Musicha Crispin, Crampin Amelia C, Kayuni Ndoliwe, Koole Olivier, Amberbir Alemayehu, Mwagomba Beatrice, Jaffar Shabbar, Nyirenda Moffat J
aMalawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi bLondon School of Hygiene and Tropical Medicine (LSHTM), London, UK cMinistry of Health, Lilongwe, Malawi.
J Hypertens. 2016 Nov;34(11):2172-9. doi: 10.1097/HJH.0000000000001070.
Interventions to impact on the burden of chronic noncommunicable diseases, such as hypertension and diabetes, include screening of asymptomatic adults, but little is known about the subsequent course of clinical care. We report on the uptake of referral for clinical assessment and retention in care, following a large urban/rural population screening program in Malawi.
Adult residents were screened for raised blood pressure and raised fasting blood glucose at a demographic surveillance site in rural Karonga District and in urban Area 25, Lilongwe with well supported chronic care clinics. Successful uptake was defined as presenting for clinical assessment within 6 weeks of referral, and nonattenders were followed at home. Logistic regression was used to examine association of uptake with demographic and clinical factors. Retention was assessed using survival analysis techniques.
A total of 27 305 participants were screened for hypertension and diabetes between May 2013 and September 2015. Of these, 4075 (14.9%) were referred for suspected hypertension (3640), diabetes (172), or both (263). Among those referred, 2480 (60.9%), reported for clinical assessment. Factors associated with uptake of care included being female, rural residency, older age, unemployment, prior medication, and diabetes. Retention, for those enrolled in care following a formal clinical assessment, was associated with the final diagnosis following clinical assessment, rural residency, and older age.
Screening for hypertension and diabetes identifies large numbers of individuals who need further clinical assessment, but strategies are needed to ensure better linkage and retention into care.
旨在减轻慢性非传染性疾病（如高血压和糖尿病）负担的干预措施包括对无症状成年人进行筛查，但对于后续临床护理过程却知之甚少。我们报告了在马拉维开展的一项大型城乡人口筛查项目后，临床评估转诊的接受情况以及护理留存率。
在卡龙加区农村的一个人口监测点以及利隆圭第25区城市中，为成年居民筛查血压升高和空腹血糖升高情况，这些地区设有得到充分支持的慢性病诊所。成功接受转诊定义为在转诊后6周内接受临床评估，未就诊者会进行家访。采用逻辑回归分析来研究接受转诊与人口统计学和临床因素之间的关联。使用生存分析技术评估留存率。
2013年5月至2015年9月期间，共有27305名参与者接受了高血压和糖尿病筛查。其中，4075人（14.9%）因疑似高血压（3640人）、糖尿病（172人）或两者皆有（263人）而被转诊。在被转诊者中，2480人（60.9%）前来接受临床评估。与接受护理相关的因素包括女性、农村居民、年龄较大、失业、既往用药情况以及糖尿病。对于经过正式临床评估后登记接受护理的患者，留存率与临床评估后的最终诊断、农村居民身份以及年龄较大有关。
高血压和糖尿病筛查可识别出大量需要进一步临床评估的个体，但需要采取策略以确保更好地与护理建立联系并提高留存率。
