|Author(s):||N. D. Labhardt*1, J. Balo2, E. Manga3, M. Ndam4, B. Stoll5|
|Affiliation(s):||1Swiss Tropical Institute, University of Basel, Basel, Switzerland, 2District Hospital Mfou, Ministry of Public Health of Cameroon, Mbankomo, 3Ministry of Public Health, 4District Hospital Mfou, Ministry of Public Health of Cameroon, Mfou, Cameroon, 5Institute of Social and Preventive Medicine, Faculty of Medicine, Geneva, Switzerland|
|Keywords:||Hypertension, diabetes, treatment adherence, treatment retention, non-communicable chronic diseases|
Low retention rates and poor treatment adherence pose major challenges to programs for non-communicable chronic diseases (NCCD) in Africa. Monitoring data of a program that integrated management of arterial hypertension and diabetes into the primary health care of non-physician clinics (NPCs) in eight rural Cameroon districts reveal a one-year retention-rate below 50%. In order to improve the effectiveness of large NCCD-programs, efficient and easily replicable interventions to improve treatment adherence are urgently needed. The aim of this randomized trial is to compare two low-cost interventions on a NPC level in rural Cameroon to lower the attrition in the program.
Thirty three rural NPCs from four districts were randomly assigned into three groups: The control group requested a written and oral commitment from the patient to follow the treatment before the treatment start. Facilities of the intervention group A had additionally an active patient-tracing by community representatives. Intervention group B provided as an incentive for adherence one month of treatment for free every four completed months with good adherence.
During a period of six months, the 33 NPC-clinics recruited 218 new, treatment-naïve patients. The average age was 60 years (inter quartile range: 51-68), 65% were female. Sixty eight percent had arterial hypertension alone, 18% arterial hypertension and impaired fasting glucose, 11% hypertension and diabetes and 9% diabetes alone.