Package of essential noncommunicable disease (PEN) interventions in primary health-care settings of Bhutan: a performance assessment study.
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Date
2014-04
Journal Title
Journal ISSN
Volume Title
Publisher
WHO Regional Office for South-East Asia
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.
Description
Keywords
Bhutan, intervention, noncommunicable diseases, primary health care
Citation
WHO South-East Asia Journal of Public Health 2014;3(2): 154-160.