Kachimanga Chiyembekezo, Cundale Katie, Wroe Emily, Nazimera Lawrence, Jumbe Arnold, Dunbar Elizabeth, Kalanga Noel
Partners in Health/Abwenzi Pa Za Umoyo, Neno, Malawi.
Neno District Health Office, Neno, Malawi.
Malawi Med J. 2017 Jun;29(2):78-83. doi: 10.4314/mmj.v29i2.1.
As Malawi continues to suffer from a large burden of noncommunicable diseases (NCDs), models for NCD screening need to be developed that do not overload a health system that is already heavily burdened by communicable diseases.
This descriptive study examined 3 screening programmes for NCDs in Neno, Malawi, that were implemented from June 2015 to December 2016. The NCD screening models were integrated into existing platforms, utilising regular mass screening events in the community, patients awaiting to be seen in a combined NCD and HIV clinic, and patients awaiting treatment at outpatient departments (OPDs). Focusing on hypertension and diabetes, we screened all adults 30 years and above for hypertension using a single blood pressure cut-off of 160/110 mmHg, as well as adults 40 years and above for diabetes, measuring either random blood sugar (RBS) or fasting blood sugar (FBS), with referral criteria of FBS > 126 mg/dL and RBS > 200 mg/dL. Data were collected on specifically designed screening registers, then entered and analysed in Excel.
Over 14,000 adults (≥ 12 years old) were screened for an array of common conditions at community screening events. Of these adults, 58% (n = 8133) and 29% (n = 4016) were screened for hypertension and diabetes, respectively. Nine percent (n = 716) and 3% ( n = 113) were referred for further hypertension and diabetes assessment respectively. At one OPD, 5818 patients (60%) had their blood pressures measured, and among adults 30 years and above, 168 eligible adults were referred for further hypertension assessment. Since the initiation of the screening programmes, the number of patients ever enrolled for NCD care every 3 months has nearly tripled, from 40 to 114.
The screening models have shown that it is not only feasible to introduce NCD screening into a public system, but screening may have also contributed to increased enrolment in NCD care in Neno, Malawi.
由于马拉维仍承受着巨大的非传染性疾病负担，因此需要开发非传染性疾病筛查模式，以免给已不堪重负的传染病卫生系统造成更大压力。
这项描述性研究对2015年6月至2016年12月在马拉维内诺实施的3个非传染性疾病筛查项目进行了考察。非传染性疾病筛查模式被整合到现有平台中，利用社区定期开展的大规模筛查活动、在非传染性疾病与艾滋病毒综合诊所候诊的患者以及在门诊部候诊治疗的患者。以高血压和糖尿病为重点，我们对所有30岁及以上的成年人进行高血压筛查，血压临界值统一设定为160/110 mmHg，对40岁及以上的成年人进行糖尿病筛查，测量随机血糖（RBS）或空腹血糖（FBS），转诊标准为FBS > 126 mg/dL和RBS > 200 mg/dL。数据收集在专门设计的筛查登记册上，然后录入Excel并进行分析。
在社区筛查活动中，超过14000名成年人（≥ 12岁）接受了一系列常见疾病的筛查。在这些成年人中，分别有58%（n = 8133）和29%（n = 4016）接受了高血压和糖尿病筛查。分别有9%（n = 716）和3%（n = 113）被转诊作进一步的高血压和糖尿病评估。在一个门诊部，5818名患者（60%）测量了血压，在30岁及以上的成年人中，有168名符合条件的成年人被转诊作进一步的高血压评估。自筛查项目启动以来，每3个月登记接受非传染性疾病护理的患者数量几乎增加了两倍，从40人增至114人。
筛查模式表明，将非传染性疾病筛查引入公共系统不仅可行，而且筛查可能也促使马拉维内诺接受非传染性疾病护理的人数有所增加。
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