Evaluating the Adherence of Primary Health Care Centers in Gaza Strip to the WHO-PEN Protocol 1: A Cross-Sectional Study

Abstract

Tayseer Afifi, Diaeddin Dwekat, Abdallah Alwali, Hasan Alyazouri and Khamis Elessi

Background: Cardiovascular disease (CVD) is common in the general population, affecting many of adults above 40 years of age. It is a multi-factorial disease. Some risk factors; such as family history, gender, ethnicity and age cannot be changed. Other risk factors are modifiable including high blood pressure, high cholesterol and diabetes. Patients will not necessarily develop cardiovascular disease if they have a risk factor. But the more risk factors they have the greater the likelihood that they will, unless protective measures and actions are taken to modify their risk factors and work to prevent them compromising their heart health.

Objectives: The objectives of this study were: to evaluate the adherence of major primary health care centers to the WHO-PEN Protocol 1, Package of essential noncommunicable (PEN) disease interventions for primary health care, recommendations;and to provide more accurate estimate of cardiovascular risk using hypertension, type 2 diabetes mellitus and tobacco use as entry points.

Methods: A cross-sectional study involving 200 patients who were already diagnosed with NCDs was conducted atprimary health care centers. Data was collected retrospectively using a self-designed questionnaire based on the WHO- PEN checklist. Patients’ files were selected randomly.

Results: Based on the analysis of whole cohort (200 cases). The prevalence of type 2 diabetes was 39% and hypertension was 28.5%, whereas 32.5% had both. There were only 17 smokers among patients representing 8.5% of the sample. Using WHO/ISH, WHO/International Society of Hypertension, Risk prediction charts; half of patients were in the tenyear cardiovascular risk category of less than 10%. On the other hand, 5% had a ten-year cardiovascular risk over 40%.49% of patients had a first-degree family history of heart disease? All patients were counseled on diet, exercise and smoking cessation.

Conclusion: These results demonstrate high adherence to the WHO-PEN protocol in these two centers reflecting a high quality of care and follow-up. Furthermore, the medical records were fully filled with adequate information for each item. However, there were some deficiencies in the risk estimation, which should be documented for better counseling for patients with high risk.

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