Abstractobjective To illustrate the method of cohort reporting of persons with diabetes mellitus (DM) in a primary healthcare clinic in Amman, Jordan, serving Palestine refugees with the aim of improving quality of DM care services.method A descriptive study using quarterly and cumulative case findings, as well as cumulative and 12-month analyses of cohort outcomes collected through E-Health in UNRWA Nuzha Primary Health Care Clinic.results There were 55 newly registered patients with DM in quarter 1, 2012, and a total of 2851 patients with DM ever registered on E-Health because this was established in 2009. By 31 March 2012, 70% of 2851 patients were alive in care, 18% had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical care: measurement of blood pressure, annual assessments for foot care and blood tests for glucose, cholesterol and renal function. 10-20% of patients with DM in the different cohorts had serious late complications such as blindness, stroke, cardiovascular disease and amputations.conclusion Cohort analysis provides data about incidence and prevalence of DM at the clinic level, clinical management performance and prevalence of serious morbidity. It needs to be more widely applied for the monitoring and management of non-communicable chronic diseases.

Abstractobjective Recording and reporting systems borrowed from the DOTS framework for tuberculosis control can be used to record, monitor and report on chronic disease. In a primary healthcare clinic run by UNRWA in Amman, Jordan, serving Palestine refugees with hypertension, we set out to illustrate the method of cohort reporting for persons with hypertension by presenting on quarterly and cumulative case finding, cumulative and 12-month analysis of cohort outcomes and to assess how these data may inform and improve the quality of hypertension care services.method This was a descriptive study using routine programme data collected through E-Health. results There were 97 newly registered patients with hypertension in quarter 1, 2012, and a total of 4130 patients with hypertension ever registered since E-Health started in October 2009. By 31 March 2012, 3119 (76%) of 4130 patients were retained in care, 878 (21%) had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical performance related to blood pressure measurements and fasting blood glucose tests to screen simultaneously for diabetes. Between 8% and 15% of patients with HT had serious complications such as cardiovascular disease and stroke.conclusion Cohort analysis is a valuable tool for the monitoring and management of noncommunicable chronic diseases such as HT.

decision was made to improve the practice and recording of routine clinic measurements and to expand the use of cohort analysis to other PHC clinics that already had e-Health.The aim of the present study was to use the principle of cohort analysis to report on the burden of DM and treatment outcomes of patients with DM registered at six PHC clinics in Jordan. Specific objectives were to report on 1) the number and characteristics of new patients with DM registered in the second quarter (Q2) of 2013 and of all patients with DM ever registered up to the end of June 2013; and 2) the treatment outcomes of patients ever registered up to the end of June 2013, along with measures of disease control and cumulative burden of disease-related complications, stratified by sex. METHODS Study designThis was a descriptive study of a quarterly and cumulative cohort of patients monitored using an e-Health record system. SettingThe study was conducted in six PHC clinics in Jordan, a country of 6 million inhabitants that also houses 2 million registered Palestine refugees, of whom 17% live in 10 official camps. UNRWA has 24 PHC clinics in Jordan, and in 2012 served a population of 1 175 021 refugees. The six PHC clinics (Nuzha, Taybeh, Marka, South Baqaa, Baqaa and Suf) situated in or near Amman, the capital city, served 302 539 (26%) refugees in 2012. Each clinic is staffed by up to four doctors and a variable number of nurses; all services are provided free of charge. Persons with diabetes mellitus and their managementPalestine refugees who attend the clinic are screened annually for DM and 6-monthly for hypertension if they are aged ⩾40 years, at risk of non-communicable diseases (NCDs) or are pre-conception or pregnant women. DM screening is performed by measuring random blood glucose on attendance at the clinic; if it is ⩾126 mg/dl (⩾7.0 mmol/l), then two fasting blood glucose (FBG) measurements are performed within a week, both of which must be ⩾126 mg/dl for diagnostic confirmation of DM. 3,4 Those with FBG between 100 and 125 mg/dl (6.0-6.9 mmol/l) are further screened for DM using an oral glucose tolerance test. 5 50% and 47%, respectively. In Q2 2013, 9740 (78%) patients attended a clinic, with >99% having undergone disease control measures: of these, 72% had postprandial blood glucose ⩽ 180 mg/dl, 71% had blood cholesterol < 200 mg/dl, 82% had blood pressure < 140/90 and 40% had body mass index < 30 kg/m 2 . Late-stage complications were present in 1130 (11.6%) patients who attended a clinic, with cardiovascular disease and stroke being the most common. Several differences in outcomes were found between males and females. International Union Against Tuberculosis and Lung Disease Conclusion:There is a high burden of disease due to DM at primary health care clinics in Jordan. Cohort analysis using e-Health is a vital way to assess management and follow-up.

Abstractobjective The aim of this study was to use E-Health to report on 12-month, 24-month and 36-month outcomes and late-stage complications of a cohort of Palestine refugees with diabetes mellitus (DM) registered in the second quarter of 2010 in a primary healthcare clinic in Amman, Jordan.method Retrospective cohort study with treatment outcomes censored at 12-month time points using E-Health in UNRWA's Nuzha Primary Health Care Clinic.results Of 119 newly registered DM patients, 61% were female, 90% were aged ≥40 years, 92% had type 2 DM with 73% of those having hypertension and one-third of patients were newly diagnosed. In the first 3 years of follow-up, the proportion of clinic attendees decreased from 72% to 64% and then to 61%; the proportion lost to-follow-up increased from 9% to 19% and then to 29%. At the three time points of follow-up, 71-78% had blood glucose ≤180 mg/dl; 63-74% had cholesterol <200 mg/dl; and about 90% had blood pressure <140/90 mmHg. Obesity remained constant at 50%. The proportion of patients with late-stage complications increased from 1% at baseline to 7% at 1 year, 14% at 2 years and 15% at 3 years.conclusion Nuzha PHC Clinic was able to monitor a cohort of DM patients for 3 years using E-Health and the principles of cohort analysis. This further endorses the use of cohort analysis for managing patients with DM and other non-communicable diseases.

Abstractobjective In six United Nations Relief and Works Agency (UNRWA) primary health care clinics in Jordan serving Palestine refugees diagnosed with hypertension, to determine the number, characteristics, programme outcomes and measures of disease control for those registered up to 30 June, 2013, and in those who attended clinic in the second quarter of 2013, the prevalence of disease-related complications between those with hypertension only and hypertension combined with diabetes mellitus.method Retrospective cohort study with programme and outcome data collected and analysed using E-Health.results There were 18 881 patients registered with hypertension with females (64%) and persons aged ≥40 years (87%) predominating. At baseline, cigarette smoking was recorded in 17%, physical inactivity in 48% and obesity in 71% of patients. 77% of all registered patients attended clinic in the second quarter of 2013; of these, 50% had hypertension and diabetes and 50% had hypertension alone; 9% did not attend the clinics and 10% were lost to follow-up. Amongst those attending clinic, 92% had their blood pressure measured, of whom 83% had blood pressure <140/90 mm Hg. There were significantly more patients with hypertension and diabetes (N = 966, 13%) who had diseaserelated complications than patients who had hypertension alone (N = 472, 6%) [OR 2.2, 95% CI 2.0-2.5], and these differences were found for both males [18% vs. 10%, OR 1.9, 95% CI 1.6-2.2] and females [11% vs. 5%, OR 2.4, 95% CI 2.1-2.9].conclusion Large numbers of Palestine refugees are being registered and treated for hypertension in UNRWA primary health care clinics in Jordan. Cohort analysis and E-Health can be used to regularly assess caseload, programme outcomes, clinic performance, blood pressure control and cumulative prevalence of disease-related complications. Current challenges include the need to increase clinic attendance and attain better control of blood pressure.