Feasibility of Managing Diabetes Patients Identified Through Community Screening in Rural Ethiopia
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Objective
To assess the feasibility of diagnosing, enrolling, and managing adults with type 2 diabetes at the primary healthcare level using the WHO Package of Essential Non-communicable Disease Interventions (WHO-PEN) approach, following identification through community – based screening in rural Ethiopia.
Design
Single-arm, pre-post clinical feasibility study.
Setting
Primary healthcare facility in Shebedino district, Sidama National Regional State, rural Ethiopia, between September 2024 and February 2025.
Participants
35 adults with newly diagnosed type 2 diabetes, identified through community-based screening and diagnosed according to the WHO and American Diabetes Association criteria.
Interventions
A six-month WHO-PEN based intervention comprising metformin based pharmacologic treatment, lifestyle counselling, and health system strengthening.
Outcome measures
Feasibility across four domains (acceptability, implementation fidelity, practicality, and preliminary clinical signal); HbA1c change from baseline to six months, analysed using the Wilcoxon signed-rank test and McNemar’s test.
Results
All 35 patients completed the six-month follow-up. At baseline, 6(17 %) had comorbid hypertension, 5 (14%) had elevated total cholesterol, 14 (40%) had low HDL cholesterol, 24 (69%) were underweight. Median HbA1c decreased from 52.0 mmol/mol (IQR: 50-56.0) at baseline to 43.0 mmol/mol (IQR: 42.0-46.0) at six months (reduction of 9.0 mmol/mol; p <0.001). By six months, 30 of 35 (85.7%) had HbA1c below the control threshold, versus 20 (57%) at baseline (p=0.002).
Conclusion
Community-identified adults with type 2 diabetes could be successfully diagnosed, linked to care, and retained using the WHO-PEN approach at a rural primary healthcare facility, with substantial improvement in glycaemic control. The absence of a control group precludes causal attribution. Medication was not adjusted for patients with persistent hyperglycaemia despite scheduled reviews, indicating a priority need to strengthen implementation of established practices rather than studying further efficacy.
STRENGTHS AND LIMITATIONS
❖ This is the first clinical feasibility study to evaluate implementation of the WHO-PEN approach for diabetes management at the primary healthcare level in rural Ethiopia, assessed using a structured, multi-domain feasibility framework.
❖ Patients were identified and linked to care through a pre-established community-based screening rather than passive health facility attendance, reducing selection bias and enabling assessment among newly diagnosed adults within the community.
❖ This is among the first studies to report diabetes management outcomes in a population with a prevalence of underweight (69%), contributing evidence on diabetes care among undernourished populations in Ethiopia.
❖ The single-arm, pre-post design, conducted at a single sit without a concurrent comparison group, limits the ability to attribute
❖ The study identified implementation gaps, including the absence of medication dose adjustment for patients above the HbA1c target during follow-up, despite scheduled review visits at three and six months.
