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Addressing Non-Communicable Diseases in Primary Healthcare in Kyrgyzstan: A Study on Population' Knowledge and Behavioral Changes.

ABSTRACT: Objective: Non-communicable diseases (NCDs) in Kyrgyzstan are responsible for 83% of all deaths. This study aimed to assess the effectiveness of WHO "Package of Essential Interventions on NCDs" (PEN) on health education and counselling at primary healthcare in Kyrgyzstan. Methods: Interventions consisted of information diffusion in primary care facilities and in communities by trained volunteers. The study aimed to assess the evolution of population's knowledge and behaviour through a questionnaire applying a quasi-experimental approach. The sample size was 2,000 at baseline and after 4 years in intervention and control oblasts. Results: Population's knowledge and behaviour improved in intervention areas compared to control areas. Knowledge on NCD-related risks increased from 61% to 87%. Behaviour improved with physical activity increasing from 23% to 32%; smokers reduced from 22% to 20%; alcohol consumption reduced from 23% to 16%; daily walking (minimum 30') improved from 40% to 71%. Conclusion: This study suggests that the PEN-protocol is effective in improving healthy behaviour, thus potentially contributing to prevent NCDs. This example from Kyrgyzstan provides a practical example for promoting PEN-protocol adaptation in other countries.

SUBMITTER: Muratalieva E

PROVIDER: S-EPMC10353050 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Addressing Non-Communicable Diseases in Primary Healthcare in Kyrgyzstan: A Study on Population' Knowledge and Behavioral Changes.

Muratalieva Elvira E Ablezova Mehrigiul M Djamangulova Tolkun T Hoffarth Tobias T Kissimova-Skarbek Katarzyna K Graeser Silke S Nendaz Mathieu M Beran David D

International journal of public health 20230704

<b>Objective:</b> Non-communicable diseases (NCDs) in Kyrgyzstan are responsible for 83% of all deaths. This study aimed to assess the effectiveness of WHO "Package of Essential Interventions on NCDs" (PEN) on health education and counselling at primary healthcare in Kyrgyzstan. <b>Methods:</b> Interventions consisted of information diffusion in primary care facilities and in communities by trained volunteers. The study aimed to assess the evolution of population's knowledge and behaviour throug ...[more]

PMID: 37469755

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Project description:Background Community-based Healthcare Interventions (CBHIs) are regarded as a critical component of healthcare task-sharing in LMICs and have the potential to address LMICs’ health system weaknesses to improve NCDs prevention care. This study aims to investigate the relationship between participation in CBHIs and NCDs early detection at medical facilities among Indonesians. Methods Data come from the fifth Indonesian Family Life Survey (2014–2015), a total of 27,692 individuals (14,820 female and 12,872 male individuals age 15 and older). Multiple ordered logistics and logistics regression was used to assess the association between individual participation in CBHI and early detection of NCDs at medical facilities. Findings Participation in CBHIs are associated with higher odds of having regular blood pressure test (adjusted odds ratio [OR], 3.09; 95% confidence interval [CI], 2.67–3.58), cholesterol test (adjusted OR, 1.88; 95% CI, 1.60–2.22), blood glucose test (adjusted OR, 1.88; 95% CI, 1.58–2.23), electrocardiogram (adjusted OR, 1.37; 95% CI, 1.06–1.76) and basic dental examination (adjusted OR, 1.32; 95% CI, 1.09–1.60) at medical facilities. The odds of having pap smears (adjusted OR, 2.20; 95% CI, 1.62–2.98) and breast self-examination (adjusted OR, 1.73; 95% CI, 1.37–2.19) among females who participated in CBHIs are substantially larger than those who did not participate in CBHIs. No significant association is shown for the basic vision examination (adjusted OR, 1.14; 95% CI, 0.95–1.37), while the association of participation in CBHIs on prostate cancer checkup (adjusted OR, 0.18; 95% CI, 0.04–0.76) was negative and significant. The results were controlled with a wide range of predisposing, enabling and need factors for NCDs early detection. Conclusion and recommendation: CBHIs may benefit NCDs early detection for the general population in Indonesia. Policymakers and health practitioners need to design CBHIs programs that are attractive to the population, especially men and younger people. Highlights • CBHIs are a distinct mode of healthcare delivery and are regarded as a critical component of healthcare task-sharing in LMICs.• CBHIs have the potential to address LMICs' health system weaknesses to improve NCDs prevention care.• Participation in CBHIs are associated with regular blood pressure, cholesterol, blood glucose, electrocardiogram, and dental tests.

Project description:IntroductionThe burden of non-communicable diseases (NCDs) is rapidly increasing in Bangladesh. Currently, it contributes to 67% of annual deaths, and accounts for approximately 64% of the disease burden. Since 70% of the Bangladeshi population residing in the rural area rely on the primary healthcare system, assessment of its capacity is crucial for guiding public health decisions to prevent and manage NCDs. This protocol is designed to recognise and assess the Bangladeshi health system's readiness for NCDs at the primary level.Methods and analysisThe study will use a mixed-method design. Numerical data will be collected using households and health facilities surveys, while qualitative data will be collected by interviewing healthcare providers, policy planners, health administrators and community members. The WHO's Service Availability and Readiness Assessment (SARA) methodology and Package of Essential Non-communicable (PEN) Disease Interventions for Primary Healthcare reference manuals will be used to assess the readiness of the primary healthcare facilities for NCD services. Furthermore, Health System Dynamics Framework will be used to examine health system factors. Using the supportive items outlined in the WHO PEN package, and indicators proposed in WHO SARA methodology, a composite score will be created to analyse facility-level data. Two independent samples t-test, analysis of variance and χ2 test methods will be used for bivariate analysis, and multiple regression analysis will be used for multivariable analysis. Complementarily, the thematic analysis approach will be used to analyse qualitative data.Ethics and disseminationThe project has been approved by the Monash University Human Research Ethics Committee (Project ID: 27112), and Bangladesh Medical Research Council (Ref: BMRC/NREC/2019-2022/270). The research findings will be shared through research articles, conference proceedings or in other scientific media. The reports or publications will not have any information that can be used to identify any of the study participants.

Project description:IntroductionThe weak health system is viewed as a major systematic obstacle to address the rising burden of non-communicable diseases (NCDs) in resource-poor settings. There is little information about the health system challenges and opportunities in organizing NCD services. This study examined the health system challenges and opportunities in organizing NCD services for four major NCDs (cervical cancer, diabetes mellitus, cardiovascular diseases, and chronic respiratory illnesses) at the primary healthcare (PHC) level in Bangladesh.MethodsUsing a qualitative method, data were collected from May to October 2021 by conducting 15 in-depth interviews with local healthcare providers, 14 key informant interviews with facility-based providers and managers, and 16 focus group discussions with community members. Based on a health system dynamics framework, data were analyzed thematically. Information gathered through the methods and sources was triangulated to validate the data.ResultsOrganization of NCD services at the PHC level was influenced by a wide range of health system factors, including the lack of using standard treatment guidelines and protocols, under-regulated informal and profit-based private healthcare sectors, poor health information system and record-keeping, and poor coordination across healthcare providers and platforms. Furthermore, the lack of functional referral services; inadequate medicine, diagnostic facilities, and logistics supply; and a large number of untrained human resources emerged as key weaknesses that affected the organization of NCD services. The availability of NCD-related policy documents, the vast network of healthcare infrastructure and frontline staff, and increased demand for NCD services were identified as the major opportunities.ConclusionDespite the substantial potential, the health system challenge impeded the organization of NCD services delivery at the PHC level. This weakness needs be to addressed to organize quality NCD services to better respond to the rising burden of NCDs at the PHC level.

Project description:OBJECTIVE:Identify, describe and appraise trials of interventions delivered by healthcare professionals to manage non-communicable diseases (NCDs) and communicable diseases that require long-term care or treatment (LT-CDs), excluding mental health and substance use disorders, in homeless adults. DESIGN:Systematic review of randomised controlled trials (RCTs), non-RCTs and controlled before-after studies. Interventions characterised using Effective Practice and Organisation of Care (EPOC) taxonomy. Quality assessed using EPOC risk of bias criteria. DATA SOURCES:Database searches (MEDLINE, Embase, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Cochrane Central Register of Controlled Trials), hand searching reference lists, citation searches, grey literature and contact with study authors. SETTING:Community. PARTICIPANTS:Adults (≥18 years) fulfilling European Typology of Homelessness criteria. INTERVENTION:Delivered by healthcare professionals managing NCD and LT-CDs. OUTCOMES:Primary outcome: unscheduled healthcare utilisation. SECONDARY OUTCOMES:mortality, biological markers of disease control, adherence to treatment, engagement in care, patient satisfaction, knowledge, self-efficacy, quality of life and cost-effectiveness. RESULTS:11 studies were included (8 RCTs, 2 quasi-experimental and 1 feasibility) involving 9-520 participants (67%-94% male, median age 37-49 years). Ten from USA and one from UK. Studies included various NCDs (n=3); or focused on latent tuberculosis (n=4); HIV (n=2); hepatitis C (n=1) or type 2 diabetes (n=1). All interventions were complex with multiple components. Four described theories underpinning intervention. Three assessed unscheduled healthcare utilisation: none showed consistent reduction in hospitalisation or emergency department attendance. Six assessed adherence to specific treatments, of which four showed improved adherence to latent tuberculosis therapy. Three concerned education case management, all of which improved disease-specific knowledge. No improvements in biological markers of disease (two studies) and none assessed mortality. CONCLUSIONS:Evidence for management of NCD and LT-CDs in homeless adults is sparse. Educational case-management interventions may improve knowledge and medication adherence. Large trials of theory-based interventions are needed, assessing healthcare utilisation and outcomes as well as assessment of biological outcomes and cost-effectiveness.

Dataset Information

Addressing Non-Communicable Diseases in Primary Healthcare in Kyrgyzstan: A Study on Population' Knowledge and Behavioral Changes.

Publications

Addressing Non-Communicable Diseases in Primary Healthcare in Kyrgyzstan: A Study on Population' Knowledge and Behavioral Changes.

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