Since the start of the SUNI-SEA project, a team of researchers have collected and reviewed NCD programme studies and interventions throughout Southeast Asia, to compile sound evidence of effective interventions, and draw on lessons learnt to inform the design of future NCD project interventions. This collection of studies was then used to conduct a meta-analysis which has recently been published in the international journal Health Policy and Planning.[1]
Since health system capacities, human and financial resources are very different in low and middle-income countries as compared to high-income countries, Southeast Asia cannot directly incorporate lessons drawn from NCD interventions in higher income countries. Rather, NCD interventions need to correspond to local capacities and require contextual solutions. Considering the limited amount of available evidence from single countries in Southeast Asia, and the geographic and cultural proximity and similarities in countries in the region, especially for economic development and health system capacities, it seems more reasonable for Southeast Asian countries to draw on the knowledge about effective NCD policies from this region as a whole.
In this article, the authors therefore aim to identify critical components of local NCD interventions that can inform the SUNI-SEA consortium about highly-effective intervention designs. To this end, the researchers reviewed almost 4,000 studies covering a wide scope of NCD interventions, of which 51 studies were eventually included the meta-analysis.
The large majority of the identified intervention studies which were evaluated for this paper, were conducted in the region’s two upper middle-income countries, Thailand (25 studies) and Malaysia (17 studies). Only a smaller number of studies were conducted in some of the region’s low- and middle-income countries: the Philippines (4), Vietnam (4), and Indonesia (1). For Myanmar, no study could be identified. This geographical concentration already highlights the importance for the SUNI-SEA consortium to provide rigorous and large-scale evidence for the community interventions in the three countries of interest – Indonesia, Vietnam and Myanmar.
The authors further sorted the studies into six different intervention categories and analysed them with respect to 23 different health and behavioural outcomes. The six categories encompassed (1) smoking interventions, (2) alcohol interventions, (3) diet and physical activity interventions, (4) screening uptake, (5) patient education and (6) interventions that investigated how changes in the general practices of health facilities can affect patients’ health outcomes.
Overall, a positive and significant average effect across all six types of intervention was found. Yet, the authors also documented evidence of substantial publication bias and under-powered studies. Making use of a meta-regression approach to correct for the publication bias, the authors instead failed to confirm positive average effects for some interventions.
Especially dietary and physical activity interventions failed to achieve improvements in analysed health outcomes, while programs focusing on smoking cessation, on the take-up of preventive screening activities or educating patients on how to cope with NCDs achieve sizeable effects.
To be able to identify critical intervention design features, the authors further conducted a moderator analysis. From this analysis, the authors can conclude that the effectiveness of an intervention depends especially on the length of implementation, and on the contact moments between the program participants and the implementing agency. Moreover, programs that were implemented in a group or community design often proved more effective than programs that targeted individuals.
The results from this meta-analysis provide important insights and knowledge for the SUNI-SEA consortium and other policy makers, on how to address the increasing NCD burden. It also calls for much more large-scale and rigorous evidence to address the challenge of NCDs in Southeast Asia.
[1] Fritz, M. & H. Fromell (2022). How to dampen the surge of non-communicable diseases in Southeast Asia: insights from a systematic review and meta-analysis. Health Policy and Planning 37(1), 152-167.