RESUMO
Non-alcoholic fatty liver disease (NAFLD) is an emerging public health problem globally. NAFLD is one of the most common liver diseases worldwide and is the most common cause of abnormal liver enzymes in many developed countries. NAFLD is estimated to afflict approximately 1 billion individuals worldwide. An estimated 20-30 % of general population is afflicted from it globally. In India NAFLD could be a silent epidemic with its prevalence ranging from 9-32%. Studies have shown, strong association of NAFLD with major Non Communicable diseases (NCD) like Diabetes, Obesity, CVD, Chronic Kidney diseases, Cancers, etc. Perceiving the threat of NAFLD and the central role of hepatic accumulation of fat in the pathogenesis of other NCD, the Government of India (GoI) has taken steps to include NAFLD in the public health agenda. It has included it in the national NCD programme, i.e., National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in 2021. India has become the first country in the world to start a national programme for preventive efforts for NAFLD. The present review describes public health relevance of NAFLD and the process of integration of Non Alcoholic Fatty Liver Diseases (NAFLD) into NPCDCS programme in India.
RESUMO
Non-alcoholic Fatty Liver Disease (NAFLD) is a distinct hepatic condition and one of the most common causes of Chronic Liver Disease globally. In February, 2021, the Government of India had launched and integrated interventions to prevent and control NAFLD in the ongoing National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). This review was conducted to identify challenges and proposes solutions for effective program implementation. The authors identified that since NPCDCS has been implemented as District-based program and NAFLD being new component, the lack of familiarity of various sub-group of staff could be a major challenge in roll-out. The sensitization of Health Workers, Medical Officer in Primary Healthcare System, the specialist doctors at all levels of care as well as private practitioners, on various aspects of NAFLD (including epidemiology, clinical features, treatment approach and other aspects) should be conducted. The Information Education Communication (IEC) material should be developed and campaigns for awareness generation amongst general public in prevention and management of the disease should be conducted.Ongoing activities to set up Health and Wellness Centres under Ayushman Bharat Program, is a good opportunity to integrate of NAFLD in primary care level. This will help India to accelerate progress towards Universal Health Coverage
RESUMO
Background: The national program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS) has been rolled out in West Bengal, with its implementation initiated through state-wide training of Medical Officers (M.O). For attaining requisite competency for meeting NPCDCS objectives, MOs have been trained at their respective district levels. Present study aimed to assess the training need, training efficacy and need for further training.Methods: A repeat cross-sectional study was conducted from May-July 2018 for M.Os of six randomly chosen districts of West Bengal, out of those whereat NPCDCS was launched in first phase. 40-45 M.Os were randomly selected from each district in liaison with district level health authorities. The total sample size was 352 with Finite population correction. On the days of training, pre and post training surveys were conducted with an identical semi-structured, pre-tested and validated questionnaire (Cronbach’s alpha >0.8) covering different levels of cognitive domain, with a maximum possible score of 100 marks. No negative marking was done for incorrect responses. Training was imparted by the Principal Investigator (accredited trainer). Ethical clearance was granted by the State Health Directorate. Informed consent from each participant was obtained.Results: Dependent sample t-test revealed significant increment (p<0.0001) in post-test scores (t=63.134) & one-way repeated measure general linear model (GLM) also revealed F=29.617 (p<.0001). The “Effect Size” was classified as “Huge” (Cohen’s D=63.134/√(352)= 3.365), as was noted between pre-test and post-test scores, based on Cohen’s convention and Sawilowsky’s addition. It was further noted that even after six hour training sessions there was 27.44% knowledge gap (p<0.0001) after adjusting for Bonferroni.Conclusions: Imperativeness of training coupled with periodic refresher training has been established as a pre-requisite for successful implementation of NPCDCS.