Novel approaches to screening for noncommunicable diseases: Lessons from Neno, Malawi

Background: As Malawi continue to suffer from a large burden of noncommunicable diseases (NCDs), models for NCD screening need to be developed that do not overload a health system that is already heavily burdened by communicable diseases. Methods: This descriptive study examines three screening programs for NCDs in Neno, Malawi that were implemented from June 2015 to December 2016. The NCD screening models were integrated into existing platforms, utilizing regular mass screening events in the community, patients awaiting to be seen in a combined NCD and HIV clinic, and patients awaiting treatment at out-patient departments(OPD). Focusing on hypertension and diabetes, we screened all adults 30 years and above for hypertension using a single blood pressure cut-off of 160/110 mmHg as well as adults 40 years and above for diabetes measuring either random blood sugar (RBS) or fasting blood sugar (FBS) with referral criteria of FBS > 126mg/dl and RBS > 200mg/dl. Data was collected on specifically designed screening registers, then entered and analysed in Excel. Results: Over 14,000 adults (12+ years) were screened for an array of common conditions at community screening events. Of these adults, 58% (N=8,133) and 29% (N=4,016) were screened for hypertension and diabetes, respectively. 9% (N=716) and 3% (N=113) were referred for hypertension and diabetes further assessment respectively. At one OPD, 5,818 (60%) patients had their blood pressure measured and among adults 30 years and above, 168 eligible adults were referred for further hypertension assessment. Since the initiation of the screening programs, the number of patients ever enrolled for NCD care every 3 months has nearly tripled, from 40 to 114. Conclusions: The screening models have shown that it is not only feasible to introduce NCD screening into a public system, but may have also contributed to increased enrolment in NCD care in Neno, Malawi.