Non-communicable diseases

Background: Collaborative partnerships are considered an essential strategy for integrating local disjointed health and social services. Currently, little evidence is available on how integrated care arrangements between professionals and organisations are achieved through the evolution of collaboration processes over time. The first aim was to develop a typology of integrated care projects (ICPs) based on the final degree of integration as perceived by multiple stakeholders. The second aim was to study how types of integration differ in changes of collaboration processes over time and final perceived effectiveness.

Prioritising preventive cancer services in Zimbabwe as the country struggles with unaffordable healthcare To the Editor: The health system in Zimbabwe has collapsed, mainly owing to underfunding and the migration of skilled personnel. [1] Treatment services have consequently become unaffordable to those in need, especially the poor, who make up more than 80% of the population. Of particular focus for this letter, Zimbabwe has not been spared from the rising burden of cancers globally. Cancers account for over a third of premature deaths from noncommunicable diseases in Zimbabwe, compared with South Africa, where they account for a fifth. [2] There are currently concerns regarding inadequate capacity to provide quality cancer care in Zimbabwe. [3] A significant number of deaths from cancers that are treatable if identified early enough, such as cervical and breast cancer, continue to be reported. Unfortunately, reports suggest that patients are struggling to access treatment services in the public sector, and are therefore resorting to alternative sources of treatment such as traditional medicine practitioners, or remote mission hospitals which, even if better staffed and equipped than hospitals in the public sector, offer substandard surgical treatments in inadequately worked up cancer patients. These externally funded mission hospitals are overwhelmed and do not offer adequate follow-up treatment services, including chemotherapy and radiotherapy, to all their clients. Several barriers prevent timely and appropriate cancer treatment in Zimbabwe. Firstly, the lack of medical insurance for the majority of the country's citizens results in delays in seeking diagnostic services for potentially cancerous diseases. It is estimated that at least 90% of the country's population is not medically insured. Owing to the prevailing harsh socioeconomic conditions, they may also not have money to pay cash for services. [4] Secondly, the country has a shortage of medical specialists in fields that include early diagnosis of cancer. Many patients are seen by specialists at provincial and tertiary hospitals when they already have advanced disease. The country has fewer than 15 clinical oncologists, [5] who practise only in the country's two major cities, Harare and Bulawayo. Thirdly, the country imports all the medicines used in the treatment of cancer, including chemotherapeutic agents and biological treatments. With the scarcity of foreign currency in the country, importing these medicines is often a challenge. Fourthly, the country has a huge backlog of cancer patients requiring surgical intervention, owing to lack of operating theatre time, equipment and staff. The ongoing attrition of nurses, worsened by the COVID-19 pandemic, has included hordes of experienced theatre nurses leaving the country. Finally, the country has very few operational radiotherapy machines in the public sector, only available at the Parirenyatwa Group of Hospitals radiotherapy centre. Patients from all over the country must travel to the capital for cancer treatment services. Ultimately, addressing the public health sector caveats highlighted above will be critical for improving cancer outcomes in Zimbabwe; in the interim, however, reducing the burden of cancer in the country through primordial, primary and secondary prevention is key. Prevention with evidence-based interventions is a cost-effective strategy, with tangible results as witnessed elsewhere. Primordial This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

In recent years, non-communicable diseases (NCDs) have globally shown increasing impact on health status in
populations with disproportionately higher rates in developing countries. NCDs are the leading cause of mortality
worldwide and a serious public health threat to developing countries. Recognizing the importance and
urgency of the issue, a one-day symposium was organized on NCDs in Developing Countries by the CIHLMU Center for
International Health, Ludwig-Maximilians-Universität, Munich on 22nd March 2014. The objective of the symposium was
to understand the current situation of different NCDs public health programs and the current trends in NCDs research and
policy, promote exchange of ideas, encourage scientific debate and foster networking, partnerships and opportunities
among experts from different clinical, research, and policy fields. The symposium was attended by more than seventy
participants representing scientists, physicians, academics and students from several institutes in Germany and abroad.
Seven key note presentations were made at the symposium by experts from Germany, UK, France, Bangladesh and
Vietnam. This paper highlights the presentations and discussions during the symposium on different aspects of NCDs
in developing countries. The symposium elucidated the dynamics of NCDs in developing countries and invited the
participants to learn about evidence-based practices and policies for prevention and management of major NCDs and
to debate the way forward.

Diabetes Mellitus (DM) comprises a group of common metabolic disorder that share the phenotype of hyperglycemia. The Worldwide prevalence of DM has risen dramatically over the past two decades. Based on current trends, more than 360 million individuals will have DM by the year 2030. Prevalence of type II DM is increasing worldwide much more rapidly than type I DM because of increasing obesity and reduced activity level and sedentary lifestyles. Six of the top ten countries with the highest rates of DM are in Asia and India is becoming capital of DM. Diabetes Mellitus can be co-related with Madhumeha dealt in Ayurveda classics. It is a type of Vataj Prameha. In Brihatrayee and Laghutrayee various drugs are described for the treatment of Prameha. Bhavaprakash Nighantu is the clinically important among Laghutrayee; also dealt with various drugs useful for Prameha.

This report provides an extensive directory of research on ageing in Africa covering the period 2004-2015, updating the Directory of Research on Ageing in Africa: 1995-2003 prepared previously by Dr. Paul Kowal for the World Health Organization. The Directory aims to profile, promote and encourage research into the health and needs of people aged 50 years or over in Africa, and to enable the use of evidence for policy. Such evidence is essential to enable countries undergoing rapid demographic and epidemiological transitions to develop
appropriate policy responses and to monitor the implementation and impact of those policies.
The Directory includes descriptions of research activities submitted by primary investigators, with
minimal editing.

Filling the evidence gaps on the status and needs of older persons in Africa requires concerted efforts from individual countries and the pan-African community, together with contributions from the international research community. It is hoped that this Directory will enhance networking and political
action and facilitate collaborative research efforts to focus on older persons in Africa.

Rice in the human diet serves underprivileged populations in Asia as a means of nutritional replenishment for energy and
protein as well serving as a vehicle for micronutrient fortification. About 85% of rice consumption is mainly white rice. A possible relationship between white rice consumption and health risk exists. The threat is real enough for the scientific community to promote wholegrain consumption in place of refined grains. In the transitioning food environment, white rice is categorised as a refined grain and is thus implicated in the development of non-communicable diseases (NCDs). There is considerable interest in exploring glycaemic index (GI) in relation to the consumption of different rice varieties. The variable glycaemic response to rice types is better appreciated from the viewpoint of factors that moderate this response. Genetic make-up, physicochemical properties, amylose and dietary fibre content, post-harvesting processing as well as cooking methods are influential factors in determining GI variability. To date, new rice varieties bio-fortified with micronutrients such as iron, zinc and beta-carotene have been produced and useful in ameliorating the micronutrient deficiencies such as iron deficiency
anaemia, stunted growth and xerophthalmia affecting children or adults in developing countries. Rice breeding and improvement programs play a major role in safeguarding the food environment, by taking into account traits that will improve rice quality in terms of GI as well as micronutrient capacity.

Introduction: Metabolic syndrome (MetS) is a public health threat rising globally at an alarming rate. Yoga as a therapy is becoming increasingly popular and its applications are increasing in various clinical conditions. Yoga is an integrated system of self-culturing, aimed at coordinated development of body and mind leading to enhanced physical health, spiritual harmony, positive thinking, happiness and peace. Aim: This study aimed to study the role of yoga as adjuvant therapy in the clinical management of MetS. Methods: The study was done an interdisciplinary collaborative work between Center for Yoga Therapy and Department of General Medicine of MGMCRI, Sri Balaji Vidyapeeth, Puducherry. Thirty newly diagnosed MetS patients were recruited; prestudy evaluations of body mass index, waist circumference, hip circumference, pulse rate, systolic blood pressure (SP), diastolic blood pressure (DP), fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin, and fasting lipid profile were done. By the method of simple randomization, subjects were allocated to yoga therapy group (n = 15), who received yoga therapy thrice weekly for 3 months along with standard medical management and to control group (n = 15) who received only standard medical management. Poststudy evaluation of all parameters was done at the end of the study period. Data were analyzed by Student's paired 't' test, as all data passed normality. Results: There was a statistically significant (p < 0.05) reduction in all the above parameters in yoga group compared to control group. Changes seen in control group were missing significance. Conclusions: It may be concluded from the present pilot study that adjuvant yoga therapy is beneficial in maintaining good health and reducing metabolic risk factors. This may have impact on utilization of yoga therapy as a secure and cost-effective add-on therapeutic modality in combating MetS.

Escalating non-communicable disease multimorbidity rates among older adults is an emerging public health concern in India, but the literature sparsely addresses the epidemiology of multimorbidity. We explore levels, patterns, combinations and predictors of multimorbidity among older adults using information on 59,764 individuals, aged 45 years and older, from the first wave of Longitudinal Ageing Study in India (LASI), 2017-2018. We computed multimorbidity score for sixteen non-communicable diseases to identify frequently occurring morbidity patterns (dyads and triads) and assess the relationship between multimorbidity and selected background characteristics. Near third of the older adult population is affected by multimorbidity, with hypertension, gastrointestinal disorders, musculoskeletal disorders, diabetes and skin diseases being the most common. Policymakers should seek strategies to increase early detection and prevention of chronic diseases, delay the age at onset of disease for those who are not affected and improve management for those affected with multiple disease conditions.

Dans les pays en voie de développement aux ressources limitées, l’augmentation de la
prévalence des maladies cardiovasculaires constitue un problème émergent majeur. Au Burundi, la
fragilité du système de santé après la fin des conflits rend primordiale la mise en place d’actions de
prévention en direction des personnes à risque. En 2007, un programme structuré de prévention des
sujets à haut risque a été mis en place dans le cadre d’un réseau de santé communautaire à Bujumbura,
la capitale. Dans 10 structures de santé et ONG et dans 3 associations de patients a été effectué un
dépistage gratuit du risque à partir de critères cliniques et de la détermination de la glycémie capillaire.
De juin 2007 à décembre 2008, 377 séances de groupe pour 1318 personnes à risque et 2457
participations (1 à 3 séances par personne sur un cycle comportant 3 thématiques) ont été réalisées par
19 infirmières et pairs éducateurs formés conjointement par un diabétologue et une ethnosociologue.
Les situations d’apprentissage de groupe permettent un choix personnalisé et éclairé d’action(s) par les
personnes à risque. Une évaluation intermédiaire du suivi éducatif réalisé chez 292 personnes ayant
terminé le cycle éducatif et bénéficié d’un 2ème bilan éducatif a montré une évolution favorable des
facteurs de risque modifiables. L’inscription rapide de cette approche dans le tissu burundais et
l’implication des pairs éducateurs aux cˆotés des professionnels de santé laissent supposer un fort
potentiel de développement dans d’autres pays. (Global Health Promotion 2010; Supp (2): pp 68–75)

Background: Polycystic Ovarian Syndrome (PCOS) is a common endocrine syndrome with the disproportionate activity of androgen. This study is intended to determine attitudes with respect to the present names for the syndrome and acuities held by women regarding the main clinical features of PCOS. The study compares the status of PCOS patients and reproductive-aged tribal women prone to PCOS in the population of Central India at Amarkantak. Methods: A cross-sectional study was performed in which a sample size of 500 females by random sampling was considered for the study and a well-validated questionnaire following the Rotterdam criteria for the diagnosis of PCOS was administered. Data collected relating to PCOS risk factors and the status of disease burden in society were analyzed using SPSS v 25. Results: The prevalence of the PCOS was around 6.6% owing to wretched lifestyle practices. Midst them, the risk factors were depression/anxiety in 32.2%, obesity in 28.4%, and diabetes in 7.6% and infertility in 1.8%. 86.6% of people were unaware of the disorder and 41.8% of them were prone to PCOS. Conclusion: Early detection and tracking of risk factors can help in the management of PCOS symptoms. A population-based program of screening and awareness including treatment modalities may be beneficial for the management of the disease.

Low-income and middle-income countries are struggling with a growing epidemic of non-communicable diseases. To achieve the Sustainable Development Goals, their healthcare systems need to be strengthened and redesigned. The Starfield 4Cs of primary care—first- contact access, care coordination, comprehensiveness and continuity—offer practical, high-quality design options for non-communicable disease care in low-income and middle-income countries. We describe an integrated non- communicable disease intervention in rural Nepal using the 4C principles. We present 18 months of retrospective assessment of implementation for patients with type II diabetes, hypertension and chronic obstructive pulmonary disease. We assessed feasibility using facility and community follow-up as proxy measures, and assessed effectiveness using singular ‘at-goal’ metrics for each condition. The median follow-up for diabetes, hypertension and chronic obstructive pulmonary disease was 6, 6
and 7 facility visits, and 10, 10 and 11 community visits, respectively (0.9 monthly patient touch-points). Loss-to- follow-up rates were 16%, 19% and 22%, respectively. The median time between visits was approximately 2 months for facility visits and 1 month for community
visits. ‘At-goal’ status for patients with chronic obstructive pulmonary disease improved from baseline to endline (p=0.01), but not for diabetes or hypertension. This is the first integrated non-communicable disease intervention, based on the 4C principles, in Nepal. Our experience demonstrates high rates of facility and community follow-up, with comparatively low lost-to-follow-up rates. The mixed effectiveness results suggest that while this intervention may be valuable, it may not be sufficient to impact outcomes. To achieve the Sustainable Development Goals, further implementation research is urgently needed to determine how to optimise non-communicable disease interventions.

Non-communicable diseases (NCDs),
are the major cause of mortality,
accounting for 38 million annual deaths
around the world. The four main NCDs
(cardiovascular diseases, cancer, chronic
respiratory diseases and diabetes) are
accounting for 82% of all NCD deaths.1
About, 80% of all NCD deaths occur in
low- and middle-income countries.2 In
Pakistan, NCDs are the leading cause
of morbidity and mortality.3 According
to WHO country profile, NCDs are
contributing for 50% of total deaths in
Pakistan and the probability of dying from
30- 70 years of age, due to four main
NCDs is 26%.4
Diabetes mellitus is ranked 4th among
NCDs causing deaths, accounting for 1.5
million global deaths each year.1 Worldwide,
estimated prevalence of diabetes
was 9% among adults (aged 18 + years)
in 2014.5 According to International
Diabetes Federation (IDF)6, 382 million
people, aging between 40 and 59 years
across the world, are currently living with
diabetes and the estimated 55% rise will
lead to 532 million diabetics in the year
2035. Eighty percent of diabetics live
in low- and middle-income countries.
Alarming situation is that 175 million
people with diabetes are undiagnosed.
In 2013, 548 billion US dollars were
spent on health expenditure related to
diabetes.6
Pakistan with a population of 184.35
million is the 6th most populous country
of the world.7 Although current national
data regarding prevalence of diabetes in
Pakistan are lacking, previous national
diabetes surveys of Pakistan by Diabetes
Association of Pakistan (DAP) and WHO
showed an overall prevalence of diabetes
as 11.47% (ranged from 6.39–16.5%).8-
11 According to IDF, there were 6.9 million
cases of diabetes in Pakistan in 2014
and prevalence of diabetes in adults of
20-79 years of age was 6.8%.12 However,
the projected estimates of IDF for 2035
shows an alarming situation and Pakistan
with an estimated number of 12.8 million
diabetics, will be ranked 8th among the
world’s top 10 countries having increased
prevalence of diabetes.6

Background: Increased antiretroviral therapy uptake in sub-Saharan Africa has resulted in improved survival of the infected. Opportunistic infections are declining as leading causes of morbidity and mortality. Though comprehensive data are lacking, concern has been raised about the rapid emergence of non-communicable diseases (NCDs) in the African HIV care setting. We therefore set out to characterise the NCD/HIV burden among adults living and ageing with HIV infection in Zimbabwe. Methods: We conducted a cross-sectional study among patients receiving care in a public sector facility. We reviewed patient records and determined the prevalence of comorbid and multi-morbid NCDs. Associations with patient characteristics were evaluated using univariate and multi-variate logistic regression modelling. Significance testing was done using 2-sided p values and 95 % confidence intervals calculated. Results: We recruited 1033 participants. 31 % were men. Significant gender differences included: older median age, more advanced disease at baseline, and greater use of stavudine and protease inhibitor containing regimens in men compared to women. The prevalence of comorbidity and multi-morbidity were, respectively, 15.3 % (95 % CI 13.3– 17.7 %) and 4.5 % (95 % CI 3.4–6.0 %). Women had higher rates than men of both co-morbidity and multi-morbid