Strengthening the delivery of asthma and chronic obstructive pulmonary disease care at primary health care facilities in Pakistan

This study aims to deliver quality asthma and chronic obstructive pulmonary disease (COPD) care through primary health care facilities in Pakistan.
Non-communicable diseases (NCDs) are among the top ten causes of mortality and morbidity in Pakistan, and contribute to a quarter of all deaths. Respiratory diseases are the most predominant, affecting 26.5% of all the patients. The National Health Survey of Pakistan (NHSP) 1990 – 94 showed the prevalence of chronic bronchitis in patients over 65 as 14% and 6% in rural females and males, respectively.  The estimated COPD mortality rate is 71 deaths per 100,000; the 4th highest rate among the 25 most populous nations in the world.  The current estimated prevalence of asthma is 10-12% in the general population with an expected 5% annual increase.
In 2003, an integrated national action plan for prevention and control of NCDs was developed. The plan emphasised the building of national health systems capacity to deliver quality care for lung health, as a part of a core health service package. Currently only about 20% of the estimated prevalent asthma and COPD cases are being identified and reported through the existing primary health care network. It is vital that this system is strengthened through providing a public health approach and standardised quality of care.
This study will use a cluster randomised controlled trial to compare the control of asthma and COPD in patients receiving quality lung health care with those receiving routine care.
Study outcomes
The study will develop a set of operational guidelines, training packages, and education materials for delivering quality lung health care using the district health system.
This study is an innovation of the service delivery strategy and builds lung health care into an existing TB programme that is integrated and decentralised within the general health system. The innovation is sustainable and replicable in Pakistan and other countries, especially those with an established TB programme.
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