Noncommunicable Diseases Programs Research Articles

Exploring Factors Affecting Health Care Providers' Behaviors for Maintaining Continuity of Care in Kerala, India; A Qualitative Analysis Using the Theoretical Domains Framework.

IntroductionAccess to patients' documented medical information is necessary for building the informational continuity across different healthcare providers (HCP), particularly for patients with non-communicable diseases (NCD). Patient-held health records (PHR) such as NCD notebooks have important documented medical information, which can contribute to informational continuity in the outpatient settings for patients with diabetes and hypertension in Kerala. We aimed to use the theoretical domains framework (TDF) to identify the perceived HCP factors influencing informational and management continuity for patients with diabetes and hypertension.MethodsWe re-analyzed semi-structured interview data for 17 HCPs with experience in the NCD programme in public health facilities in Kerala from a previous study, using the TDF. The previous study explored patients, carers and HCPs experiences using PHRs such as NCD notebooks in the management of diabetes and hypertension. Interview transcripts were deductively coded based on a coding framework based on the 14 domains of TDF. Specific beliefs were generated from the data grouped into the domains.ResultsData were coded into the 14 domains of TDF and generated 33 specific beliefs regarding maintaining informational and management continuity of care. Seven domains were judged to be acting as facilitators for recording in PHRs and maintaining continuity. The two domains “memory, attention and decision process” and “environmental context and resources” depicted the barriers identified by HCPs for informational continuity of care.ConclusionIn this exploration of recording and communicating patients' medical information in PHRs for patients with diabetes and hypertension, HCPs attributions of sub-optimal recording were used to identify domains that may be targeted for further development of supporting intervention. Overall, nine domains were likely to impact the barriers and facilitators for HCPs in recording in PHRs and communicating; subsequently maintaining informational and management continuity of care. This study showed that many underlying beliefs regarding informational continuity of care were based on HCPs' experiences with patient behaviors. Further research is needed for developing the content and appropriate support interventions for using PHRs to maintain informational continuity.

Knowledge and attitude of peripheral health workers regarding Non-Communicable diseases in a Rural area of Rajasthan

Background: Mortality due to Non communicable disease (NCD) has increased from 50% to 60% in India from 2004 to 2014. Increasing mortality due to NCD has compelled Government of India to launch a national program (NPCDCS). This program has involved peripheral health workers hence this study was conducted to assess level of knowledge and attitude of peripheral health workers working in rural area of CHC Naila regarding NCDs. Methods: Present study was conducted at CHC Naila, Rajasthan, during June to Dec 2019. All (38) peripheral health staff working under CHC Naila were assessed and categorised regarding NCD and NPCDCS program. Results: Majority (77%) peripheral health workers had more than ten years of field experience. All have heard about NPCDCS program and type of NCDs covered under it. they were aware of sign & symptoms of common NCDs, however 18.42% of these were not aware of their role of community awareness about risk factors of NCDs and conducting regular screening. Conclusion: Though the level of awareness of health workers regarding type of NCDs, its consequences and risk factors was good however skill development training is needed so that they can screen people effectively and motivate them for healthy life style for optimum result.

Integration of Non Alcoholic Fatty Liver Diseases (NAFLD) into NPCDCS programme: A recent initiative in India

Non-alcoholic fatty liver disease (NAFLD) is an emerging public health problem globally. NAFLD is one of the most common liver diseases worldwide and is the most common cause of abnormal liver enzymes in many developed countries. NAFLD is estimated to afflict approximately 1 billion individuals worldwide. An estimated 20-30 % of general population is afflicted from it globally. In India NAFLD could be a silent epidemic with its prevalence ranging from 9-32%. Studies have shown, strong association of NAFLD with major Non Communicable diseases (NCD) like Diabetes, Obesity, CVD, Chronic Kidney diseases, Cancers, etc. Perceiving the threat of NAFLD and the central role of hepatic accumulation of fat in the pathogenesis of other NCD, the Government of India (GoI) has taken steps to include NAFLD in the public health agenda. It has included it in the national NCD programme, i.e., National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2021. India has become the first country in the world to start a national programme for preventive efforts for NAFLD. The present review describes public health relevance of NAFLD and the process of integration of Non Alcoholic Fatty Liver Diseases (NAFLD) into NPCDCS programme in India.

Interprofessional Collaboration On Non-Communicable Disease Programs (NDP) In Primary Health Services

This study aims to discuss interprofessional collaboration in the Non-Communicable Disease program and the factors that influence interprofessional collaboration in the program. The research method used in this study is a qualitative descriptive method. The type of data used in this research is qualitative data, which is divided into primary data and secondary data. The results showed that interprofessional collaboration is a strategy to achieve the desired quality of results effectively and efficiently in health services. Communication in collaboration is an important element to improve service quality and patient safety. A non-communicable disease (NCD) is a disease or medical condition that cannot be passed from one individual to another. Most NCDs occur in low- and middle-income countries. Based on WHO data, NDP was the cause of 68% of deaths in the world in 2012. Interprofessional collaboration at Posbindu NDP Puskesmas is carried out by the PNDP Program Holder. Other Puskesmas officers are only involved in determining the schedule for implementing activities so that they do not conflict with the schedule of other Puskesmas activities. Planning is done in writing with a planning format from the Treasurer of the Health Center. However, this plan is only related to the development and service activities of the NDP Posbindu. The factors that influence interprofessional cooperation in the NDP program are cooperation, communication, ethics, and the role of the profession.

Improving care for hypertension and diabetes in india by addition of clinical decision support system and task shifting in the national NCD program: I-TREC model of care

BackgroundThe growing burden of hypertension and diabetes is one of the major public health challenges being faced by the health system in India. Clinical Decision Support Systems (CDSS) that assist with tailoring evidence-based management approaches combined with task-shifting from more specialized to less specialized providers may together enhance the impact of a program. We sought to integrate a technology “CDSS” and a strategy “Task-shifting” within the Government of India’s (GoI) Non-Communicable Diseases (NCD) System under the Comprehensive Primary Health Care (CPHC) initiative to enhance the program’s impact to address the growing burden of hypertension and diabetes in India.MethodsWe developed a model of care “I-TREC” entirely calibrated for implementation within the current health system across all facility types (Primary Health Centre, Community Health Centre, and District Hospital) in a block in Shaheed Bhagat Singh (SBS) Nagar district of Punjab, India. We undertook an academic-community partnership to incorporate the combination of a CDSS with task-shifting into the GoI CPHC-NCD system, a platform that assists healthcare providers to record patient information for routine NCD care. Academic partners developed clinical algorithms, a revised clinic workflow, and provider training modules with iterative collaboration and consultation with government and technology partners to incorporate CDSS within the existing system.DiscussionThe CDSS-enabled GoI CPHC-NCD system provides evidence-based recommendations for hypertension and diabetes; threshold-based prompts to assure referral mechanism across health facilities; integrated patient database, and care coordination through workflow management and dashboard alerts. To enable efficient implementation, modifications were made in the patient workflow and the fulcrum of the use of technology shifted from physician to nurse.ConclusionDesigned to be applicable nationwide, the I-TREC model of care is being piloted in a block in the state of Punjab, India. Learnings from I-TREC will provide a roadmap to other public health experts to integrate and adapt their interventions at the national level.Trial registrationCTRI/2020/01/022723.

Outpatient use patterns and experiences among diabetic and hypertensive patients in fragile settings: a cross-sectional study from Lebanon

ObjectivesAssess and describe the health service use and delivery patterns for non-communicable disease (NCD) services in two contrasting fragility contexts and by other principal equity-related characteristics including gender, nationality and...

Perspective from 2021 Observations & Interventions in Micronutrient Research in Pune, India

Exciting research has happened in Pune since the publication in 2011 of our review on the role of maternal micronutrients in intrauterine programming of non-communicable diseases. We have completed a preconceptional micronutrient intervention in adolescents with the aim of improving the health of their offspring. This randomized controlled trial was based on our findings in the Pune Maternal Nutrition Study, and is called the Pune Rural Intervention in Young Adolescents (PRIYA) study. Interventions included: (1) vitamin B12 alone; (2) vitamin B12 with multi-micronutrients and milk powder; and (3) placebo. The vitamin B12 dose was 2 μg/day, to make it relevant in terms of physiology and public health. All groups received iron and folic acid as per the Indian national policy. A total of 557 adolescents (17 years of age, 291 boys and 266 girls) were enrolled; those with very low vitamin B12 levels were excluded and treated. Participants were carefully followed up to record marriages and pregnancies, and deliveries were attended to study neonatal outcomes. Very few of the boys married; by contrast, 182 of the girls married and 149 of them delivered a live child during the trial.

Prevalence, Awareness, Treatment, and Control of Hypertension and Diabetes: Results From Two State-Wide STEPS Survey in Punjab and Haryana, India.

BackgroundIndia which is home to more than one sixth of the world's population, accounts for more than two thirds of total deaths due to non-communicable diseases (NCD). Out of this, hypertension and diabetes are the most common NCDs. Awareness, treatment, and control of hypertension and diabetes remains a major challenge despite various national programs being run to curb the rising burden NCDs. In order to fill the knowledge gap, awareness, treatment, and control of diabetes and hypertension were studied by using data from the STEPS survey among the adult population in two major northern Indian states of Punjab and Haryana.MethodsTwo state-wide NCD risk factors surveys were conducted using WHO STEPS methodology among 5,127 individuals in Punjab and 5,078 individuals in Haryana aged 18–69 years in the year 2014–15 and 2016–18. Standardized questionnaire was used to determine the behavioral risk factors in step one followed by anthropometric measurements for physical risk factors in step two and in the third step serum and urine samples were collected for biochemical risk factors.ResultsThe prevalence of hypertension in Punjab was 40.1% while that in Haryana was 26.2%. In Punjab, only 48.3% of the hypertensive were aware of their condition, 30.9% were on treatment while only 18.3% of the cases were controlled. While in Haryana 33.4% of the respondents were aware of their condition, 26.3% are on treatment while only 12% of the cases were controlled. Similarly, the prevalence of diabetes was 14.3 and 15.1% in Punjab and Haryana, respectively. In Punjab 34.2% of diabetics were aware of their condition, 28.2% were on treatment while only 14.2% of the cases were controlled. The awareness and control rates in Haryana were similar to that in Punjab. 29.5% of the respondents were aware of their condition, 22.4% were on treatment while only 13.8% of the cases of diabetes were controlled. Family history of diabetes and hypertension was found to be associated with higher odds of being aware, on treatment and controlled blood glucose and blood pressure levels in both Punjab and Haryana.DiscussionHypertension and diabetes are a major public health problem in Punjab and Haryana and awareness, treatment and control rates are low which require specific interventions with a focus on access to treatment, regular follow up for better control. There is an urgent need to effectively implement the existing national NCD programmes in these states in India.

Current status of regular exercise and influencing factors in 18-64 year old labor force population in Beijing

Objective: To understand the regular exercise status and influencing factors in 18-64 year-old labor force population in Beijing, and provide evidences for behavioral intervention. Methods: Data were collected from Beijing Adult Non-communicable and Chronic Diseases and Risk Factors Surveillance Program from August to December, 2017. The stratified cluster sampling method was used to select 13 240 survey subjects throughout the city. The valid sample size included in this study were 11 604 persons aged 18 to 64 years. Questionnaire was used to collection the information about basic demographic characteristics, chronic disease history and physical activity prevalence of the study subjects. The body height and weight were measured by standard methods. Fasting venous blood samples were collected for the detection of fasting blood glucose, blood lipids and other biochemical indicators. Software SPSS 20.0 was used fort complex sampling sample weighting and data analysis. Results: The proportions of the study subjects who did regular exercise and never had leisure-time activity in 18-64 year-old labor force population in Beijing were 23.74% (95%CI: 21.51%-26.12%) and 64.34% (95%CI: 61.66%-66.94%) respectively; The average daily physical activity time was 23.44 min (95%CI: 21.16-25.71), and the total daily sedentary behavior time was 6.96 hours (95%CI: 6.80-7.13). With the increase of age, the proportions of the study subjects who did regular exercise and never had leisure-time activity increased (P=0.006, P<0.001). With the increase of educational level, the proportion of those who did regular exercise increased (P<0.001), and the proportion of those who never had leisure-time activity decreased (P<0.001); the higher the level of physical activity, the higher the regular exercise proportion (P<0.001); the proportions of employed people who did regular exercise was lower than those in unemployed people (P<0.001); the proportions of women never had leisure-time activity was higher than those in men (P=0.024). The results of multivariate analysis showed that older age and higher education level were positive factors for regular exercise (35- years old: OR=0.653, 95%CI: 0.530-0.804, P<0.001; 50-64 years old: OR=0.695, 95%CI: 0.560-0.864, P=0.001; high school/technical secondary school/technical School: OR=0.679, 95%CI: 0.593-0.777, P<0.001; college graduation: OR=0.478, 95%CI: 0.387-0.590, P<0.001; bachelor degree and above: OR=0.435, 95%CI: 0.347-0.546, P<0.001), while employment (OR=1.631, 95%CI: 1.330-2.000, P<0.001) and married/cohabitation (OR=1.340, 95%CI: 1.093-1.644, P=0.038) were negative factors for regular exercise. Conclusions: The rate of regular exercise in 18-64 year-old labor force population in Beijing needs to be improved. Older age and high educational level were positive factors for regular exercise, while being married and employed were negative factors for it.

Integrating a community-based approach to non-communicable diseases care: a pilot programme in Bangladesh

BackgroundAs the threat of non-communicable diseases grows in Bangladesh, BRAC, in partnership with Medtronic, launched a pilot programme in early 2020 to leverage community health workers to improve the health outcomes of patients with hypertension and diabetes. This project builds off of BRAC's existing non-communicable disease programme, established in 2016, but incorporates patient-centred approaches to monitor and improve both patient compliance and outcomes. MethodsActivities included BRAC-run non-communicable disease centres to diagnose and treat patients with non-communicable diseases and specially trained community health workers to provide community-level care and strengthen referral linkages with NCD centres. BRAC also worked diligently to adapt its programming to the context of COVID-19, including equipping a subset of enrolled patients with machines to record their blood pressure and blood glucose levels at home with additional supervision by community health workers. FindingsPreliminary results were promising—on average, 90% of both home-based and clinic-based patients showed clinical improvements, and 91% were retained in care. About 98% of community health workers had on-time follow-up of patients with non-communicable diseases, showing routine compliance of care at the household level. InterpretationDespite the pandemic, community health workers proved to be an effective tool in chronic disease management because the community trusts them and is receptive to their guidance, empowering health workers to deliver non-communicable disease care and promote lifestyle modifications. Contingent on further funding, BRAC will evaluate the effectiveness of this model in sustaining clinical outcomes and identifying pathways to scale across BRAC's large-scale health programme of over 40 000 community health workers. FundingMedtronic (formerly known as Medtronic Foundation).

Primary Health Care Workforce in Southeast Asia Region, Existing Status and Strategies for Non-Communicable Diseases and Oral Health Alliance: A Scoping Review.

Oral diseases and non-communicable diseases (NCD) share modifiable risk factors and common social determinants, thus creating new opportunities for improving oral health. The existing primary health care workers can play an integral role in NCD and oral health care integration by creating awareness, promoting oral health, controlling risk factors, and referring for timely dental care. This study aimed to identify and understand the roles of the existed human health resources working at primary health care and develop strategies to build on a unified NCD and oral health alliance human resources at this level.A scoping review was conducted to identify the primary health workforce in the Southeast Asia region, their roles and responsibility, and integration in oral health care. Various databases like NCBI (PubMed), Google Scholar, World Health Organisation (WHO)-Southeast Asia region (SEAR), Ministry of Health and Family Welfare websites in SEAR were comprehensively searched from January 1980 to December 2020 for reports, reviews, and original research. The keywords used were “primary health care workers,” “community health care workers,” “primary oral health care in SEAR,” etc. Only full-text articles in English language and reports available in Ministry of Health and Family Welfare (MOHFW) sites of SEAR were included in the study.Information was taken from 39 full-text articles, six WHO reports, and two reports from Ministry of Health sites of SEAR. Primary health workers (PHW) are known by multiple names in different countries of Southeast Asia. They share various common roles and responsibilities. There are many opportunities for the prevention and control of oral diseases in the SEAR. Basic systems and human resources for the control of NCD are in place in many countries. Oral health can be integrated with NCD programs and policies to reduce the burden of diseases.

Impact of COVID-19 on the Noncommunicable Disease Programs Provided in the Primary Health Care Centers in Al-Rusafa Directorate of Health, 2020

Background In recent years, noncommunicable diseases (NCDs) have globally shown an increasing impact on health status with disproportionately higher rates in developing countries. During the outbreak, health workers, equipment, and facilities have been reallocated to address the influx of patients with COVID-19. Restructuring of the health system could result in the closure of some health facilities. Objective The aim of this paper was to determine the impact of COVID-19 on the performance of NCD programs implemented in the primary health care centers in Al-Rusafa DOH through comparing the performance indicators of 2019 and 2020, and to identify the potential causes of the changes. Methods The study was conducted in Baghdad, Al-Rusafa, during the period from April to June 2021. A systematic sample was used to enroll 20 primary health care centers. The descriptive analysis focused on frequencies and percentages. Continuous variables are presented as mean (SD), and the independent t test was used to assess statistical significance. A P value of less than .05 is considered statistically significant. Results There was a decrease in the number of served patients, even reaching zero in some units. Most staff were partially or completely assigned to the COVID-19 pandemic. There was a decline in yearly need of education material and folders for programs in 2020 and awareness campaigns performed in 2019 and 2020. The main reasons in the decline of these services were the closure of outpatient services as per government directive, the closure of outpatient disease-specific consultation clinics, and the decrease in outpatient volume due to patients not presenting. Conclusions The COVID-19 pandemic affected the NCD services in Iraq, including the disruption of many aspects of these services.

Implementation of a large-scale breast cancer early detection program in a resource-constrained setting: real-world experiences from 2 large states in India.

BackgroundThe Breast Health Initiative (BHI) was launched to demonstrate a scalable model to improve access to early diagnosis and treatment of breast cancer.MethodsA package of evidence‐based interventions was codesigned and implemented with the stakeholders, as part of the national noncommunicable disease program, through the existing primary health care system. Data from the first 18 months of the BHI are presented.ResultsA total of 108,112 women received breast health education; 48% visited the health facilities for clinical breast examination (CBE), 3% had a positive CBE result, and 41% were referred to a diagnostic facility. The concordance of CBE findings between health care providers and adherence to follow‐up care improved considerably, with more women visiting the diagnostic facilities and completing diagnostic evaluation within 1 month from initial screening, and with only 9% lost to follow‐up. The authors observed a clinically meaningful decrease in time to complete diagnostic evaluation with biopsy, from 37 to 9 days.ConclusionsThe results demonstrate the feasibility and effectiveness of implementing a large‐scale, decentralized breast cancer early detection program delivered through the existing primary health care system in India.

Early programming of hypertension.

Hypertension (HTN) is a modifiable risk factor for cardiovascular disease (CVD) and should be included in the study of developmental origins of health and disease (DOHaD). during gestation and perinatal life may affect developmental plasticity, during which the fetus adapts to environmental conditions that pose During intrauterine and perinatal development, different environmental factors have an impact on the early programming of noncommunicable diseases (NCDs). This review provides a summary of the evidence that connects the fetus' plasticity and adaptive changes to unfavorable environmental factors that alter the adult phenotype in the development of HTN. Such adaptive changes result from epigenetic changes that favor the development of HTN and CVD in adulthood with intergenerational implications. Lastly, we mention preventive strategies to limit or reverse any variable that may alter developmental programming leading to HTN later in life.

Comparison Between ASCVD Versus WHO Risk Score in Predicting of 10-Year Cardiovascular Risk in an Iranian Adult: A Hospital-Based Cross-Sectional Study

Cardiovascular disease (CVD) mortality has increased in the Iranian population. Word Health Organization (WHO) risk score was recently used in Iranian prevention and control of non-communicable disease programs for risk assessment. The purpose of the study was to compare the 10-year cardiovascular risk using atherosclerotic cardiovascular disease (ASCVD) and WHO risk score. In a cross-sectional study, data from patients with cardiac symptoms without any documents related to CVD were collected from the outpatient clinic. The proportion of subjects with high CVD risk according to ASCVD and WHO risk score and also agreement between two scores was presented. The sensitivity and specificity of ASCVD according to the WHO risk score as a national risk assessment tool were calculated. The study included 284 subjects with a mean age of 53.80 (8.78) years and 68 % of women. The frequency of subjects with high CVD risk based on ASCVD and WHO was 35% and 6%, respectively. The agreement between the two scores was moderate (κ=0.45), with the most agreement in identifying low-risk subjects. The sensitivity and specificity of ASCVD according to the WHO risk score was 95.3% and 75.1%, respectively. The present finding showed that Agreement between two risk scores was moderated, especially in stratifying low-risk subjects. But, the ASCVD risk score categorized more people as a high risk rather than the WHO tool. Assessment of the accuracy of the WHO risk score with comparing predicted risk with observed risk in a cohort study for the Iranian population is necessary.

Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities.

Type 2 diabetes mellitus (T2DM), which was once thought to be rare in sub-Saharan Africa (SSA), is now well established in this region. The SSA region is undergoing a rapid but variable epidemiological transition fuelled by the pace of urbanization, with disease burden profiles shifting from communicable diseases to non-communicable diseases (NCDs). Information on the epidemiology of T2DM has increased, but wide variations in study methods, diagnostic biomarkers and criteria hamper analytical comparison, and data from high-quality studies are limited. The prevalence of T2DM is still low in some rural populations but moderate or high rates are reported in many countries/regions, with evidence for an increase in some. In addition, the proportion of undiagnosed T2DM is still high. The prevalence of T2DM is highest in African people living in urban areas, and the gradient between African people living in urban areas and people in the African diaspora is rapidly fading. However, data from longitudinal studies are lacking and there is limited information on chronic complications and the genetics of T2DM. The large unmet needs for T2DM care call for greater investment of resources into health systems to manage NCDs in SSA. Proposed health-system paradigms are being developed in some countries/regions. However, national NCD programmes need to be adequately funded and coordinated to stem the tide of T2DM and its complications.

Addressing severe chronic NCDs across Africa: measuring demand for the Package of Essential Non-communicable Disease Interventions-Plus (PEN-Plus).

Severe chronic non-communicable diseases (NCDs) pose important challenges for health systems across Africa. This study explores the current availability of and demand for decentralization of services for four high-priority conditions: insulin-dependent diabetes, heart failure, sickle cell disease, and chronic pain. Ministry of Health NCD Programme Managers from across Africa (N = 47) were invited to participate in an online survey. Respondents were asked to report the status of clinical care across the health system. A care package including diagnostics and treatment was described for each condition. Respondents were asked whether the described services are currently available at primary, secondary and tertiary levels, and whether making the service generally available at that level is expected to be a priority in the coming 5 years. Thirty-seven (79%) countries responded. Countries reported widespread gaps in service availability at all levels. We found that just under half (49%) of respondents report that services for insulin-dependent diabetes are generally available at the secondary level (district hospital); 32% report the same for heart failure, 27% for chronic pain and 14% for sickle cell disease. Reported gaps are smaller at tertiary level (referral hospital) and larger at primary care level (health centres). Respondents report ambitious plans to introduce and decentralize these services in the coming 5 years. Respondents from 32 countries (86%) hope to make all services available at tertiary hospitals, and 21 countries (57%) expect to make all services available at secondary facilities. These priorities align with the Package of Essential NCD Interventions-Plus. Efforts will require strengthened infrastructure and supply chains, capacity building for staff and new monitoring and evaluation systems for efficient implementation. Many countries will need targeted financial assistance in order to realize these goals. Nearly all (36/37) respondents request technical assistance to organize services for severe chronic NCDs.

World health organization-package of essential noncommunicable disease intervention in iran's health system based on 5As healthy lifestyle counseling model: A randomized-controlled trial protocol.

BACKGROUND:The Iran Package for Essential Noncommunicable Disease (Ira-PEN) program has been established since 2018 with the aim of controlling and caring of noncommunicable diseases (NCDs) as well as their underlying causes in Iran. In this study protocol, a healthy lifestyle module will be used for the first time in Iran, which was recommended in 2018 by the World Health Organization to train health workers. This module relies on the 5As model, a training intervention design, then, implement, evaluate, and present the results to the managers and decision makers of the Ira-PEN program.MATERIALS AND METHODS:This study will be performed in 2 stages, including 2 steps per stage. The first stage involves designing the 2 steps and validation of the healthy lifestyle counseling skills tool. The tool will encompass a health counseling evaluation checklist and a counseling assessment questionnaire according to the counseling recipients. The second stage also entails 2 steps; designing a training program for health workers in the field of healthy lifestyle counseling based on the Oles-Cement model followed by implementation and evaluation.CONCLUSIONS:The training program and the results obtained in this study will be presented to the managers and decision makers of both the Ira-PEN program and NCDs control in Iran, and it is suggested to enhance the training program, network, and educational curriculum of health workers in providing healthy lifestyle counseling to play a more effective role in changing the public behavior toward a healthy lifestyle and preventing the risk factors of NCDs.

Ethical Considerations Associated with Closing a Non-communicable Disease Program in a Humanitarian Setting

Managing non-communicable diseases (NCDs) in crisis-affected and fragile humanitarian contexts requires special attention because primary health care systems often collapse or become compromised in such settings. As a result, addressing and managing these diseases become more challenging. Humanitarian organizations that intervene in crisis situations are increasingly including NCD management in the services they support and provide; however, they encounter a range of issues such as ensuring the quality of care, sustainability of programs, and the possibility of unintended harms. This case study explores ethical considerations raised by a mobile NCD program run by an international humanitarian organization in a country affected by a protracted civil war.

Noncommunicable disease program for blood pressure ontrol in Tamil Nadu, India: Bridging care gaps among patients with hypertension in public health facilities

Noncommunicable disease program for blood pressure ontrol in Tamil Nadu, India: Bridging care gaps among patients with hypertension in public health facilities