NCD Prevention and Control Division, Department of Public Health, Ministry of Health and Sports, Nay Pyi Taw, Myanmar.
International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India.
PLoS One. 2020 Feb 18;15(2):e0229081. doi: 10.1371/journal.pone.0229081. eCollection 2020.
Myanmar adopted the World Health Organization (WHO) Package for Essential Non-Communicable Disease Interventions (PEN) in 20 pilot townships in 2017. This study was conducted to assess the implementation of PEN, its effectiveness and understand the facilitators and barriers in its implementation.
Mixed methods design involving a quantitative component (retrospective study analysing both aggregate and individual patient data from PEN project records; cross-sectional facility survey using a structured checklist) and a descriptive qualitative component.
A total of 152,446 individuals were screened between May 2017-December 2018 comprising of current smokers (17.5%), tobacco chewers (26.3%), Body Mass Index ≥25 kg/m2 (30.6%), raised blood pressure i.e. ≥ 140/90 mmHg (35.2%) and raised blood sugar i.e. Random Blood Sugar >200 mg/dl, Fasting Blood Sugar >126 mg/dl (17.1%). Nearly 14.8% of those screened had Cardiovascular Disease (CVD) risk score ≥20%, 34.6% had CVD risk not recorded. Of 663 patients registered with diabetes and/or hypertension in 05 townships, 27 (4.1%) patients made three follow-up visits after the baseline visit, of whom, CVD risk assessment, systolic blood pressure and blood sugar measurement was done in all visits in 89.0%, 100.0% and 78.0% of cases respectively. Health facility assessment showed 64% of the sanctioned posts were filled; 90% of those appointed been trained in PEN; key essential medicines for PEN were available in half of the facilities surveyed. Confidence of the health care staff in managing common NCD and perceived benefits of the project were some of the strengths.
High loss to follow up, poor recording of CVD risk score, lack of essential medicines and equipments were the key challenges identified that need to be addressed before further expansion of PEN project to other townships.
2017 年，缅甸在 20 个试点城镇采用了世界卫生组织（WHO）基本非传染性疾病干预包（PEN）。本研究旨在评估 PEN 的实施情况、效果，并了解实施过程中的促进因素和障碍。
采用混合方法设计，包括定量部分（回顾性研究，分析 PEN 项目记录中的总体和个体患者数据；使用结构化清单的横断面设施调查）和描述性定性部分。
2017 年 5 月至 2018 年 12 月期间，共有 152446 人接受了筛查，其中包括当前吸烟者（17.5%）、嚼烟者（26.3%）、身体质量指数（BMI）≥25kg/m2（30.6%）、血压升高即≥140/90mmHg（35.2%）和血糖升高即随机血糖>200mg/dl、空腹血糖>126mg/dl（17.1%）。接受筛查的人群中，近 14.8%的人心血管疾病（CVD）风险评分≥20%，34.6%的人未记录 CVD 风险。在 05 个城镇登记有糖尿病和/或高血压的 663 名患者中，有 27 名（4.1%）患者在基线就诊后进行了三次随访，其中 89.0%、100.0%和 78.0%的患者在所有就诊中均进行了 CVD 风险评估、收缩压和血糖测量。卫生机构评估显示，已批准的职位中有 64%得到填补；90%被任命的人员接受过 PEN 培训；接受调查的设施中，有一半配备了 PEN 的基本药物。卫生保健人员对管理常见非传染性疾病的信心和对项目的预期收益是一些优势。
高失访率、CVD 风险评分记录不良、缺乏基本药物和设备是确定的关键挑战，需要在 PEN 项目向其他城镇进一步扩展之前加以解决。
