Development of an integrated relevance-based management model for chronic non-communicable diseases and their risk factors, in a rural area of Limpopo Province, South Africa
Abstract
The aim of this study was to develop an integrated evidence-based model for the management of chronic non-communicable diseases in a rural community of Limpopo Province, South Africa.
Methods: The study followed a developmental study design which followed the Type 2 Developmental Research which was oriented toward a general analysis of design and development. The employed research methods followed a mixture of quantitative and qualitative techniques which were literature review, WHO STEPwise approach to surveillance of NCD risk factors, Focus Group Discussions, semi-structured Interviews and quality circles. Participants (n=1409) were residents of the Dikgale HDSS from which standardized international protocols were used to measure behavioural risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical and activity), physical characteristics (weight, height, waist and hip circumferences, blood pressure). Purposive sampling method was used for qualitative research to determine knowledge, experience and barriers on chronic disease management from patients, nurses, community health workers (CHWs), traditional health practitioners (THPs) and managers of chronic disease programme. Data were analysed using STATA 12 for windows, INVIVO and Excel spreadsheet.
Findings: The study revealed that the epidemiological transition is occurring in Dikgale. This rural area already has a high burden of risk factors for non-communicable diseases, especially smoking, alcohol consumption, low fruit and vegetables intake, physical inactivity, overweight and obesity, hypertension, High Cholesterol which can lead to various form of dangerous disease such as Coronary heart Diseases, high blood cholesterol, hypertriglyceridemia and Low levels of high-density lipoprotein cholesterol (HDL). The mainly mentioned barriers by both the nurses, chronic disease patients, CHWs and THPs are lack of knowledge, shortage of medication and shortage of nurses in the clinics which causes patients to stay for a long period in a clinic. Lack of training on the management of chronic diseases, supervision by the district and provincial health managers together with poor dissemination of guidelines has been found to be a contributing factor to lack of knowledge in nurses and CHWs. THPs revealed that the cultural insensitivity from the nurses (disrespect) makes not to collaborate with nurses on health service delivery.
Conclusions: Substantial high levels of the various risk factors among adults in Dikgale area suggest an urgent need for adopting healthy life style modifications and the development of an integrated chronic care model. Therefore, this highlights the need for health interventions that are aimed to control risk factors at the population level in order to slow the progress of the coming epidemic in non-communicable diseases. Lastly, concerted action is needed to strengthen the delivery of medications, improvement of chronic disease knowledge and establishment of a link with traditional healers and integrate their services in order to early detect and manage chronic diseases in the community.