Characteristics and retention-in-care of patients with non- communicable diseases in MSF clinics in

Chaturangi Yapa,1 Philippa Boulle,2 Kathryn Glass,1 Iza Ciglenecki,2 Florencia Romero,2 Kamalini Lokuge 1

1 Research School of Population Health, Australian National University, Canberra, Australia; 2 Medecins sans Frontieres, Geneva, Switzerland

1. BACKGROUND • Non communicable diseases (NCDs) – mainly cardiovascular disease, diabetes, cancer and chronic respiratory disease – are the world’s biggest killers. About 38 million people around the world die from these diseases every year 1.

• The 10 countries identified by the United Nations High Commissioner for Refugees (UNHCR) as the largest source of refugees in 2015 all have significant NCD burden, with NCDs accounting for 19–62% of total mortality 2.

• In Lebanon, MSF has been providing primary health care to Syrian refugees and vulnerable Lebanese in four clinics throughout the Bekaa Valley and two clinics in Tripoli, since 2012. In these clinics, there has been an emphasis on the management and follow up of patients with NCDs. In 2016, the disease burden from NCDs represented almost 25% of total consultations at both sites.

2. AIMS 4. RESULTS • To describe the characteristics of patients who • Between January 2013 and November 2016, there were 12, 900 patients with data available for analysis. received NCD care at the MSF clinics in Bekaa • At both sites, the majority of patients were aged between 45 and 59 years, more than half were females Valley and Tripoli between January 2013 and (Table 1), > 97% were Syrians of whom about 70% had registered with UNHCR. November 2016 • The most common NCDs seen were hypertension, type 2 diabetes mellitus and cardiovascular disease (Figure 1) • To describe the main types of NCDs seen at these Figure 1. NCDs seen at Bekaa Valley and Tripoli, 2013 - 2016 clinics Table 1. Baseline characteristics of cohort Bekaa Valley, Tripoli, 8000 n = 7947 n = 4953 Bekaa Valley • To quantify retention-in-care of patients with 7000 Tripoli diabetes and hypertension No. (%) No. (%) 6000 Age (years) 5000 0 – 24 628 (7.9) 318 (6.4) 4000 25 – 44 1452 (18.3) 786 (15.9) 3000 3. METHODS 45 – 59 3213 (40.4) 2042 (41.2) 2000 1000 60 – 74 2089 (26.3) 1303 (26.3) Setting: 0 75 + 416 (5.2) 258 (5.2) MSF primary health care clinics in the Bekaa Valley 149 (1.9) 246 (5.0) (, , and ) and Missing Sex Tripoli (Abdeh and Daz). Female 4657 (58.6) 2731 (55.1)

Male 3286 (41.3) 2212 (44.7) Study Design: Missing 4 (0.1) 10 (0.2) Retrospective descriptive analysis of all patients who were registered with a non-communicable disease and entered onto the MSF NCD health Table 2: Retention-in-care for patients with diabetes and hypertension database between January 2013 and November • The median length of follow up for Diabetes Hypertension 2016 at any of the four MSF clinics in the Bekaa patients with diabetes and hypertension Median follow up time, days (IQR) 251 (33 - 618) 240 (21 - 638) Valley or any of the two MSF clinics in Tripoli. was about 8 months (Table 2). Median no. of visits per patient (IQR) 8 (2 - 18) 7 (2 - 17) • Approximately 20% of patients only came Patients with only one visit, no. (%) 862 (18) 1396 (20) for one visit. Data collected routinely: Socio-demographic information - Age, sex, ethnicity and UNHCR registration status Clinical information - Medical history, 5. CONCLUSIONS anthropometrics, blood pressure measurements, • The age distribution of patients with NCDs is similar to that seen in prior to the war, suggesting that primary diagnosis, synopsis of medical condition, refugees living with NCDs in the Bekaa Valley and Tripoli are accessing healthcare for their illness. treatment received • The proportion of the three main NCDs seen in our cohort are similar to that reported in other studies of Outcomes – time in care, visits per patient Syrian refugees with NCDs living in the Middle-East. • Further efforts need to be focussed on the follow-up and retention-in-care of patients with diabetes and hypertension. 6. LIMITATION • Not all patients registered with an NCD were 7. ACKNOWLEDGEMENTS entered onto the NCD health database. This may affect demographic characteristics and retention • Funding: Australian Government Research Training Program Scholarship rates presented. • MSF field teams in Bekaa Valley and Tripoli, Lebanon

REFERENCES 1. World Health Organization (2013) Global action plan for the prevention and control of noncommunicable diseases 2013-2020, available from: http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf?ua=1 2. Rabkin M, et al. (2016) Addressing chronic diseases in protracted emergencies: Lessons from HIV for a new health imperative, Global Public Health; DOI: 10.1080/17441692.2016.1176226