RESUMO
Introduction: In Egypt the Primary health care perspective of chronic diseases remains poorly defined and the distribution as well as the natural histories of many chronic illnesses remains obscure. While progress has been made, in identifying some specific treatment strategies, preventive strategies still lacking behind. Study hypothesis: The prevalence of chronic diseases is under estimated and underserved in rural areas
Aim of the study: Foundation of a Primary Health Care [PHC] model, for detecting, recording and follow-up of chronic diseases in their served communities
Specific Objectives: 1. To determine the prevalence of target chronic diseases [diabetes mellitus I and II, hypertension, end stage renal disease and chronic liver disease in the served rural community. 2. Foundation a database model of chronic disease in PHC setting for further epidemiological studies
Study Design: Intervention operational research
Subject and Methods: Twenty-four Primary Health Care [PHC] units assigned randomly, six representing each of the four studied districts representing the four Governorates assigned for the Health System Upgrading Project II to work in. The principal nurse, Al Raeda Refias within the unit's catchments area and PHC physician were the responsible local personnel. Nurses were subjected for orientation, completing forms and conducting screening test at PHC or home settings for all family members, when an index case is there [previously or newly diagnosed]. Same procedure to be done for suspected or referred cases by El Raedas whom were subjected for more detailed orientation about target diseases, their signs and symptoms. Training concerning how to prepare family lists [suspected cases recorded in different color], referral of suspected member to PHC nurse for screening and to validate the diagnosis by the PHC physician. A simple computerized data base [using Excel] was designed in each PHC and PHC team was trained to implement
Results: The total population surveyed in this study assumed to be 227, 335 individuals. The total number of identified patients with the four assigned diseases was 2135; of which 387 were affected by 2 diseases, and 53 were found to have 3 conditions. The total count of the four target diseases were 2575 conditions [910 diabetes mellitus of both types with a prevalence of 4/1000], 1208 hypertension [5.3/1000], 126 renal failure [0.6/1000] and 331 liver cell failure [1.5/1000]. With the exception of liver disease, female predominated and 70% of patients were illiterate
Conclusion: chronic diseases in rural communities were underestimated; more attention should be given to different aspect of care, regular active screening to trace disease clustering and identification of risk factors, epidemiological features, monitoring and follow-up with suitable curative services