Expanded and intensified population-based screening and diagnosis of hypertension and diabetes mellitus among rural adults in Northern India: An implementation research in routine programmatic setting

Abstract

Background: The National Noncommunicable Disease Program of India currently recommends population-based NCD screening (PBS) among people aged ≥30 years. The low turnaround for diagnosis confirmation is a consistent issue the program has faced since its launch. The current study assessed an expanded PBS (including people 18–29 years) and intensified (home-based) diagnosis confirmation strategy for hypertension (HT) and diabetes mellitus (DM) in a routine programmatic setting. Materials and Methods: This implementation research was conducted among all people aged ≥18 years in a rural health block in northern India. The eligible population was screened for HT and DM (using random blood sugar), and the screen positives were asked to visit a nearby public health facility (preferably) for diagnosis. An intensified home-based diagnosis confirmation was offered to screen positives who did not visit the health facility for diagnosis confirmation. Results: Of the 2004 participants screened, 1149 (57.3%) were female and 586 (28.2%) were aged 18–29 years. A total of 353 (20.2%) and 200 (10.9%) were found newly screened positive for HT and DM, respectively. The turnout rate for facility-based confirmation ranged from 69.6% to 91.2%. The prevalence of HT and DM in people aged 18–29 years and ≥30 years was 6.1% and 2.9% and 30.0% and 26.2%, respectively. The expanded screening and intensified home-based diagnosis confirmation strategies yielded an additional 12.8% HT and 24.1% DM among the total new cases detected. Conclusion: An expanded PBS and intensified diagnosis confirmation is feasible in a programmatic setting and has yielded additional new cases. Cost effectiveness of the above strategy must be assessed in future studies. Further, in-depth understanding of the risk perception, and potential cultural, social, and health system factors for improving the uptake of confirmatory tests is the need of the hour.

Keywords

• home-based diagnosis
• mass screening
• noncommunicable diseases
• primary care
• young population