Early detection and management of major non-communicable diseases in urban primary healthcare facilities in Ethiopia: a study protocol for a type-3 hybrid implementation-effectiveness design

Abstract

IntroductionIntegrating early detection and management of non-communicable diseases in primary healthcare has an unprecedented role in making healthcare more accessible particularly in low- and middle-income countries such as Ethiopia. This study aims to design, implement and evaluate an evidence-based intervention guided by the HEARTS technical package and implementation guide to address barriers and facilitators of integrating early detection and management of hypertension, diabetes mellitus and cardiovascular diseases in primary healthcare settings of Addis Ababa.MethodologyWe will employ a type-3 hybrid implementation-effectiveness study from November 2020 to May 2022. This study will target patients ≥40 years of age. Ten health centres will be randomly selected from each subcity of Addis Ababa. The study will have four phases: (1) Baseline situational analysis (PEN facility-capacity assessment, 150 observations of patient healthcare provider interactions and 697 patient medical record reviews), (2) Consolidated Framework for Implementation Research (CFIR) inspired qualitative assessment of barriers and facilitators (20 in-depth interviews of key stakeholders), (3) Design of intervention protocol. The intervention will have capacity enhancement components including training of non-communicabledisease (NCDservice providers, provision of essential equipment/supporting materials and monthly monitoring and feedback and (4) Implementation monitoring and evaluation phase using the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework. Outcomes on early detection and management of NCDs will be assessed to examine the effectiveness of the study.Ethics and dissemination planEthical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board and Addis Ababa Health Bureau. We plan to present the findings from this research in conferences and publish them in peer-reviewed journals.

Non-communicable Diseases Week: Best Practices in Addressing the NCDs Burden from Tanzania

“…Integrating NCD screening during the annual NCDs week was shown to be feasible and can increase the enrolment of previously unidentified patients into available health services. As reported elsewhere, promoting early detection and early enrolment into treatment is vital in preventing fatal complications [10,11]. Furthermore, preventive measures are known to be more cost-effective and reduce the cost of health financing for NCDs to individuals and the health system [12].…”

Pengendalian Penyakit Tidak Menular Melalui Promosi dan Deteksi Dini

“…Faktor risiko yang dapat dimodifikasi meliputi tekanan darah tinggi, merokok, diabetes mellitus, aktivitas fisik, obesitas, dan kolesterol darah tinggi, sedangkan faktor risiko yang tidak dapat dimodifikasi meliputi usia, jenis kelamin, faktor genetik, ras, dan etnis (IDF, 2015; Imamura F, O'Connor L, Ye Z, Mursu J, Hayashino Y, Bhupathiraju SN, et al, 2015). Faktor resiko tersebut di ataslah yang menjadi titik prioritas dalam proses pengendalian dalam manajemen PTM Manajemen PTM merupakan tantangan terutama di negara berpenghasilan rendah dan menengah karena beban ganda penyakit menular dan tidak menular, kekurangan sumber daya manusia dan material dan lainnya persaingan prioritas ekonomi di negara-negara tersebut (Yifter H, Omer A, Gugsa S, et al 2021.). Oleh karena itu sesuai dengan Undang-Undang Kesehatan Nomor 36 tahun 2009, pengendalian PTM diselenggarakan melalui promosi, deteksi dini, pengobatan, dan rehabilitasi dengan menyesuaikan kondisi yang ada di masyarakat sehingga penaganan PTM menjadi lebih komprehensif.…”

Barriers and enablers to improving integrated primary healthcare for non-communicable diseases and mental health conditions in Ethiopia: a mixed methods study

“…Reliance on vertical programmes or centralised models of specialist care has resulted in high treatment gaps for both NCDs [ 7 ] and MHCs [ 8 ] and a fragmented and inadequate response to co-morbidity or multi-morbidity [ 9 ]. In response, it has been recommended to integrate care for people with NCDs and MHCs into service packages delivered within PHC [ 10 , 11 ].…”