Incorporating selected non-communicable diseases into facility-based surveillance systems from a resource-limited setting in Africa

Abstract

Background: As Mozambique faces a double burden of diseases, with a rise of Non Communicable Diseases (NCD) superimposed to uncontrolled communicable diseases (CD), routine disease surveillance system does not include NCD. The objectives of our study were to i) upgrade of the current surveillance system by adapting the data collection tools to NCD; ii) describe the occurrence and profile of selected NCD using these data collection tools.

Methods: Workshops were implemented in a first referral urban hospital of Mozambique to train clinical staff, administrative workers and nurses on NCD surveillance, as well as select conditions to be prioritized. Based on the WHO Global Action Plan and Brazaville Declaration for NCD prevention and control, we selected arterial hypertension, diabetes, stroke, chronic respiratory diseases, mental illness and cancers. Data collection tools used for CD were changed to include age, gender, outcome and visit type. Between February/2014 and January/2015 we collected data at an urban hospital in Mozambique's capital.

Results: Over 12 months 92,018 new patients were assisted in this hospital. Data was missing or diagnosis was unreadable in 2637 (2.9%) thus only 89,381 were used for analysis; of these 6423 (median age 27 years; 58.4% female) had at least one selected NCD as their primary diagnosis: arterial hypertension (2397;37.31%), mental illness (1497;23.30%), asthma (1495;23.28%), diabetes (628;9.78%), stroke (299;4.66%), chronic obstructive pulmonary disease 61 (0.95%) and cancers 46 (0.72%). Emergency transfers were needed for 76 patients (1.2%), mainly due to hypertensive emergencies (31; 40.8%) and stroke (18;23.7%). Twenty-four patients died at entry points (0.3%); 10 of them had hypertensive emergencies.

Conclusion: Changes in existing surveillance tools for communicable diseases provided important data on the burden and outcomes of the selected NCD helping to identify priority areas for training and health care improvement. This information can be used to design the local NCD clinics and to strengthen the health information system in resource-limited settings in a progressive and sustainable way.

Keywords: Disease surveillance; Health information system; Non-communicable diseases.

Conflict of interest statement

Ethics approval and consent to participate

We used anonymized data collected for health surveillance but asked bioethics approval as per national guidelines in Mozambique (Comité Nacional de Bioética para a Saúde, IRB 00002657).

Consent for publication

Not Applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Training scheme, cadres involved and themes discussed and at MGH

Fig. 2

Summary of patients registered at MGH over 12 months with breakdown of traumatic, non-traumatic patients diagnosed with selected conditions and other patients see seen at entry points. “INJURY” includes physical injury and poisoning (except if related to suicidal attempt, in which case it was considered mental illness); “OTHERS” include CD and other non-communicable diseases that were not selected for surveillance

Fig. 3

Distribuition of selected NCD by age groups