An innovative model for management of cardiovascular disease risk factors in the low resource setting of Cambodia

Nazaneen Nikpour Hernandez, Samiha Ismail, Heang Hen, Maurits van Pelt, Miles Witham, Justine Davies

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The author’s institute in Cambodia utilises Peer Educators (PEs) to screen and manage diabetes and hypertension in the community; a revolving drug fund (RDF) is used to finance the programme. Clinical outcomes and retention in the program are necessary to know if implementation of this program is to be widespread. We analysed clinical outcomes and patient retention in the programme between 2007-2016 in Takeo, Cambodia. For all those enrolled in the programme, the average change in blood pressure (BP) and percentage with controlled hypertension (BP < 140 / < 90 mmHg) or diabetes (fasting blood glucose (BG) < 7mg/dl, post-prandial BG < 130mg/dl, or HBA1C < 7%) was calculated every 6 months from enrolment. Attrition rate in the nth year of enrolment was calculated; associations with loss to follow-up were explored using cox regression. 9139 patients enrolled between January 2007 and March 2016. For all hypertensives, mean change in systolic and diastolic BP within the first year was -15.1mmHg (SD 23.6, p <0.0001) and -8.6mmHg (SD 14.0, p <0.0001), respectively. BP control was 50.5% at year 1, peaking at 70.6% at 5.5 years. 41.3% of patients with diabetes achieved blood sugar control at 6 months and 44.4% at 6.5 years. An average of 2.3 years [SD 1.9] was spent in programme. Attrition rate within year 1 of enrolment ranged from 29.8% to 61.5% with average of 44.1% [SD 10.3] across 2008-2015. Patients with hypertension were more likely to leave the program compared to those with diabetes and males more likely than females. The programme shows a substantial and sustained rate of diabetes and hypertension control for those who remain in the program and could be a model for implementation in other low middle-income settings, however, further work is needed to improve patient retention.
Original languageEnglish
JournalHealth Policy and Planning
Publication statusPublished - 20 Nov 2020


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