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VOLUNTARY MEDICAL MALE CIRCUMCISION FOR NONCOMMUNICABLE DISEASE CASE FINDING, NAMIBIA
Nikki Soboil1, Shawn J. Rooinasie2, Catherine Laube3, Abubakari Mwinyi1, Amir Shaker2
1Jhpiego, Swakopmund, Republic of Namibia,2Ministry of Hlth and Social Services, Erongo Regional Directorate, Swakopmund, Republic of,3Jhpiego, Baltimore, MD, USA
The burden of non-communicable diseases (NCDs), including hypertension (HTN), is growing in sub-Saharan Africa (SSA), particularly in urban areas, with evidence of considerable under-diagnosis. An estimated 38% of urban Namibians are living with HTN. HTN is more prevalent in African males, and prevalence increases with age. A systematic review of HTN in SSA found less than 40% of people with HTN had been previously diagnosed. Males, whose health seeking is less common than females', are particularly likely to suffer from undiagnosed HTN and other NCDs in Namibia. Voluntary medical male circumcision (VMMC) is one of few health services catering to males, and thus a rare opportunity for HTN screening. Jhpiego launched high volume nurse-led voluntary medical male circumcision VMMC services at Swakopmund State Hospital in Erongo Region, Namibia in May 2016, and more than 90% of the clients served to date have been aged 20 years and above, in contrast to VMMC clients across East and Southern Africa to date, the majority of whom have been aged between 10 to 19 years.
Jhpiego abstracted data from client records for males registered for VMMC services between 13 May and 31 July 2016, including pre-operative physical screening data, to characterize the proportion of clients with blood pressure above 140/90 mm Hg. A random sample of 28 hypertensive clients were contacted post-hoc to determine whether they had been previously diagnosed.
Of the 1,266 males screened for VMMC between 13 May and 31 July 2016, 367 (29%) were hypertensive. Of hypertensive clients, 136 (37%) were Stage 1 (140-159/90-99 mm Hg), 89 (24%) were Stage 2 (160-179/100-109 mm Hg), and 142 (39%) were isolated systolic (>140/<90 mm Hg). Of the random sample of 28 hypertensive clients contacted post-hoc, 15 (53%) were newly diagnosed.
VMMC can be a critical platform for HTN and other NCD screening, particularly in programs serving mature clients. VMMC programs seeking to attract a greater proportion of males aged 15-29 should prioritize careful pre-operative physical screening, as well as a systematic approach to deferrals and active referrals for clients diagnosed with HTN. Service delivery models integrated/co-located with primary care may help reduce loss to follow up for males newly diagnosed with HTN. Research is needed to better understand the full NCD disease burden in VMMC clients within and outside of Namibia.