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Adler AJ, Wroe EB, Atzori A, Bay N, Bekele W, Bhambhani VM, Nkwiro RB, Boudreaux C, Calixte D, Chiwanda Banda J, Coates MM, Dagnaw WW, Domingues K, Drown L, Dusabeyezu S, Fenelon D, Gupta N, Ssinabulya I, Jain Y, Kalkonde Y, Kamali I, Karekezi C, Karmacharya BM, Koirala B, Makani J, Manenti F, Mangwiro A, Manuel B, Masiye JK, Goma FM, Mayige MT, McLaughlin A, Mensah E, Salipa NM, Mutagaywa R, Mutengerere A, Ngoga G, Patiño M, Putoto G, Ruderman T, Salvi D, Sesay S, Taero F, Tostão E, Toussaint S, Bukhman G, Mocumbi AO. Protocol for an evaluation of the initiation of an integrated longitudinal outpatient care model for severe chronic non-communicable diseases (PEN-Plus) at secondary care facilities (district hospitals) in 10 lower-income countries. BMJ Open 2024; 14:e074182. [PMID: 38296295 PMCID: PMC10828858 DOI: 10.1136/bmjopen-2023-074182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/21/2023] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION The Package of Essential Noncommunicable Disease Interventions-Plus (PEN-Plus) is a strategy decentralising care for severe non-communicable diseases (NCDs) including type 1 diabetes, rheumatic heart disease and sickle cell disease, to increase access to care. In the PEN-Plus model, mid-level clinicians in intermediary facilities in low and lower middle income countries are trained to provide integrated care for conditions where services traditionally were only available at tertiary referral facilities. For the upcoming phase of activities, 18 first-level hospitals in 9 countries and 1 state in India were selected for PEN-Plus expansion and will treat a variety of severe NCDs. Over 3 years, the countries and state are expected to: (1) establish PEN-Plus clinics in one or two district hospitals, (2) support these clinics to mature into training sites in preparation for national or state-level scale-up, and (3) work with the national or state-level stakeholders to describe, measure and advocate for PEN-Plus to support development of a national operational plan for scale-up. METHODS AND ANALYSIS Guided by Proctor outcomes for implementation research, we are conducting a mixed-method evaluation consisting of 10 components to understand outcomes in clinical implementation, training and policy development. Data will be collected through a mix of quantitative surveys, routine reporting, routine clinical data and qualitative interviews. ETHICS AND DISSEMINATION This protocol has been considered exempt or covered by central and local institutional review boards. Findings will be disseminated throughout the project's course, including through quarterly M&E discussions, semiannual formative assessments, dashboard mapping of progress, quarterly newsletters, regular feedback loops with national stakeholders and publication in peer-reviewed journals.
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Affiliation(s)
- Alma J Adler
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Emily B Wroe
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | | | - Neusa Bay
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Wondu Bekele
- Mathiwos Wondu-Ye Ethiopia Cancer Society, Addis Ababa, Ethiopia
| | - Victoria M Bhambhani
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Chantelle Boudreaux
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Matthew M Coates
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Katia Domingues
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Laura Drown
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Neil Gupta
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Yogesh Jain
- NCDI Poverty Network, Surguja, Chhattisgarh, India
| | | | | | | | - Biraj Man Karmacharya
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA
- School of Medical Sciences, Kathmandu University, Kathmandu, Nepal
| | | | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Beatriz Manuel
- Department of Community Health, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Jones K Masiye
- Noncommunicable Diseases and Mental Health Clinical Services, Malawi Ministry of Health, Lilongwe, Malawi
| | | | | | | | - Emmanuel Mensah
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Reuben Mutagaywa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | | | - Gedeon Ngoga
- Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda
| | - Marta Patiño
- Partners In Health Sierra Leone, Kono, Sierra Leone
| | | | | | - Devashri Salvi
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Santigie Sesay
- Noncommunicable Diseases and Mental Health, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Fameti Taero
- Mozambique Institute for Health Education and Research, Maputo, Mozambique
| | - Emílio Tostão
- Department of Agricultural Economics and Development, Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Gene Bukhman
- Center for Integration Science, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Ana Olga Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Maputo, Mozambique
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Gaynes BN, Akiba CF, Hosseinipour MC, Kulisewa K, Amberbir A, Udedi M, Zimba CC, Masiye JK, Crampin M, Amarreh I, Pence BW. The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity-Building Scale-Up Trial: Study Design and Protocol. Psychiatr Serv 2021; 72:812-821. [PMID: 33291973 PMCID: PMC8187465 DOI: 10.1176/appi.ps.202000003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Depression is a leading cause of death and disability worldwide, including in low- and middle-income countries (LMICs). Depression often coexists with chronic medical conditions and is associated with worse clinical outcomes. This confluence has led to calls to integrate mental health treatment with chronic disease care systems in LMICs. This article describes the rationale and protocol for a trial comparing the clinical effectiveness and cost-effectiveness of two different intervention packages to implement evidence-based antidepressant management and psychotherapy into chronic noncommunicable disease (NCD) clinics in Malawi. METHODS Using constrained randomization, the Sub-Saharan Africa Regional Partnership (SHARP) for mental health capacity building will assign five Malawian NCD clinics to a basic implementation strategy via an internal coordinator, a provider within the chronic care clinic who champions depression services by providing training, supervision, operations, and reporting. Another five clinics will be assigned to depression services implementation via an internal coordinator along with an external quality assurance committee, which will provide a quarterly audit of intervention component delivery with feedback to providers and the health management team. RESULTS The authors will compare key implementation outcomes (fidelity to intervention), clinical effectiveness outcomes (patient health), and cost-effectiveness and will assess characteristics of clinics that may influence uptake and fidelity. NEXT STEPS This trial will provide key information to guide the Malawi Ministry of Health in scaling up depression management in existing NCD settings. The SHARP trial is anticipated to substantially contribute to enhancing both mental health treatment and implementation science research capacity in Malawi and the wider region.
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Affiliation(s)
- Bradley N Gaynes
- Department of Psychiatry (Gaynes) and Department of Medicine (Hosseinipour), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Behavior (Akiba) and Department of Epidemiology (Pence), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; Department of Mental Health and Psychiatry, University of Malawi College of Medicine, Blantyre, Malawi (Kulisewa); Partners in Hope, Lilongwe, Malawi (Amberbir); Malawi Ministry of Health, Lilongwe, Malawi (Udedi, Masiye); University of North Carolina Project-Malawi, Lilongwe, Malawi (Zimba); Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi (Crampin); National Institute of Mental Health, Bethesda, Maryland (Amarreh)
| | - Christopher F Akiba
- Department of Psychiatry (Gaynes) and Department of Medicine (Hosseinipour), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Behavior (Akiba) and Department of Epidemiology (Pence), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; Department of Mental Health and Psychiatry, University of Malawi College of Medicine, Blantyre, Malawi (Kulisewa); Partners in Hope, Lilongwe, Malawi (Amberbir); Malawi Ministry of Health, Lilongwe, Malawi (Udedi, Masiye); University of North Carolina Project-Malawi, Lilongwe, Malawi (Zimba); Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi (Crampin); National Institute of Mental Health, Bethesda, Maryland (Amarreh)
| | - Mina C Hosseinipour
- Department of Psychiatry (Gaynes) and Department of Medicine (Hosseinipour), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Behavior (Akiba) and Department of Epidemiology (Pence), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; Department of Mental Health and Psychiatry, University of Malawi College of Medicine, Blantyre, Malawi (Kulisewa); Partners in Hope, Lilongwe, Malawi (Amberbir); Malawi Ministry of Health, Lilongwe, Malawi (Udedi, Masiye); University of North Carolina Project-Malawi, Lilongwe, Malawi (Zimba); Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi (Crampin); National Institute of Mental Health, Bethesda, Maryland (Amarreh)
| | - Kazione Kulisewa
- Department of Psychiatry (Gaynes) and Department of Medicine (Hosseinipour), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Behavior (Akiba) and Department of Epidemiology (Pence), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; Department of Mental Health and Psychiatry, University of Malawi College of Medicine, Blantyre, Malawi (Kulisewa); Partners in Hope, Lilongwe, Malawi (Amberbir); Malawi Ministry of Health, Lilongwe, Malawi (Udedi, Masiye); University of North Carolina Project-Malawi, Lilongwe, Malawi (Zimba); Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi (Crampin); National Institute of Mental Health, Bethesda, Maryland (Amarreh)
| | - Alemayehu Amberbir
- Department of Psychiatry (Gaynes) and Department of Medicine (Hosseinipour), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Behavior (Akiba) and Department of Epidemiology (Pence), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; Department of Mental Health and Psychiatry, University of Malawi College of Medicine, Blantyre, Malawi (Kulisewa); Partners in Hope, Lilongwe, Malawi (Amberbir); Malawi Ministry of Health, Lilongwe, Malawi (Udedi, Masiye); University of North Carolina Project-Malawi, Lilongwe, Malawi (Zimba); Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi (Crampin); National Institute of Mental Health, Bethesda, Maryland (Amarreh)
| | - Michael Udedi
- Department of Psychiatry (Gaynes) and Department of Medicine (Hosseinipour), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Behavior (Akiba) and Department of Epidemiology (Pence), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; Department of Mental Health and Psychiatry, University of Malawi College of Medicine, Blantyre, Malawi (Kulisewa); Partners in Hope, Lilongwe, Malawi (Amberbir); Malawi Ministry of Health, Lilongwe, Malawi (Udedi, Masiye); University of North Carolina Project-Malawi, Lilongwe, Malawi (Zimba); Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi (Crampin); National Institute of Mental Health, Bethesda, Maryland (Amarreh)
| | - Chifundo C Zimba
- Department of Psychiatry (Gaynes) and Department of Medicine (Hosseinipour), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Behavior (Akiba) and Department of Epidemiology (Pence), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; Department of Mental Health and Psychiatry, University of Malawi College of Medicine, Blantyre, Malawi (Kulisewa); Partners in Hope, Lilongwe, Malawi (Amberbir); Malawi Ministry of Health, Lilongwe, Malawi (Udedi, Masiye); University of North Carolina Project-Malawi, Lilongwe, Malawi (Zimba); Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi (Crampin); National Institute of Mental Health, Bethesda, Maryland (Amarreh)
| | - Jones K Masiye
- Department of Psychiatry (Gaynes) and Department of Medicine (Hosseinipour), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Behavior (Akiba) and Department of Epidemiology (Pence), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; Department of Mental Health and Psychiatry, University of Malawi College of Medicine, Blantyre, Malawi (Kulisewa); Partners in Hope, Lilongwe, Malawi (Amberbir); Malawi Ministry of Health, Lilongwe, Malawi (Udedi, Masiye); University of North Carolina Project-Malawi, Lilongwe, Malawi (Zimba); Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi (Crampin); National Institute of Mental Health, Bethesda, Maryland (Amarreh)
| | - Mia Crampin
- Department of Psychiatry (Gaynes) and Department of Medicine (Hosseinipour), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Behavior (Akiba) and Department of Epidemiology (Pence), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; Department of Mental Health and Psychiatry, University of Malawi College of Medicine, Blantyre, Malawi (Kulisewa); Partners in Hope, Lilongwe, Malawi (Amberbir); Malawi Ministry of Health, Lilongwe, Malawi (Udedi, Masiye); University of North Carolina Project-Malawi, Lilongwe, Malawi (Zimba); Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi (Crampin); National Institute of Mental Health, Bethesda, Maryland (Amarreh)
| | - Ishmael Amarreh
- Department of Psychiatry (Gaynes) and Department of Medicine (Hosseinipour), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Behavior (Akiba) and Department of Epidemiology (Pence), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; Department of Mental Health and Psychiatry, University of Malawi College of Medicine, Blantyre, Malawi (Kulisewa); Partners in Hope, Lilongwe, Malawi (Amberbir); Malawi Ministry of Health, Lilongwe, Malawi (Udedi, Masiye); University of North Carolina Project-Malawi, Lilongwe, Malawi (Zimba); Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi (Crampin); National Institute of Mental Health, Bethesda, Maryland (Amarreh)
| | - Brian W Pence
- Department of Psychiatry (Gaynes) and Department of Medicine (Hosseinipour), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill; Department of Health Behavior (Akiba) and Department of Epidemiology (Pence), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; Department of Mental Health and Psychiatry, University of Malawi College of Medicine, Blantyre, Malawi (Kulisewa); Partners in Hope, Lilongwe, Malawi (Amberbir); Malawi Ministry of Health, Lilongwe, Malawi (Udedi, Masiye); University of North Carolina Project-Malawi, Lilongwe, Malawi (Zimba); Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi (Crampin); National Institute of Mental Health, Bethesda, Maryland (Amarreh)
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Gupta N, Coates MM, Bekele A, Dupuy R, Fénelon DL, Gage AD, Getachew T, Karmacharya BM, Kwan GF, Lulebo AM, Masiye JK, Mayige MT, Ndour Mbaye M, Mridha MK, Park PH, Dagnaw WW, Wroe EB, Bukhman G. Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries. BMJ Open 2020; 10:e038842. [PMID: 33040014 PMCID: PMC7549470 DOI: 10.1136/bmjopen-2020-038842] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
CONTEXT AND OBJECTIVES Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad range of acute and chronic NCDI conditions. DESIGN Secondary analysis of existing cross-sectional survey data. SETTING We used data from Service Provision Assessment surveys in Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Nepal, Senegal and Tanzania, focusing on public first-referral level hospitals in each country. OUTCOME MEASURES We defined sets of equipment and medications required for diagnosis and management of four acute and nine chronic NCDI conditions and determined availability of these items at the health facilities. RESULTS Overall, 797 hospitals were included. Medication and equipment availability was highest for acute epilepsy (country estimates ranging from 40% to 95%) and stage 1-2 hypertension (28%-83%). Availability was low for type 1 diabetes (1%-70%), type 2 diabetes (3%-57%), asthma (0%-7%) and acute presentations of diabetes (0%-26%) and asthma (0%-4%). Few hospitals had equipment or medications for heart failure (0%-32%), rheumatic heart disease (0%-23%), hypertensive emergencies (0%-64%) or acute minor surgical conditions (0%-5%). Data for chronic pain were limited to only two countries. Availability of essential medications and equipment was lower than previous facility-reported service availability. CONCLUSIONS Our findings demonstrate low availability of essential equipment and medications for diverse NCDIs at first-referral level hospitals in eight LICs. There is a need for decentralisation and integration of NCDI services in existing care platforms and improved assessment and monitoring to fully achieve universal health coverage.
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Affiliation(s)
- Neil Gupta
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Matthew M Coates
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Abebe Bekele
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Roodney Dupuy
- Le Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | | | - Anna D Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- College of Medicine and Health Science, Institute of Public Health, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Biraj Man Karmacharya
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Gene F Kwan
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Aimée M Lulebo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | | | - Maïmouna Ndour Mbaye
- Department of Internal Medicine, University Hospital Center of Dakar, Cheikh Anta Diop University, Dakar, Senegal
| | - Malay Kanti Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Paul H Park
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Wubaye Walelgne Dagnaw
- Partners In Health, Boston, Massachusetts, USA
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Emily B Wroe
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Gene Bukhman
- Program in Global Noncommunicable Disease and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Ndhlovu HLL, Masiye JK, Chirwa ML, Nyirenda NM, Dhlamini TD, Beaney T, Ster AC, Poulter NR. May Measurement Month 2018: an analysis of blood pressure screening results from Malawi. Eur Heart J Suppl 2020; 22:H80-H82. [PMID: 32884478 PMCID: PMC7456181 DOI: 10.1093/eurheartj/suaa034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Raised blood pressure (BP) is a growing health care problem in the world leading to over 10 million deaths annually. May Measurement Month (MMM), which aims at raising awareness and screening people for raised BP, is assisting people to know their BP status. In 2018, an opportunistic cross-sectional survey was carried out during May and June in 10 791 volunteers aged 18 years and above following that done in 2017. The screening took place in Lilongwe, Blantyre, Dedza, Kasungu, and Nkhatabay districts mostly in hospitals/clinics, marketplaces, workplaces, and churches/mosques with Kasungu and Nkhatabay in rural areas. After multiple imputation, 2404 (22.3%) had hypertension. Of individuals not receiving antihypertensive treatment, 2101 (20.0%) were found to have raised BP. Only 303 (12.6%) of those with hypertension were receiving antihypertensive treatment, and of these 101 (33.3%) had uncontrolled BP. MMM was the largest BP screening campaign ever undertaken in Malawi. The results identified a large number of individuals with raised BP who were unaware and not on treatment and over one-third of those on treatment were uncontrolled, indicating the need for better management of cases. These results suggest that opportunistic screening can identify significant numbers with raised BP.
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Affiliation(s)
- Henry L L Ndhlovu
- Moyowathu HealthCare Services, Area 49, Off Kaunda Road, At Shoprite Bus Stage, Near old C.C.A.P, Lilongwe, Malawi
| | - Jones K Masiye
- Ministry of Health Headquarters, Non-Communicable Diseases and Mental Health Department, Lilongwe, Malawi
| | - Maureen L Chirwa
- Prime Health Consulting and Services, Plot No Area 47/5/240, Malingunde Road, Area 47, Lilongwe, Malawi
| | | | | | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK.,Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London W6 8 RP, UK
| | - Anca Chis Ster
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
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Ndhlovu HLL, Masiye JK, Chinula G, Chirwa M, Mbeba M, Beaney T, Xia X, Kobeissi E, Poulter NR. May Measurement Month 2017: results of a blood pressure screening campaign in Malawi-Sub-Saharan Africa. Eur Heart J Suppl 2019; 21:D74-D76. [PMID: 31043884 PMCID: PMC6479420 DOI: 10.1093/eurheartj/suz060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. A World Health Organization and Ministry of Health STEPS Survey conducted in 2009 in Malawi found that 32.9% tested positive for age-standardized hypertension. The survey further showed that three-quarters (75%) of the participants never had their BP measured before and 94.9% with high BP were unaware of the hypertensive condition. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. BP measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. The screening took place in cities of Lilongwe and Blantyre mostly in hospitals, clinics, marketplaces, workplaces, and churches. About 4009 individuals were screened during MMM17. After multiple imputations, 849 (22.3%) had hypertension. Of individuals not receiving antihypertensive medication, 697 (19.1%) were found to have hypertension. Only 152 individuals were receiving antihypertensive medication, and of these 78 (51.4%) had uncontrolled BP. MMM17 was the largest BP screening campaign ever undertaken in Malawi. The results identified a large number with hypertension who were not on treatment and over half of those on antihypertensive treatment who were uncontrolled, indicating the need for better management of cases. These results suggest that opportunistic screening can identify significant numbers with raised BP.
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Affiliation(s)
- Henry L L Ndhlovu
- Moyowathu HealthCare Services, Area 49, Off Kaunda Road, at Shoprite Bus Stage, Near old C.C.A.P, Lilongwe, Malawi
| | - Jones K Masiye
- Ministry of Health, Ministry of Health Headquarters, Non-communicable Diseases and Mental Health Department, Lilongwe, Malawi
| | - Georgina Chinula
- Prime Health Consulting and Services, Plot No Area 47/5/240, Malingunde Road, Area 47, Lilongwe, Malawi
| | - Maureen Chirwa
- Prime Health Consulting and Services, Plot No Area 47/5/240, Malingunde Road, Area 47, Lilongwe, Malawi
| | - Mary Mbeba
- Department of Medical and Surgical Nursing, Kamuzu College of Nursing, Blantyre Campus, Blantyre, Malawi
| | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Xin Xia
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Elsa Kobeissi
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London W12 7RH, UK
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