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Background: Although primary care models for the care of common non-communicable diseases (NCD) have been developed in sub-Saharan Africa, few have described an integrated, decentralized approach at the community level. We report the results of a four-year, Ethiopian project to expand this model of NCD care to 15 primary hospitals and 45 health centres encompassing a wide geographical spread and serving a population of approximately 7.5 million people. Methods: Following baseline assessment of the 60 sites, 30 master trainers were used to cascade train a total of 621 health workers in the diagnosis, management and health education of the major common NCDs identified in a scoping review (hypertension, diabetes, chronic respiratory disease and epilepsy). Pre- and post-training assessments and regular mentoring visits were carried out to assess progress and remedy supply or equipment and medicines shortages and establish reporting systems. The project was accompanied by a series of community engagement activities to raise awareness and improve health seeking behaviour. Results: A total of 643,296 people were screened for hypertension and diabetes leading to a new diagnosis in 24,313 who were started on treatment. Significant numbers of new cases of respiratory disease (3,986) and epilepsy (1,925) were also started on treatment. Mortality rates were low except among patients with hypertension in the rural health centres where 311 (10.2%) died during the project. Loss to follow up (LTFU), defined as failure to attend clinic for > 6 months despite reminders, was low in the hospitals but represented a significant problem in the urban and rural health centres with up to 20 to 30% of patients with hypertension or diabetes absenting from treatment by the end of the project. Estimates of the population disease burden enrolled within the project, however, were disappointing; asthma (0.49%), hypertension (1.7%), epilepsy (3.3%) and diabetes (3.4%). Conclusion: This project demonstrates the feasibility of scaling up integrated NCD services in a variety of locations, with fairly modest costs and a methodology that is replicable and sustainable. However, the relatively small gain in the detection and treatment of common NCDs highlights the huge challenge in making NCD services available to all. Summary points: There is a large body of literature recommending decentralisation of noncommunicable disease (NCD) care, but extremely few "real-world" examples at scale. Those that do are largely examples of NCD care limited to single diseases and in similar geographical or cultural settings. This project provides screening, enrolment and clinical outcomes data for fully integrated, multi-level NCD clinics across a wide geographical area in Africa's second most populous nation. It is one of the first examples of scaled-up comprehensive care for all-comers with chronic noninfectious disease in rural and urban Ethiopia. The extra costs and effort involved in staff training, mentoring and community engagement are not inconsiderable for a modest gain in the detection and treatment of common NCDs. Its major limitation is that it is a "real-world" intervention and observational cohort, studied over a period constrained by a global pandemic and internal civil conflict. It uses routinely collected clinical data, limiting the ability to fully evaluate all relevant clinical outcomes. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chronic Non-communicable Diseases are increasingly becoming more prevalent and burden to the health care system in developing countries including Ethiopia. However, evidences showing the magnitude of the problem in those countries are scarce particularly in a community setting. The objective of this study was to determine the magnitude of chronic non communicable diseases in a community. METHODS: A population-based cross-sectional study was conducted in Gilgel Gibe Field Research Center from late September 2008 to end of January 2009. A random sample of 4,469 individuals aged 15-64 years was studied. Data on characteristics and chronic symptom inventories were collected by interviewing study participants. Blood pressure was taken three times from each individual and blood sugar and lipid levels were determined after an overnight fasting. Data were analyzed using SPSS for Windows version 16.0 and STATA 11. RESULTS: The overall prevalence of CNCD was 8.9% (7.8% men and 9.8% women). The specific observed prevalence were 0.5% for diabetes mellitus (DM), 2.6% for hypertension, 3.0% for cardiovascular diseases, 1.5% for asthma and 2.7% for mental illness. In addition 3.1% and 9.3% of the study population had been informed to have DM and hypertension respectively. CONCLUSION: There is a high prevalence of CNCD among the study population indicating an immediate need for preventive action and also warrant further nationally representative study. [ABSTRACT FROM AUTHOR]

BACKGROUND: The burden of chronic non-communicable diseases is on the rise in middle and low income countries on top of the existing infectious diseases. Moreover, the distributions of the specific risk factors are not systematically identified in those countries hampering the designing of appropriate preventive and control strategies. The objective of this component of the study was to describe the distribution of risk factors for chronic non-communicable diseases. METHODS: The cross sectional study was conducted from September 2008 to January 2009 at Gilgel Gibe Field Research Center of Jimma University. Data were collected using WHO steps instruments translated into the local languages. Individuals for the study were selected by stratified random sampling for interviewing, physical examination and biochemical tests from the study base. Data were analyzed using SPSS for Windows version 16.0 and STATA 11. RESULTS: The distribution of the various categories of risk factors is identified. Among the behavioral risk factors, the prevalence of smoking is 9.3%, alcohol consumption 7.3%, consumption of fruits and vegetables below adequate level 27.0%, low level physical activity (16.9%) and khat chewing (38.6%). The prevalence of physical risk factors is 9.3% for hypertension, 2.6% for overweight and 33.3% central obesity. The prevalence of metabolic disorders is 10.7% for high total cholesterol and 7.7% for raised triglyceride. Overall, 80.0% of the population had at least one of the risk factors. CONCLUSION: The magnitude of risk factors for chronic non-communicable diseases is considerably high in the study population. Appropriate preventive measure and should be designed to prevent and control these risk factors. [ABSTRACT FROM AUTHOR]