NCD Module Guide
The Health Services Report captures non-communicable diseases (NCDs) service delivery on a monthly basis. All service data are disaggregated by Channel : Franchise Facility, Service Delivery Partner, or PSI Direct Service Provision. For franchise facilities and service delivery partners, only services that meet PSI’s criteria for service delivery through partners can be reported. For detailed definitions of these channels and channel types, please click here: https://helppsi.freshdesk.com/support/solutions/articles/14000014984-common-data-element-definitions
Why collect these data?
The tables compile data on cervical cancer, hypertension, and type 2 diabetes screening and treatment. Gestational diabetes can be found in the Maternal and Neonatal Health Module. While programmatic indicators are reported to the government and donors at a country level, PSI requires reporting at the global level to: 1) improve internal programmatic quality; 2) contribute to external VMMC discussions at a global level and support donor advocacy; and 3) calculate DALYs averted. In each table, we have noted where data will be used to estimate impact.
The table below outlines the module’s tabs, tables and their corresponding data elements:
Section 1: Screening | Data Elements |
| Table 1: Screening by channel | Clients screened for cervical cancer by screening method (VIA/VILI, pap smear, HPV DNA test) Clients screened for hypertension Clients screened for Type 2 diabetes |
| Table 2: Diagnosis by channel | Clients diagnosed with hypertension Clients diagnosed with Type 2 diabetes |
Section 2: Treatment & Management | Data Elements |
| Table 1: Cervical cancer treatment by channel | Cryotherapy treatment by screening method (after VIA/VILI, pap smear, or HPV DNA test) Conization/LEEP by screening method (after VIA/VILI screening, pap smear, HPV DNA test) |
| Table 2: Hypertension and Type 2 diabetes control by channel | Clients whose hypertension is controlled Clients whose Type 2 diabetes is controlled |
Section 3: Client Age | Data Elements |
| Table 1: Screening by client age | Clients screened for cervical cancer Clients screened for hypertension Clients screened for diabetes |
Each table and data element are described in further detail below.
Section 1: Screening | Data Elements |
| Table 1: Screening by channel | Clients screened for cervical cancer by screening method (VIA/VILI, pap smear, HPV DNA test) Clients screened for hypertension Clients screened for Type 2 diabetes |
| Table 2: Diagnosis by channel | Clients diagnosed with hypertension Clients diagnosed with Type 2 diabetes |
| Data Element: Clients screened for cervical cancer by screening method (VIA/VILI, pap smear, HPV DNA test) |
| Purpose: This data element is measuring the total number of clients screened for cervical cancer, disaggregated by screening method and channel |
| Precise Definitions: Cervical cancer is caused by certain strains of human papillomaviruses (HPV). Cervical cancer screening of sexually active or formerly sexually active women can determine whether women are at risk of developing cervical cancer based on changes in cervical cells and/or the presence of HPV DNA. There are several ways to screen for cervical cancer. These include:
Cytology/Pap Smear: A sample of cervical cells is taken by the provider using a spatula and/or small brush, fixed onto slides and examined by a trained pathologist in a laboratory. VIA/VILI: VIA and VILI are two types of visual assessment used to identify pre-cancerous lesions on the cervix that, if not treated, could lead to cervical cancer. Visual inspection with acetic acid (VIA) uses 3-5% with acetic acid (vinegar) and can be done with the naked eye. If precancerous cells are present, the vinegar will make areas with abnormalities temporarily appear white and opaque to the human eye. Visual inspection with Lugol’s iodine (VILI), also known as Schiller’s test, uses Lugol’s iodine instead of acetic acid to help visualize any abnormalities. Providers may also use instruments to help better visualize cervical lesions. Cervicography, or taking a picture of the cervix, is one way in which providers can improve their ability to diagnose lesions that are difficult to diagnose. This can be done by taking an image of the cervix using a digital camera and putting the image on a screen. A number of visual enhancement tools now exist. HPV DNA Testing: This is a molecular test that allows providers to identify high-risk types of HPV. For HPV DNA testing, secretions are collected from the cervix or vagina using a swab or small brush and then placed into a container with a special liquid. This container will be sent to a laboratory (or processed on site in some cases), and sample will be analyzed for the presence of HPV DNA. For a detailed definition of “channel” see the common data elements definition page |
| Unit of Measure: Number of screenings performed |
| Disaggregated by: Screening method (VIA/VILI, pap smear, HPV DNA test) Channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision) |
| Justification/Management Utility: This information will provide insight into how effectively our cervical cancer service provision programs are growing. It will also help us understand which screening methods are used across PSI’s network members. |
| Data Element: Clients screened for hypertension |
| Purpose: This data element is measuring the total number of clients screened for hypertension |
| Precise Definitions: Hypertension is the medical term for high blood pressure. Both screening and diagnosis for hypertension is done by taking a blood pressure reading. Blood pressure is most often measured with a device known as a sphygmomanometer, which consists of a stethoscope, arm cuff, dial, pump, and valve. Any client whose blood pressure is taken should be recorded. An individual's blood pressure is defined by two measurements:
Blood pressure is reported as the systolic pressure over diastolic pressure (e.g., 120/70 or 120 over 70).Clients screened for hypertension should be counted on their initial visit. Any subsequent BP reading is required for diagnosis should not be counted here, but instead should be counted under diagnosis. The only exceptions to this are if the initial blood pressure measurement is very high (≥180mm Hg) or if there is known damage from high blood pressure, such as heart, eye, or kidney injury. In this case, hypertension can be diagnosed during the initial screening visit. For an individual to be counted as screened, two readings should be taken in the same visit, at least 5 minutes apart, with the client resting comfortably. Blood pressure should be measured in both arms initially, and the arm with the higher reading used for future measurements. For a detailed definition of “channel” see the common data elements definition page |
| Unit of Measure: Number of screenings performed |
| Disaggregated by: Channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision) |
| Justification/Management Utility: The benefits of screening and treatment for hypertension are well documented. They lead to a reduction in incidence of stroke, heart failure, and coronary heart disease. Collecting this information will help PSI document its expanding NCD portfolio and advocate for funding to further this work. |
| Data Element: Clients screened for Type 2 diabetes |
| Purpose: This data element is measuring the total number of clients screened for Type 2 diabetes using random plasma glucose, fasting plasma glucose, oral glucose tolerance test, and/or hemoglobin A1C |
| Precise Definitions: Type 2 diabetes is a chronic condition that presents with either insulin resistance or inadequate production of insulin. Type 2 diabetes is commonly associated with modifiable lifestyle factors such as smoking, diet, and exercise along with age, race, family history, and presence of hypertension. Screening for type 2 diabetes refers to the measurement of blood glucose (sugar), which can be performed using a variety of methods outlined below. Any client whose blood glucose is taken should be recorded. For screening purposes, clients should only be counted on their initial visit. Any follow-up tests required for diagnosis should be recorded under diagnosis. Most screening strategies for Type 2 diabetes include some form of risk assessment (e.g., patient history or questionnaire) along with measurement of blood glucose. Blood glucose can be assessed using a number of methods. The method used should be appropriate for the local context and consider available resources. Random Plasma Glucose (RPG) Test: Blood glucose level is measured in a sample of blood, either with a glucometer using capillary blood or in a laboratory using venous blood. This test is performed at any time without patient preparation; however, a disadvantage is that results can vary widely depending on timing and composition of the patient’s last meal. Also, capillary blood and venous blood may produce different results, requiring a conversion factor. Fasting Plasma Glucose (FPG) Test: Blood glucose level is measured in a sample of blood, either with a glucometer using capillary blood or in a laboratory using venous blood. In preparation for a FPG test, the patient must fast (no food or calorie-containing beverages) for at least 8 hours before the test. Oral Glucose Tolerance Test (OGTT): During an OGTT, a person drinks a 75-gram glucose solution following an 8-hour fast. Two hours after drinking the solution, blood glucose is tested with a glucometer using capillary blood or in a laboratory using venous blood. An OGTT is most commonly done to check for diabetes that occurs in pregnancy. HemoglobinA1c: HbA1c is a blood test detecting levels of glycosylated hemoglobin, expressed as a percentage. This indicates average blood glucose control over the previous 2-3 months, and is therefore also useful in diabetes monitoring. HbA1c testing must be performed in a laboratory and requires stringent quality assurance testing and assays that are standardized to international reference values. This test requires venous blood draw, which is more invasive and requires more training to implement than capillary blood sampling. The A1c test is not used for screening cystic fibrosis-related diabetes, gestational diabetes in pregnant women, or for diabetes in children and adolescence. For a detailed definition of “channel” see the common data elements definition page |
| Unit of Measure: Number of screening tests completed |
| Disaggregated by: Channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision) |
| Justification/Management Utility: Diabetes has become a major cause of morbidity and mortality worldwide. Complications of the disease can include damage to eyes (retinopathy) leading to blindness, to kidneys (nephropathy) leading to renal failure; and to nerves (neuropathy) leading to impotence and diabetic foot disorders (which include severe infections and amputation). Early screening and lifestyle adjustments can prevent the onset and progression of diabetes. Collecting this information will help PSI document its expanding NCD portfolio and advocate for funding to further this work. |
| Data Element: Clients diagnosed with hypertension |
| Purpose: This data element is measuring the total number of clients diagnosed with hypertension with confirmatory BP measurement (performed on a subsequent visit at least one week apart) |
| Precise Definitions: Hypertension is the medical term for high blood pressure. Both screening and diagnosis for hypertension is done by taking a blood pressure reading. Blood pressure is most often measured with a device known as a sphygmomanometer, which consists of a stethoscope, arm cuff, dial, pump, and valve. An individual's blood pressure is defined by two measurements:
Blood pressure is reported as the systolic pressure over diastolic pressure (e.g., 120/70 or 120 over 70).An individual (non-pregnant adult) is considered diagnosed with hypertension with a BP reading of >140 systolic pressure and/or > 90 diastolic pressure measured at two visits at least one week apart. The only exceptions to this are if the blood pressure is very high (≥180mm Hg) or if there is known damage from high blood pressure, such as heart, eye, or kidney injury. In this case, hypertension can be diagnosed during his/her initial visit, and the client should be evaluated for appropriate management right away. Clients should only be counted once for diagnosis, even if they’ve been screened multiple times. For a detailed definition of “channel” see the common data elements definition page |
| Unit of Measure: Number of diagnoses made |
| Disaggregated by: Channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision) |
| Justification/Management Utility: The benefits of screening, diagnosis and successful management of hypertension are well documented. They lead to a reduction in incidence of stroke, heart failure, and coronary heart disease. Collecting this information will help PSI document its expanding NCD service delivery portfolio and advocate for funding to further this work. |
| Data Element: Clients diagnosed with Type 2 diabetes |
| Purpose: This data element is measuring the total number of clients diagnosed with Type 2 diabetes with a confirmatory fasting blood glucose test, oral glucose tolerance test, and/or hemoglobin A1C |
| Precise Definitions: Type 2 diabetes is a chronic condition that presents with either insulin resistance or inadequate production of insulin. Type 2 diabetes is commonly associated with modifiable lifestyle factors such as smoking, diet, and exercise along with age, race, family history, and presence of hypertension. Both screening and diagnosis are done by measuring a person’s blood glucose (sugar) levels at different time points. Blood glucose can be assessed using a number of methods. The method used should be appropriate for the local context and consider available resources. An initial blood glucose measurement is used for screening. Screening tests are followed by a second test in order to make a diagnosis. If facilities to perform laboratory analysis of blood glucose are available, diabetes diagnosis should be based on blood glucose levels in venous blood samples. If laboratory analysis is not available, blood glucose should be tested using a glucometer. Types of blood glucose tests that can be used for diagnosis of Type 2 diabetes includes: Fasting Plasma Glucose (FPG) Test: Blood glucose level is measured in a sample of blood, either with a glucometer using capillary blood or in a laboratory using venous blood. In preparation for a FPG test, the patient must fast (no food or calorie-containing beverages) for at least 8 hours before the test. Oral Glucose Tolerance Test (OGTT): During an OGTT, a person drinks a 75-gram glucose solution following an 8-hour fast. 2 hours after drinking the solution, blood glucose is tested with a glucometer using capillary blood or in a laboratory using venous blood. An OGTT is most commonly done to check for diabetes that occurs in pregnancy. HemoglobinA1c: HbA1c is a blood test detecting levels of glycosylated hemoglobin, expressed as a percentage. This indicates average blood glucose control over the previous 2-3 months, and is therefore also useful in diabetes monitoring. HbA1c testing must be performed in a laboratory and requires stringent quality assurance testing and assays that are standardized to international reference values. This test requires venous blood draw, which is more invasive and requires more training to implement than capillary blood sampling. The A1c test is not used for screening cystic fibrosis-related diabetes, gestational diabetes in pregnant women, or for diabetes in children and adolescence. WHO-endorsed blood glucose diagnostic values for Type 2 diabetes in non-pregnant adults are: Fasting Plasma Glucose (FPG): ≥126 mg/dL (7.0 mmol/L) Oral Glucose Tolerance Test (OGTT): ≥200 mg/dL (11.1 mmol/L) HemoglobinA1c (HbA1c): ≥6.5% An initial screening test is followed by a second blood glucose test in order to make a diagnosis. The only exception is an initial blood glucose level >200 mg/dL or 11.1mmol/L in the presence of diabetes symptoms (blindness/eye damage, nerve damage, severe infections or amputation of the feet) is enough data for diagnosis, and the test does not need to be repeated. For a detailed definition of “channel” see the common data elements definition page |
| Unit of Measure: Number of clients diagnosed with Type 2 diabetes |
| Disaggregated by: Channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision) |
| Justification/Management Utility: Diabetes has become a major cause of morbidity and mortality worldwide. Complications of the disease can include damage to eyes (retinopathy) leading to blindness, to kidneys (nephropathy) leading to renal failure; and to nerves (neuropathy) leading to impotence and diabetic foot disorders (which include severe infections and amputation). Early screening and lifestyle adjustments can prevent the onset and progression of diabetes. Collecting this information will help PSI document its expanding NCD portfolio and advocate for funding to further this work. |
Section 2: Treatment & Management | Data Elements |
| Table 1: Cervical cancer treatment by channel | Cryotherapy treatment by screening method (after VIA/VILI, pap smear, or HPV DNA test) Conization/LEEP by screening method (after VIA/VILI screening, pap smear, HPV DNA test) |
| Table 2: Hypertension and Type 2 diabetes control by channel | Clients whose hypertension is controlled Clients whose Type 2 diabetes is controlled |
| Data Element: Cryotherapy treatment by screening method (after VIA/VILI, pap smear, or HPV DNA test) |
| Purpose: This data element records the number of clients treated based on the initial screening method (i.e. “Cryotherapy (after VIA/VILI screening)” counts the number of clients who screened positive after VIA or VILI and were treated using cryotherapy.) |
| Precise Definitions: Cryotherapy is a form of treatment for cervical precancerous lesions. Cryotherapy eliminates precancerous areas on the cervix by freezing them. It involves applying a highly cooled metal disc (cryoprobe) to the cervix, and freezing surface of the cervix using either carbon dioxide (CO2) or nitrous oxide (N2O) gas. Cytology/Pap Smear: A sample of cervical cells is taken by the provider using a spatula and/or small brush, fixed onto slides and examined by a trained pathologist in a laboratory. VIA/VILI: VIA and VILI are two types of visual assessment used to identify pre-cancerous lesions on the cervix that, if not treated, could lead to cervical cancer. Visual inspection with acetic acid (VIA) uses 3-5% with acetic acid (vinegar) can be done with the naked eye. If precancerous cells are present, the vinegar will make areas with abnormalities temporarily appear white and opaque to the human eye. Visual inspection with Lugol’s iodine (VILI), also known as Schiller’s test, uses Lugol’s iodine instead of acetic acid to help visualize any abnormalities. Providers may also use instruments to help better visualize cervical lesions. Cervicography, or taking a picture of the cervix, is one way in which providers can improve their ability to diagnose lesions that are difficult to diagnose. A number of visual enhancement tools now exist. HPV DNA Testing: This is a molecular test that allows providers to identify high-risk types of HPV. For HPV DNA testing, secretions are collected from the cervix or vagina using a swab or small brush and then placed into a container with a special liquid. This container will be sent to a laboratory (or processed onsite in some cases), and sample will be analyzed for the presence of HPV DNA. For a detailed definition of “channel” see the common data elements definition page |
| Unit of Measure: Number of clients treated with cryotherapy |
| Disaggregated by: Channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision) |
| Justification/Management Utility: These data will provide important trend data on service delivery at the global level. Programmatic trends help to identify both challenges and successes; areas that need greater attention and support as well as opportunities for platform-to-platform assistance. These data are also key inputs for proposals, further ensuring cervical cancer program strengthening through new funding. This data is also used for estimating DALYs averted. |
Data Element: Conization/LEEP by screening method (after VIA/VILI screening, Pap smear, or HPV DNA test) |
| Purpose: Data Element records the number of clients treated based on the initial screening method. (i.e. “Conization/LEEP (after VIA/VILI screening)” counts the number of clients who screened positive after VIA or VILI and were treated using conization/LEEP.) |
| Precise Definitions: Conization Conization of the cervix is defined as excision of a cone-shaped or cylindrical wedge from the cervix uteri. Conization can be performed with a scalpel (cold-knife conization), laser, or electrosurgical loop (LEEP). Loop electrosurgical excision procedure (LEEP) Removal of abnormal areas from the cervix using a loop made of thin wire powered by an electrosurgical unit. The loop tool cuts and coagulates at the same time, and this is followed by use of a ball electrode to complete the coagulation. C old knife conization (CKC) CKC is the removal of a cone-shaped area from the cervix, including portions of the outer (ectocervix) and inner cervix (endocervix). The amount of tissue removed will depend on the size of the lesion and the likelihood of finding invasive cancer. Cytology/Pap Smear: A sample of cervical cells is taken by the provider using a spatula and/or small brush, fixed onto slides and examined by a trained pathologist in a laboratory. VIA/VILI: VIA and VILI are two types of visual assessment used to identify pre-cancerous lesions on the cervix that, if not treated, could lead to cervical cancer. Visual inspection with acetic acid (VIA) uses 3-5% with acetic acid (vinegar) can be done with the naked eye. If precancerous cells are present, the vinegar will make areas with abnormalities temporarily appear white and opaque to the human eye. Visual inspection with Lugol’s iodine (VILI), also known as Schiller’s test, uses Lugol’s iodine instead of acetic acid to help visualize any abnormalities. Providers may also use instruments to help better visualize cervical lesions. Cervicography, or taking a picture of the cervix, is one way in which providers can improve their ability to diagnose lesions that are difficult to diagnose. A number of visual enhancement tools now exist. HPV DNA Testing: This is a molecular test that allows providers to identify high-risk types of HPV. For HPV DNA testing, secretions are collected from the cervix or vagina using a swab or small brush and then placed into a container with a special liquid. This container will be sent to a laboratory (or processed onsite in some cases), and sample will be analyzed for the presence of HPV DNA. For a detailed definition of “channel” see the common data elements definition page |
| Unit of Measure: Number of clients treated with LEEP or cold knife conization |
| Disaggregated by: Channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision) |
| Justification/Management Utility: These data will provide important trend data on service delivery at the global level. Programmatic trends help to identify both challenges and successes; areas that need greater attention and support as well as opportunities for platform-to-platform assistance. These data are also key inputs for proposals, further ensuring cervical cancer program strengthening through new funding. This data is also used for estimating DALYs averted. |
| Data Element: Clients diagnosed with hypertension whose condition is controlled |
| Purpose: This data element is measuring the total number of hypertensive clients whose hypertension meets the clinical definition of ‘controlled’ |
| Precise Definitions: The main goal of hypertension treatment is to manage the hypertension as well as other identified CVD risk factors. Patients must understand that hypertension management is often a life-long commitment, and that it may be dangerous to terminate or be inconsistent with their treatment, both with drugs and lifestyle changes, without consulting with their health care provider. Once a client has been diagnosed with hypertension, the following thresholds should be used to define successful management of the condition, or ‘control of hypertension’: A blood pressure <140/90 mmHg is considered as controlled for non-pregnant adults up to 80 years of age and those >80 years who also have chronic kidney disease or diabetes. A blood pressure <150/90 mmHg is considered as controlled for individuals >80 years, as this higher systolic level is associated with strong cardiovascular and stroke prevention. There are many elements of patient care that contribute to successful control of hypertension, once a client has been diagnosed with the condition. This may include lifestyle modification and/or treatment with one or more oral medications. Lifestyle modification is important for hypertension management. Changes in lifestyle factors such as physical activity, diet, and smoking can help prevent or control some negative effects of hypertension. Drug therapy can be initiated earlier if blood pressure is clearly not responding to lifestyle modification, and/or if other risk factors present. Treatment options depend on patient’s clinical condition and availability of medications. Please refer to PSI’s clinical guidelines for hypertension for more details on clinical management of hypertension. For a detailed definition of “channel” see the common data elements definition page |
| Unit of Measure: Number of clients with hypertension seen in a given month who meet the clinical definition of control |
| Method of Calculation: Client records/facility register |
| Disaggregated by: Channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision) |
| Justification/Management Utility: |
| Data Element: Clients diagnosed with type 2 diabetes whose condition is controlled |
| Purpose: This data element is measuring the total number of clients diagnosed with type 2 diabetes whose condition meets the clinical definition of controlled. |
| Precise Definitions: Type 2 diabetes is a chronic disease requiring lifelong management. Though some cases may be controlled through lifestyle interventions alone, some will require oral medications and/or insulin therapy. Therefore, availability of care must be available to all those with diabetes, taking into account the local context. The role of blood glucose control in preventing the development and progression of complications has been proven in type 2 diabetes. Setting targets for blood glucose control is a necessary part of diabetes treatment. Because diabetes is an often asymptomatic condition, targets provide motivation and a system of benchmarking to promote successful management. Targets should be individualized and take into account life expectancy, disease duration, presence or absence of micro- and macrovascular complications, CVD risk factors, co-morbidities, and risks for hypoglycemia, and should be periodically reviewed and modified as needed. Lower glucose targets may be considered if easily and safely obtained. Likewise, higher targets may be set for people with comorbidities (such as advanced renal disease or macrovascular complications), histories of severe hypoglycemia, or limited life expectancy, as long as the patient does not exhibit hyperglycemia-related symptoms. HbA1c is the preferred indicator of glucose control, as it reflects average glucose control over the previous 2-3 months. Where HbA1c measurement is not possible, plasma glucose levels can be used. Once a client has been diagnosed with type 2 diabetes, the following thresholds should be used to define successful management of the condition, or ‘control of blood glucose’: HbA1c: < 7.0% / 53 mmol/mol Fasting/pre-meal plasma glucose: <115 mg/dL/ 6.5 mmol Post-meal plasma glucose: <140 - 160 mg/dL / 9.0 mmol Please refer to PSI’s global clinical guidelines for type 2 diabetes for more details on clinical management of diabetes. |
| Unit of Measure: Number of clients with diabetes seen in a given month who meet the clinical definition of control |
| Method of Calculation: Client records/facility register |
| Disaggregated by: Channel (Franchise facility, Service Delivery Partner, PSI Direct Service Provision) |
| Justification/Management Utility: These data are also key inputs for proposals, further ensuring NCD program strengthening through new funding. This data is also used for estimating DALYs. |
Section 3: Client Age | Data Elements |
| Table 1: Screening by client age | Clients screened for cervical cancer Clients screened for hypertension Clients screened for diabetes |
| Data Element: Clients screened for cervical cancer by age |
| Purpose: This data element is measuring the total number of clients screened for cervical cancer, disaggregated by age |
| Precise Definitions: Women 30-49 years of age are considered to be at highest risk of cervical cancer, based on population-based data, and this age group is considered the target group for screening. Cervical cancer is caused by certain strains of human papillomaviruses (HPV). Cervical cancer screening of sexually active or formerly sexually active women can determine women are at risk of developing cervical cancer based on changes in cervical cells and/or the presence of HPV DNA. There are several ways to screen for cervical cancer. These include:
Cytology/Pap Smear: A sample of cervical cells is taken by the provider using a spatula and/or small brush, fixed onto slides and examined by a trained pathologist in a laboratory. VIA/VILI: VIA and VILI are two types of visual assessment used to identify pre-cancerous lesions on the cervix that, if not treated, could lead to cervical cancer. Visual inspection with acetic acid (VIA) uses 3-5% with acetic acid (vinegar) can be done with the naked eye. If precancerous cells are present, the vinegar will make areas with abnormalities temporarily appear white and opaque to the human eye. Visual inspection with Lugol’s iodine (VILI), also known as Schiller’s test, uses Lugol’s iodine instead of acetic acid to help visualize any abnormalities. Providers may also use instruments to help better visualize cervical lesions. Cervicography, or taking a picture of the cervix, is one way in which providers can improve their ability to diagnose lesions that are difficult to diagnose. A number of visual enhancement tools now exist. HPV DNA Testing: This is a molecular test that allows providers to identify high-risk types of HPV. For HPV DNA testing, secretions are collected from the cervix or vagina using a swab or small brush and then placed into a container with a special liquid. This container will be sent to a laboratory (or processed onsite in some cases), and sample will be analyzed for the presence of HPV DNA. |
| Unit of Measure: Number of clients being screened for cervical cancer |
| Disaggregated by: Age (<30, 30-49, >50) |
| Justification/Management Utility: This information will provide insight into how effectively our cervical cancer service provision programs are growing. It will also help to monitor whether cervical cancer screenings are reaching women in the highest risk group (age 30-49). |
| Data Element: Clients screened for hypertension by age |
| Purpose: This data element is measuring the total number of clients screened for hypertension, disaggregated by age |
| Precise Definitions: Hypertension is the medical term for high blood pressure. Both screening and diagnosis for hypertension is done by taking a blood pressure reading. Blood pressure is most often measured with a device known as a sphygmomanometer, which consists of a stethoscope, arm cuff, dial, pump, and valve. Any client whose blood pressure is taken should be recorded. An individual's blood pressure is defined by two measurements:
Blood pressure is reported as the systolic pressure over diastolic pressure (e.g., 120/70 or 120 over 70). Clients screened for hypertension should be counted on their initial visit. Any subsequent BP reading is required for diagnosis should not be counted here, but instead should be counted under diagnosis. The only exceptions to this are if the initial blood pressure measurement is very high (≥180mm Hg) or if there is known damage from high blood pressure, such as heart, eye, or kidney injury. In this case, hypertension can be diagnosed during the initial screening visit. For an individual to be counted as screened, two readings should be taken in the same visit, at least 5 minutes apart, with the client resting comfortably. Blood pressure should be measured in both arms initially, and the arm with the higher reading used for future measurements. |
| Unit of Measure: Number of clients screened for hypertension |
| Disaggregated by: Age (<30, 30-49, >50) |
| Justification/Management Utility: The benefits of screening and treatment for hypertension are well documented. They lead to a reduction in incidence of stroke, heart failure, and coronary heart disease. Collecting this information will help PSI document its expanding NCD portfolio and advocate for funding to further this work. Screenings should reach those in the highest risk age groups. |
| Data Element: Clients screened for diabetes by age |
| Purpose: This data element is measuring the total number of clients screened for diabetes, disaggregated by age |
| Precise Definitions: Type 2 diabetes is a chronic condition that presents with either insulin resistance or inadequate production of insulin. Type 2 diabetes is commonly associated with modifiable lifestyle factors such as smoking, diet, and exercise along with age, race, family history, and presence of hypertension. Screening for type 2 diabetes refers to the measurement of blood glucose (sugar), which can be performed using a variety of methods outlined below. Any client whose blood glucose is taken should be recorded. For screening purposes, clients should only be counted on their initial visit. Any follow-up tests required for diagnosis should be recorded under diagnosis. Most screening strategies for Type 2 diabetes include some form of risk assessment (e.g., patient history or questionnaire) along with measurement of blood glucose. Blood glucose can be assessed using a number of methods. The method used should be appropriate for the local context and consider available resources. Random Plasma Glucose (RPG) Test: Blood glucose level is measured in a sample of blood, either with a glucometer using capillary blood or in a laboratory using venous blood. This test is performed at any time without patient preparation; however, a disadvantage is that results can vary widely depending on timing and composition of the patient’s last meal. Also, capillary blood and venous blood may produce different results, requiring a conversion factor. Fasting Plasma Glucose (FPG) Test: Blood glucose level is measured in a sample of blood, either with a glucometer using capillary blood or in a laboratory using venous blood. In preparation for a FPG test, the patient must fast (no food or calorie-containing beverages) for at least 8 hours before the test. Oral Glucose Tolerance Test (OGTT): During an OGTT, a person drinks a 75-gram glucose solution following an 8-hour fast. Two hours after drinking the solution, blood glucose is tested with a glucometer using capillary blood or in a laboratory using venous blood. An OGTT is most commonly done to check for diabetes that occurs in pregnancy. HemoglobinA1c: HbA1c is a blood test detecting levels of glycosylated hemoglobin, expressed as a percentage. This indicates average blood glucose control over the previous 2-3 months, and is therefore also useful in diabetes monitoring. HbA1c testing must be performed in a laboratory and requires stringent quality assurance testing and assays that are standardized to international reference values. This test requires venous blood draw, which is more invasive and requires more training to implement than capillary blood sampling. The A1c test is not used for screening cystic fibrosis-related diabetes, gestational diabetes in pregnant women, or for diabetes in children and adolescence. |
| Unit of Measure: Number of clients screened for type 2 diabetes |
| Disaggregated by: Age (<30, 30-49, >50) |
| Justification/Management Utility: Collecting this information will help PSI document its expanding NCD portfolio and advocate for funding to further this work. |