Situation Analysis of Population Level Interventions Targeting Risk Factors for Diabetes Mellitus and Hypertension Implemented in Rwanda, Malawi, and South Africa: A Desk Review

Abstract Background The prevalence of non-communicable diseases in low- and middle-income countries is increasing. Hypertension and diabetes mellitus share four main risk factors namely tobacco use, harmful alcohol consumption, unhealthy diet, and physical inactivity. In this desk review, we analysed existing interventions targeted at the above risk factors in Rwanda, Malawi, and South Africa. We compared existing interventions with recommended WHO ‘Best-Buys’ interventions. Methods Documents were sourced directly from stakeholders or retrieved online. We designed a data extraction template and grouped interventions under the four risk factors. Based on the WHO Strategy for Diet, Physical Activity and Health, each intervention was analyzed under three categories - supporting policies, supporting programs, and enabling environment. Results 2633 documents were screened across the three countries. 72 documents were included in the review. All three countries had a national NCD policy. Rwanda had the largest number of interventions on physical activity. It was also the only country with a public smoking ban in place. Interventions on diet in Rwanda largely addressed undernutrition rather than risk factors for diabetes mellitus and hypertension. There was no alcohol policy. South Africa had the largest number of interventions targeting unhealthy diet. A policy on alcohol was in place in addition to a liquor act which regulated the purchase and marketing of alcohol. There were designated days to promote physical activity, but no structured nationwide programs. There were multiple initiatives to promote smoking cessation in designated areas such as schools and workplaces. Malawi had developed an alcohol policy. Diet programs largely focused on curbing undernutrition in school going children rather than NCDs. There were no policies on salt restriction or sugar sweetened beverages. There were no interventions targeted at tobacco smoking or structured physical activity programs. In all three countries, there were more policies than programs to implement the said policies. Conclusion All three countries had responded to the NCD burden through overarching NCD programs and policies. There were gaps amongst the three countries in the breadth of interventions addressing each of the risk factors for diabetes mellitus and hypertension namely tobacco use, harmful alcohol consumption, unhealthy diet, and physical inactivity.