Community-based diabetes and hypertension prevention and care in Kaski district of Nepal
Project Site / location:
District: Kaski,
Municipality: Rupa, Madi, Machhapuchre and Annapurna Rural Municipality
Project Background:
In 2020, the prevalence of T2DM in Nepal was 8.5% (95% CI 6.9–10.4%), which was higher than that of 8.4% (95% CI 6.2–10.5%) in 2014 Similarly, in 2020 the prevalence of pre-diabetes was 9.2% (95% CI 6.6 – 12.6%) compared to 2014, which was 10.3% (95% CI 6.1–14.4%). The prevalence of type 2 diabetes is higher than national estimates as shown by our study i.e. 11.7% (95% CI: 10.5-13.1). Relative to neighboring countries such as Pakistan, Sri Lanka and Bangladesh, Nepal has a higher prevalence of T2DM and impaired glucose tolerance (11). As the prevalence of diabetes is on the rise, there is a proportionate rise in the complications that are associated with diabetes. Treatment and management of diabetes is still a major challenge in Nepal, for reasons such as low disease awareness among the population; various socio-cultural factors; educational strategies; and paucity of programs to detect, manage and prevent diabetes and its complications. Prevention of T2DM is therefore a critical public health priority for Nepalese populations.
Project Objectives:
- To provide community-level diabetes screening, counselling, and necessary referrals through the mobilization of FCHVs (community level)
- To strengthen diabetes care at Health Posts (the most peripheral health facility)
- To advocate for institutionalizing diabetes care at the community and the peripheral health facility
Activities to be carried out under Project/Program:
- Development of monitoring plan and monitoring visit (Including monitoring visit from social welfare council)
- Baseline and endline (FGD, KII/IDI related logistic, data enumerators, Travel, accommodation, data analysis, report preparation cost)
- Training for FCHV on prevention and management of NCDs.
- Distribution of glucometers and other teaching aids for 200 FCHVs.
- Refresher training session and quality improvement forum for the FCHVs.
- Continuous feedback, supervision, and monitoring of the FCHVs.
- Trained FCHVs will screen 25,000 people in the general population for diabetes through home visits.
- Individuals diagnosed with diabetes will be referred to higher-level care.
- FCHVs will continue to provide home visits for individuals with diabetes once every six months to track progress.
- Assessing awareness of diabetes among all those identified diabetes during screening at regular intervals throughout the study period and at end line at 36 months.
- Annual World Diabetes Day will be held in each of the participating communities.
- All untrained staff at health posts will receive PEN training (Orientation to local health facility staff).
- Medical supplies and equipment will be distributed to health posts
- Continuous feedback, supervision, and monitoring of health posts staff.
- HbA1c for confirmation of diabetes.
- Diabetes treatment can be initiated locally in the rural municipalities. Patients with uncomplicated diabetes will no longer have to visit tertiary-level facilities for initial care.
- Health posts staff will check for urinary ketones in severe hyperglycemic patients as per PEN protocol.
- Health posts staff will liaise with the medical doctor on-call to facilitate transfer and coordinate initial care of patients with ≥ 2+ urinary ketones to higher-level care.
- Established advisory board on local, provincial and national level and conduct advisory board meeting.
- Develop curriculum for integrating hypertension and diabetes.
- Advocacy workshop/meeting at local, provincial and national level.