Introduction:
Ensuring equitable access to kidney care remains a challenge in low- and middle-income countries (LMICs). Health promotion and disease prevention through community awareness along with early detection of associated risk factors and timely management at primary care centres can help reduce the burden of kidney disease. Kidney, Hypertension, Diabetes, and Cardiovascular diseases (KHDC) program was started in 2003 as part of an initiative from ISN for detection and management of major Non-Communicable Diseases (NCDs) in LMICs like Nepal. Here we present a broader approach to be undertaken by the program in Eastern Nepal during 2023-2027. The implementation of program focuses on strengthening existing health systems and engaging communities on NCDs awareness. Also, we present some insights from our preliminary experience of the program including analysis outcomes from screening activities.
Methods:
An expected population of 89,885 are screened for risk factors by 251 Female Community Health Volunteers (FCHVs). High-risk screening approach is undertaken in three municipalities which includes regions with geographical remoteness and poor access to healthcare. FCHVs are trained in delivering health promotion messages, Blood Pressure (BP) measurement, Blood Sugar (BS) measurement and eliciting exposure to risk factors through brief history taking. Population above 40 years of age, high BP, high BS, high waist circumference, existing personal or family history of NCDs, tobacco/alcohol use, history of gestational diabetes/hypertension, etc. are considered as criteria for evaluating high risk for NCDs. The high-risk individuals are then referred to primary level health centers for screening of diabetes, hypertension, chronic kidney disease (CKD) and cardiovascular diseases. Trainings are provided to 164 Health Care Providers (HCPs), at 38 health centers, to manage early presentations, identify complications, and evaluate necessity of prompt referral based on clinical evaluation, blood pressure measurements, blood glucose tests (fasting blood glucose, HbA1c), serum creatinine, lipid profile, and urine analysis (albumin, creatinine, ACR).
Results:
During the first year of the program implementation, training of 149 HCPs, and 56 FCHVs were undertaken. Out of 3051 adult population at the communities, 1177 high risk population were identified by FCHVs and subsequently examined by HCPs. A population coverage of 66.4% (n=729) was achieved among adults aged 40 years and above (n=1098) in the communities. Of the three most common risk factors for chronic kidney disease; proteinuria, diabetes and hypertension were detected among 2.5% (n=30), 4.2% (n=50), and 19.6% (n=231) individuals, respectively. Estimated Glomerular Filtration Rate (eGFR) was < 60 ml/1.73m2 among 1.6% (n=19) individuals. Among them two individuals had both proteinuria and eGFR < 60 ml/1.73m2.
Conclusions:
Engaging communities through FCHVs, as in our experience, have shown good prospect for early detection of NCDs by bringing affordable access to healthcare at doorsteps. Equally, task sharing through competency-based trainings for non-physician HCPs can improve early detection and management in resource poor settings. Existing health systems can be strengthened through noble solutions that are sustainable to help improve care provisions for NCDs including kidney disease at LMICs.
I have potential conflict of interest to disclose.
KHDC program (2023-2027) is supported by Service Social International (SSI) through Geneva University Hospitals (HUG).
I did not use generative AI and AI-assisted technologies in the writing process.