Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi

Autor: Katie Tayler-Smith, Gerald P. Douglas, D. Nkhoma, P. Bondwe, Anthony D. Harries, P. Khomani, Serge Ade, Anne Ben-Smith, Oliver J. Gadabu, Engy Ali, Beatrice Mwagomba, Ronald Manjomo, L. Chikosi
Jazyk: angličtina
Předmět:
ISSN: 2220-8372
Popis: Chronic non-communicable diseases (NCDs) are now the world's leading cause of mortality, with a significant and rapidly growing impact in low- and middle-income countries (LMICs).1,2 In 2010, there were 34.5 million deaths (two of every three deaths globally) due to NCDs, with cancer, ischaemic heart disease, stroke and diabetes being the predominant causes.3 Despite the increasing burden of disease and associated mortality, access to prevention, care and treatment remains out of reach for most people in LMICs, and as a result there have been calls for action to improve the situation.4,5 In September 2011, the United Nations convened a high-level meeting on NCDs, and agreement was reached on a goal to reduce NCD deaths by 25% by 2025 in people aged 30–70 years.6,7 This was taken forward into the Sustainable Development Goals (SDG), with SDG 3.4 aiming to reduce premature mortality from NCDs by one third by 2030.8 The targets selected to achieve this goal include reducing elevated blood pressure, smoking cessation, reducing salt intake and increasing physical activity. While there is increasing agreement about the upstream policies required to combat NCDs and reduce NCD mortality, far less is known downstream about how to deliver and monitor quality services for the prevention, care and treatment of chronic disease for the millions of people in need. In LMICs, patients with NCDs are usually managed in tertiary or secondary level hospitals, but there is an urgent and important need to know how to decentralise and integrate the management of NCDs into primary health care and how to monitor the incidence and prevalence of disease, treatment outcomes and associated morbidity and mortality in this setting. A recent study from Kenya reported on the integrated management of patients with hypertension and/or diabetes in a primary health care setting supported by Medecins Sans Frontieres (MSF), with encouraging results.9 There is little information, however, about how this could work at the peripheral level in government settings in other LMICs. In Malawi, a nationwide World Health Organization (WHO) STEPwise approach to Surveillance (STEPS) survey showed that in 2009 respectively 33% and 6% of the population surveyed had hypertension and diabetes mellitus (DM);10 as a result, a Non-Communicable Diseases Management Unit was established within the Ministry of Health. A national strategy and action plan for NCDs has been developed, including the roll-out of the concept of a ‘chronic care clinic’. Currently, most patients with NCDs such as hypertension, DM, asthma and epilepsy are managed in one of the four national tertiary care facilities, or, in some district hospitals, in specialised out-patient clinics treating one disease at a time on separate days of the week. Such specialised clinics are difficult for patients with more than one disease, and may not be cost-effective. A decision was therefore made by the Ministry of Health, in collaboration with partners, to pilot the use of chronic care clinics for key NCDs such as hypertension, DM, asthma and epilepsy at the primary health care level. To test the concept, a chronic care clinic was set up in the primary health care facility in Area 25, Lilongwe, with patient enrolment starting from March 2014. A decision was made to assess the feasibility, challenges, burden of disease and monitoring system during a 12–15 month period soon after the clinic opened in order to identify gaps, correct mistakes and adjust resources to the disease patterns being observed. The aim of this study was to describe the management and monitoring of patients with NCDs in this primary health care clinic, along with the burden, treatment and programme outcomes of these patients. Specific objectives were to determine, between March 2014 and 30 June 2015: 1) the number of patients registered in each quarter and cumulatively with the different NCDs; 2) the baseline demographic characteristics, risk factors and existing disease-related complications of all patients who had been cumulatively registered by 30 June 2015; 3) the programmatic outcomes in patients cumulatively registered in the five quarters; and 4) the management and treatment outcomes of patients with specific NCDs.
Databáze: OpenAIRE
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