Addressing the burden of chronic non-communicable diseases in Dikgale rural area of Limpopo province

My research interests are in Health Systems Policy, Management and Intervention research. This is mainly because I want to contribute to the improvement of the public health system by encouraging the use of operational research for decision making, collaborating with institutions of higher learning in Limpopo Province regarding issues related to research to capacitate departmental research, and develop teaching programs in the department which focus on health economics and other related items. This includes but is not limited to preventive, remedial, maintenance care and the incorporation of traditional health into the district health system. I would like to strengthen my role in the public and private sectors and to effectively create and implement health policies and manage programs that promote the public health system. This will help to  confront complex health issues, such as improving access to health care, controlling infectious disease, chronic diseases and development, implementation and monitoring of interventions to control chronic diseases with an aim to pursue the goal “health for all” in the wider scope of human rights and social justice.

This passion for health and social development stimulated me to further my studies by pursuing a PhD in Medical Science. The aim of my study – which I presented at the PHASA conference – was to develop an integrated evidence-based model for the management of chronic non-communicable diseases (NCDs) in a rural community of Limpopo Province, South Africa. This was done based on the fact that the burden of NCDs is predicted to increase substantially in South Africa over the next decades if measures are not taken to combat the trend. An insight into the extent of risk factors for NCDs in South Africa is crucial for effective advocacy and action. There is a need to understand the barriers and challenges encountered by nurses, chronic disease patients, Community Health Workers (CHWs) and Traditional Health Practitioners (THPs) before one can plan how to improve chronic disease management. In response to many of the chronic disease management barriers and to improve health outcomes in the community, patient participation together with the involvement of CHWs and THPs has gained momentum.

My study aimed at determining how an integrated model involving chronic nurses, patients, CHWs and THPs can be developed and actively pursued as a viable means to improve chronic disease management particularly in a rural community of Limpopo Province, South Africa. The developed model will serve as an intervention program for the management, prevention and control of chronic NCDs in Primary Health Care facilities. This will help to establish the mechanism and the processes of redesigning the primary health care system with the clear purpose of reducing morbidity and mortality due to chronic illness. The perception is that, in order to effectively respond to the complex social, cultural and behavioural issues associated with NCDs, a health system should be oriented towards health promotion, prevention and delivery of cost effective interventions through a primary health care approach.

The summary of my study findings are as follows:

The mean age of the participants was 44±20.8 years and approximately 71.1% of the participants were unemployed with 58% of participants having primary school education or no education. The prevalence of current smokers was 13.7% with daily smokers contributing 81.3% and alcohol consumption was at 16.3% increasing with age. Majority of participants (88.6%) had low daily intake of fruit and vegetables and low physical activity (66.5%). The prevalence of hypertension was 38.2%, overweight; obesity and high waist circumference were most prevalent in females. High cholesterol levels and total cholesterol/HDL cholesterol ratio were 32.6% and 10.9% respectively and more prevalent in females than in males. The prevalence of hypertriglyceridemia was 25.4%. The older people were 1.8 times more likely to be hypertensive, 4.1 times more likely to have high fasting blood glucose, 2.6 times more likely to  have high cholesterol levels and 2.4 times more likely to have raised triglycerides levels (all p<0.05). People with low education were 1.8 more likely to be hypertensive, 4.4 times more likely to have high fasting blood glucose, 1.8 times more likely to  have high cholesterol levels and 1.5 more likely to have raised triglycerides levels (all p<0.05).

The current study also showed that chronic disease patients have a first contact with health care professionals at the primary health care level in the study area. The main  barriers mentioned by both the nurses and people living with chronic conditions are lack of knowledge, shortage of medication and shortage of nurses in the clinics which causes patients to wait for a long period in a clinic. Health care workers are poorly trained on the management of chronic diseases. Lack of supervision by the district and provincial health managers together with poor dissemination of guidelines has been found to be a contributing factor to lack of knowledge in nurses in the clinics within the study area. Both nurses and people living with chronic conditions together with community health workers mentioned the need to communicate with traditional healers and integrate their services in order to early detect and manage chronic diseases in the community better.

In conclusion, this study suggests urgent need for adopting healthy life style modifications and the development of an integrated chronic care model. This highlights the need for health interventions aimed to control risk factors at the population level, improve a link with traditional healers and integrate their services in order to early detect and manage chronic diseases in the community. Therefore Primary Health Care (PHC) services should increasingly accommodate screening for chronic NCDs including risk factors. The developed model will serve as a contribution to the improvement of NCD management in rural areas.

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