Dukpa Wangchuk1, Navkiran Kaur Virdi2, Renu Garg3, Shanthi Mendis4, Nani Nair5, Dorji Wangchuk6, Rajesh Kumar2. 1. Division of Noncommunicable Diseases, Department of Public Health, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan. 2. School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 3. World Health Organization, Regional Office for South-East Asia, New Delhi, India. 4. World Health Organization (WHO) headquarters, Geneva, Switzerland. 5. WHO Representative, Bhutan. 6. Director General Health Services, Bhutan.
Abstract
BACKGROUND: A World Health Organization (WHO) package of essential noncommunicable (PEN) disease interventions was piloted in two districts of Bhutan by non-physician health workers. They conducted risk assessment among patients aged over 40 years who visited the outpatient department of health institutions. Blood glucose was also measured among those who were overweight/ obese (body mass index ≥23 kg/m2) or had a high waist circumference (>80 cm in women and >90 cm in men). Appropriate counselling, treatment and referral were provided to the patients. The performance of the PEN project in detecting and managing noncommunicable diseases (NCDs) and their risk factors was assessed. METHODS: All health institutions of Paro (one district hospital and three basic health units [BHUs]) and Bumthang districts (one district hospital and four BHUs), were included in the PEN pilot assessment study. All patients who had presented to the clinics in the pilot districts from 1 June to 31 August 2012 constituted the study population. The data were collected from the clinical form, supervisor's report and monthly report of the PEN project. The characteristics of patients with an NCD at registration and at the third follow-up visit were compared in a before-after analysis. Absolute changes in the characteristics of patients were computed for those who had completed the required followups during a 3-month assessment period. RESULTS: In a 3-month period, 39 079 patients had attended clinics in the pilot districts. About 10% of the clinic attendees (3818/39 079) were aged over 40 years; of these, 22.6% (864/3818) had a high blood pressure, and 49.7% (1896/3818) were overweight/obese or had a high waist circumference. Screening of overweight/ obese/high waist circumference cases revealed that 26.1% (494/1896) had high blood sugar levels. Out of the 896 patients who were registered on PEN protocols, 13% had >20% risk of developing cardiovascular diseases (CVDs) in next 10 years as per the WHO/International Society of Hypertension risk-assessment charts. Among 444 who had three follow-up visits, high 10-year-CVD risk (>20%) had declined from 13% to 7.3%. Among 400 persons with hypertension, use of medication increased and high blood pressure declined from 42.3% to 21.5%. Among 115 persons with diabetes, use of anti-diabetes medication increased and high blood sugar declined from 68/100 to 51/100. CONCLUSION: Implementation of the PEN intervention in the primary health-care setting of Bhutan led to improvement in blood pressure and diabetes control, and reduction in CVD risk.
BACKGROUND: A World Health Organization (WHO) package of essential noncommunicable (PEN) disease interventions was piloted in two districts of Bhutan by non-physician health workers. They conducted risk assessment among patients aged over 40 years who visited the outpatient department of health institutions. Blood glucose was also measured among those who were overweight/ obese (body mass index ≥23 kg/m2) or had a high waist circumference (>80 cm in women and >90 cm in men). Appropriate counselling, treatment and referral were provided to the patients. The performance of the PEN project in detecting and managing noncommunicable diseases (NCDs) and their risk factors was assessed. METHODS: All health institutions of Paro (one district hospital and three basic health units [BHUs]) and Bumthang districts (one district hospital and four BHUs), were included in the PEN pilot assessment study. All patients who had presented to the clinics in the pilot districts from 1 June to 31 August 2012 constituted the study population. The data were collected from the clinical form, supervisor's report and monthly report of the PEN project. The characteristics of patients with an NCD at registration and at the third follow-up visit were compared in a before-after analysis. Absolute changes in the characteristics of patients were computed for those who had completed the required followups during a 3-month assessment period. RESULTS: In a 3-month period, 39 079 patients had attended clinics in the pilot districts. About 10% of the clinic attendees (3818/39 079) were aged over 40 years; of these, 22.6% (864/3818) had a high blood pressure, and 49.7% (1896/3818) were overweight/obese or had a high waist circumference. Screening of overweight/ obese/high waist circumference cases revealed that 26.1% (494/1896) had high blood sugar levels. Out of the 896 patients who were registered on PEN protocols, 13% had >20% risk of developing cardiovascular diseases (CVDs) in next 10 years as per the WHO/International Society of Hypertension risk-assessment charts. Among 444 who had three follow-up visits, high 10-year-CVD risk (>20%) had declined from 13% to 7.3%. Among 400 persons with hypertension, use of medication increased and high blood pressure declined from 42.3% to 21.5%. Among 115 persons with diabetes, use of anti-diabetes medication increased and high blood sugar declined from 68/100 to 51/100. CONCLUSION: Implementation of the PEN intervention in the primary health-care setting of Bhutan led to improvement in blood pressure and diabetes control, and reduction in CVD risk.
Authors: David Peiris; Arpita Ghosh; Jennifer Manne-Goehler; Lindsay M Jaacks; Michaela Theilmann; Maja E Marcus; Zhaxybay Zhumadilov; Lindiwe Tsabedze; Adil Supiyev; Bahendeka K Silver; Abla M Sibai; Bolormaa Norov; Mary T Mayige; Joao S Martins; Nuno Lunet; Demetre Labadarios; Jutta M A Jorgensen; Corine Houehanou; David Guwatudde; Mongal S Gurung; Albertino Damasceno; Krishna K Aryal; Glennis Andall-Brereton; Kokou Agoudavi; Briar McKenzie; Jacqui Webster; Rifat Atun; Till Bärnighausen; Sebastian Vollmer; Justine I Davies; Pascal Geldsetzer Journal: PLoS Med Date: 2021-03-04 Impact factor: 11.069