Community Outreach Boosts Chronic Disease Screening in Uganda
Chronic diseases account for about 28 percent of deaths in sub-Saharan Africa, and by 2030 they will kill nearly twice as many people in the region as they do today. In Uganda, screening for cancer, diabetes, cardiovascular disease, and other illnesses remains limited despite the availability of inexpensive and effective diagnostic techniques.
The Strengthening TB and HIV/AIDS Response – Eastern Region (STAR-E) project, funded by the US Agency for International Development (USAID), and led by Management Sciences for Health (MSH), has been working to integrate chronic disease screening into its outreach activities. Screening includes tests for cervical cancer, high blood pressure, breast cancer, and diabetes. Blood pressure screening is a standard service at antenatal clinics, adult antiretroviral therapy (ART) clinics, and facilities offering safe male circumcision. To facilitate screening, STAR-E has procured blood pressure machines for all antenatal care (ANC) and ART clinics.
Integrating screening for chronic diseases in conjunction with outreach during internationally recognized commemorative days has been especially successful for STAR-E in 2014. The project conducted screenings this year on World Cancer Day in in February and International Women’s Day in March.
The World Cancer Day screening targeted commercial sex workers as well as the general population, and took place at the Busia Health Center IV and the Amalgamated Transport and General Workers Union (ATGWU) resource center. At both sites, the outreach began with educating mothers about cervical cancer, emphasizing the importance of screening, risk factors, and where to access services. Health workers offered counseling before the actual screening. Both sites also offered screening for sexually transmitted infections. At the ATWGU, health workers checked the blood pressure of about 30 women and diagnosed two cases of hypertension, provided counseling on healthy habits, and prescribed treatment.
To mark International Women’s Day, STAR-E conducted an integrated service delivery outreach in Nabiganda, an underserved community in Butaleja district. STAR-E extensively used the media, including local radio, to mobilize the community. In addition, the hospital ambulance traveled through neighboring subcounties for four days prior to the event to publicize the outreach. It included general health education; blood sugar and blood pressure checks; HIV counseling and testing; cervical cancer screening, diagnosis, and treatment/referral for STIs, and referral of women with pre-cancerous lesions to a nearby hospital; male and female condom education, promotion, and distribution; and safe male circumcision.
During that oneday event, STAR-E screened 475 women for chronic diseases and referred several to Mbale Regional Referral Hospital for further testing and care. Diagnoses included 53 cases of severe hypertension, 52 cases of mild hypertension, and 13 cases of diabetes.
The STAR-E approach emphasizes the community as being at the core of all project interventions. STAR-E strives to help communities to take ownership of their health-related issues by recognizing, appreciating, and involving them in activities to scale up demand and access to services. The integrated screening and community outreach activities have proven to be a particularly effective way to gain community participation.
Jennifer Francesca Acio is the gender and people living with HIV advisor for STAR-E.