Early Experiences in the Integration of Noncommunicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo

Background: Health services in humanitarian crises increasingly integrate the management of non-communicable diseases into primary care. As there is little description of such programs, this case study aims to describe the initial implementation of non-communicable disease management within emergenc...

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Autores principales:	Ruwan Ratnayake, Alison Wittcoff, John Majaribu, Jean-Pierre Nzweve, Lambert Katembo, Kambale Kasonia, Adelard Kalima Nzanzu, Lillian Kiapi, Pascal Ngoy
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2021
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/f06c4597d666463c80f5e74049f28614
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spelling	oai:doaj.org-article:f06c4597d666463c80f5e74049f286142021-12-02T17:31:27ZEarly Experiences in the Integration of Noncommunicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo2214-999610.5334/aogh.3019https://doaj.org/article/f06c4597d666463c80f5e74049f286142021-03-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/3019https://doaj.org/toc/2214-9996Background: Health services in humanitarian crises increasingly integrate the management of non-communicable diseases into primary care. As there is little description of such programs, this case study aims to describe the initial implementation of non-communicable disease management within emergency primary care in the conflict-affected Beni Region of Democratic Republic of the Congo (DRC). Objectives: We implemented and evaluated a primary care approach to hypertension and diabetes management to assess the feasibility of patient monitoring, early clinical and programmatic outcomes, and costs, after seven months of care. Methods: We designed clinical and programmatic modules for diabetes and hypertension management for clinical officers and the use of patient cards and community health workers to improve adherence. We used cohort analysis (April to October 2018), time-trend analysis, semi-structured interviews, and costing to evaluate the program. Findings: Increases in consultations for hypertension (incidence rate ratio [IRR] 13.5, 95% CI 5.8.31.5, 'p' < 0.00) and diabetes (IRR 3.6, 95% CI 1.12.9, 'p' < 0.05) were demonstrated up to the onset of violence and an Ebola epidemic in August 2018. Of 833 patients, 67% were women of median age 56. Nearly all were hypertensives (88.7%) and newly diagnosed (95.9%). Treatment adherence, defined as attending .2 visits in the seven month period, was demonstrated by 45.4% of hypertension patients. Community health workers had contact with 3.2.3.8 patients per month. Respondents stated that diabetes care remained fragmented with insulin and laboratory testing located outside of primary care. Program and management costs were 115 USD per person per treatment course. Conclusions: In an active conflict setting, we demonstrated that non-communicable disease care can be well-organized through clinical training and cohort analysis, and adherence can be addressed using patient-held cards and monitoring by community health workers. Nearly all diagnoses were new, emphasizing the need to establish self-management. Insecurity reduced access for patients but care continued for a subset of patients during the Ebola epidemic.Ruwan RatnayakeAlison WittcoffJohn MajaribuJean-Pierre NzweveLambert KatemboKambale KasoniaAdelard Kalima NzanzuLillian KiapiPascal NgoyUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 87, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Ruwan Ratnayake Alison Wittcoff John Majaribu Jean-Pierre Nzweve Lambert Katembo Kambale Kasonia Adelard Kalima Nzanzu Lillian Kiapi Pascal Ngoy Early Experiences in the Integration of Noncommunicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo
description	Background: Health services in humanitarian crises increasingly integrate the management of non-communicable diseases into primary care. As there is little description of such programs, this case study aims to describe the initial implementation of non-communicable disease management within emergency primary care in the conflict-affected Beni Region of Democratic Republic of the Congo (DRC). Objectives: We implemented and evaluated a primary care approach to hypertension and diabetes management to assess the feasibility of patient monitoring, early clinical and programmatic outcomes, and costs, after seven months of care. Methods: We designed clinical and programmatic modules for diabetes and hypertension management for clinical officers and the use of patient cards and community health workers to improve adherence. We used cohort analysis (April to October 2018), time-trend analysis, semi-structured interviews, and costing to evaluate the program. Findings: Increases in consultations for hypertension (incidence rate ratio [IRR] 13.5, 95% CI 5.8.31.5, 'p' < 0.00) and diabetes (IRR 3.6, 95% CI 1.12.9, 'p' < 0.05) were demonstrated up to the onset of violence and an Ebola epidemic in August 2018. Of 833 patients, 67% were women of median age 56. Nearly all were hypertensives (88.7%) and newly diagnosed (95.9%). Treatment adherence, defined as attending .2 visits in the seven month period, was demonstrated by 45.4% of hypertension patients. Community health workers had contact with 3.2.3.8 patients per month. Respondents stated that diabetes care remained fragmented with insulin and laboratory testing located outside of primary care. Program and management costs were 115 USD per person per treatment course. Conclusions: In an active conflict setting, we demonstrated that non-communicable disease care can be well-organized through clinical training and cohort analysis, and adherence can be addressed using patient-held cards and monitoring by community health workers. Nearly all diagnoses were new, emphasizing the need to establish self-management. Insecurity reduced access for patients but care continued for a subset of patients during the Ebola epidemic.
format	article
author	Ruwan Ratnayake Alison Wittcoff John Majaribu Jean-Pierre Nzweve Lambert Katembo Kambale Kasonia Adelard Kalima Nzanzu Lillian Kiapi Pascal Ngoy
author_facet	Ruwan Ratnayake Alison Wittcoff John Majaribu Jean-Pierre Nzweve Lambert Katembo Kambale Kasonia Adelard Kalima Nzanzu Lillian Kiapi Pascal Ngoy
author_sort	Ruwan Ratnayake
title	Early Experiences in the Integration of Noncommunicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo
title_short	Early Experiences in the Integration of Noncommunicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo
title_full	Early Experiences in the Integration of Noncommunicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo
title_fullStr	Early Experiences in the Integration of Noncommunicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo
title_full_unstemmed	Early Experiences in the Integration of Noncommunicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo
title_sort	early experiences in the integration of noncommunicable diseases into emergency primary health care, beni region, democratic republic of the congo
publisher	Ubiquity Press
publishDate	2021
url	https://doaj.org/article/f06c4597d666463c80f5e74049f28614
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Early Experiences in the Integration of Noncommunicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo

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