Assessment Of National Programme For Prevention And Control Of Cancer, Diabetes, Cardiovascular Diseases And Stroke (Npcdcs) With Respect To Individuals Screened Positive For Diabetes And Hypertension At Sub-Centre Level Camps In Belagavi Taluka In Karnataka – A Cross Sectonal Study

Abstract

Abstract Introduction: Deaths due to Non-Communicable Diseases (NCDs) have increased worldwide since 2000 A. D., and according to the World Health Organization (WHO) report in 2012, 56 million deaths occurred worldwide, of which 38 million (68%) were due to NCDs and in India, deaths due to NCDs in 2008 were 5.3 million, prevalence per 1,000 population of diabetes was 62.47, hypertension was 159.46, Ischemic Heart Diseases (IHD) was 37 and stroke was 1.54. A rapid health transition is being experienced in India, with large, rising burdens of chronic non-communicable diseases. The first point of contact of patients with health services are Primary Health care facilities, which are the most appropriate places for patient screening, early detection, provision for continuous care for uncomplicated patients and patient referral to specialists. The Government of India had launched “The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke” (NPCDCS) in 2010 and the programme was launched in Belagavi district on 29th September 2015. Periodic evaluation helps us to understand the problems a programme is facing in managing, implementing and utilizing service, so that appropriate modifications can be suggested. Objectives: 1. To assess the Knowledge, Attitude and Utilization practices of the beneficiaries screened positive for Diabetes and Hypertension who had attended ‘National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS)’ camps held at Sub-Centre level in Belagavi taluka. 2. To assess the implementation of NPCDCS at District Hospital (DH), Community Health Centre (CHC), Primary Health Centres (PHCs) and Selected Sub-Centres (SCs) in Belagavi taluka. Materials and Methods: A Cross sectional study was conducted in Belagavi taluka of Belagavi district in Karnataka state from 1st January 2017 to 31st December 2017. The list of PHCs and SCs was obtained from the District Health Office, Belagavi and District hospital (DH), one Community Health Centre (CHCs), 12 Primary Health Centres (PHCs) were selected. Multistage random sampling method was used and three Sub-centres (SCs) from each PHC were selected, accounting to 36 sub-centres and 10 beneficiaries from each sub-centre accounting to 360 beneficiaries were selected. The concerned Medical Officers at the DH, CHC and PHC, the concerned ANMs of the selected Sub-centres were contacted. Written informed consent was obtained and the data was collected using a pre-tested pre-designed structured questionnaire in personal interview by the investigator. 10 beneficiaries from each Sub-centre were selected from the NPCDCS register, who had attended the NCD camps six months prior to the visit of the interviewer. In case of non-availability of the concerned staff, another two repeat visits were made for complete data collection by the investigator. Results: The NPCDCS was implemented 100% at District Hospital, Community Health Centre and 12 Primary Health Centres and in all selected 36 Sub-Centres with the activities of opportunistic screening of individuals above the age 30 years and above and health promotion at all health care facilities. The district NCD clinic was established with adequate man power in the district hospital, but the Cardiac Care Unit was not yet established and the necessary investigations were available. In the CHC though the NCD clinic was established, the manpower was inadequate with vacant posts and the necessary investigations were partially available (37.5%). The PHCs covered a population of 4, 77,805 with 70 Sub-Centres, mean population covered by each PHC being 39,817 and mean population per SC being 6,825. The activities of out-patient care, in-patient care were rendered 100% and the necessary equipment were available in all 12 PHCs of Belagavi taluka. The selected 36 SCs covered a population of 2,48,753 with mean SC population of 6,909. 63% of the SCs were conducting the NCD camps weekly, with average number of NCD camps conducted per SC being 30 per year and the population screened for NCDs across all 36 SCs was 64, 096 accounting to 25.77% of the population coverage. The prevalence of diabetes was found to be 4.87% and prevalence of hypertension was found to be 4.99% and 69% of the ANMs had received training regarding NPCDCS and all the necessary equipment was adequate except for referral cards. Out of the 360 beneficiaries, 58.33% were females, 89.72% were married, 82% were Hindus by religion, 45.83% belonged to nuclear family, 40.83% of them had completed primary schooling, 56.67% were BPL ration card holders and 63% of them belonged to Class IV and V socio-economic status. Overall awareness about NCDs was 43.11%, Anganwadi workers and ASHAs were the informants about NCD camps for 56% of the participants. 72.22% of them were aware about NCD camps, 58.89% of them approached nearest PHC for health care and 85% of the participants visited the doctor for confirmation of the disease, 74.44% were compliant for prescribed medications, 67.22% of them were on regular follow up and only 48.61% of them received medications for free from the government health facilities. Conclusion: It was observed in the present study that there was 100% implementation of NPCDCS and screening activities at all levels of health care. The NCD clinic was established in the district hospital, Belagavi with 100% manpower and at CHC with no adequate manpower and equipment. NCD screening camps were being conducted at all SCs and only two third of ANMs had received training for NPCDCS and the necessary equipment and IEC materials were available at all selected SCs for conduction of NCD camps. Knowledge and awareness about NCDs was not sufficient among the beneficiaries under NPCDCS and it was observed that ASHAs and Anganwadi workers played the key role of informants for public about conduction of sub-centre NCD camps. Though the beneficiaries were referred to their respective PHCs for confirmation and treatment of the disease, many participants were ignorant and compliance for prescribed medications and follow up care was poor. It was also seen that the participants who visited the doctor for confirmation of the disease had better treatment compliance for medications and follow up care than those who did not visit the doctor at PHC.