Management Of Non-communicable Diseases Research Articles

Enhancing Non-Communicable Disease Management in Elderly Families: A Community Outreach Initiative

Non-communicable diseases (NCDs) are a significant public health concern, particularly among elderly families. Limited access to healthcare resources and inadequate disease management exacerbation the impact of NCDs on this vulnerable population. This study aimed to implement a community outreach initiative focused on enhancing non-communicable disease management in elderly families. A comprehensive intervention was designed, including health education workshops, individualized health assessments, and the establishment of support networks. Pre- and post-intervention assessments were conducted to measure changes in knowledge levels, health status, health management practices, health behaviors, and family resilience among elderly families. Following the intervention, there was a substantial improvement in knowledge regarding NCDs and their management. Additionally, participants exhibited enhanced health status and more effective health management practices. Positive changes in health behaviors, such as regular exercise and balanced nutrition, were also observed. Moreover, family resilience significantly increased, strengthening their ability to cope with health challenges. The community outreach initiative demonstrated significant positive outcomes in non-communicable disease management among elderly families. Targeted interventions can play a role in empowering this demographic, improve their health and well-being, and encouraging community-based health services.

Human resources challenges in the management of diabetes and hypertension in Mozambique.

The major burden of non-communicable diseases (NCDs) globally occurs in low-and middle-income countries, where this trend is expected to increase dramatically over the coming years. The resultant change in demand for health care will imply significant adaptation in how NCD services are provided. This study aimed to explore self-reported training and competencies of healthcare providers, and the barriers they face in NCD services provision. A qualitative design was used to conduct this study. Data was collected through semi-structured interviews with government officials within the Mozambican Ministry of Health, district health authorities, health facility managers, and health providers at urban and rural health facilities of Maputo, in Mozambique. The data was then analyzed under three domains: provider´s capacity building, health system structuring, and policy. A total of 24 interviews of the 26 planed with managers and healthcare providers at national, district, and health facility levels were completed. The domains analyzed enabled the identification and description of three themes. First, the majority of health training courses in Mozambique are oriented towards infectious diseases. Therefore, healthcare workers perceive that they need to consolidate and broaden their NCD-related knowledge or else have access to NCD-related in-service training to improve their capacity to manage patients with NCDs. Second, poor availability of diagnostic equipment, tools, supplies, and related medicines were identified as barriers to appropriate NCD care and management. Finally, insufficient NCD financing reflects the low level of prioritization felt by managers and healthcare providers. There is a gap in human, financial, and material resources to respond to the country's health needs, which is more significant for NCDs as they currently compete against major infectious disease programming, which is better funded by external partners. Healthcare workers at the primary health care level of Mozambique's health system are inadequately skilled to provide NCD care and they lack the diagnostic equipment and tools to adequately provide such care. Any increase in global and national responses to the NCD challenge must include investments in human resources and appropriate equipment.

Health State and Barriers to the Provision of Health Services among Forcibly Displaced Myanmar Nationals in Bangladesh

Background: Forcibly displaced Myanmar nationals (FDMNs) are one of the most persecuted minorities groups, suffering from an abundance of health issues. They are exposed to a wide range of stressful events that are associated with adverse health consequences, which leads to decreased life expectancy due to increased morbidity and mortality. Methodology: A descriptive cross-sectional survey among conveniently selected 203 healthcare workers (HCWs) to assess the health state and barriers to the provision of health services to FDMNs in the Kutupalong and Balukhali camps at Ukhiya Upazilla, Cox's Bazar. Data were collected by face-to-face interviews by using a semi-structured questionnaire. Results: The mean age of the HCW was 29.2±3.6 years and mean service duration was 5.8±4.1 months. Most of the health facilities provided treatment for CDs (62.5%) and NCDs (80.0%). About one-third of the facilities had no laboratory facilities for diagnosing CDs (32.2%) and NCDs (40.0%). More than half of HCCs (55.0%) were maintain sterilization processes, such as boiling (90.9%), chemical components (45.5%) and an autoclave machine (13.6%). One-fourth of the HCWs (25.6%) get training during their joining times and above two-thirds of the HCWs (69.5%) received training after joining their service. The most frequently cited challenges faced during the provision of health services were transportation barriers (96.4%), language barriers (87.2%), scarcity of drugs (67.5%), vague disease histories (60.9%), unfavorable weather (59.4%) and electricity problems (44.7%). Conclusion: This study suggests that an organized primary healthcare service, specially designed for communicable and non-communicable disease prevention and management is necessary to improve health condition of FDMNs. Eastern Med Coll J. July 2023; 8 (2): 33-39

Root Cause Analysis of Gaps in Non-communicable Disease Monitoring in a Sub-district Hospital, Tamil Nadu: A Quality Improvement Initiative.

Introduction Non-communicable diseases (NCDs) present a significant public health challenge globally, and India is deeply affected. With the largest population in the world, India struggles with a high burden of NCDs, encompassing cardiovascular diseases, diabetes, cancer, and chronic respiratory conditions. These ailments contribute substantially to morbidity and mortality, placing a strain on healthcare systems. Despite efforts through public health initiatives, NCD monitoring and management remain deficient, especially at grassroots levels. Methods At a sub-district hospital in Tamil Nadu, India, a quality improvement initiative targeted diabetes and hypertension, prevalent NCDs. Utilizing Fishbone analysis and process flow diagrams, we identified gaps in NCD monitoring. Employing the Plan-Do-Study-Act model and reorienting the patient flow, we enhanced NCD monitoring by optimizing patient health record maintenance within the hospital. Results Root cause analysis identified a lack of patient record protocols and patient loss of records as key hindrances in NCD monitoring. We revamped patient flow and implemented a robust record-keeping system, boosting access to patient health records. This initiative was embraced by healthcare providers, enhancing NCD management. Leveraging these records, we assessed control rates of diabetes and hypertension patients effectively. Conclusion The research underscores the importance of maintaining comprehensive patient health records in healthcare centers for enhancing NCD monitoring. These records serve as valuable tools for healthcare providers, aiding in the monitoring and treatment of patients with diabetes and hypertension. By leveraging these records, healthcare providers can achieve better disease control outcomes, thereby improving the overall management of NCDs.

Innovative Management of Non-Communicable Disease in a Low-Income Country: Supporting Nurses and Midwives to Set Up and Manage a Nurse-Led Diabetes Clinic at Bo Government Hospital in Sierra Leone

Recognising the increasing prevalence of diabetes globally and the challenges faced by communities with limited resources, the Organisation of Sierra Leonean Healthcare Professionals Abroad (TOSHPA) proposed the establishment of a nurse/midwife-led clinic for patients with Type 2 and gestational diabetes to be established in Bo Government Hospital (BGH) Southern Sierra Leone. The nurse/midwife-led approach can prove to be an effective and sustainable solution and is done in collaboration with the Ministry of Health (MOH) and BGH Management Team in Sierra Leone. The project is funded by The Burdett Trust for Nursing, UK. BGH will allow second-motivated registered nurses and midwives who have a passion for community health to be trained/upskilled and capacitated to work in an extended role. The training will focus on patient assessment, investigations, diagnosis, treatment, health promotion, education, cultural competency, effective communication and active follow-up.

Behavioural risk factors for non-communicable diseases among South African Durban-based refugees: a cross-sectional study.

Behavioural risk factors for non-communicable diseases (NCDs) are rising among refugees, increasing chronic disease prevalence that causes morbidity and mortality. This study aimed to ascertain the prevalence, awareness and management of behavioural risk factors for NCDs among South African Durban-based refugees. A once-off quantitative, cross-sectional design was conducted on the behavioural risk factors for NCDs among 122 randomly selected Durban-based refugees using a modified version of the World Health Organisation (WHO) STEPwise approach to NCDs surveillance (STEPS) instrument. Participants' awareness and management of risk factors for NCDs were determined with a behavioural NCD awareness and management of behavioural NCD risk factor questionnaire. Smoking and alcohol prevalence were 4.1% and 20.7%, respectively, with 40.8% consuming fewer than five servings of fruit and/or vegetables daily. Participants performed more than 150 min of moderate physical activity per week. A significant 30.8% (p < 0.001) was aware that consuming alcohol poses an extremely large risk, similarly for smoking (38.7%; p < 0.001]. A significant 56.2% (p < 0.001) believe that regularly eating raw vegetables presents no risk, likewise for being physically active (51.7%; p < 0.001). A significant 40.6% (p < 0.001) of the participants always drink water or non-alcoholic drinks to manage their alcohol consumption, 54.2% (p < 0.001) manage their unhealthy diet by sometimes filling half their plates with fruits and vegetables, and 49.2% manage their physical activity levels by sometimes choosing a range of physical activities (p < 0.001). Refugees' lack of awareness of behavioural risk factors for NCDs highlights the importance for health service providers to present health promotion programs to make refugees aware of their behavioural NCD's risk factors and how it impacts their health.

The impact of multimorbidity among adults with cardiovascular diseases on healthcare costs in Indonesia: a multilevel analysis

BackgroundCardiovascular diseases (CVDs) are the leading cause of death in Indonesia, accounting for 38% of the total mortality in 2019. Moreover, healthcare spending on CVDs has been at the top of the spending under the National Health Insurance (NHI) implementation. This study analyzed the association between the presence of CVDs with or without other chronic disease comorbidities and healthcare costs among adults (> 30 years old) and if the association differed between NHI members in the subsidized group (poorer) and non-subsidized households group (better-off) in Indonesia.MethodsThis retrospective cohort study analyzed the NHI database from 2016–2018 for individuals with chronic diseases (n = 271,065) ascertained based on ICD-10 codes. The outcome was measured as healthcare costs in USD value for 2018. We employed a three-level multilevel linear regression, with individuals at the first level, households at the second level, and districts at the third level. The outcome of healthcare costs was transformed with an inverse hyperbolic sine to account for observations with zero costs and skewed data. We conducted a cross-level interaction analysis to analyze if the association between individuals with different diagnosis groups and healthcare costs differed between those who lived in subsidized and non-subsidized households.ResultsThe mean healthcare out- and inpatient costs were higher among patients diagnosed with CVDs and multimorbidity than patients with other diagnosis groups. The predicted mean outpatient costs for patients with CVDs and multimorbidity were more than double compared to those with CVDs but no comorbidity (USD 119.5 vs USD 49.1, respectively for non-subsidized households and USD 79.9 vs USD 36.7, respectively for subsidized households). The NHI household subsidy status modified relationship between group of diagnosis and healthcare costs which indicated a weaker effect in the subsidized household group (β = -0.24, 95% CI -0.29, -0.19 for outpatient costs in patients with CVDs and multimorbidity). At the household level, higher out- and inpatient costs were associated with the number of household members with multimorbidity. At the district level, higher healthcare costs was associated with the availability of primary healthcare centres.ConclusionsCVDs and multimorbidity are associated with higher healthcare costs, and the association is stronger in non-subsidized NHI households. Households' subsidy status can be construed as indirect socioeconomic inequality that hampers access to healthcare facilities. Efforts to combat cardiovascular diseases (CVDs) and multimorbidity should consider their distinct impacts on subsidized households. The effort includes affirmative action on non-communicable disease (NCD) management programs that target subsidized households from the early stage of the disease.

Seeking Optimal Extraction Method for Augmenting Hibiscus sabdariffa Bioactive Compounds and Antioxidant Activity

The dried flowers of Hibiscus sabdariffa (HS), available worldwide, have various applications in both non-medicinal and medicinal fields. The growing global interest in the health benefits of HS is linked to its potential prevention or management of non-communicable diseases. The aim of this research was to find the optimal extraction method that ensures the maximum yield of multiple beneficial bioactive components, such as polyphenols, anthocyanins, vitamin C, β-carotene, antioxidant activity, free radical scavenging activity DPPH and ferric reducing antioxidant power (FRAP). To this end, stirring, pulsed electric field, and ultrasound-assisted extraction were evaluated, either alone or in combination. Under optimized extraction conditions, the obtained extract exhibited an elevated total polyphenol content (37.82 mg of gallic acid equivalents/g dry weight (dw)), total anthocyanin content (610.42 μg of cyanidin equivalents/g dw), total carotenoids content (921.84 μg of β-carotene equivalents/g dw), and ascorbic acid content (507.44 mg/100 g dw). Remarkably, the extracts exhibited strong antioxidant properties (487.51 μmol of ascorbic acid equivalents (AAE)/g dw and 243.42 μmol AAE/g dw as evidenced by FRAP and DPPH assays, respectively). This research advances the parameters that should be employed to produce the optimal and nutritionally enhanced HS flower extracts, that can be used in the commercial sector.

Mobile Apps for Common Noncommunicable Disease Management: Systematic Search in App Stores and Evaluation Using the Mobile App Rating Scale.

The success of mobile apps in improving the lifestyle of patients with noncommunicable diseases through self-management interventions is contingent upon the emerging growth in this field. While users of mobile health (mHealth) apps continue to grow in number, little is known about the quality of available apps that provide self-management for common noncommunicable diseases such as diabetes, hypertension, and obesity. We aimed to investigate the availability, characteristics, and quality of mHealth apps for common noncommunicable disease health management that included dietary aspects (based on the developer's description), as well as their features for promoting health outcomes and self-monitoring. A systematic search of English-language apps on the Google Play Store (Google LLC) and Apple App Store (Apple Inc) was conducted between August 7, 2022, and September 13, 2022. The search terms used included weight management, obesity, diabetes, hypertension, cardiovascular diseases, stroke, and diet. The selected mHealth apps' titles and content were screened based on the description that was provided. Apps that were not designed with self-management features were excluded. We analyzed the mHealth apps by category and whether they involved health care professionals, were based on scientific testing, and had self-monitoring features. A validated and multidimensional tool, the Mobile App Rating Scale (MARS), was used to evaluate each mHealth app's quality based on a 5-point Likert scale from 1 (inadequate) to 5 (excellent). Overall, 42 apps were identified. Diabetes-specific mHealth apps accounted for 7% (n=3) of the market, hypertension apps for 12% (n=5), and general noncommunicable disease management apps for 21% (n=9). About 38% (n=16) of the apps were for managing chronic diseases, while 74% (n=31) were for weight management. Self-management features such as weight tracking, BMI calculators, diet tracking, and fluid intake tracking were seen in 86% (n=36) of the apps. Most mHealth apps (n=37, 88%) did not indicate whether there was involvement of health professionals in app development. Additionally, none of the apps reported scientific evidence demonstrating their efficacy in managing health. The overall mean MARS score was 3.2 of 5, with a range of 2.0 to 4.1. Functionality was the best-rated category (mean score 3.9, SD 0.5), followed by aesthetics (mean score 3.2, SD 0.9), information (mean score 3.1, SD 0.7), and engagement (mean score 2.9, SD 0.6). The quality of mHealth apps for managing chronic diseases was heterogeneous, with roughly half of them falling short of acceptable standards for both quality and content. The majority of apps contained scant information about scientific evidence and the developer's history. To increase user confidence and accomplish desired health outcomes, mHealth apps should be optimized with the help of health care professionals. Future studies on mHealth content analysis should focus on other diseases as well.

Policies for type 2 diabetes and non-communicable disease management during the COVID-19 pandemic in Kenya and Tanzania: a desk review and views of decision-makers

BackgroundThe COVID-19 pandemic caused disruptions in care that adversely affected the management of non-communicable diseases (NCDs) globally. Countries have responded in various ways to support people with NCDs during the...

Factors Associated with Knowledge of Hypertension in Rural Guinea, 2023: Case of the Rural Commune of Maferinyah

Introduction: While numerous studies have explored hypertension knowledge across Africa, they have predominantly focused on urban hospital settings and diagnosed patients. This study aimed to evaluate the determinants of hypertension knowledge in rural Guinea, a less-explored demographic. Methods: This cross-sectional study was conducted from March 01 to April 2023 within the Maferinyah sub-district and employed multivariate logistic regression to analyze the relationship between hypertension knowledge and various demographic characteristics. Results: The study included 701 individuals aged 16–65 years (mean age 38 years), with a predominance of women (68.3%) and those without formal education (62.8%). Key findings revealed that high economic status (aOR= 2.97; 95% CI: 1.91 - 4.64), age brackets of 41-50 years (aOR= 6.30; 95% CI: 3.51 - 11.5), 30-40 years (aOR= 4.74; 95% CI: 2.89 - 7.90), over 50 years (aOR= 4.13; 95% CI: 2.51 - 6.87), and unemployment (aOR= 2.60; 95% CI: 1.75 - 3.89) were significantly associated with higher hypertension awareness. Conclusion: Analysis of the collected data highlights a notable deficit in awareness of hypertension and its associated risk factors among the rural population of Guinea, underscoring the urgent need for targeted educational and awareness initiatives, especially among younger populations, to improve the understanding and management of Hypertension and other non-communicable diseases.

Pattern of multimorbidity in middle-aged and older-aged people with mild intellectual disability in Australia.

Non-communicable diseases (NCDs), also known as chronic diseases, now constitute a major proportion of ill-health across most adult and older populations including in people with intellectual disability. The current paper is a comparative analysis of prevalence of NCDs across mid-aged and older-aged people with mild intellectual disability. Comparative data comes from two cross-sectional surveys using similar methodology and timeframes. The analysis sample comprises mid-aged group (30-50 years, N = 291) and older-aged group (≥60 years, N = 391). People with mild intellectual disability start developing NCDs in early to mid-adulthood and increases with age. The mean number of NCDs in mid-aged group was 0.86 (SD, 0.84) compared to 3.82 in older group (SD, 2.67). There needs to be early identification and management of NCDs using relevant health promotion and preventative measures at optimal intervention points. The training of healthcare professionals needs improvement.

Brown Adipose Tissue, Batokines, and Bioactive Compounds in Foods: An Update.

The discovery of metabolically active brown adipose tissue (BAT) in human adults and the worldwide increase in obesity and obesity-related chronic noncommunicable diseases (NCDs) has made BAT a therapeutic target in the last two decades. The potential of BAT to oxidize fatty acids rapidly and increase energy expenditure inversely correlates with adiposity, insulin and glucose resistance, and cardiovascular and metabolic diseases. Currently, BAT is recognized by a new molecular signature; several BAT-derived molecules that act positively on target tissues have been identified and collectively called batokines. Bioactive compounds present in foods are endowed with thermogenic properties that increase BAT activation signaling. Understanding the mechanisms that lead to BAT activation and the batokines secreted by it within the thermogenic state is fundamental for its recruitment and management of obesity and NCDs. This review contributes to recent updates on the morphophysiology of BAT, its endocrine role in obesity, and the main bioactive compounds present in foods involved in classical and nonclassical thermogenic pathways activation.

Person-Centred Care: A Support Strategy for Managing Non-Communicable Diseases.

Over the last decade, the inadequacy and unsustainability of current healthcare services for managing long-term co-morbid and multi-morbid diseases have become evident. This study, involving 426 adults with at least one non-communicable disease in Slovenia, aimed to explore the link between quality of life, life satisfaction, person-centred care, and non-communicable disease management. Results indicated generally positive perceptions of quality of life, general health, and life satisfaction of individuals with non-communicable diseases. Participants assessed their physical health as the highest of the four quality of life domains, followed by the environment, social relations, and psychological health. Significant differences occurred in life satisfaction, general health, quality of life, and person-centred care for managing non-communicable diseases. But, there were no significant differences in person-centred care according to the living environment. The study revealed a positive association between person-centred care and effective non-communicable disease management, which is also positively associated with quality of life, general health, and life satisfaction. Person-centred care is currently the most compassionate and scientific practice conceived, representing a high ethical standard. However, implementing this approach in healthcare systems requires a cohesive national strategy led by capable individuals to foster stakeholder collaboration. Such an approach is crucial to address the deficiencies of existing healthcare services and ensure person-centred care sustainability in non-communicable disease management.

Strengthening primary health care through integration of non-communicable disease services: Insights from the abundant health model in Vietnam

ABSTRACT Vietnam is aging rapidly, leading to a substantial rise in morbidity and mortality associated with non-communicable diseases (NCDs). Despite the Government’s 2015 NCD care and management guidelines, there was no practical implementation. From 2018 to 2020, the Abundant Health (AH) model was introduced to enhance the screening and management of hypertension and diabetes at community health stations (CHSs). This study explores the potential for scaling up this model to other provinces in Vietnam and identifying structural enabling factors and challenges based on the model’s lessons learned. The study was conducted in five provinces of Vietnam, using a mixed methods approach of desk review, focus group discussions, key informant interviews, and a survey. Intervention feasibility and acceptability were evaluated using the framework developed by Gadke et al., with a scale of 5 points indicating the highest rating for upscaling the AH model. The sample comprised 164 healthcare providers, 5 group discussions, and 14 focus group discussions. The overall statistical value for Cronbach’s alpha was 0.87, the factor analysis identified 4 factors, and the scale is appropriate for evaluation. The AH model received high average scores for relevance (4.25 over 3 items) and acceptability (4.24 over 4 items). However, feasibility (including suitability and affordability) obtained a lower score (3.65 over 7 items), with primary concerns regarding the availability of local funding for activities (3.04) and the adequacy of equipment and medicines at CHSs (3.08). Enabling factors for delivering quality NCD services at the primary level included strong government commitment to NCD management at the grassroots health level and high community demand for quality NCD management and continuum services. The most significant barriers identified were the scarcity of physicians at CHSs and high staff turnover. The AH model, which encompasses screening, management, and treatment of hypertension and diabetes at CHSs, has demonstrated feasibility and potential for upscaling in Vietnam. Moreover, this model can be adopted in other low- and middle-income countries.

Digital health integration for noncommunicable diseases: Comprehensive process mapping for full-life-cycle management.

To create a systematic digital health process mapping framework for full-life-cycle noncommunicable disease management grounded in key stakeholder engagement. A triphasic, qualitative methodology was employed to construct a process mapping framework for digital noncommunicable disease management in Shanghai, China. The first phase involved desk research to examine current guidance and practices. In the second phase, pivotal stakeholders participated in focus group discussions to identify prevalent digital touchpoints across lifetime noncommunicable disease management. In the final phase, the Delphi technique was used to refine the framework based on expert insights and obtain consensus. We identified 60 digital touchpoints across five essential stages of full-life-cycle noncommunicable disease management. Most experts acknowledged the rationality and feasibility of these touchpoints. This study led to the creation of a comprehensive digital health process mapping framework that encompasses the entire life cycle of noncommunicable disease management. The insights gained emphasize the importance of a systemic strategic, person-centered approach over a fragmented, purely technocentric approach. We recommend that healthcare professionals use this framework as a linchpin for efficient disease management and seamless technology incorporation in clinical practice.

Differences in integrated assessment and management of non-communicable diseases (NCDs) for people with HIV across the WHO European region.

We aimed to assess the extent of integration of non-communicable disease (NCD) assessment and management in HIV clinics across Europe. A structured electronic questionnaire with 41 multiple-choice and rating-scale questions assessing NCD assessment and management was sent to 88 HIV clinics across the WHO European Region during March-May 2023. One response per clinic was collected. In all, 51 clinics from 34 countries with >100 000 people with HIV under regular follow-up responded. Thirty-seven clinics (72.6%) reported shared NCD care responsibility with the general practitioner. Systematic assessment for NCDs and integration of NCD management were common overall [median agreement 80%, interquartile range (IQR): 55-95%; and 70%, IQR: 50-88%, respectively] but were lowest in central eastern and eastern Europe. Chronic kidney disease (median agreement 96%, IQR: 85-100%) and metabolic disorders (90%, IQR: 75-100%) were regularly assessed, while mental health (72%, IQR: 63-85%) and pulmonary diseases (52%, IQR: 40-75%) were less systematically assessed. Some essential diagnostic tests such as glycated haemoglobin (HbA1c) for diabetes (n = 38/51, 74.5%), proteinuria for kidney disease (n = 30/51, 58.8%) and spirometry for lung disease (n = 11/51, 21.6%) were only employed by a proportion of clinics. The most frequent barriers for integrating NCD care were the lack of healthcare workers (n = 17/51, 33.3%) and lack of time during outpatient visits (n = 12/51, 23.5%). Most HIV clinics in Europe systematically assess and manage NCDs. People with HIV appear to be screened more frequently than the general population at the same age. There are, however, larger gaps among eastern European clinics in general and for clinics in all regions related to mental health, pulmonary diseases and the employment of some essential diagnostic tests.

Governance of noncommunicable diseases in Afghanistan.

Noncommunicable diseases (NCDs)arethe main reasons of mortality worldwide. One of every two person is dying due to NCDs in Afghanistan. International policy actors, mainly the World Health Organization (WHO), published several reports and declarations on controlling and preventing NCDs. This study aimed to provide a situation for governance of NCDs in Afghanistan and proper solutions for identified challenges. We conducted qualitative research utilizing interpretive phenomenology. A self-developed questionnaire was developed to conduct the semi-structured interviews with 39 experts fromAfghanistan. The results were analyzed using a deductive framework analysis. Six building block framework of health system developed by theWHO was used as predefined framework for this study. The governance building block of health system consists of five subthemes including policy making, planning, organizing, stewardship, and control. We identified main strengths, weaknesses, opportunities, and challenges for these subthemes. The experts also provided key recommendations to address the challenges. Management of NCDs is a neglected part of the health system in Afghanistan. Strengthening evidence-based policy making with technical and indigenous planning, establishing responsive units with adequate financial and human resources within different ministries to address "health in all policies" concept, passing and implementing national laws and regulations to support national strategies for prevention and control of NCDs, and establishing decentralized monitoring systems to control the implementation of these strategies are the main recommendations of this study. Local government and international policy actors should invest and support the development of a multisectoral coordination system at national level for Afghanistan.

THE EFFECT OF EDUCATION ABOUT THE DASH DIET ON AWARENESS SCORES OF THE HAZARDS OF HYPERTENSION

Background: According to the records of the World Health Organization (WHO), one billion people in the world suffer from hypertension, two-thirds of whom are in developing countries with moderate and low incomes. We can do non-pharmacological therapy by providing education about the dash diet to the hypertension hazard awareness score. Where this dash diet emphasizes consuming high levels of potassium, calcium, and magnesium. Purpose: to determine the effect of education about the dash diet on the awareness score of the dangers of hypertension. Methods: Pre-experimental research design with a one group pre-test and post-test design carried out in one group without a control group. This research was conducted on January 30 - February 18, 2023. The population in this study were 266 patients who experienced hypertension at the Kenten Palembang Health Center. The sampling technique used purposive sampling with a sample of 38 respondents. Data collection through the pre-test provided question paper, then the intervention provided education about the hypertension hazard awareness score, then the post-test provided similar questions. Data analysis used univariate and bivariate analysis. Results: there is an effect of education about the dash diet on the awareness score of the dangers of hypertension (p value = 0.000). Suggestion: it is hoped that this can be an additional reference that can be used as an alternative action/therapy in non-communicable disease management programs, namely hypertension.

Effect of food-based nutrition intervention on management of non-communicable diseases among people living with HIV in Busia County hospital, Kenya

Good nutrition optimizes benefits of ART (Antiretroviral therapy) and increases treatment adherence, both prolongs lives of PLHIV (NASCOP, 2014), without proper care and management it exposes them to non-communicable diseases (NCDs). Key objective; to determine the effect of food-based nutrition intervention on the management of NCDs among PLHIV in Busia. The design was experimental using randomized control trial approach. The control group had 30 subjects who were fed on Plumpy‘nut while treatment group had 30 subjects who were fed on Power Porridge (PROLCARMIV), for 60 days. Subjects were purposively selected from the Comprehensive Care Clinic (CCC) in Busia County referral hospital- Kenya, further study subjects were randomly selected using simple random sampling, assigned equally to each group. Data were collected using a structured questionnaire analyzed using Social Package for Statistical Sciences version 26. Prevalence of NCDS; 75.5% hypertension; 15.6% diabetes and 8.9% heart disease; post-intervention BMI for intervention group increased; laboratory analyses; Hb post–intervention results; mean levels were higher in intervention group (M=13.62, SD=2.69) p-value = 0.487 compared to control group (12.69, SD=1.24), p value= 0.471. Random Blood Sugar (RBS) were higher in control group (5.96, SD=1.70), with p value= &lt;0.001, intervention group (M=5.79, SD=1.02), with p-value = &lt;0.001. Post-intervention liver function test; TB, AST, and ALT showed higher SD indicating variability. Lipid profile; showed TC mean (4.39 (0.95) for control group; a mean of 3.78(0.94) for the intervention group: p=0.017; HDL for the control group with a mean of 1.58(0.57): mean of 1.14 (0.53) for the intervention group with p=0.036: TG for the control group, mean of 1.50 (0.50): for the intervention group with p= 0.017: mean of 1.14: (0.46): LDL for control group with a mean of 2.26 (0.66): mean of 1.43 (0.42): for the intervention group with p= 0.041: TC, HDL, TG, and LDL all exhibited significant decreases. Kidney function tests; no significant differences between the two groups. Conclusion; Compliance for PROLCARMIV; 82.5%, attracting uptake of CCC services. PROLCARMIV can manage NCDs among PLHIV, answering the alternative hypothesis, this would inform policy. Key words: Food-Based Nutrition Intervention, HIV, NCDs, PLHIV, PROLCARMIV, Power Porridge