cohortmonitoring&of&persons&with&ncd& in unrwa:&a.&seita ... ·...
TRANSCRIPT
Cohort monitoring of persons with NCD in UNRWA: A. Seita ([email protected])
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Tropical Medicine and InternaBonal Health
Volume 17 No 9 PP 1163-‐1170 September 2012
1, 2 UNRWA (HQ & Jordan) 3 Tokyo University (Tokyo) 4 InternaBonal Union Against Tuberculosis and Lung Disease (Paris) 5 London School of Hygiene and Tropical Medicine (London) 6 Medicine san FronBers (Luxemburg) 7 World Diabetes FoundaBon (Denmark)
Care for persons with diabetes (DM) and hypertension (HTN) in UNRWA
• Two decepBvely simple quesBons – ①How many paBents have been diagnosed?
– ②What happens to them?
• Can we answer them? 0
50,000
100,000
150,000
200,000
250,000
2007 2008 2009 2010 2011
No. of Pales/ne refugees with DM / HTN in UNRWA
Others (Lebanon, Syria, Jordan)
Gaza + West Bank 2
Care for persons with diabetes (DM) and hypertension (HTN) in UNRWA
0
50,000
100,000
150,000
200,000
250,000
2007 2008 2009 2010 2011
No. of Pales/ne refugees with DM / HTN in UNRWA
Others (Lebanon, Syria, Jordan)
Gaza + West Bank
à Largely Yes. -‐ But not in full details (>10,000 new paBents a year)
à Largely No. -‐ 10% sample survey (1/yr) -‐ Not in details in compliance “Regularly come/examined?” -‐ Not fully reliable control mix of new & old paBents (>200,000 paBents in total)
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• Two decepBvely simple quesBons – ①How many paBents have been diagnosed?
– ②What happens to them?
• What should we do?
Cohort monitoring: started in TB • Started with DOTS in 1990s
– Cohort: Group of people treated as a group • Quarterly cohort with two key analysis
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Pa/ents registered in 2011 Q1
2012 Q1 2011 Q4 2011 Q3 2011 Q2 2011 Q1
Pa/ents registered in 2011 Q2
Pa/ents registered in 2011 Q3
in 2001 Q4 in 2011 Q4
in 2012 Q1
Now
①“How many new pa5ents?” à Count No. of paBents
registered in Jan-‐Mar 2012.
②“What happens to them?” à Assess treatment outcomes
of paBents registered in Jan-‐Mar 2011.
Cohort monitoring: NCD in UNRWA • Nuzha health center (Jordan)
– 55,000 pop. E-‐health from 2009.
• Quarterly cohort with four key analysis
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Pa/ents registered in 2011 Q1
2012 Q1 2011 Q4 2011 Q3 2011 Q2 2011 Q1
Pa/ents registered in 2011 Q2
Pa/ents registered in 2011 Q3
in 2001 Q4 in 2011 Q4
in 2012 Q1
Now
①“How many new pa5ents?” à Count new paBents à Count all paBents
②“What happens to them?” à Assess all paBents
à Assess cohort separately
How many paBents? (new)
Quarterly cohort registra/on • Count paBents newly registered between Jan-‐Mar 2012 (Table 2)
àQuarterly incidence (97 new paBents)
àSupport to raBonal planning of drugs
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97 Gender
Age
Category of disease
Diagnosis
Place of diagnosis
How many paBents? (total)
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Cumula/ve cohort registra/on • Count all paBents registered up to 31 Mar 2012 (Table 3)
àUpdated prevalence (4130 all paBents)
àSupport to raBonal planning of drugs
Gender
Age
Category of disease
Diagnosis
Place of diagnosis
4130
What happens to them? (total)
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Cumula/ve treatment outcomes • Assess treatment
status of all paBents registered by 31 Mar 2012 (Table 4)
àCompliance – Anendance (76%), examined (74%)
• Assess control status? -‐ orange & banana!
4130
Remaining in care 3119 76
No anendance in Q1 (Jan-‐Mar ‘12) 878 21
Of paBents remaining in care No. of BP measured No. with BP <140/90 mmHg
3119 2297 1704
74 74
What happens to them?
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12-‐15 month cohort outcome analysis • Asses treatment
status of paBents registered in Jan-‐Mar 2011 at 1 Apr 2012 (Table 5, excerpt)
• 1-‐yr survival analysis à Compliance
– Anendance (62%) – Examined (74%, 3%...)
à Control rate (76%) à Late complicaBons
(N.B. Excerpt)
226
Remaining in care 140 62
No anendance in Q1 2012 84 38
Of paBents remaining in care No. of BP measured No. with BP <140/90 mmHg
140 104 79
74 76
Of paBents remaining in care PaBents with HT only FBG measured PaBents with HT & DM Cholesterol measured Serum creaBnine measured
79 2 140 140 139
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100 99
• Basic epidemiology data – Incidence (97 paBents) – Prevalence (4130 pts)
• Performance – Anended (76%) – Examined (74%)
• Outcome – Controlled (76%)
• Impact – Late complicaBons (8%)
51%
59%
65%
72%
80%
50%
75%
100%
0 12 months
24 months
36 months
48 months
60 months
Q4 2005 Q4 2006 Q4 2007 Q4 2008 Q4 2009
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Cohort monitoring for NCD care scale up National cohort survival analysis (Malawi) (12, 24, 36, 48 and 60 months after ART start)
Ref. A.D Harries, International Union Against TB & Lung Disease