EuropeAid/132-456/L/ACT/ZM: "Community-based project on non-communicable-diseases"
6° Missione: Prevenzione Diabete ed Ipertensione arteriosa - Luglio/Agosto 2015
- Dr.Filomena Pietrantonio - MD - Dir.F.F. UOC Medina Interna – Osp.S.Eugenio – ASL RmC
Report: Agenda: 1) 28.07.15: Meeting with Dr.Ketty MD and setting up the mission agenda; Preparation of educational material on hypertension and diabetes trainings; 2) 29.07.15: Clinical Presentation on chronic diseases with focus on diabetes and hypertension; 3) 30.07.15: Clinical Presentation on chronic diseases with focus on diabetes and hypertension; Visit at the weekly diabetes clinic at the OPD of Kafue District Hospital and meeting with representatives of the Diabetes Association of Zambia and Dr. Gulnora Sultanova Responsible of the Diabetes Clinic; 4) 31.07.15: Clinical Presentation on chronic diseases with focus on diabetes and hypertension. Meeting with Project Manager of NCD Project, Dr Aaron Kamalondo, Council Secretary, Kafue Council; 5) 01.08.15: Monitoring of outreach activities carried out in Muchuto supported by the project; 6) 02.08.15: Preparing final report; 7) 03.08.15: Meeting in Lusaka with Dr Lubeya, to evaluate the training courses done, to define the training needs in the field of non-communicable diseases a
Purpose of the mission was to realize 3 short training courses on diabetes and hypertension focusing on practical recommendations and increasing attention on lifestyle changes; to continue the follow up of the ongoing project’s activities on people education, screening and prevention; to plan further training activities in the field of hypertension, diabetes and cancer of the uterine cervix, to suggest improvement actions.The consultant started working organizing meetings with key project stakeholders to agree priorities for action. The supervision activities of the action taken has been the starting point to define training needs and subsequent activities to be implemented to improve the quality of services, users’ satisfaction and technical skills of the operators. Meetings with medical and nursing staff have been very fruitful and have shown interest on training on the job and a teaching practical approach through case studies and review of clinical activities.
Clinical Presentation on chronic diseases was realized with focus on diabetes and hypertension. An Observational Study before and after training program on Hypertension and Diabetes treatment was proposed to the staff in order to improve their skills in Diabetes and Hypertension management. Actions to improve the management of chronic diseases (diabetes, hypertension, screening of cervix cancer) have been discussed and agreed.
Mission key findings: a) Monitoring of on project on going activities; b) outreach activities monitoring in Muchuto focusing on diabetes, hypertension and cervical cancer screening, health education activities and population empowerment; c) Visit at the weekly diabetes clinic at the OPD of Kafue District Hospital and Dr. Gulnora Sultanova Responsible of the Diabetes Clinic.
Meeting with the stakeholders; Meeting with representatives of the Diabetes Association of Zambia with the proposal to organize a joint training course on Diabetes. Meeting at Council Chamber of the Project Manager of NCD Project, Dr Aaron Kamalondo, Council Secretary, Kafue Council to evaluate the project and to define the training needs in the field of non-communicable diseases and in particular for Diabetes and Hypertension. Introduction of the new proposals for the project activities to Dr Kamalondo: Study before and after training; Event to promote health awareness on Non Communicable Diseases. Clinical Presentation on Chronic Diseases with focus on Diabetes and Hypertension. Practical experience of the added value of the safe food (vegetables, fruit, Mediterranean diet) during the training courses: 29.07.15: 20 people attended the presentation: Medical Officers (2); Clinical officers (4); Nurses (10); Midwives (4); 30.07.15: 26 people attended the presentation: Medical Officers (6); Clinical officers (8) Nurses 12; 31.07.15: 20 Community health workers attended the training. An Observational Study before and after training program on Chronic Disease was proposed. Preparation of documents for the setting up of shared protocols on diabetes and hypertension Choice of operating protocols and definition of an evaluation period of effectiveness (3 months). Main problems: Screening is carried out only with the vinegar and the positive are subjected to cryotherapy. The Pap test is not carried out and there are long lead times for the histological examination of doubtful cases. Missing study comparing vinegar and Pap tests to verify the correlation between positive and negative for the determination of false positives and false negatives with the method that uses vinegar. Poor adherence of patients to treatment protocols and dietary guidelines; problems to use insulin due to lack of availability and distrust of patients. Poor use of insulin is due to lack of trust of patients due to Stock rupture in the pharmacy. Need to intensify the activities of health education especially in rural areas. Lack of awareness of the importance of lifestyle changes in prevention of NCD. To be improved: The use of cameras to create images of the cervix in the peripheral Clinics; internet connection to enter the screening data in the general database, images collection using connecting cable from TV to cameras. Efficiency of the laboratory increasing the number of available tests to manage diabetes emergencies and to follow up properly diabetes and hypertension.