Novel approaches to screening for noncommunicable diseases: Lessons from Neno, Malawi|
Kachimanga, Chiyembekezo; Cundale, Katie; Wroe, Emily; Nazimera, Lawrence; Jumbe, Arnold; Dunbar, Elizabeth & Kalanga, Noel
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.