(PEN) interventions in primary health-care settings

(PEN) interventions in primary health-care settings

Package of essential noncommunicable disease (PEN) interventions in primary health-care settings in the Democratic People’s Republic of Korea: a feasibility study

Choe Suk Hyon1
, Kim Yong Nam1 , Han Chae Sun1 , Renu Garg2 Pyongyang, Democratic People’s Republic of Korea, 4 , Suraj Man Shrestha2
1Ministry of Public Health, Pyongyang, Democratic People’s Republic of Korea, 2 South-East Asia, New Delhi, India, 3
Research, Chandigarh, India Correspondence to: Dr Rajesh Kumar (dr.rajeshkumar@gmail.com)

Abstract
The prevention and control of noncommunicable diseases (NCDs) is a priority for the Democratic People’s Republic of Korea. Mortality due to NCDs in people aged over 30 years was 1239 per 100 000 in 2009 and the 2014–2020 national strategy includes population-level goals for health promotion and disease prevention. This paper reports a pilot study on the feasibility of implementing components of the World Health Organization (WHO) Package of essential noncommunicable disease (PEN) interventions for primary health care in low-resource settings (WHO PEN) to enable early detection and management of cardiovascular disease and diabetes mellitus at the level of primary care.

WHO PEN protocols were adapted for local use by household doctors, who provide ambulatory care in polyclinics in the mornings and household visits in the afternoons.
The pilot project was implemented in two polyclinics in Pyongyang, covering a population of 32 000. After training, and during routine household visits in June 2014, 70 household doctors screened all adults aged over 35 years (18 340) for cardiovascular disease and diabetes mellitus, and their risk factors. A total of 2319 patients with cardiovascular disease or diabetes, and those with high-risk factors, were referred to the polyclinics for three quarterly visits for testing and management.
Final household screening of the population was done in June 2015. This pilot project demonstrated the feasibility of integrating screening and management into the standard primary health-care system in the Democratic People’s Republic of Korea.

The household doctors were able to detect and manage risks for cardiovascular disease and diabetes by using the protocols based on WHO PEN. Among 18 340 individuals aged over 35 years, implementation of WHO PEN interventions led to a significant reduction in the number of people with a 10-year risk of cardiovascular disease ≥20% (from 1748 [9.5%] to 543 [3.0%]) over a 1-year period. Involvement of household doctors can increase access to services for prevention and control of cardiovascular disease and diabetes in the Democratic People’s Republic of Korea.
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Keywords: cardiovascular disease, Democratic People’s Republic of Korea, diabetes, intervention, primary health care
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Background Noncommunicable diseases (NCDs) pose a significant public health burden globally.1
In terms of both morbidity and mortality, the global epidemic of NCDs is not only increasing but also having a disproportionate impact in low- and middle income countries.3
Korea, mortality due to NCDs in individuals aged over 30 years was 1239 per 100 000 in 2009.4 [International comparison data?] 

In most countries, people of low socioeconomic status who live in marginalized communities have a higher risk of death from NCDs than those in more advantaged communities.2

In the Democratic People’s Republic of Prevention of NCDs has been
a priority for some time for the Democratic People’s Republic of Korea, which ratified the World Health Organization (WHO) Framework Convention on Tobacco Control in 2005.5
The 2014–2020 national strategy aims to reduce the prevalence of NCDs, the proportion of premature deaths, loss of working ability, and risk factors for NCDs. It also aims to conduct multisectoral activities to target risk factors and improve the quality of medical services.6 

In addition to the policies for health promotion and disease prevention targeted at the population level, approaches to risk detection and risk management at the individual level have also been advocated. Early detection and management of individuals with NCDs or at high risk of NCDs can reduce the complications of NCDs, thereby improving survival and quality of life. In high-income countries, mortality from cardiovascular disease has declined, owing to better access to services for prevention and treatment of NCDs.7 
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, Kim Un Ok3 , Rajesh Kumar4 World Health Organization Regional Office for World Health Organization Country Office for the Democratic People’s Republic of Korea, School of Public Health, Postgraduate Institute of Medical Education and