Caseload, management and treatment outcomes of patients with hypertension and/or diabetes mellitus in a primary health care programme in an informal setting

Abstract

Abstractobjective In three primary health care clinics run by M edecins Sans Fronti eres in the informal settlement of Kibera, Nairobi, Kenya, we describe the caseload, management and treatment outcomes of patients with hypertension (HT) and/or diabetes mellitus (DM) receiving care from January 2010 to June 2012.method Descriptive study using prospectively collected routine programme data. results Overall, 1465 patients were registered in three clinics during the study period, of whom 87% were hypertensive only and 13% had DM with or without HT. Patients were predominantly female (71%) and the median age was 48 years. On admission, 24% of the patients were obese, with a body mass index (BMI) > 30 kg/m 2 . Overall, 55% of non-diabetic hypertensive patients reached their blood pressure (BP) target at 24 months. Only 28% of diabetic patients reached their BP target at 24 months. For non-diabetic patients, there was a significant decrease in BP between first consultation and 3 months of treatment, maintained over the 18-month period. Only 20% of diabetic patients with or without hypertension achieved glycaemic control. By the end of the study period, 1003 (68%) patients were alive and in care, one (<1%) had died, eight (0.5%) had transferred out and 453 (31%) were lost to follow-up.conclusion Good management of HT and DM can be achieved in a primary care setting within an informal settlement. This model of intervention appears feasible to address the growing burden of non-communicable diseases in developing countries.keywords hypertension, diabetes mellitus, primary health care, Kenya, medical management, operational research

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

“…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 Médecins Sans Frontières (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'.…”

“…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 Médecins Sans Frontières (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.…”

“…Managing and monitoring chronic non-communicable diseases in a primary health care clinic, Lilongwe, Malawi R. C. Manjomo, 1 B. Mwagomba, 2 S. Ade, 3,4 E. Ali, 5 A. Ben-Smith, 6 P. Khomani, 1 P. Bondwe, 1 D. Nkhoma, 1 G. P. Douglas, 7 K. Tayler-Smith, 5 L. Chikosi, 8 A. D. Harries,3,9 O. J. Gadabu 1 C hronic 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.…”

Non-communicable diseases in the Western Area District, Sierra Leone, before and during the Ebola outbreak

“…7,8 As PUD requires endoscopy for a definitive diagnosis, which is not possible at most health-care levels …”

“…7,8 In Sierra Leone, NCDs are also generally managed at tertiary and secondary level hospitals. Peripheral health units (PHUs), however, have increasingly begun to take on this workload with established referral mechanisms to ensure that patients with selected NCDs (e.g., diabetes, epilepsy) or severe complications from hypertension or peptic ulcer disease can be referred from primary health care level to secondary or tertiary care facilities.…”