Implementation of World Health Organization Package of Essential Noncommunicable Disease Interventions for Cardiovascular Risk Management in Gaza/Palestine: A Retrospective Record Review Study

Abstract

Background: Noncommunicable diseases (NCDs) are among the most common medical problems encountered in medical practice worldwide. The World Health Organization package of essential NCD (WHO PEN) interventions is a broad framework for integration of major NCDs into primary health care. These interventions include screening of diseases and their risk factors to prevent complications. WHO supports the adoption of WHO PEN into the Palestine Ministry of Health. PEN has been implemented in Gaza district since 2015, but only the protocols for cardiovascular disease and diabetes were selected for implementation. This study may help us to detect the impact of implementing PEN. Methods: A retrospective record review study was conducted using a random sample of 143 files from a total of 280 registered NCD patients who were followed up for 2 years at Alsourani clinic. Data were extracted manually from the medical records with the completion of a data sheet. Results: The study showed that most of the population was female (n = 86, 60.1%). The mean age was 58.8 ± 11.7 years. The vast majority were living a sedentary lifestyle (n = 141, 98.6%). Patients with one or more comorbidities were also tabulated according to the presence of each comorbidity among all subjects: Hypertension (n = 92, 64.3%), any diabetes (n = 90, 62.9%), type 2 diabetes (n = 86, 60.1%), type 1 diabetes (n = 4, 2.8%), dyslipidemia (n = 41, 28.7%), neuropathy (n = 27, 18.9%), ischemic heart disease (n = 20, 14%), cerebrovascular disease (n = 4, 2.8%), retinopathy (n = 8, 5.6%), mental illness (n = 4, 2.8%), nephropathy (n = 3, 2.1%), cancer (n = 2, 1.4%), and respiratory diseases (n = 1, 0.7%). There was no statistically significant difference between pre- A nd post-parameter interventions for systolic and diastolic blood pressure, waist circumference, weight, body mass index, and cholesterol, as well as for tobacco use and cardiovascular risk (p > 0.05). In contrast, fasting blood sugar was lower, with a statistically significant difference (p = 0.049). Conclusion: NCDs in Palestine are a major health problem. Sustainability of WHO PEN interventions is recommended with insurance to support the needs of NCD patients and home visits. NCD interventions are compromised due to health care system gaps at primary care level. Therefore, we need strengthening of the primary health care system.