Non-communicable Diseases Clinics Research Articles

Screening for Abuse of Older Adults: A Study Done at Primary Health Care Level in Punjab, India.

Background:Little is known about elder abuse in the domestic environment. In lower-middle income countries like India, the demographic transition is throwing novel challenges. The older adults are relatively more vulnerable because of coexisting medical and psychological problems. Any form of abuse affects mental health and increases the chances of anxiety and depression among the older adults. The study aimed to assess the burden of abuse amongst older adults visiting a primary health care center of north India.Methods:This is secondary data analysis conducted on the data collected in the primary study between September 2017 and June 2018 in northern India among 311 older adult patients attending the noncommunicable disease clinic. Diabetes mellitus and hypertension were diagnosed as per standard guidelines. Vulnerability to Abuse Screening Scale (VASS) was used to assess elder abuse. Depression, anxiety, and loneliness were assessed by using the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, and University of California, Los Angeles (UCLA) loneliness 20-item scale, respectively. Multiple logistic regression was carried out to explore the factors associated with elder abuse after ruling out collinearity between independent variables.Results:About 24% of older adults experienced abuse in the last 12 months. One-fourth of the older adults reported vulnerability, nearly half reported coercion and dejection, and most of them reported experiencing dependence. Participants also had a high prevalence of anxiety (39%), depression (54%), and features suggestive of loneliness (38.6%). Multiple logistic regression analysis showed that abuse was predicted by educational status, per-capita income, and loneliness.Conclusion:About one-fourth of the older adults experience abuse. This highlights the importance of routine screening of older adults at the primary care level.

Effectiveness of Beetroot Juice as Adjuvant Therapy on Blood Pressure among Patients with Hypertension

T he present study was intended to assess the effectiveness of beetroot juice as adjuvant therapy on blood pressure among patients with hypertension attending Noncommunicable Disease Clinic, Ambalappuzha . Quasi experimental one group pre-test post-test design was adopted. A sample of 35 patients with hypertension was selected consecutively. The tool consisted of an interview schedule to determine the sociopersonal and clinical data and a standardized calibrated mercury sphygmomanometer and stethoscope to measure the blood pressure. 1 week apart, two pre-test blood pressure measurements were taken at patient’s home. The researcher administered 200 ml of beetroot juice to the patients before breakfast for 14 consecutive days in addition to existing antihypertensive drug therapy . Post-test blood pressure measurements were taken on the 8th and 15th day of initiating the therapy at patient’s home . It was found that the pre-test value of systolic BP, 148.13±5.36 mm Hg was reduced to 139.29±5.43 mm Hg and the pre-test value of diastolic BP, 92.52±3.05 mm Hg was reduced to 88.39±4.39 mm Hg after adjuvant therapy for 14 consecutive days. Paired-t test revealed a crucial difference in the level of blood pressure among patients with hypertension after adjuvant therapy with beetroot juice (p=<0.001). Chi-square analysis showed that there was no significant association between change in blood pressure and selected variables among patients with hypertension. The study concluded that beetroot juice as adjuvant therapy was effective in reducing blood pressure among patients with hypertension.

Context matters: a qualitative study of the practicalities and dilemmas of delivering integrated chronic care within primary and secondary care settings in a rural Malawian district

BackgroundWith the increasing double burden of communicable and non-communicable diseases (NCDs) in sub-Saharan Africa, health systems require new approaches to organise and deliver services for patients requiring long-term care. There is increasing recognition of the need to integrate health services, with evidence supporting integration of HIV and NCD services through the reorganisation of health system inputs, across system levels. This study investigates current practices of delivering and implementing integrated care for chronically-ill patients in rural Malawi, focusing on the primary level.MethodsA qualitative study on chronic care in Phalombe district conducted between April 2016 and May 2017, with a sub-analysis performed on the data following a document analysis to understand the policy context and how integration is conceptualised in Malawi; structured observations in five of the 15 district health facilities, selected purposively to represent different levels of care (primary and secondary), and ownership (private and public). Fifteen interviews with healthcare providers and managers, purposively selected from the above facilities. Meetings with five non-governmental organisations to study their projects and support towards chronic care in Phalombe. Data were analysed using a thematic approach and managed in NVivo.ResultsOur study found that, while policies supported integration of various disease-specific programmes at point of care, integration efforts on the ground were severely hampered by human and health resource challenges e.g. inadequate consultation rooms, erratic supplies especially for NCDs, and an overstretched health workforce. There were notable achievements, though most prominent at the secondary level e.g. the establishment of a combined NCD clinic, initiating NCD screening within HIV services, and initiatives for integrated information systems.ConclusionIn rural Malawi, major impediments to integrated care provision for chronically-ill patients include the frail state of primary healthcare services and sub-optimal NCD care at the lowest healthcare level. In pursuit of integrative strategies, opportunities lie in utilising and expanding community-based outreach strategies offering multi-disease screening and care with strong referral linkages; careful task delegation and role realignment among care teams supported with proper training and incentive mechanisms; and collaborative partnership between public and private sector actors to expand the resource-base and promoting cross-programme initiatives.

Non-communicable disease management in vulnerable patients during Covid-19.

It is now well established that non-communicable diseases (NCD), like diabetes mellitus, hypertension,, respiratory and heart disease, particularly among the elderly, increase the susceptibility to COVID-19 disease. Mortality in 60%-90% of the COVID-19 cases is attributed to either one or more of these comorbidities. However, healthcare management for control of COVID-19 involves public health and policy decisions that may critically undermine the existing health needs of the most vulnerable NCD patients. Temporary closure of outpatient health facilities in some secondary and tertiary care hospitals have deprived millions of NCD patients of their regular medication and diagnostic health needs. The lack of robust primary healthcare facilities in most states, and the failure to maintain physical distancing norms due to inadequate infrastructure is also problematic. In the absence of effective public health interventions, socioeconomically vulnerable patients are likely to become non-adherent increasing manifold their risk of disease complications. In this context, the feasibility of dispensing longer than usual drug refills for chronic NCD conditions at functional government health facilities, home delivery of essential drugs, running dedicated NCD clinics at PHCs, and utilisation of telemedicine opportunities for care and support to patients warrant aggressive exploration. Keywords: Covid-19, NCDs, Medical ethics, epidemic, India.

Self-care practices and needs in patients with hypertension, diabetes, or both in rural Uganda: a mixed-methods study

BackgroundThe prevalence of non-communicable diseases (NCDs) is increasing in rural sub-Saharan Africa. Implementation and adaptation of recommended self-care practices is crucial for successful management of NCDs to prevent complications. However, little is known about self-care practices in patients living in rural sub-Saharan Africa. In this study, we aimed to understand patients' adherence to self-care practices for hypertension, diabetes, or both, in rural Uganda and their reasons for non-adherence. MethodsWe conducted a mixed-methods study in adult patients previously diagnosed with diabetes or hypertension, or both, who attended outpatient NCD clinics at three health facilities in Nakaseke district. We concurrently collected quantitative data from a random sample of patients using pretested, structured questionnaires and held focus group discussions and in-depth interviews with a purposive sample of patients. Descriptive statistics were calculated for the quantitative data. Qualitative analysis was conducted using a thematic approach. FindingsBetween April and August, 2019, we administered questionnaires and carried out six focus group discussions and 19 in-depth interviews with 385 participants. Mean age was 54·0 years (SD 14·57) and most respondents, 257 (66·8%), were female. Of the 385 participants, 39·2% (151) had diabetes; 36·9% (142) had hypertension, and 23·9% (92) had both conditions. Most respondents reported daily adherence to medication for hypertension (79·5% [186/234]) and diabetes (84·8% [206/243]). Few participants (15·6% [60/385]) reported daily vigorous physical activity, but 63·1% (243/385) reported moderate physical activity at least once per week. Most respondents reported adherence to recommendations for dietary changes (75·6% [291/385]), non-smoking (98·7% [380/385]), alcohol abstinence (90·1% [347/385]), and weight management (75·6% [291/385]). From the interviews and discussions, patients reported that they tried to adhere to recommended medications but were limited by the inability to obtain them. Most patients reported irregular self-monitoring and many reported confusion about recommended practices due to mixed messages, mainly from their peers. Respondents also reported use of herbal remedies, soaking swollen feet in salt water, and coping with stress through prolonged sleep, social isolation, and alcohol use. InterpretationVaried self-care practices exist among rural Ugandan NCD patients. Patients inconsistently engage in recommended practices because of uncertain access to medicines, structural barriers, and inconsistent messaging. Locally adapted educational self-care programmes and consistent access to medicines could help improve self-care in these patients. As low-income countries like Uganda continue to advance their NCD policies, specific attention should be focused on strategies to ensure equitable access to essential NCD medicines. Additionally, the unique circumstances of people living in rural settings should be taken into account when developing programmes for management of NCDs. FundingYale Institute of Global Health Hecht Global Health Faculty Network Award

Integration of Chronic Oncology Services in Noncommunicable Disease Clinic in Rural Rwanda.

Background:In rural sub-Saharan Africa, access to care for severe non-communicable diseases (NCDs) is limited due to myriad delivery challenges. We describe the implementation, patient characteristics, and retention rate of an integrated NCD clinic inclusive of cancer services at a district hospital in rural Rwanda.Methods:In 2006, the Rwandan Ministry of Health at Rwinkwavu District Hospital (RDH) and Partners In Health established an integrated NCD clinic focused on nurse-led care of severe NCDs, within a single delivery platform. Implementation modifications were made in 2011 to include cancer services. For this descriptive study, we abstracted medical record data for 15 months after first clinic visit for all patients who enrolled in the NCD clinic between 1 July 2012 and 30 June 2014. We report descriptive statistics of patient characteristics and retention.Results:Three hundred forty-seven patients enrolled during the study period: oncology – 71.8%, hypertension – 10.4%, heart failure – 11.0%, diabetes – 5.5%, and chronic respiratory disease (CRD) – 1.4%. Twelve-month retention rates were: oncology – 81.6%, CRD – 60.0%, hypertension – 75.0%, diabetes – 73.7%, and heart failure – 47.4%.Conclusions:The integrated NCD clinic filled a gap in accessible care for severe NCDs, including cancer, at rural district hospitals. This novel approach has illustrated good retention rates.

Screening for cognitive impairment among the elderly attending the noncommunicable diseases clinics in a rural area of Punjab, North India.

Amongst all the ailments among the elderly persons, cognitive impairment has significant impact on the quality of life. Non-communicable diseases (NCDs) like diabetes and hypertension increase the risk of cognitive impairment and dementia. Little is known about the prevalence and correlates of cognitive impairment in elderly with NCDs. The present study aimed to evaluate the prevalence and correlates of cognitive impairment among elderly patients living with NCDs. 297 patients attending the chronic disease clinic of two Community Health Centres were evaluated using Hindi mini-mental scale (HMSE), University of California Los Angeles Loneliness Scale (UCLA LS), Geriatric Depression Scale, Generalized Anxiety Disorder (GAD-7 scale) and Vulnerability to Abuse Screening Scale. More than one-fourth (27.3 %) of participants had cognitive impairment as per the HMSE scores. The mean HMSE score was lowest (23.90+6.61) among patients with hypertension followed by patients with diabetes alone (26.90+4.46). People with hypertension had lower mean scores on all the domains of HMSE. Multivariable binary logistic regression depicted younger age, high education status, per capita income, long duration of diseases, loneliness, and hypertension emerged as the significant risk factors associated with cognitive impairment. Older adults with non-communicable diseases have high prevalence of cognitive impairment. Physicians should make the patients and their family members aware about the association of non-communicable diseases with cognitive impairments and should encourage these persons to use remedial measures to reduce the risk of future development of dementia.

High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti.

Background:Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti.Objectives:We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associations of poverty with sex and distance from the health facility.Methods:We performed a cross-sectional study of patients with NCDs attending a public-sector health center in rural Haiti 2013–2016, and compared poverty among patients with poverty among a weighted community sample from the Haiti 2012 Demographic and Health Survey. We adapted the multidimensional poverty index: people deprived ≥44% of indicators are among the poorest billion people worldwide. We assessed hardship financing: borrowing money or selling belongings to pay for healthcare. We examined the association between facility distance and poverty adjusted for age and sex using linear regression.Results:Of 379 adults, 72% were women and the mean age was 52.5 years. 17.7% had hypertension, 19.3% had diabetes, 3.1% had heart failure, and 33.8% had multiple conditions. Among patients with available data, 197/296 (66.6%) experienced hardship financing. The proportions of people who are among the poorest billion people for women and men were similar (23.3% vs. 20.3%, p > 0.05). Fewer of the clinic patients were among the poorest billion people compared with the community (22.4% vs. 63.1%, p < 0.001). Patients who were most poor were more likely to live closer to the clinic (p = 0.002).Conclusion:Among patients with NCD conditions in rural Haiti, poverty and hardship financing are highly prevalent. However, clinic patients were less poor compared with the community population. These data suggest barriers to care access particularly affect the poorest. Socioeconomic data must be collected at health facilities and during community-level surveillance studies to monitor equitable healthcare access.Highlights:Poverty and hardship financing are highly prevalent among NCD patients in rural Haiti.Patients attending clinic are less poor than expected from the community.People travelling farther to clinic are less poor.Socioeconomic data should be collected to monitor healthcare access equity.

Diabetic retinopathy screening at primary and community health centers in Maharashtra.

In order to integrate and improve eye care in noncommunicable disease (NCD) clinics, screening for diabetic retinopathy (DR) in people with diabetes mellitus (DM) was introduced in primary and secondary-level government health facilities. Initially, the project was carried out at the fixed health facilities at one district hospital (DH), two sub-district hospitals (SDH) and two community health centers (CHCs). This was combined with training of existing health care personnel, information-education-communication (IEC) campaign among patients and service providers along with the provision of essential equipment required for screening. In the revised strategy, NCD nurses were also trained for screening. Of 12,788 DM patients registered in NCD clinics, 63.8% (n = 8159) were screened for DR by trained paramedical ophthalmic assistants and the four trained NCD nurses using non-mydriatic fundus camera and teleophthalmology supported remote grading of retinopathy. DR was detected in 9.45% (n = 771) patients and sight-threatening DR (STDR) was detected in 2.35% (n = 192) in one or both eyes. Of 8,159 people screened, 55% (n = 4481) and 45% (n = 3678) were screened at CHC and mobile screening at primary health centers (PHC), respectively. DR screening in a fixed facility at CHC combined with the mobile screening at PHC level and fixed-day screening strategy provides effective coverage.

Relationship between Stages of Change and Glycemic Control in Patients with Type 2 Diabetes Mellitus in a Primary Health-care Setting.

ABSTRACTIntroduction:Advanced stages of change (SOC) are usually associated with lower glycated hemoglobin (HbA1c) scores in patients with type 2 diabetes mellitus (T2DM). Additionally, these patients’ adherence to antidiabetic medications is crucial to achieve controlled HbA1c scores. The purpose of this study was to determine the relationship between SOC and HbA1c as well as between medication adherence and HbA1c in patients with T2DM in a primary health-care setting in Qatar.Materials and Methods:A cross-sectional observational study was conducted in patients with T2DM at the noncommunicable diseases clinics at Mesaimeer Healthcare Center and West Bay Health Care Center. Medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS-8), whereas a two-item SOC questionnaire was used to measure the SOC. HbA1c values were obtained from the electronic database at the clinic. Spearman rank correlations were performed, with the significance level set at α < 0.05.Results:A total of 387 patients were included in the analysis. More than 75% of them reported that they were in the maintenance stage, and 35.4% of them had a controlled diabetes status. There was no significant correlation between SOC and HbA1c or between medication adherence and HbA1c.Conclusions:There was no relationship between SOC and HbA1c or between medication adherence and HbA1c in patients with T2DM, indicating that in this study, self-reported measures are not associated with the HbA1c scores of patients.

Overview and project highlights of an initiative to integrate diabetic retinopathy screening and management in the public health system in India.

Purpose:Diabetes is a public health concern in India and diabetic retinopathy (DR) is an emerging cause of visual impairment and blindness. Approximately 3.35–4.55 million people with diabetes mellitus (PwDM) are at risk of vision-threatening DR (VTDR) in India. More than 2/3 of India's population resides in rural areas where penetration of modern medicine is mostly limited to the government public health system. Despite the increasing magnitude, there is no systematic screening for the complications of diabetes, including DR in the public health system. Therefore, a pilot project was initiated with the major objectives of management of DR at all levels of the government health system, initiating a comprehensive program for the detection of eye complications among PwDM at public health noncommunicable disease (NCD) clinics, augmenting the capacity of physicians, ophthalmologists and health support personnel and empowering carers/PwDM to control the risk of DR through increased awareness and self-management.Methods:A national task force (NTF) was constituted to oversee policy formulation and provide strategic direction. 10 districts were identified for implementation across 10 states. Protocols were developed to help implement training and service delivery.Results:Overall, 66,455 PwDM were screened and DR was detected in 16.2% (10,765) while VTDR was detected in 7.5%. 10.1% of those initially screened returned for the next annual assessment. There was a 7-fold increase in the number of PwDM screened and a 7.6-fold increase in the number of PwDM treated between 2016 and 2018.Conclusion:Services for detecting and managing DR can be successfully integrated into the existing public health system.

A scalable, self-sustaining model for screening and treatment of diabetic retinopathy in rural Karnataka.

The Indian health infrastructure is struggling to handle the burgeoning number of people with diabetes. Managing the complications of diabetes in an organized manner through the government health programs is still a distant reality. Here, we describe a program aimed at addressing the problem of diabetic retinopathy in rural areas of Tumkur district in Karnataka. By amalgamating telescreening and our own novel distributive care model, we were able to screen 85% of the registered diabetics in the Government noncommunicable disease clinics and treat 95% of those needing laser therapy. We also describe the importance of using electronic medical records in public health programs which not only increase the efficiency in screening for disease but help in increasing uptake of treatment by tracking defaulters.

Outcomes of decentralizing hypertension care from district hospitals to health centers in Rwanda, 2013-2014.

Three district hospitals (DHs) and seven health centers (HCs) in rural Rwanda. To describe follow-up and treatment outcomes in stage 1 and 2 hypertension patients receiving care at HCs closer to home in comparison to patients receiving care at DHs further from home. A retrospective descriptive cohort study using routinely collected data involving adult patients aged ⩾18 years in care at chronic non-communicable disease clinics and receiving treatment for hypertension at DH and HC between 1 January 2013 and 30 June 2014. Of 162 patients included in the analysis, 36.4% were from HCs. Patients at DHs travelled significantly further to receive care (10.4 km vs. 2.9 km for HCs, P < 0.01). Odds of being retained were significantly lower among DH patients when not adjusting for distance (OR 0.11, P = 0.01). The retention effect was consistent but no longer significant when adjusting for distance (OR 0.18, P = 0.10). For those retained, there was no significant difference in achieving blood pressure targets between the DHs and HCs. By removing the distance barrier, decentralizing hypertension management to HCs may improve long-term patient retention and could provide similar hypertension outcomes as DHs.

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&lt;0.0001) and higher heart rates (80.73±17.0 bpm vs 72.7±12.5 bpm, p&lt;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&lt;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&lt;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&lt;0.01), it was due to lower HDL (0.99±0.5 vs 1.3±0.2 mmol/L, p&lt;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&lt;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&lt;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&lt;0.0001). Left ventricular systolic dysfunction (&lt;40%) was significantly more prevalent in the African cohort (21% vs 0.4%, p&lt;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.&#x0D; Study Design: A mixed methods cross sectional study design was used.&#x0D; Place and Duration of Study: Mbale Regional Referral Hospital among patients attending the NCD clinic from May to July 2017.&#x0D; 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.&#x0D; 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 &lt;.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).&#x0D; 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...