Implementing a package of noncommunicable disease interventions in the Republic of Moldova: two-year follow-up data

Collins, Dylan; Inglin, Laura; Laatikainen, Tiina; Ciobanu, Angela; Curocichin, Ghenadie; Șalaru, Virginia; Zatic, Tatiana; Anisei, Angela; Chiosa, Diana; Munteanu, Maria; Alexa, Zinaida; Farrington, Jill

doi:10.1017/s1463423620000420

Cited by 7 publications

(4 citation statements)

References 6 publications

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“…A final limitation, which is also common to other care cascade studies, is the presumption of a "treat-to-target" approach to hypertension management with the target set to controlling BP <140/90 mm Hg. Recent guidelines have defined hypertension at lower thresholds [29], aimed for BP control at lower levels [29,30], and advocated a "benefit-based" approach that involves offering hypertension therapy to patients at high CVD risk even if their BP is below the hypertension threshold [29,31,32]. This new approach is based on evidence that even someone with "normal" BP according to the thresholds used in this study could benefit from BP therapy that substantially reduces their elevated CVD risk.…”

Section: Plos Medicinementioning

confidence: 99%

Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study

et al. 2021

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Background Lack of nationwide evidence on awareness, treatment, and control (ATC) of hypertension among older adults in India impeded targeted management of this condition. We aimed to estimate rates of hypertension ATC in the older population and to assess differences in these rates across sociodemographic groups and states in India. Methods and findings We used a nationally representative survey of individuals aged 45 years and over and their spouses in all Indian states (except one) in 2017 to 2018. We identified hypertension by blood pressure (BP) measurement ≥140/90 mm Hg or self-reported diagnosis if also taking medication or observing salt/diet restriction to control BP. We distinguished those who (i) reported diagnosis (“aware”); (ii) reported taking medication or being under salt/diet restriction to control BP (“treated”); and (iii) had measured systolic BP <140 and diastolic BP <90 (“controlled”). We estimated age–sex adjusted hypertension prevalence and rates of ATC by consumption quintile, education, age, sex, urban–rural, caste, religion, marital status, living arrangement, employment status, health insurance, and state. We used concentration indices to measure socioeconomic inequalities and multivariable logistic regression to estimate fully adjusted differences in these outcomes. Study limitations included reliance on BP measurement on a single occasion, missing measurements of BP for some participants, and lack of data on nonadherence to medication. The 64,427 participants in the analysis sample had a median age of 57 years: 58% were female, and 70% were rural dwellers. We estimated hypertension prevalence to be 41.9% (95% CI 41.0 to 42.9). Among those with hypertension, we estimated that 54.4% (95% CI 53.1 to 55.7), 50.8% (95% CI 49.5 to 52.0), and 28.8% (95% CI 27.4 to 30.1) were aware, treated, and controlled, respectively. Across states, adjusted rates of ATC ranged from 27.5% (95% CI 22.2 to 32.8) to 75.9% (95% CI 70.8 to 81.1), from 23.8% (95% CI 17.6 to 30.1) to 74.9% (95% CI 69.8 to 79.9), and from 4.6% (95% CI 1.1 to 8.1) to 41.9% (95% CI 36.8 to 46.9), respectively. Age–sex adjusted rates were lower (p < 0.001) in poorer, less educated, and socially disadvantaged groups, as well as for males, rural residents, and the employed. Among individuals with hypertension, the richest fifth were 8.5 percentage points (pp) (95% CI 5.3 to 11.7; p < 0.001), 8.9 pp (95% CI 5.7 to 12.0; p < 0.001), and 7.1 pp (95% CI 4.2 to 10.1; p < 0.001) more likely to be aware, treated, and controlled, respectively, than the poorest fifth. Conclusions Hypertension prevalence was high, and ATC of the condition were low among older adults in India. Inequalities in these indicators pointed to opportunities to target hypertension management more effectively and equitably on socially disadvantaged groups.

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Section: Plos Medicinementioning

confidence: 99%

Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study

et al. 2021

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“… 88 Between 2016 and 2018, in the Republic of Moldova, adapting existing educational training resources for NCD (eg, WHO package of essential noncommunicable [PEN] disease) 89 and conducting focused clinical training in 20 sites was accompanied by sustained improvement in NCD risk factors in primary health care. 90 In Nepal, similar professional educational program had been implemented and the results on quality of care are awaited. 91 …”

Section: Implementation Science For Ncdsmentioning

confidence: 99%

Bridging the “Know-Do” Gaps in Five Non-Communicable Diseases Using a Common Framework Driven by Implementation Science

F¹,

Elborn²,

Lansberg³

et al. 2023

JHL

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According to the United Nations High-Level Meeting 2018, five non-communicable diseases (NCDs) including cardiovascular diseases, chronic respiratory diseases, diabetes mellitus, cancer, and mental health conditions accounted for two-thirds of global deaths. These five NCDs share five common risk factors including tobacco use, unhealthy diets, physical inactivity, alcohol use, and air pollution. Low- and middle-income countries (LMICs) face larger burden of NCDs than high-income countries (HICs), due to differences in ecological, technological, socioeconomic and health system development. Based on high-level evidence albeit mainly from HICs, the burden caused by NCDs can be reduced by affordable medicines and best practices. However, “know-do” gaps, ie, gaps between what we know in science and what we do in practice, has limited the impact of these strategies, especially in LMICs. Implementation science advocates the use of robust methodologies to evaluate sustainable solutions in health, education and social care aimed at informing practice and policies. In this article, physician researchers with expertise in NCDs reviewed the common challenges shared by these five NCDs with different clinical courses. They explained the principles of implementation science and advocated the use of an evidence-based framework to implement solutions focusing on early detection, prevention and empowerment, supplemented by best practices in HICs and LMICs. These successful stories can be used to motivate policymakers, payors, providers, patients and public to co-design frameworks and implement context-relevant, multi-component, evidence-based practices. In pursuit of this goal, we propose partnership, leadership, and access to continuing care as the three pillars in developing roadmaps for addressing the multiple needs during the journey of a person with or at risk of these five NCDs. By transforming the ecosystem, raising awareness and aligning context-relevant practices and policies with ongoing evaluation, it is possible to make healthcare accessible, affordable and sustainable to reduce the burden of these five NCDs.

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“…Tools (36) and simplified protocols (37) available for implementing this intervention in primary health care also identify individuals with previous heart attacks and strokes to ensure the continuation of drug treatment (secondary prevention). The total risk approach is being implemented in many LMICs (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51) and already included in the basic benefit packages in some universal health coverage initiatives (3).…”

Section: Reviewmentioning

confidence: 99%

Are low-and-middle-income countries using scarce resources effectively to tackle noncommunicable diseases in the pandemic era?

Mendis¹

2023

Asian J. Internal Med.

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The noncommunicable disease (NCD) burden continues to grow and is a major threat to socioeconomic development, particularly in low-and-middleincome countries. The COVID-19 pandemic has had a significant negative impact on the prevention and control of NCDs. Pre-existing challenges to the prevention and control of NCDs, including financial and health workforce limitations, have been further intensified by the COVIDpandemic. Despite these barriers, accelerating action to address NCDs is imperative to reduce premature mortality and escalating healthcare costs. In the post-pandemic context, a strong focus on cost and sustainability considerations is essential for making progress on reducing premature mortality by one-third by 2030: Sustainable Development Goal target 3.4. Low and middle income countries (LMIC) can succeed only by prioritizing the implementation and national scale-up of at least 16 very cost-effective NCD interventions. Among them are population-wide policy interventions which address tobacco, harmful use of alcohol, physical inactivity and unhealthy diet. The only health system intervention affordable to all LMICs embraces the total risk approach to tackle hypertension, diabetes, hypercholesterolemia, smoking and overweight in an integrated manner in a primary health care pathway. The burden of sustainability calls for the inclusion of best buy interventions as integral components of the basic benefits package of Universal Health Coverage initiatives.

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Implementing a package of noncommunicable disease interventions in the Republic of Moldova: two-year follow-up data

Cited by 7 publications

References 6 publications

Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study

Awareness, treatment, and control of hypertension in adults aged 45 years and over and their spouses in India: A nationally representative cross-sectional study

Bridging the “Know-Do” Gaps in Five Non-Communicable Diseases Using a Common Framework Driven by Implementation Science

Are low-and-middle-income countries using scarce resources effectively to tackle noncommunicable diseases in the pandemic era?

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