Brief Background:
The master of the ceremony Dr Poba Zobegow started the proceedings of the webinar by introducing the speaker Dr Prerna Bansal and the moderator, Dr Pallavi Koirala.
Dr Bansal is currently working as an Assistant Professor in the Department of Community Medicine at the College of Medical Science, Bharatpur, Chitwan. After her MD in Community Medicine, she completed a fellowship in diabetes from Medaversity and Apollo Hospital, Educational and Research Foundation, Hyderabad, India. She was a member of the Rapid Response team for COVID-19, Chitwan District, of the Government of Nepal (2020-22), and is a focal person for the GoN, representing COMS since the beginning of the COVID-19 pandemic for implementing prevention and control measures.
Dr Pallavi Koirala, the moderator of the programme is a recent graduate of Community Medicine. She has been actively involved in case investigation and contact tracing (CICT) in COVID-19 from the College of Medical Sciences, Bharatpur. She has had more than 15 health-related articles published in national news media like Republica and Swasthya Khabar Patrika.
Dr Bansal started the presentation by introducing the problem of diabetes both globally and locally. Diabetes has a high disease burden, with diverse social determinants, and is associated with various co-morbidities, requiring a multidisciplinary team for management. Consequently, there can be diverse barriers and challenges associated with the prevention and treatment of diabetes. Beyond the health care system, diabetes care requires contribution from different sectors including the food industry for a holistic care approach to this disease.
Dr Bansal described the need for the prevention of metabolic diseases like diabetes in Nepal, and what those would include. She stated that both high-risk group and population-based approaches are required to tackle this issue in a country like Nepal, using a multi- tired, risk stratification approach, with short and long-term plans. Thus setting the scene, Dr Bansal went on to describe the range of potential community-based interventions to tackle diabetes. Setting goals of integrated team-based care and a population-wide intervention in the pre-pathogenic stage, the incidence of diabetes could be potentially decreased, by utilizing a community-based approach. This was backed by evidence as well, stating so, Dr Prerna then introduced the Community based interventional program on “Diabetes Prevention and Control”, which was ongoing in Bharatpur, Chitwan since Shrawan 2079.
Objectives of the Webinar:
1. To reiterate the need for diabetes because of its increasing incidence and prevalence.
2. To gather evidence-based information about the community-based approach to tackling diabetes at the local level.
3. To know about the ongoing action taken at the local level in terms of prevention and control of diabetes.
4. To generate more areas with such a community-based program available for population-based intervention for metabolic diseases in other parts of the country, as a way of moving forward to managing non-communicable diseases.
Key Points Discussed during the webinar:
- About 422 million people worldwide have diabetes majority living in low and middle-income countries. (2014).
- The cases of diabetes are estimated to increase to about 642 million by 2035, with an increasing burden in low and middle-income countries.
- In 2019, diabetes is the 9th leading cause of death, with an estimated 1.5 million death attributed to diabetes.
- In Nepal, the prevalence of Diabetes is about 8.4%, with 50% of people with known diabetes, not under any medication.
- Prevalence of diabetes steadily rising.
- Need for multiple avenues of public health action, including the health system, better provisions for health promotion and population-wide policies.
- Prevention strategies should include both high-risk and population approaches.
- Considerations to be taken in designing of prevention strategy include:
- Prevalence/ burden of diabetes
- Prevalence/ burden of undiagnosed diabetes
- Current status/ trajectory of environment/ cultural risk
- The capacity of the health system to manage diabetes
- Potential of communities and insures to support high-risk individuals
- Political context/ will for population-wide intervention
- A time horizon of public health goals
- Actions at the Local level, at Bharatpur, Chitwan:
- 2015-16 established a diabetes centre
- Helping screening and treatment at the community level with the organization of health cams
- Raising awareness about diabetes through the diabetes centre.
- Since Shrawan, 2079 running a community-based interventional program on Diabetes Prevention and Control in the central part of Nepal, which is a long-term project, under the Department of Community Health Services, a wing of the Department of Community Medicine, College of Medical Sciences, Bharatpur, Chitwan
- The activities under the community-based intervention program mainly focus on interventions at all levels of prevention within the community.
Its activities include:
- Health promotion, through the use of motivational and educational slogans.
- Health education
- Lifestyle modification
- Behavioural change advocacy
- Community participation: Ties were set up with the Diabetes Society of Chitwan (an independent society), with 800 people around that area and more than 4000 diabetes patients registered in this society. To conduct community programmes and facilitate them.
- Functions as a diabetes screening clinic: At the entrance of the College of Medical Science there is a small clinic (started on 1 Shrawan 2079) which is open from 6 am to 8 am all days of the week and is focused to bring awareness, screening also provides treatment to diabetics.
- Functioning as a Diabetes Care Call Centre: For diabetic patients to communicate and contact if they require any information regarding their disease.
Points for the Policy Brief:
- Similar to the guidelines for diagnosis, screening and treatment set by the American Diabetes Association and the Centers for Disease Control, a guideline should be developed which is feasible for the local context of Nepal.
- A specific diagnostic algorithm should be developed for the management of diabetes in Nepal so that all people can get treatment based on uniform guidelines.
- Adequate budget and resources (manpower and infrastructure) allocation should be present for non-communicable diseases like diabetes.
- Regular capacity-building activities should be organized for health care workers.
- The Local Government should help facilitate community-based health interventions so that the people benefit.
Points to be Discussed in Executive Committee:
The following points should be considered in the forthcoming Executive Committee:
- The capacity building of the residents for providing awareness about Non-communicable diseases like diabetes
- Provision of regular health camps to be organized to screen for non-communicable disesase or heath awareness generating activities by residents
- Regular training regarding health-related policies and regulations should be shared through webinars. This could help the residents to remain updated regarding the policies
Conclusion:
Diabetes demands a multi-tiered strategy to reduce complications, and progression of disease in high-risk individuals, and poses a population-wide risk. The incidence and prevalence of diabetes are steadily on the rise, so effective strategies have to be made. A community-based approach is one strategy which has ample benefits and is sustainable long term, and this approach could benefit to tackle the problem in low and middle-income countries like Nepal.