD; ii) describe the occurrence and profile of selected NCD using these data collection tools.MethodsWorkshops were implemented in a first referral urban hospital of Mozambique to train clinical staff, administrative workers and nurses on NCD surveillance, as well as select conditions to be prioritized. Based on the WHO Global Action Plan and Brazaville Declaration for NCD prevention and control, we selected arterial hypertension, diabetes, stroke, chronic respiratory diseases, mental illness and cancers. Data collection tools used for CD were changed to include age, gender, outcome and visit type. Between February/2014 and January/2015 we collected data at an urban hospital in Mozambique’s capital.ResultsOver 12 months 92,018 new patients were assisted in this hospital. Data was missing or diagnosis was unreadable in 2637 (2.9%) thus only 89,381 were used for analysis; of these 6423 (median age 27 years; 58.4% female) had at least one selected NCD as their primary diagnosis: arterial hypertension (2397;37.31%), mental illness (1497;23.30%), asthma (1495;23.28%), diabetes (628;9.78%), stroke (299;4.66%), chronic obstructive pulmonary disease 61 (0.95%) and cancers 46 (0.72%). Emergency transfers were needed for 76 patients (1.2%), mainly due to hypertensive emergencies (31; 40.8%) and stroke (18;23.7%). Twenty-four patients died at entry points (0.3%); 10 of them had hypertensive emergencies.ConclusionChanges in existing surveillance tools for communicable diseases provided important data on the burden and outcomes of the selected NCD helping to identify priority areas for training and health care improvement. This information can be used to design the local NCD clinics and to strengthen the health information system in resource-limited settings in a progressive and sustainable way.

Cost of Integrated Chronic Care for Severe Noncommunicable Diseases at District Hospitals in Rural Sub-Saharan Africa

Background: Integrated clinical strategies to address noncommunicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention of behavioral risk factors and treatment of common conditions at primary health centers. This study examines the cost of decentralizing integrated nurse-driven, physician-supervised chronic care for more severe NCDs to outpatient specialty clinics associated with district hospitals in rural Rwanda. Conditions addressed included type 1 and type 2 diabetes, chronic respiratory disease, and heart failure. Methods: A retrospective costing analysis was conducted from the facility perspective using data from administrative sources and the electronic medical record systems of Butaro district hospital in rural Rwanda. We determined initial startup and annual operating cost of the Butaro district advanced NCD clinic for the fiscal year 2013-2014. Per-patient annual cost by disease category were determined. Findings: A total of $51,444 U.S. dollars (USD) in startup costs was necessary to establish a new advanced NCD clinic serving a population of approximately 300,000 people ($0.2 per capita). The annual operating cost for this clinic was $68,040 USD ($0.3 per capita) to manage a 632-patient cohort and provide training, supervision, and mentorship to primary health centers. Labor comprised 53% of total cost, followed by medications at 17%. Diabetes mellitus had the highest annual cost per patient ($151 USD), followed by heart failure ($104 USD), driven primarily by medication therapy and laboratory testing. Interpretation: This is the first study to evaluate the costs of integrated, decentralized chronic care for some severe NCDs in rural sub-Saharan Africa. The findings show that these services may be affordable to governments even in the most constrained health systems. Funding Statement: The authors declare: None. Declaration of Interests: The authors declare: None. Ethics Approval Statement: Ethical approval was obtained by the Rwanda National Ethics Committee and Institutional Review Board of Brigham and Women’s Hospital.

Integrating diabetic retinopathy detection with noncommunicable disease clinics at government hospitals in Kerala through teleophthalmology

Integrating diabetic retinopathy detection with noncommunicable disease clinics at government hospitals in Kerala through teleophthalmology

A Study on the Pattern of Self-reported Tobacco Addiction in Hypertensive Patients in Gujarat, India.

BackgroundBoth hypertension (HTN) and tobacco addiction pose a threat to the health, environment, and socioeconomic status (SES) of the people. When tobacco use disorder exists in people with HTN, it hastens the disease progress and causes early complications. The present study aimed to study the knowledge and practice of tobacco addiction in patients with HTN and find out the correlates of knowledge and practice of tobacco addiction.MethodsA cross-sectional study was conducted for a period of one year in the Jamnagar District of Western Gujarat, India. Out of total 400 samples, 50% were collected from the five selected Community Health Centers (CHCs) by random sampling and the rest from non-communicable disease (NCD) clinics at the tertiary care hospital of the district.FindingsMost of the patients were in their fifties or above (67.0%), women (57.0%), and married (86.5%). Only 12.0% had awareness about the hazards of tobacco addiction and the prevalence of tobacco addiction was 11%. It was found that use of smokeless tobacco (SLT) among samples was the highest (72.7%) followed by dual consumption, i.e., SLT and smoking (20.5%). The frequency of consumption was ≥ 5 times/day in 54.5%, 70.4% were addicted for > 10 years, and only 15.9% had ever tried to quit tobacco while only 11.4% had successfully quit it. It was seen that those who were aged < 50 years, men, literates, employed, and those belonging to higher SES and urban residence had better knowledge of the health hazards. This was found to have significant statistical association.ConclusionThe results provide valuable insight into the tobacco addiction in patients with HTN on which non-pharmacological treatment of HTN can be based.

Co-existing Non-communicable Diseases and Mental Illnesses Amongst the Elderly in Punjab, India.

Background: There is scant literature from India assessing the burden of mental disorders among elderly patients with non-communicable diseases (NCDs). This study aimed to determine the prevalence of depression and generalised anxiety disorder (GAD) among the elderly population with diabetes and/or hypertension and risk factors for psychiatric morbidity. Methodology: A cross-sectional study was conducted between September–December 2017 by using a semi-structured questionnaire amongst an elderly population (n=320), who were attending an NCD clinic in a rural district in the northern state of Punjab, India. The Geriatric Depression Scale (30-item) and GAD-7 scale were used to assess depression and GAD. Result: Depression was found in 58.1% (95% confidence interval [CI] 52.6–63.4%) of the study participants; of whom, 34.1% had severe depression. The proportion of GAD was found to be 38.7% (95% CI 33.6–44.2%), with 19.7% scoring in the severe range. Both GAD and depression was found in 37.8% (95% CI 32.7–43.2%). Female gender, nuclear family, being single/separated/divorced/widowed, low-income status and comorbid NCDs (especially hypertension) were found to be risk factors associated with depression and GAD. Conclusion: NCDs with co-morbid mental illness are a growing public health problem amongst the elderly population of the country. The NCD programme should make immediate efforts to provide mental-health care as part of a holistic care package to elderly with NCDs.

Clustering of cardiovascular disease risk factors - Syndemic approach: Is sit a time to shift toward integrated noncommunicable disease clinic?

The concurrent occurrence of many noncommunicable disease (NCD) risk factors is common, and it can play a synergistic role in occurrence of NCDs. This study aimed to identify the magnitude of clustering of NCD risk factors, patterns of risk factors emerged in clustering, and variations in clustering of risk factors based on socioeconomic factors. A cross-sectional survey was undertaken in an urban area of Puducherry among 2399 adults during 2014-2015. Sociodemographic and behavioral risk factors were assessed through a validated STEPS survey tool. Individuals with three or more risk factors were classified to have clustering of NCD risk factors. Socioeconomic positions in relation to clustering were identified through Chi-square analysis followed by multiple logistic regression where clustering at family and area was adjusted through multilevel modeling techniques. Of the 2399 adults, 1741 (73%) had clustering of NCD risk factors. Inadequate consumption of fruits and vegetables, high salt intake, and high waist circumference are the three predominant risk factors across all subgroups. Adults belonging to Christian religion (adjusted odds ratio [adjOR]: 2.8, 95% confidence interval [CI]: 1.5-5.2), aged 35 years and over (adjOR: 2.0, 95% CI: 1.4-6.0), and illiterates (adjOR: 1.8, 95% CI: 1.1-5.5) are more likely to have clustered NCD risk factors compared to others. Clustering of NCD risk factors is highly prevalent in this region and mainly driven by dietary practices and obesity measures. There is an urgent need to reorient the health system toward integrated approach with mandated inclusion of nutritionist in NCD health service delivery.

Prevalence of Depression and Anxiety Among Patients with Noncommunicable Diseases in The Kingdom of Bahrain

Background and objectives: There is a high coexistence between mental disorders and chronic noncommunicable diseases (NCD). Patients with chronic illnesses have higher rates of depression and anxiety when compared to the healthy individuals. The study aimed to estimate the prevalence of depression and anxiety and to explore the associated risk factors. Methods: A cross sectional study conducted in the NCD clinics of five health centers in the Kingdom of Bahrain included all patients attending these clinics from January 2016 to March 2016. Hospital anxiety and depression scale (HADS) was used to screen patients for depression and anxiety. Logistic regression analyses were used to identify risk factors associated with anxiety and depression. All the analyses were conducted using STATA 12; P &lt; 0.05 was considered statistically significant. Results: A total of 456 patients were included in the study. Mild and moderate to severe type of depression were observed in 71 (15.6%) and 53 (11.6%) patients, respectively. According to the multivariable model, the odds of having high depression score was significantly higher in patients aged &lt; 45 years (adjusted odds ratio (OR) = 2.01; P = 0.01), with low income (adjusted OR = 1.99; P = 0.02), with personal history of mental illness (adjusted OR = 5.13; P = 0.001), and with lower educational levels (P = 0.02). Mild and moderate to severe anxiety scores were observed in 55 (12.1%) and 34 (7.5%) patients, respectively. According to the multivariate model, the odds of having high anxiety score was significantly higher in females (adjusted OR = 2.85; P &lt; 0.001), patients aged &lt; 45 years (adjusted OR = 2.41; P = 0.005), in patients with low income (adjusted OR = 3.62; P &lt; 0.001), and in those with personal history of mental illness (adjusted OR = 4.5; P = 0.004). Conclusion: There is a high prevalence of depression and anxiety among patients attending NCD clinics in the Kingdom of Bahrain. Therefore, screening of mental health diseases should be established.

Integrating a diabetes and hypertension case management package within primary health care: a mixed methods feasibility study in Bangladesh

BackgroundAlmost three quarters of non-communicable disease (NCD) deaths, and 82% of premature NCD deaths, occur in low- and middle-income countries. Bangladesh has an estimated 7 million hypertensives and 10 million diabetics, and primary care is struggling to respond. Our aim was to develop and support implementation of a diabetes and hypertension case management package, and assess its appropriateness, feasibility and acceptability in two NCD clinics within two primary-care centres in Bangladesh.MethodsWe used a convergent mixed methods design. We first assessed the level of appropriate hypertension and cardiovascular disease patient management, based on a composite outcome indicator using data from patients’ treatment cards. Appropriate management was primarily informed by International Diabetes Federation (IDF) and World Health Organisation (WHO) guidelines. We then performed qualitative in-depth interviews with doctors and patients to explain these quantitative findings and to understand the challenges to achieving appropriate patient management in the NCD clinics.ResultsEighty-one newly diagnosed patients were recruited. Over 3 months, 53.1% (95% CI 42.3% to 63.6%) of patients were appropriately managed. We found incomplete diagnosis (especially missing hypertension diagnosis alongside diabetes) and non-provision of follow-up appointments were the main causes of the relatively low level of appropriate management. We conducted interviews with 11 patients and 8 health professionals and found a shortage of human resources, reporting materials, available drugs and diagnostic equipment. This undermined patients’ willingness to attend clinics and doctors’ willingness to offer follow-ups. Hands-on skill-building training was valuable in increasing doctors’ competence for appropriate management, but was seen as a novel training method and faced constraints to implementation.ConclusionsA clinical guide, skill-based training and recording package can be implemented in routine primary care and can lead to appropriate management of around half of diabetic and hypertensive patients in a low-income country. However, considerable health systems challenges must be addressed before more patients can be managed appropriately.