Tropical Health Education Trust, Addis Ababa, Ethiopia.
Health Poverty Action, Addis Ababa, Ethiopia.
BMC Health Serv Res. 2024 Jul 25;24(1):847. doi: 10.1186/s12913-024-11328-x.
Although primary care models for the care of common non-communicable diseases (NCD) have been developed in sub-Saharan Africa, few have described an integrated, decentralized approach at the community level. We report the results of a four-year, Ethiopian project to expand this model of NCD care to 15 primary hospitals and 45 health centres encompassing a wide geographical spread and serving a population of approximately 7.5 million people.
Following baseline assessment of the 60 sites, 30 master trainers were used to cascade train a total of 621 health workers in the diagnosis, management and health education of the major common NCDs identified in a scoping review (hypertension, diabetes, chronic respiratory disease and epilepsy). Pre- and post-training assessments and regular mentoring visits were carried out to assess progress and remedy supply or equipment and medicines shortages and establish reporting systems. The project was accompanied by a series of community engagement activities to raise awareness and improve health seeking behaviour.
A total of 643,296 people were screened for hypertension and diabetes leading to a new diagnosis in 24,313 who were started on treatment. Significant numbers of new cases of respiratory disease (3,986) and epilepsy (1,925) were also started on treatment. Mortality rates were low except among patients with hypertension in the rural health centres where 311 (10.2%) died during the project. Loss to follow up (LTFU), defined as failure to attend clinic for > 6 months despite reminders, was low in the hospitals but represented a significant problem in the urban and rural health centres with up to 20 to 30% of patients with hypertension or diabetes absenting from treatment by the end of the project. Estimates of the population disease burden enrolled within the project, however, were disappointing; asthma (0.49%), hypertension (1.7%), epilepsy (3.3%) and diabetes (3.4%).
This project demonstrates the feasibility of scaling up integrated NCD services in a variety of locations, with fairly modest costs and a methodology that is replicable and sustainable. However, the relatively small gain in the detection and treatment of common NCDs highlights the huge challenge in making NCD services available to all.
虽然在撒哈拉以南非洲已经开发出针对常见非传染性疾病（NCD）的初级保健模式，但很少有模式在社区层面描述了一种综合、分散的方法。我们报告了一个为期四年的埃塞俄比亚项目的结果，该项目旨在将这种 NCD 护理模式扩展到 15 家初级医院和 45 个卫生中心，这些医院和中心分布广泛，服务人口约为 750 万人。
在对 60 个地点进行基线评估后，使用 30 名首席培训师对总共 621 名卫生工作者进行了培训，这些卫生工作者接受了广泛审查中确定的主要常见 NCD（高血压、糖尿病、慢性呼吸道疾病和癫痫）的诊断、管理和健康教育。在培训前后进行评估，并定期进行指导访问，以评估进展情况，解决供应或设备和药品短缺问题，并建立报告系统。该项目还伴随着一系列社区参与活动，以提高认识和改善卫生寻求行为。
共有 643296 人接受了高血压和糖尿病筛查，导致 24313 人新确诊并开始接受治疗。还对大量新发现的呼吸道疾病（3986 例）和癫痫（1925 例）患者进行了治疗。死亡率很低，除了农村卫生中心的高血压患者外，该中心有 311 名（10.2%）患者在项目期间死亡。尽管有提醒，但医院的失访（LTFU）率较低，但在城市和农村卫生中心却是一个严重的问题，高达 20%至 30%的高血压或糖尿病患者在项目结束时未接受治疗。然而，该项目登记的人群疾病负担估计令人失望；哮喘（0.49%）、高血压（1.7%）、癫痫（3.3%）和糖尿病（3.4%）。
该项目证明了在各种地点扩大综合 NCD 服务的可行性，成本相当低，且具有可复制和可持续性的方法。然而，常见 NCD 的检测和治疗率的相对较小增加突出表明，要使 NCD 服务普及到所有人，仍面临巨大挑战。
