Challenges in non-communicable disease management at primary healthcare facilities in rural Bangladesh: a cross-sectional mixed-methods study of patient non-retention and system readiness.

backgroundNon-communicable diseases (NCDs), particularly hypertension and diabetes, have shown a rising trend in Bangladesh despite ongoing management initiatives at primary healthcare facilities. Understanding both the prevalence and management challenges is critical for effective intervention.

methodsThis cross-sectional mixed-methods study was conducted from March to September 2023 across 12 selected upazilas in Khulna and Jashore districts of Bangladesh. The study aimed to identify adults at risk for hypertension and diabetes mellitus and explore challenges faced by patients and healthcare providers. A total of 120 community campaigns were conducted to screen adults, and 248 healthcare facilities were assessed for NCD service availability, provider training, and logistics.

resultsAmong 13,189 adult participants (40.8% male, 59.2% female), 45.8% were at risk of NCDs, while 54.2% were already affected. Hypertension was observed in 34.5% of participants and elevated random blood glucose in 27.9%. Hypertension was more common among males (30.0% vs. 24.2%, p < 0.001), while elevated glucose was higher among females (21.2% vs. 17.7% in males, p < 0.001). Overall, 40.1% were overweight or obese. Among diagnosed patients, 32.0% were non-retention to facility follow-up. Facility assessments showed that 52.8% offered NCD screening services, 51.4% of providers had received NCD-related training, 46.8% had glucometers, and only 24.6% had educational materials. Providers highlighted patient non-retention as a major challenge, while patients cited socio-economic and treatment-related barriers.

conclusionA substantial proportion of adults were either affected by or at risk of NCDs. Key Factors associated with non-retention and system gaps were observed including patient non-retention and limited facility readiness. Targeted community-level interventions addressing adherence and service gaps are essential to improve NCD management. CLINICAL TRIAL NUMBER: Not applicable.