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1
Background: Cardiovascular disease (CVD), mainly heart attack and stroke, is the
leading cause of premature mortality in low and middle income countries (LMICs).
Identifying and managing individuals at high risk
...
of CVD is an important strategy to prevent and control CVD, in addition to multisectoral population-based interventions to reduce CVD risk factors in the entire population.
Methods: We describe key public health considerations in identifying and managing individuals at high risk of CVD in LMICs.
Results: A main objective of any strategy to identify individuals at high CVD risk is to maximize the number of CVD events averted while minimizing the numbers of
individuals needing treatment. Scores estimating the total risk of CVD (e.g. ten-year risk of fatal and non-fatal CVD) are available for LMICs, and are based on the main CVD risk factors (history of CVD, age, sex, tobacco use, blood pressure, blood cholesterol and diabetes status). Opportunistic screening of CVD risk factors enables identification of persons with high CVD risk, but this strategy can be widely applied in low resource settings only if cost effective interventions are used (e.g. the WHO Package of Essential NCD interventions for primary health care in low resource settings package) and if treatment (generally for years) can be sustained, including continued availability ofaffordable medications and funding mechanisms that allow people to purchase medications without impoverishing them (e.g. universal access to health care). Thisalso emphasises the need to re-orient health systems in LMICs towards chronic diseases management.
Conclusion: The large burden of CVD in LMICs and the fact that persons with high
CVD can be identified and managed along cost-effective interventions mean that
health systems need to be structured in a way that encourages patient registration, opportunistic screening of CVD risk factors, efficient procedures for the management of chronic conditions (e.g. task sharing) and provision of affordable treatment for those with high CVD risk. The focus needs to be in primary care because that is where most of the population can access health care and because CVD programmes can be run effectively at this level.
more
In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of
...
patients who are treated reach their target levels for blood pressure, blood sugar and blood cholesterol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
more
Diabetes mellitus (DM) is one of the commonest chronic diseases worldwide. Self-Management Education (SME) is regarded as a critical element of tre
...
atment for all people with diabetes, as well as those at risk of developing the condition. While a great variety of diabetes self-management education (DSME) interventions are available in high-income countries, limited information exists on educational programs for the prevention and management of diabetes complications in Africa. This study, therefore, aimed at synthesizing information in the literature to describe the state of the science of DSME interventions in the WHO African Region.
more
The NCD Alliance website provides information and resources on preventing and controlling non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, diabetes, and mental health conditions. The Alliance advocat
...
es for global health policies, supports countries in integrating NCD care into universal health coverage, and fosters collaboration among governments, civil society, and health organizations. Key sections include policy briefs, advocacy priorities, research reports, and campaigns aimed at reducing NCD-related health disparities and improving health outcomes worldwide. The site serves as a hub for NCD advocacy, awareness, and community engagement.
more
Diabetes mellitus is a major cause of morbidity and mortality in Scotland and worldwide, with an increasing prevalence. In 2009 there were around 228,000 people registered as having
...
diabetes in Scotland, an increase of 3.6% from the preceding year. This increase relates, in part, to the increasing age of the population, an increase in obesity and also perhaps to increasing survival of those with diabetes.
more
Management of Diabetes Mellitus-Tuberculosis
recommended
1st edition
This resource provides practical guidance for front line health workers responsible for the diagnosis, management and care of patients with these two diseases. Published in collaboration with the World
...
Diabetes Foundation
more
Accessed November 2017.
Position Statement
Diabetes Care2018;42(Suppl. 1):S1–S194.
The burden of diabetes is enormous, positioning it as one of the main challenges facing public health today. Currently, it is estimated that 62 mil
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lion people are living with diabetes in the Region of the Americas and projections show its prevalence will continue rising over the following years. The Region shows the highest number of years of healthy life lost (through either disability or premature death) due to diabetes worldwide. The high costs associated with its treatment produce a heavy economic burden. Its complications can seriously affect the quality of life of people living with diabetes, their families, and society and overload health systems. This report shows the latest internationally comparable data on diabetes and its main risk factors by year, country, and sex.
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This manual aims to provide an overview of this subject to health care professionals, paramedics and other voluntary services involved in health care promotion
Diabetes Burdens: 10.5% adults around the world are currently loving with diabetes.
This is an abridged version of the 2019 Standards containing the evidence-based recommendations most pertinent to primary care. The tables and figures have been renum-bered from the original document to match this ver
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sion. The complete 2019 Standards of Care document, including all supporting references, is available at professional.diabetes.org/standards.
This is an abridged version of the American Diabetes Association’s Standards of Medical Care in Diabetes—2019. Diabetes Care2018;42(Suppl. 1):S1–S194. The complete 2019 Standards supplement, including all supporting references, is available at professional.diabetes.org/standards.
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The prevalence of chronic non-communicable diseases such as diabetes, cardiovascular diseases and cancers has been on the increase in Kenya in the recent past. This has bee
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n occasioned by changes in social and demographic situation in the country. The life expectancy in the country is improving, while the country is developing at a rapid pace. This has resulted in people living more years and at the time adopting lifestyles that have negative impacts on their health. This increase in diabetes and other non-communicable diseases has given rise to a double burden of communicable and non-communicable diseases in Kenya
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The mounting burden of type 2 diabetes is a major concern in healthcare systems worldwide. The purpose of this study is to investigate the trend
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of type 2 diabetes from 1990 to 2019 in Asia.
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Obesity and diabetes are affecting the peoples of the Americas at high and increasing rates. National surveys demonstrate that obesity is increasing in prevalence among all age groups; 7% to 12%
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of children under 5 years old and
one-fi fth of adolescents are obese, while rates of overweight and obesity among adults approach 60%. Obesity is the major modifi able risk factor for diabetes.
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Effectiveness of a diabetes program based on digital health on capacity building and quality of care in type 2 diabetes: a pragmatic quasi-experimental study
Moreas Morelli, D.; Rubinstein, F.; Santero, M.; et al.
BMC Health Services Research, part of Springer Nature
(2023)
CC2
Health systems in Latin America face many challenges in controlling the increasing burden of diabetes. Digital health interventions are a promise for the provision
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of care, especially in developing countries where mobile technology has a high penetration. This study evaluated the effectiveness of the implementation of a Diabetes Program (DP) that included digital health interventions to improve the quality of care of persons with type 2 Diabetes (T2DM) in a vulnerable population attending the public primary care network.
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In 2016, the risk of premature mortality1 from noncommunicable diseases (NCDs) in Ethiopia was 18.3%. The economic costs of NCDs are significant and are due principally to their impact on the non-he
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alth sector (reduced workforce and productivity). In this study, it is estimated that NCDs cost Ethiopia at least 31.3 billion birr (US$ 1.1 billion) per year, equivalent to 1.8% of the gross domestic product (GDP). Less than 15% of the costs are for health care.
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Lancet Glob Health 2018, Published Online September 12, 2018 http://dx.doi.org/10.1016/S2214-109X(18)30387-5
Namibia is no exception to the growingglobal concern on the increasing burden of NCDs. Namibia is an upper middle income country with fast economic growth since independence in 1990. The country is bearing the double burden
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of communicable and noncommunicable diseases and rapid urbanization. There is also high income inequality among the population.
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