The Health Department is launching a major initiative as part of a national programme for developing a registry for non-communicable diseases (NCDs) with focus on protocol-based standardised management of diabetes and hypertension.
According to the latest estimates, (as reported by the Achutha Menon Centre for Health Science Studies (AMCHSS), which studied a representative sample of 12,000 adults in Kerala) on an average, nearly one out of three persons above 18 years in Kerala has hypertension, while one out of five has diabetes, making the management of these two conditions a priority.
Quality standards
The State government has now chosen to integrate this programme, announced by the Ministry of Health in 2017-18, with two other initiatives, one of which is the India Hypertension Management Initiative (IHMI), a national programme being implemented by the Indian Council of Medical Research (ICMR) and Vital Strategies. The other is developing Quality Standards for the implementation of Standard Treatment Guidelines for the diagnosis and management of primary hypertension in Kerala, for which the State is partnering with the Imperial College, London, and World Health Organisation (WHO).
The integrated programme will be implemented in six districts in the State — Thiruvananthapuram, Thrissur, Kannur, Wayanad, Ernakulam and Alappuzha. Protocol-based diabetes management too has been added as an additional component as 20% of the State’s population suffer from diabetes.
“The study reported that the treatment and control of hypertension and diabetes are alarmingly low even among the educated, with only 13% of those diagnosed with hypertension and 16% of those with diabetes achieving adequate BP and blood sugar controls. Our aim is to increase this control rate to at least 50%,” a senior health official told The Hindu.
Everyone over 30 years in the designated area will be screened under each ASHA for diabetes and hypertension at primary health centres (PHC) through outreach camps and household surveys.
The screening at the Primary Health Centre level has already been initiated while field-level screening will be taken up soon.
Patient-friendly
Under the IHMI initiative, an expert committee has developed and revised hypertension and diabetes management protocols in such a way that henceforth the specified drugs in the protocol alone will be purchased and distributed by the State to PHCs. The aim is to make the treatment schedule more patient-friendly and to improve adherence.
“Blood pressure and blood sugar levels will be routinely checked for anyone above 18 years coming to the sub-centres or clinics and protocol-based management will be initiated for those with diabetes or hypertension.
The target Blood Pressure is below 140/90 mmHg for those below 80 years and below 150/90 mmHg for those above 80 years.
The target routine blood sugar (RBS) should be less than 140 mg/dl.
These patients will be followed-up for one year to ensure treatment adherence. Vital Strategies is offering technical assistance and training for personnel.
They have also appointed cardiovascular health officers and treatment supervisors in four districts to follow up on the patients, sources said.
‘‘The patients will be evaluated every quarter. The training of medical officers and health staff has been completed and protocols have been disseminated,” he said.
The separate module for the programme has been integrated into the e-health platform so that details of every patient is recorded, analysed and systematically followed up for an entire year to measure the impact of the protocol-based management of diabetes and hypertension.
