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Diabetes with dignity

Active Since: 2016

Contributing to SDGs…

Building on the existing healthcare system and resources, with the aim of testing the feasibility and effectiveness of a model of enhanced Diabetes care in adults through the empowerment of ASHAs, ANMs, MPWs and Medical Officers (MOs) in a rural community of district Pune, Maharashtra. The project DWD was implemented by Chellaram Diabetes...

MEMBER COMPANIES

PARTNER ORGANISATIONS

  • Hospitals/Health Facilities

    Chellaram Diabetes Institute

    Contribution

    Mainly contribute to the evaluation of the intervention program.

  • Private foundation or development organization

    Public Health Foundation of India

    Contribution

    Mainly contribute to the evaluation of the intervention program.

Objectives

  • Pilot the feasibility and effectiveness of a model of enhanced care for diabetes mellitus in a rural community of district Pune, Maharashtra
  • To empower the community health workers known as Accreditated Health Activists (ASHAs) by training them to screen adults for diabetes by house-to house survey and refer subjects with high risk diabetes in the community to Government Primary Health Centers (GPHC)
  • Follow the diabetes subjects by doing monthly house to house visits for 6 months for motivating them for testing, lifestyle modifications and hospital visits
  • To build the capacity of the allied government health workers as well as Medical Officers (MO) of the PHCs on the management of patients with diabetes
  • To create awareness in the community, both directly and via community health organizations

India has the second highest number of people (73 million) with Diabetes, just after China and unless intensive measures are instituted, the number would rise to 134 million by 2045. The problem in India is intensified due to its huge rural population, which face issues such as poor access and availability of healthcare. This is complemented by issues such as illiteracy, poverty and lack of awareness about non-communicable diseases (NCDs) such as Diabetes. Accredited Social Health Activists (ASHAs) are the first point of contact with the health system for villagers residing in rural settings. ASHAs have also been traditionally involved in activities related to vertical programmes such as the reproductive, maternal, new-born, child and adolescent health programme. The Government of India launched the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke (NPCDCS) in 2010 but there were no specific guidelines for engagement of ASHAs in the NPCDCS. Only recently, new guidelines have been developed under the NPCDCS for ASHAs, Multipurpose Workers (MPWs) and medical officers. Some interventions in India involving ASHAs and community health workers such as Auxiliary Nurse Midwife (ANM) and MPW have been shown to be effective in prevention and management of Diabetes.

Project DWD was a pilot, community-based quasi-experimental trial, conducted in two Primary Health Centre (PHC) areas (Intervention area – Pandare PHC; Control area – Shirshuphal PHC) of Baramati block in Pune district. The project was implemented in five villages each under each PHC. Intensive training sessions were conducted with ASHA for screening of high-risk subjects (adult 30-70 year old) with diabetes in both the intervention and control areas. ASHAs conducted initial screenings using the Indian Diabetes Risk Score (IDRS) tool and glucometers and referred the at-risk participants and known cases of diabetes to sub-centres for further evaluation. Baseline evaluation was conducted with 431 diabetic participants which included clinical assessments including anthropometry, blood pressure (BP) recording, biochemical evaluation including HbA1c and lipid profile, urine microalbumin, ankle brachial index (by a hand-held Doppler), vibratory perception threshold (by Biothesiometer) and retinal images (by fundus camera). The non-clinical assessment involved assessment of knowledge, attitudes and practices of participants related to diabetes and healthy lifestyle and indicators of quality of life (QoL) through interviewer-administered surveys. The baseline evaluations were followed by a six month community-based and ASHA-led DWD intervention only in the intervention area, involving monthly home visits and patient/caregiver as well as community-based awareness raising. The community-based institutions such as the Village, Health, Sanitation and Nutrition Committee (VHSNC), Gram Sabha and Diabetes Self-help Groups (SHGs) and community-leaders such as village Sarpanch were also involved in awareness raising activities. The six month intervention was followed by endline evaluation with 416 diabetic participants using similar methods as used for baseline evaluation. No intervention except educational leaflets were given to participants in the control area

SDGs THE PARTNERSHIP CONTRIBUTES TO

SDG 3: Good Health and Wellbeing

  1. 3.4: NCDs (including mental health)
  2. 3.C: Health workforce

SDG 9: Industry Innovation and Infrastructure

SDG 17: Partnerships for the Goals 

RESULTS & MILESTONES

Project DWD was effective in significantly lowering mean HbA1c values in the intervention group (6.4% decline from baseline to endline) compared to an increase in the control group (10.4% increase from baseline to endline) after adjusting for covariates. Similar significant benefit was observed among the participants for LDL cholesterol where mean values declined by 2.3% in the intervention group compared with a 12.4% increase in the control group after adjusting for covariates. No significant benefit was observed in the intervention group (vs. the control group) for any other clinical indicators. Significant improvements in knowledge about symptoms of diabetes, knowledge about prevention and management of diabetes, knowledge about complications of diabetes, and quality of life indicators (self-care and depression/anxiety) were observed in the intervention group participants compared with participants in the control group