Screening For Non-communicable Diseases Research Articles

Contribution of community health care volunteers in facilitating mobilization for diabetes and hypertension screening among the general population residing in urban puducherry - An operational research study.

Introduction:Non-communicable diseases (NCDs) have contributed to almost half of the global disease burden. Many countries have experimented with Community Health Volunteers (CHVs) to provide necessary care for NCDs. We aimed at evaluating the contribution of CHVs in mobilizing adults for the Diabetes and Hypertension screening in a selected Primary Health Centre (PHC) of Puducherry, India.Methodology:A community-based operational research study was conducted, where five volunteers from each of the 13 anganwadis functioning under the PHC were chosen as study participants. They were interviewed before enrolment for willingness. Four batches of sensitization and training sessions were conducted to provide the necessary training. CHVs were then given 3 months to mobilize the individuals for NCD screening. This model was evaluated using the Theoretical underpinning technique.Results:Of the total 85 CHVs suggested, around 65 (76.5%) showed willingness for rendering services. Approximately 32 (49.2%) discontinued during the initial weeks of the intervention due to various reasons. The remaining CHVs could reach 363/1470 (24.7%), eligible individuals, among them, 303 (83.5) were convinced to visit the health centre for screening. From the total members who were screened, approximately 52 (17%) and 31 (10%) were diagnosed to have diabetes and hypertension respectively and were initiated on treatment as per national guidelines.Conclusion:About half of the CHVs who volunteered, remained till the end and effectively contributed to a screening of NCDs. The involved volunteers aided in improvising the NCD coverage under the PHC.

Enablers & challenges of tribal women & health system for implementation of screening of non-communicable diseases & common cancers: A mixed-methods study in Palghar district of Maharashtra, India.

Non-communicable diseases (NCDs) and cancers of breast, oral cavity and cervix contribute to around 5.87 million (60%) deaths in India. Despite this, there is limited evidence on preparedness of the tribal health system in mitigating these conditions. This mixed-methods study aimed at identifying enablers and challenges using a multistakeholder approach for the screening of NCDs and common cancers in a tribal block of Maharashtra, India. This study was conducted in a tribal community of Dahanu taluka in Palghar district of Maharashtra. A total of nine focus group discussions (FGDs) among tribal women and accredited social health activists (ASHAs), 13 key informant interviews (KIIs) among auxiliary nurse midwives (ANMs) and community health officers (CHO) and facility surveys of five public health facilities were conducted. The FGDs and KIIs were conducted using guides, recorded digitally, transcribed, analyzed and triangulated to identify emerging themes. The tribal women had limited knowledge about NCDs and common cancers. Paucity of health facilities, out-of-pocket expenditure, misconceptions, belief on traditional healers and inability to prioritize health were identified as major challenges. The ASHAs were recognized as a key connecting link between health system and community while provision of culturally appropriate IEC materials and adequate training were recognized as critical enablers by healthcare providers in implementing screening for NCDs and common cancers. The study recommends incorporating socioculturally relevant strategies in the tribal population and strengthening health facilities in terms of infrastructure and training with involvement of ASHAs for successful implementation of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) through health and wellness centres.

Screening Vaccinees for Non-Communicable Diseases and Risk Factors at a Covid-19 Vaccination Center in Vadodara, Gujarat.

Adult population visiting COVID vaccination center is a potential teachable moment for screening and preventive advice on non-communicable diseases. The objective of this study was to assess the proportion of vaccinees volunteering for screening and to know the proportion of newly detected hypertensives and diabetics among the screened vaccinees at COVID-19 vaccination center. This descriptive, cross-sectional, operational research study was carried out at the COVID vaccination center at a medical college in central Gujarat from July to September 2021. After receiving the vaccine, the vaccinee was offered screening through a community-based assessment checklist for risk factors of non-communicable diseases, blood pressure, and blood sugar measurement. Those volunteering for this screening received a slip mentioning their risk score, blood pressure and blood sugar reading, and relevant health information and disease prevention advice. The study variables were acceptability (proportion of vaccinees volunteering for screening) and yield (newly detected hypertensives and diabetics among those screened). Among vaccinees, 27.7% volunteered for risk scoring and blood pressure measurement, whereas 8.3% volunteered for blood sugar measurement. Around 15.5% of vaccinees had high-risk scores as per the community-based assessment checklist. The yield of freshly detected high blood pressure and high blood sugar was 19.3% and 10.5%, respectively. The yield was similar even among vaccinees under 30 years of age. Vaccinees demonstrated interest in undergoing screening for non-communicable diseases. Yield indicates that such screening is worth the effort.

Healthcare system responses to non-communicable diseases’ needs of Syrian refugees: The cases of Jordan and Lebanon

IntroductionSince the start of the Syrian conflict in 2011, Jordan and Lebanon have hosted large refugee populations, with a high pre-conflict burden of non-communicable diseases (NCDs). We aimed to explore NCD service provision to Syrian refugees in these two host countries and to identify lessons learned that may inform the global response to the changing health needs of refugees. MethodsBetween January 2017 and June 2018, we conducted 36 in-depth interviews with stakeholders from Jordan and Lebanon, as well as global stakeholders, to understand the context, the achievements, gaps and priorities in the provision and uptake of NCD prevention, testing and treatment services to Syrian refugees. FindingsBoth countries succeeded in embedding refugee health care within national health systems, yet coverage and quality of NCD health services offered to Syrian refugees in both contexts were affected by under-funding and consequent policy constraints. Changes in policies relating to cost sharing, eligibility and vulnerability criteria led to difficulties navigating the system and increased out-of-pocket payments for Syrians. Funding shortages were reported as a key barrier to NCD screening, diagnosis and management, including at the primary care level and referral from primary to secondary healthcare, particularly in Lebanon. These barriers were compounded by suboptimal implementation of NCD guidelines and high workloads for healthcare providers resulting from the large numbers of refugees. ConclusionsDespite the extraordinary efforts made by host countries, provision and continuity of high quality NCD services at scale remains a tremendous challenge given ongoing funding shortfalls and lack of prioritization of NCD care for refugees. The development of innovative, effective and sustainable solutions is necessary to counter the threat of NCDs.

A Community-Based Noncommunicable Disease Prevention Intervention in Punjab, India: Baseline Characteristics of 11,322 Adults.

Background:Noncommunicable diseases (NCD) are the leading cause of death in India, with cardiovascular diseases (CVD) in particular accounting for nearly 1 in 3 deaths. The prevention of key CVD risk factors – namely, diabetes and hypertension – is a public health priority.Objectives:The objective is to describe the results of large-scale, community-based NCD screening using the Government of India's Community Based Assessment Checklist (CBAC) scoring system.Materials and Methods:Trained enumerators visited each household in 10 villages in Punjab, India, between September 2019 and March 2020. Standardized methods were used to measure blood pressure, blood glucose, waist circumference, family medical history, and lifestyle behaviors.Results:A total of 11,322 adults (52.1% women; mean age 48.3 years) completed the assessment and 14.4% were classified as high-risk (CBAC >4). Those classified as high-risk were significantly more likely to have hypertension (46.0% vs. 20.6% among low-risk, P < 0.0001) and diabetes (12.0% vs. 7.7%, P < 0.0001). Only 26.8% of those with hypertension were diagnosed and only 14.9% treated. Proportions among those with diabetes were similarly low: 29.2% diagnosed and 16.0% treated.Conclusions:To the best of our knowledge, this is the first study to estimate the prevalence of high-risk CBAC scores in a population-based sample. Given that the Government of India aims to undertake population-based screening of all adults >30 years for NCDs, the results of this study are directly translatable.

Hypertension among adults enrolled in HIV care in northern Tanzania: comorbidities, cardiovascular risk, and knowledge, attitudes and practices.

Cite this articlePreeti Manavalan et al. Hypertension among adults enrolled in HIV care in northern Tanzania: comorbidities, cardiovascular risk, and knowledge, attitudes and practices. Pan African Medical Journal. 2022;41(285). 10.11604/pamj.2022.41.285.26952Introductionthe epidemiology of non-communicable diseases (NCDs) among people living with HIV (PLHIV) in sub-Saharan Africa is poorly described. In this observational study we examined a cohort of hypertensive PLHIV in northern Tanzania and described comorbidities, cardiovascular risk, and hypertension knowledge, attitudes and practices.Methodsconsecutive patients attending an HIV clinic were screened for hypertension; those who met hypertension study criteria were enrolled. Participants completed a hypertension knowledge, attitudes and practices survey, and underwent height, weight, and waist circumference measurements and urine dipstick, fasting blood sugar, and lipid panel analyses. Kidney disease was defined as 1+ proteinuria, diabetes mellitus was defined as fasting glucose >126mg/dL, and 10-year atherosclerotic cardiovascular disease (ASCVD) risk was defined per the Pooled Cohorts Equations.Resultsof 555 screened patients, 105 met hypertension criteria and 91 (86.7%) were enrolled. The prevalence of diabetes mellitus, kidney disease, and overweight or obesity was 8.8%, 28.6%, and 86.7%, respectively. Almost all participants (n=86, 94.5%) had two or more medical comorbidities. More than half (n=39, 52.7%) had intermediate or high 10-year risk for an ASCVD event. While only 3 (3.3%) participants were able to define hypertension correctly, most would seek care at a medical facility (n=89, 97.8%) and take medication chronically for hypertension (n=79, 87.8%).Conclusionwe found a high burden of medical comorbidity and ASCVD risk among hypertensive PLHIV in northern Tanzania. Integration of routine NCD screening in the HIV clinical setting, in combination with large-scale educational campaigns, has the potential to impact clinical outcomes in this high-risk population.

Screening for various non communicable diseases: a community based multi-diagnostic mega camp approach study from Raichur, Karnataka

Background: The 77% of all non-communicable illnesses (NCDs) deaths are in low-and middle-income countries. Cardiovascular diseases account for most NCD deaths, or 17.9 million people annually, followed by cancers (9.3 million), respiratory diseases (4.1 million), and diabetes (1.5 million). These 4 groups of diseases account for over 80% of all premature NCD deaths. Objective was to study prevalence of NCDs and its trends with respect to age and gender.Methods: The present community based descriptive observational study was conducted at Navodaya medical college hospital and research centre, Raichur that caters Urban and rural area of Raichur. The 4063 apparently healthy population from urban and rural part of Raichur were screened during the multi diagnostic mega camp at urban and rural areas around Raichur during the period of January to September 2021. Results: Prevalence of diabetes in our study was 46.3%, hypertension 45.3%, cataract 46.3% and COPD as 20.7%. Prevalence of diabetes was more in 41-60 years i.e., 41.6%. Prevalence of hypertension was more in 41-50 years i.e., 25.3%. Prevalence of diabetes was more in males i.e., 54.1%. Prevalence of hypertension was more in males i.e., 50.8%.Conclusions: Prevalence of all NCDs was more in above 40 years and more in males except COPD.

Improving uptake of non-communicable disease screening in Sri Lanka: eliciting people's preferences using a discrete choice experiment.

A national programme to universally screen the population between 35 and 65 years for non-communicable diseases was established at 'Healthy Lifestyle Centres (HLCs)' in 2011 in Sri Lanka. Despite several efforts by policymakers, the uptake of screening remained <10% of the target population and with disparities in uptake across districts and among men and women. Considering service beneficiaries as a vital stakeholder, a discrete choice experiment was carried out to estimate people's preference for a non-communicable disease screening service delivery model in rural, urban and estate sectors in a district in Sri Lanka. The choice design and the general survey questionnaire was developed through focus group discussions, literature reviews and stakeholder consultations. Data were collected by stratified random sampling, with 187 participants from the urban sector, 253 from the rural sector and 152 from the estate/plantation sector. People's preference was assessed as utility estimates derived using multinomial logistic regression. Reliability was assessed within test among all study participants and with test-retest among 40 participants showed 80% precision. Urban and rural sectors gave the highest priority to workplace screening over screening at HLCs. The estates attributed the highest priority for cost-free screening. If cost-free screening is offered with having to spend 1-2 hours at the most preferred opening times for each sector with warm and friendly staff, the uptake of screening can predicted to be increased by 65, 29 and 21 times in urban, rural and estate sectors, respectively, relative to having to attend HLCs from 8 a.m. to 4 p.m., spending >2 hours and Rs. 1000 with unfriendly staff. Thus, people's preferences on service delivery aspects seemed to have differed from government priorities. Preferences when ill and apparently healthy differed, as they preferred to spend less time and money when healthy than when ill.

Exploration of Machine Learning and Statistical Techniques in Development of a Low-Cost Screening Method Featuring the Global Diet Quality Score for Detecting Prediabetes in Rural India

BackgroundThe prevalence of type 2 diabetes has increased substantially in India over the past 3 decades. Undiagnosed diabetes presents a public health challenge, especially in rural areas, where access to laboratory testing for diagnosis may not be readily available. ObjectivesThe present work explores the use of several machine learning and statistical methods in the development of a predictive tool to screen for prediabetes using survey data from an FFQ to compute the Global Diet Quality Score (GDQS). MethodsThe outcome variable prediabetes status (yes/no) used throughout this study was determined based upon a fasting blood glucose measurement ≥100 mg/dL. The algorithms utilized included the generalized linear model (GLM), random forest, least absolute shrinkage and selection operator (LASSO), elastic net (EN), and generalized linear mixed model (GLMM) with family unit as a (cluster) random (intercept) effect to account for intrafamily correlation. Model performance was assessed on held-out test data, and comparisons made with respect to area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. ResultsThe GLMM, GLM, LASSO, and random forest modeling techniques each performed quite well (AUCs >0.70) and included the GDQS food groups and age, among other predictors. The fully adjusted GLMM, which included a random intercept for family unit, achieved slightly superior results (AUC of 0.72) in classifying the prediabetes outcome in these cluster-correlated data. ConclusionsThe models presented in the current work show promise in identifying individuals at risk of developing diabetes, although further studies are necessary to assess other potentially impactful predictors, as well as the consistency and generalizability of model performance. In addition, future studies to examine the utility of the GDQS in screening for other noncommunicable diseases are recommended.

A pilot evaluation of Swasthya Pahal program using SMAART informatics framework to support NCD self-management.

Empirical research acknowledges the capability of mHealth and eHealth interventions for ensuring high-quality and tailored healthcare to individuals. People living with various health conditions get access to a wide range of healthcare services through digital interventions. The aim of the study is to examine the usefulness of Swasthya Pahal, a community-based Health for all program, aimed to enhance screening and self-management of diabetes, hypertension, and obesity among police personnel. A convenient sample of 64 individuals aged 18 years and above present at the Police Sanchar Training Centre, Dehradun, Uttarakhand were enrolled over 2 days in January 2020. The Swasthya Pahal pilot program was approved by the Uttarakhand State Police authorities. Individuals' health data was recorded using an interactive, bi-lingual, touch screen, computer-based program. Subjective data was collected and self-reported information was gathered about (I) socio-demographics, (II) health behaviors, (III) clinical status, and (IV) Knowledge, Attitudes, and Practices (KAP). Objective data assessments included measurements such as weight, blood pressure, and blood sugar levels using a series of physiological sensors. Additional information gathered at 1 month follow up included modifications that individuals made in their self-management of diabetes and hypertension, diet, physical activity, alcohol consumption, and smoking. Information was gathered related to individuals' interest in receiving SMS based health messages. The average age of study participants was 37 (SD =8) years, 88% were males, and 42% had graduate education. Hypertension (31%) was found to be the most common family history. Thirty-six percent of individuals were presently smokers or consumed alcohol. Sixty-two percent of them self-reported doing some form of exercise. Walking, jogging and yoga were the most common exercise types. Eighty-seven percent of them were not receiving any treatment to self-manage hypertension. Based on the JNC 8 criteria, 37% of the individuals were hypertensive. Fifty of the 64 individuals expressed interest to receive SMS message, 64% of them expressed keenness to receive weekly SMS messages. Messages related to diet, physical activity, sleep, and smoking and alcohol consumption were perceived as important. The Swasthya Pahal program using the SMAART informatics framework is a useful tool to enhance screening and self-management of non-communicable diseases (NCDs) among police personnel.

Reiterating the Importance of Publicly Funded and Provided Primary Healthcare for Non-communicable Diseases: The Case of India Comment on "Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare".

India has established health and wellness centres (HWCs) and appointed mid-level healthcare providers (community health officers, CHOs) to provide free and comprehensive primary healthcare (PHC), through screening, prevention, control, management and treatment for non-communicable diseases (NCDs), in addition to existing services for communicable diseases, and reproductive and child health. The range of services being provided and the number of people accessing ambulatory care in these government centres have increased, leading to more equitable healthcare access and financial protection. In policy debates, contestations exist prioritising between PHC or hospital services, and between publicly-provided healthcare or privatised and "purchased" services. Nationally and globally the influence of industries and corporations in health governance has weakened the response against NCDs. PHC initiatives for NCDs must be publicly funded and provided, located within communities, and necessitate action on the determinants of health. The experiences from Australia (a high-income country) and India (a low-and middle-income country) amply illustrate this.

Patient outcomes in integrated HIV and non-communicable disease models of care: a scoping review

Background High rates of non-communicable diseases (NCD) among people living with human immunodeficiency virus (HIV) have been reported in high HIV burden, low-resource settings. The growing dual burden of HIV and NCD epidemics has necessitated introduction of integrated models of HIV and NCD care in order to leverage existing HIV care infrastructure for NCDs. There is a paucity of evidence on the effects of integrated care on long-term patient outcomes. We sought to review literature that described effects of integration on long-term patient outcomes. Methods We reviewed literature published between 01 Jan 2000 to 25 September 2019, that described long-term patient outcomes in HIV and NCD integrated models of care in order to understand the effects of integration on long-term patient outcomes. Relevant literature was searched in PubMed, Scopus, EBSCOhost and Web of Science. A manual search of abstracts in the International AIDS Society and the Journal of Acquired Immunodeficiency Syndrome was also conducted. Results One thousand six hundred and sixty articles were identified, 31 of which were read in full, with 11 meeting eligibility criteria. Patient outcomes in four models of integrated care were identified: (i) integration of NCD screening and treatment services into established HIV centres; (ii) integration of HIV screening and treatment services into established NCD centres; (iii) simultaneous integration of HIV and NCD services at health facilities; and (iv) integrated HIV and NCD care specifically for multi-morbid patients. Studies reported high rates of control of HIV and NCD across the various models of integrated care. However, majority of studies lacked comparator groups required to ascertain non-inferiority of integrated care over non-integrated care. Conclusions There is limited evidence on the effect of integrated HIV and NCD models of care on long-term patient outcomes especially in low-resource, high-burden settings. Randomized clinical trials with clearly defined comparator groups and standardized measures of HIV and NCD outcomes are needed to demonstrate non-inferiority of integrated against non-integrated care.

Socialization Of Clean And Healthy Living Behaviors And Screening Of Non-Communicable Diseases In Efforts To Prevent The Pandemic Covid-19

Coronavirus (COV) is a large family of viruses that cause a slaughter starting from mild to severe symptoms. The disease caused by this virus is called Covid-19. One effort in the prevention of Covid-19's penis is to hold a health protocol and get clean life behavior and sehāt in everyday life. Market Ganesha is one of the traditional markets that functions for buying and selling facilities where many people gather so that it becomes a means of repentance of Covid-19 if the community is a PHB pedagang and not applied health protocols. From the results of the activity it was seen that the community was enthusiastic in participating in the socialization of PHBS and alternately to carry out glucose blood pressure. This socialization activity is not only explained but but also socialization of Gerdik and behavior and obedient to the efforts of nitrance. This activity also completes one of the destinations, namely members of the health examination of residents in the form of blood pressure checks and laboratories (blood glucose examination). New) With the majority of respondents are in the category of 41-50 years and the majority of respondents with female sex. The conclusion is that the trader's society has a risk factor for suffering from the disease not menulus (PTM) especially and diabetes mellitus.

Reaching underserved South Africans with integrated chronic disease screening and mobile HIV counselling and testing: A retrospective, longitudinal study conducted in Cape Town.

Community-based, mobile HIV counselling and testing (HCT) and screening for non-communicable diseases (NCDs) may improve early diagnosis and referral for care in underserved populations. We evaluated HCT/NCD data and described population characteristics of those visiting a mobile clinic in high HIV disease burden settings in Cape Town, South Africa, between 2008 and 2016. Trained counsellors registered patients ≥12 years old at a mobile clinic, which offered HCT and blood pressure, diabetes (glucose testing) and obesity (body mass index) screening. A nurse referred patients who required HIV treatment or NCD care. Using multivariable logistic regression, we estimated correlates of new HIV diagnoses adjusting for gender, age and year. Overall, 43,938 individuals (50% male; 29% <25 years; median age = 31 years) tested for HIV at the mobile clinic, where 27% of patients (66% of males, 34% of females) reported being debut HIV testers. Males not previously tested for HIV had higher rates of HIV positivity (11%) than females (7%). Over half (55%, n = 1,343) of those previously diagnosed HIV-positive had not initiated ART. More than one-quarter (26%) of patients screened positive for hypertension (males 28%, females 24%, p<0.001). Females were more likely overweight (25% vs 20%) or obese (43% vs 9%) and presented with more diabetes symptoms than males (8% vs 4%). Females (3%) reported more symptoms of STIs than males (1%). Reporting symptoms of sexually transmitted infections (aOR = 3.45, 95% CI = 2.84, 4.20), diabetes symptoms (aOR = 1.61, 95% 1.35, 1.92), and TB symptoms (aOR = 4.40, 95% CI = 3.85, 5.01) were associated with higher odds of a new HIV diagnosis after adjusting for covariates. Findings demonstrate that mobile clinics providing integrated HCT and NCD screening may offer the opportunity of early diagnosis and referral for care for those who delay screening, including men living with HIV not previously tested.

Point Prevalence Study of Communicable and Non-Communicable Diseases and Cervical Cancer Screening in Female Sex Workers (FSW) in an Urban Area of Eastern India

Point Prevalence Study of Communicable and Non-Communicable Diseases and Cervical Cancer Screening in Female Sex Workers (FSW) in an Urban Area of Eastern India

Building health system responsiveness to noncommunicable diseases for Gweru District adults, Zimbabwe: a case study

PurposeGweru District, Zimbabwe faces a major challenge of noncommunicable diseases (NCDs). Globally, health systems have not responded successfully to problems in prevention and management of NCDs. Despite numerous initiatives, reorienting health services has been slow in many countries. Gweru District has similar challenges. The purpose of this paper is to explore what the health systems in Zimbabwe have done, and are doing to respond to increasing numbers of NCD cases in adults in the nation, especially in the district of GweruDesign/methodology/approachThe study employed a descriptive narrative review of the academic and grey literature, supplemented by semi-structured key informant interviews with 14 health care staff and 30 adults living with a disease or caring for an adult with a disease in Gweru District.FindingsRespondents identified many limitations to the response in Gweru. Respondents said that screening and diagnosis cease to be helpful when it is difficult securing medications. Nearly all community respondents reported not understanding why they are not freed of the diseases, showing poor understanding of NCDs. The escalating costs and scarcity of medications have led people to lose trust in services. Government and NGO activities include diagnosis and screening, provision of health education and some medication. Health personnel mentioned gaps in transport, medication shortages, poor equipment and poor community engagement. Suggestions include: training of nurses for a greater role in screening and management of NCDs, greater resourcing, outreach activities/satellite clinics and better integration of diverse NCD policies.Originality/valueThis research offers an understanding of NCD strategies and their limitations from the bottom-up, lived experience perspective of local health care workers and community members.

Appraisal of Beneficiaries’ Perspective on Opportunities and Barriers of NCD Clinics in a Coastal District of Kerala

Background: Non-Communicable diseases (NCDs) have become the main causes of morbidity andmortality in many developing countries. In India, NCD Clinics are set up by the guidelines of NationalProgramme for Control of Diabetes, Hypertension, Cardiovascular Disease and Stroke (NPCDCS) for thecontrol, prevention and treatment of NCDs. Govt of Kerala introduced the NCD clinics to compact thedisease burden of the state in 2010 through the National Health Mission.Objective: To appraise the beneficiaries’ perspective on opportunities and barriers of NCD Clinics inAlappuzha district.Methods: It was a qualitative study conducted over a period of 6 weeks among the people in the agegroup of 30 years and above residing in Ambalappuzha taluk. 28 in-depth interviews and 18 focus groupdiscussions were conducted and the reviews of records in the primary health centres using a questionnairewere done. Thematic analysis of observations and percentage estimation of service indicators were done.Result: The study revealed a cluster of four themes such as awareness about the services, availability,accessibility, acceptability of services and Satisfaction about the services. Although there is receptivenessto the services, barriers to mainstreaming also exist which persuade them not to utilise these services. In allPHCs the indicators for screening for NCDs are less than 80%. Screening services should be strengthenedmore. So, the need to revamp the structure and systems to enhance the utilisation of the services of NCDClinics is highlighted.

Eligibility for home care of asymptomatic COVID-19 patients: challenges from a low resource setting in Central Kerala, South India

Background: As a large spectrum of COVID 19 disease is asymptomatic, there came a need for home based management of asymptomatic cases, which can ensure efficient utilisation of resources for care of severe cases. On 7th August 2020, Kerala government came up with advisory for home care of asymptomatic cases. The study was done to assess eligibility for home care among patients then admitted in COVID First Line Treatment Centres in Palakkad and to identify the challenges to aid in further planning and decision making about home care.Methods: A cross sectional study was conducted among 133 laboratory confirmed COVID 19 cases admitted to CFLTCs during 08 August 2020 to 12 August 2020. Semi-structured questionnaire was administered over telephone, after getting oral informed consent from patients. Analysis was done using Statistical package for social sciences (SPSS) 20.Results: 28.31% of asymptomatic cases were eligible for home care. The challenges were lack of separate room with attached bathroom and ventilation (29%), absence of facility to separate vulnerable persons at home (18.5%), lack of healthy caretaker (15.9%) and being unaware about co-morbidity status (27%). Significant associations were found between socioeconomic status and availability of separate room with attached bathroom as well as separate facility to accommodate vulnerable persons.Conclusions: Major factors limiting eligibility for home care were lack of facility to self isolate and to separate vulnerable persons away from home. Both factors were common among patients from BPL families. 27.4% of asymptomatic patients were unaware of co-morbidity status. This reinforces importance of screening for non communicable diseases in the community.

Generating evidence on screening, diagnosis and management of non-communicable diseases during pregnancy; a scoping review of current gap and practice in India with a comparison of Asian context.

BackgroundChildren born to high-risk pregnancies are more likely to experience adverse health outcomes later in life. As estimated, 15% of all pregnancies are at risk of various life-threatening conditions leading to adverse maternal and foetal outcomes. Millennium Development Goal resulted in the global reduction of maternal death from 390,000 to 275000 in 1990–2015). Similarly, to keep this momentum, the current United Nations Sustainable Development Goal (SDG: 3.1) aims at reducing the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, and this can be achieved by addressing high-risk pregnancy contributing to significant mortality and morbidity. In India, gestational diabetes, gestational hypertension, and gestational hypothyroidism were identified as factors contributing to the high-risk pregnancy. This review summarises the commonly used approach for screening, diagnosis, and management of these conditions in the Asian population. It draws a comparison with the current protocols and guidelines in the Indian setting.MethodsElectronic search in PubMed and Google Scholar, reference snowballing, and review of current guidelines and protocols were done between January 2010 to October 2019. Published studies reporting Screening, diagnosis, and management of these conditions were included. Articles selected were then screened, appraised for quality, extract relevant data, and synthesised.ResultsScreening, diagnosis, and management of these three conditions vary and no single universally accepted criteria for diagnosis and management exist to date. In India, national guidelines available have not been evaluated for feasibility of implementation at the community level. There are no national guidelines for PIH diagnosis and management despite the increasing burden and contribution to maternal and perinatal morbidity and mortality. Criteria for diagnosis and management of gestational diabetes, gestational hypertension, and gestational hypothyroidism varies but overall early screening for predicting risk, as reported from majority of the articles, were effective in minimizing maternal and foetal outcome.ConclusionExisting National guidelines for Screening, Diagnosis, and Management of Gestational Diabetes Mellitus (2018) and Gestational Hypothyroidism (2014) need to be contextualized and modified based on the need of the local population for effective treatment. Findings from this review show that early screening for predicting risk to be an effective preventive strategy. However, reports related to a definitive diagnosis and medical management were heterogeneous.

Smoking and tobacco: working towards the endgame as a vital part of post-COVID-19 recovery

Smoking and tobacco: working towards the endgame as a vital part of post-COVID-19 recovery