scholarly journals Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anand Krishnan ◽  
Prashant Mathur ◽  
Vaitheeswaran Kulothungan ◽  
Harshal Ramesh Salve ◽  
Sravya Leburu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Centre ◽  
Noncommunicable Disease ◽  
Essential Medicines ◽  
World Health ◽  
Noncommunicable Diseases ◽  
System Response ◽  
Disease Monitoring ◽  
Care Facilities ◽  
Monitoring Survey

Abstract Background The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18). Methods NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) – Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises. Results Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3–3.3) in rural public to 9.0% (95% CI; 6.2–13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities. Conclusion Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.

scholarly journals National noncommunicable disease monitoring survey (NNMS) in India: Estimating risk factor prevalence in adult population

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0246712
Author(s):  
Prashant Mathur ◽  
Vaitheeswaran Kulothungan ◽  
Sravya Leburu ◽  
Anand Krishnan ◽  
Himanshu Kumar Chaturvedi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Salt Intake ◽  
Action Plan ◽  
National Level ◽  
Noncommunicable Disease ◽  
World Health ◽  
Disease Monitoring ◽  
Monitoring Framework ◽  
Monitoring Survey

Background The primary objective of National NCD monitoring survey (NNMS) was to generate national-level estimates of key NCD indicators identified in the national NCD monitoring framework. This paper describes survey study protocol and prevalence of risk factors among adults (18–69 years). Materials and methods NNMS was a national level cross-sectional survey conducted during 2017–18. The estimated sample size was 12,000 households from 600 primary sampling units. One adult (18–69 years) per household was selected using the World Health Organization-KISH grid. The study tools were adapted from WHO-STEPwise approach to NCD risk factor surveillance, IDSP-NCD risk factor survey and WHO-Global adult tobacco survey. Total of 8/10 indicators of adult NCD risk factors according to national NCD disease monitoring framework was studied. This survey for the first time estimated dietary intake of salt intake of population at a national level from spot urine samples. Results Total of 11139 households and 10659 adults completed the survey. Prevalence of tobacco and alcohol use was 32.8% (95% CI: 30.8–35.0) and 15.9% (95% CI: 14.2–17.7) respectively. More than one-third adults were physically inactive [41.3% (95% CI: 39.4–43.3)], majority [98.4% (95% CI: 97.8–98.8)] consumed less than 5 servings of fruits and / or vegetables per day and mean salt intake was 8 g/day (95% CI: 7.8–8.2). Proportion with raised blood pressure and raised blood glucose were 28.5% (95% CI: 27.0–30.1) and 9.3% (95% CI: 8.3–10.5) respectively. 12.8% (95% CI: 11.2–14.5) of adults (40–69 years) had ten-year CVD risk of ≥30% or with existing CVD. Conclusion NNMS was the first comprehensive national survey providing relevant data to assess India’s progress towards targets in National NCD monitoring framework and NCD Action Plan. Established methodology and findings from survey would contribute to plan future state-based surveys and also frame policies for prevention and control of NCDs.

scholarly journals Availability, Price, and Affordability of Essential Medicines to Manage Noncommunicable Diseases: A National Survey From Nepal

2019 ◽  
Vol 56 ◽  
pp. 004695801988757 ◽  
Author(s):  
Saval Khanal ◽  
Lennert Veerman ◽  
Margaret Ewen ◽  
Lisa Nissen ◽  
Samantha Hollingworth
Keyword(s):  
Public Sector ◽  
Noncommunicable Disease ◽  
Essential Medicines ◽  
World Health ◽  
Noncommunicable Diseases ◽  
Cross Sectional Survey ◽  
Future Health ◽  
The Public ◽  
Public Facilities ◽  
Significant Difference

The aim of this study was to evaluate the availability, price, and affordability of essential noncommunicable disease (NCD) medicines in Nepal. A cross-sectional survey was conducted in Nepal in 2015 using World Health Organization/Health Action International (WHO/HAI) methodology. We collected data on the availability and price of 60 essential NCD medicines from medicine distribution outlets in both the public and private health care sectors in 6 regions. Essential NCD medicines were more available in the private sector (78%) than the public sector (60%). Furosemide tablets were the cheapest (NPR 0.6/10 tablets) and streptokinase injections were the most expensive (NPR 2200/vial) drugs. There was no significant difference ( P > .05) in availability and affordability of essential NCD medicines across the 6 survey areas. Treating selected NCD conditions with medicines was generally affordable, with 1 month of treatment costing no more than a day’s wage of the lowest paid unskilled government worker. The lower availability of NCD medicines in the public sector limits the effectiveness of the government’s policy of providing free health services at public facilities. Although NCD medicines were generally affordable, future health policy should aim to ensure improved equitable access to NCD medicines, particularly in public facilities.

scholarly journals Diagnostics and monitoring tools for noncommunicable diseases: a missing component in the global response

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Antonio Bernabé-Ortiz ◽  
Jessica H. Zafra-Tanaka ◽  
Miguel Moscoso-Porras ◽  
Rangarajan Sampath ◽  
Beatrice Vetter ◽  
...  
Keyword(s):  
Health System ◽  
New Technologies ◽  
Action Plan ◽  
Building Blocks ◽  
Communicable Diseases ◽  
Noncommunicable Disease ◽  
World Health ◽  
Noncommunicable Diseases ◽  
Diagnostic Tools ◽  
Monitoring Tools

AbstractA key component of any health system is the capacity to accurately diagnose individuals. One of the six building blocks of a health system as defined by the World Health Organization (WHO) includes diagnostic tools. The WHO’s Noncommunicable Disease Global Action Plan includes addressing the lack of diagnostics for noncommunicable diseases, through multi-stakeholder collaborations to develop new technologies that are affordable, safe, effective and quality controlled, and improving laboratory and diagnostic capacity and human resources. Many challenges exist beyond price and availability for the current tools included in the Package of Essential Noncommunicable Disease Interventions (PEN) for cardiovascular disease, diabetes and chronic respiratory diseases. These include temperature stability, adaptability to various settings (e.g. at high altitude), need for training in order to perform and interpret the test, the need for maintenance and calibration, and for Blood Glucose Meters non-compatible meters and test strips. To date the issues surrounding access to diagnostic and monitoring tools for noncommunicable diseases have not been addressed in much detail. The aim of this Commentary is to present the current landscape and challenges with regards to guidance from the WHO on diagnostic tools using the WHO REASSURED criteria, which define a set of key characteristics for diagnostic tests and tools. These criteria have been used for communicable diseases, but so far have not been used for noncommunicable diseases. Diagnostic tools have played an important role in addressing many communicable diseases, such as HIV, TB and neglected tropical diseases. Clearly more attention with regards to diagnostics for noncommunicable diseases as a key component of the health system is needed.

scholarly journals Evaluation of Prescribing Indicators in a Paediatric Population Seen in an Outpatient Consultation at the Gaspard Kamara Health Centre in 2019 (Senegal)

Pharmacy ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 113
Author(s):  
Oumar Bassoum ◽  
Mouhamadou Faly Ba ◽  
Ndèye Marème Sougou ◽  
Djibril Fall ◽  
Adama Faye
Keyword(s):  
Descriptive Analysis ◽  
Health Centre ◽  
Paediatric Population ◽  
Essential Medicines ◽  
World Health ◽  
Bivariate Analysis ◽  
Prescribing Indicators ◽  
Outpatient Consultation ◽  
International Nonproprietary Name ◽  
Health Organization

Introduction: Data on drug use in paediatrics are scarce in Senegal. The objective of this study was to assess the prescribing indicators in a paediatric population seen in an outpatient consultation at a Health Centre in Dakar, Senegal. Methods: A retrospective and analytical study was conducted. The study population consisted of prescriptions for children aged 0 to 14 years who were seen in ambulatory consultation between 1 June and 30 November 2019. The sample size was 600 prescriptions. The systematic survey was then conducted. Five prescription indicators recommended by the World Health Organization were calculated. The R software was used for descriptive analysis, bivariate analysis and binomial logistic regression. Results: The average number of drugs per prescription was 2.56. The proportion of drugs prescribed under the International Nonproprietary Name (INN) was 18.9%, while the proportion of drugs on the National Essential Medicines List (NEML) was 41.3%. The proportions of prescriptions with at least one antibiotic and one injectable product were 41.5% and 1.3%, respectively. Conclusions: This study showed that prescribing habits were inadequate. Thus, it would be necessary to move towards continuing training of prescribers in the wise use of medicines.

scholarly journals Expanding the definition of noncommunicable disease

2016 ◽  
Vol 04 (02) ◽  
pp. 067-070 ◽  
Author(s):  
Ranabir Salam
Keyword(s):  
Liver Disease ◽  
Road Traffic ◽  
Public Health Problem ◽  
The United States ◽  
Noncommunicable Disease ◽  
World Health ◽  
Noncommunicable Diseases ◽  
World Population ◽  
The World ◽  
Definition Of

AbstractNoncommunicable diseases (NCDs) are responsible for 68% of all deaths in 2012. Eighty-two percent of these “premature” deaths occurred in low- and middle-income countries. Most of the NCD deaths are caused by cardiovascular diseases, cancer, diabetes, chronic respiratory diseases, mental health, road traffic accidents, and violence. The World Health Organization, several governments, and nongovernmental organizations have taken up numerous programs to curb the menace of NCDs. However, the present programs do not include some common chronic medical conditions which also lead to considerable morbidity and mortality. The present review highlights three important chronic disorders: chronic kidney disease (CKD), liver disease (cirrhosis and nonalcoholic fatty liver), and thyroid diseases. CKD is an internationally recognized public health problem affecting 5–10% of the world population. CKD resulted in 956,000 deaths in 2013 and proposes them to be included in the world wide accepted definition of NCD. Cirrhosis and chronic liver disease were the tenth leading cause of death for men and the twelfth for women in the United States in 2001. Moreover, 4–10% of the global population have thyroid dysfunction. This mini-review proposes to expand the definition of NCD to include these three major illnesses.

scholarly journals Gaps in Capacity in Primary Care in Low-Resource Settings for Implementation of Essential Noncommunicable Disease Interventions

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
S. Mendis ◽  
Igbal Al Bashir ◽  
Lanka Dissanayake ◽  
Cherian Varghese ◽  
Ibtihal Fadhil ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Information ◽  
Health Financing ◽  
Noncommunicable Disease ◽  
Noncommunicable Diseases ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Objective.The objective was to evaluate the capacity of primary care (PC) facilities to implement basic interventions for prevention and management of major noncommunicable diseases (NCDs), including cardiovascular diseases and diabetes.Methods.A cross-sectional survey was done in eight low- and middle-income countries (Benin, Bhutan, Eritrea, Sri Lanka, Sudan, Suriname, Syria, and Vietnam) in 90 PC facilities randomly selected. The survey included questions on the availability of human resources, equipment, infrastructure, medicines, utilization of services, financing, medical information, and referral systems.Results and Conclusions.Major deficits were identified in health financing, access to basic technologies and medicines, medical information systems, and the health workforce. The study has provided the foundation for strengthening PC to address noncommunicable diseases. There are important implications of the findings of this study for all low- and middle-income countries as capacity of PC is fundamental for equitable prevention and control of NCDs.

Counselling on smoking cessation in primary care from the population perspective in two regions of the Russian Federation

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
M Kashutina ◽  
A Kontsevaya ◽  
M Mckee ◽  
D Leon
Keyword(s):  
Primary Care ◽  
Smoking Cessation ◽  
Regression Model ◽  
Healthcare System ◽  
Roc Curve ◽  
Roc Analysis ◽  
Noncommunicable Disease ◽  
The Arctic ◽  
Factors Associated ◽  
Care Facilities

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): This study was conducted as part of the International Project on Cardiovascular Disease in Russia (IPCDR). IPCDR is supported by the Wellcome Trust [100217/Z/12]; the Norwegian Ministry of Health; the Norwegian Institute of Public Health; UiT, The Arctic University of Norway. Background. Smoking is one of the main risk factors for noncommunicable disease, which account for about 71% of the world"s population mortality. The prevalence of smoking in Russia is 27.3% totally and average 37% in males. One of the effective strategies smoking cessation is counselling in primary care facilities.  Purpose. Identify the frequency of counseling on smoking cessation in primary care from the population perspective in two regions of Russia and determine the socio-economic and behavioural factors associated with receiving advice on smoking. Methods. The study was carried out within the framework of the international scientific project "Know your heart" (2015-2018). A representative sample of residents of Novosibirsk and Arkhangelsk aged 35 to 69 years was included in the study. The frequency of getting advice on smoking cessation was analyzed among those respondents who have contacts with the healthcare system over the last year (n = 3320) and among those who are currently smokers (n = 738). Data were analyzed using SPSS v.17 and Jamovi v.1.6.8. Factors associated with the chance of getting were analyzed by binomial logistic regression analysis. The reliability of regression model was assessed using ROC analysis. Results. Only 491 responders (66.5%) who smoked and visited primary care facilities received advice on smoking cessation. Females were significantly less likely to receive counselling compared with males (Odds Ratio (OR) = 0.41; 95% Confidence Interval (CI) 0.27-0.60; p˂0.001), people aged 65+ compared with age group 35-44 (OR = 0.37; 95% CI 0.16-0.82; p = 0.014), working persons compared with pensioners (OR = 0.58; 95% CI 0.35-0.98; p = 0.041). Obesity (BMI = 30.0-34.9) significantly increased the chance of getting advice on smoking cessation compared with normal body mass (OR = 2.05; 95% CI 1.19-3.52; p = 0.010), as well as visits the GP (for visiting GP 1-2 times a year: OR = 1.66; 95% CI 1.12-2.46; p = 0.011; for visiting GP 3-4 times a year: OR = 3.35; 95% CI 1.76-6.36; p˂0.001; for visiting GP≥5 times a year: OR = 2.94; 95% CI 1.41-6.13; p = 0.004). Other types of contacts with healthcare system included in the analysis (visits to other specialists, hospitalizations, ambulance calls during previous 12 months) were not associated with the chance of getting advice on smoking quitting. The accuracy of the obtained regression model was 62.13 (p˂0.001). ROC analysis showed that the sensitivity of the model is 89.2%, specificity is 31.6%, the area under the ROC curve (AUC) is 0.710 ± 0.020 (95% CI 0.67-0.75) that corresponds to the good quality of the model. Conclusion. The healthcare system needs to be more proactive in conducting counseling on smoking cessation. Gender, age, BMI, visit to a GP were associated with receiving counseling on smoking cessation. More attention should be paid to women, elderly people and men with normal BMI. Other specialists except GPs also should pay attention to the patients smoking habits and give advice. Abstract Figure. ROC curve

scholarly journals Prevalence of risk factors for noncommunicable diseases in an indigenous community in Santiago Atitlán, Guatemala

2017 ◽  
Vol 41 ◽  
pp. 1 ◽  
Author(s):  
Max Luna ◽  
David Chen ◽  
Álvaro Rivera-Andrade ◽  
Jessica González ◽  
David Burt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Educational Interventions ◽  
Indigenous Community ◽  
Noncommunicable Disease ◽  
World Health ◽  
Noncommunicable Diseases ◽  
High Yield ◽  
Entire Group ◽  
Inverse Association ◽  
Cross Sectional

Objective. To describe the prevalence of noncommunicable disease (NCD) risk factors and assess knowledge of those risk factors in the indigenous community of Santiago Atitlán in Guatemala, a lower-middle income country. Methods. A population-based, cross-sectional study was conducted using a modified version of the World Health Organization’s STEPS protocol. Adults aged 20–65 years were surveyed regarding demographics and NCD risk factors, and the survey was followed by anthropometric and biochemical measurements. Results. Out of 501 screened individuals, 350 respondents were enrolled. The mean age was 36.7 years, and 72.3% were women. Over 90% reported earning less than US$ 65 per month. Almost 80% were stunted. Among women, 37.3% were obese and over three-quarters had central obesity. Over three-quarters of the entire group had dyslipidemia and 18.3% had hypertension, but only 3.0% had diabetes. Overall, 36.0% of participants met criteria for metabolic syndrome. There was no significant association between participants’ education and NCD risk factors except for an inverse association with obesity by percent body fat. Conclusions. Santiago Atitlán is a rural, indigenous Guatemalan community with high rates of poverty and stunting coexisting alongside high rates of obesity, particularly among women. Additionally, high rates of hypertension and dyslipidemia were found, but a low rate of diabetes mellitus. Knowledge of NCDs and their risk factors was low, suggesting that educational interventions may be a high-yield, low-cost approach to combating NCDs in this community.

scholarly journals Hypoxaemia prevalence and management among children and adults presenting to primary care facilities in Uganda: a prospective cohort study.

2021 ◽  
Author(s):  
Hamish R Graham ◽  
Yewande Kamuntu ◽  
Jasmine Miller ◽  
Anna Barrett ◽  
Blasio Kunihira ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Pulse Oximetry ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Oxygen Therapy ◽  
World Health ◽  
Blood Oxygen ◽  
Severe Hypoxaemia ◽  
Care Facilities

Introduction Hypoxaemia (low blood oxygen) is common among hospitalised patients, increasing risk of death five-fold and requiring prompt detection and treatment. However, we know little about hypoxaemia prevalence in primary care and the role for pulse oximetry and oxygen therapy. This study assessed the prevalence and management of hypoxaemia at primary care facilities in Uganda. Methods Prospective cohort study in 30 primary care facilities in Uganda, Feb-Apr 2021. Clinical data collectors assessed blood oxygen level (SpO2) of all acutely unwell children, adolescents, and adults, and followed up children aged under 15 years with SpO2<93% to determine subsequent care and outcome. Primary outcome: proportion of children under 5 years of age with severe hypoxaemia (SpO2<90%). Secondary outcomes: severe/moderate hypoxaemia (SpO2 90-93%) by age/sex/complaint. Results Among children U5, the prevalence of severe hypoxaemia was 1.3% (95% CI 0.9 to 2.1); an additional 4.9% (3.9 to 6.1) had moderate hypoxaemia. Performing pulse oximetry according to World Health Organization guidelines exclusively on children with respiratory complaints would have missed 14% (3/21) of severe hypoxaemia and 11% (6/55) of moderate hypoxaemia. Hypoxaemia prevalence was low among children 5-14 years (0.3% severe, 1.1% moderate) and adolescents/adults 15+ years (0.1% severe, 0.5% moderate). A minority (12/27, 44%) of severely hypoxaemic patients were referred; 3 (12%) received oxygen. Conclusion Hypoxaemia is common among acutely unwell children under five years of age presenting to Ugandan primary care facilities. Routine pulse oximetry has potential to improve referral, management and clinical outcomes. Effectiveness, acceptability, and feasibility of pulse oximetry and oxygen therapy for primary care should be investigated in implementation trials.

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