{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:05:39Z","timestamp":1785434739354,"version":"3.56.0"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Non-communicable diseases (NCDs) account for nearly 74% of global deaths, with 86% of premature NCD mortality occurring in low- and middle-income countries. In Malawi, hypertension, diabetes mellitus, and asthma contribute substantially to morbidity and mortality. Integrated service delivery models such as the Integrated Chronic Care Clinics (IC3) in Neno District aim to improve chronic disease management; however, evidence on disease control within these models remains limited. This study assessed disease control and associated correlates among patients receiving care in IC3 clinics in rural Malawi. We conducted a mixed-methods retrospective cross-sectional study at Neno District Hospital and Lisungwi Community Hospital. Quantitative data were extracted from OpenMRS electronic medical records for 1,790 patients diagnosed with hypertension, diabetes, or asthma. Disease control was defined as blood pressure &lt;140\/90 mmHg (&lt;130\/80 mmHg for hypertensive diabetics), HbA1c\u2009&lt;\u20097% for diabetes, and symptom-based criteria for asthma. Associations between disease control and demographic or clinical variables were assessed using chi-square tests and logistic regression. Qualitative data were collected through 17 focus group discussions and 56 in-depth interviews with patients and healthcare providers. Hypertension control was achieved in 55% of patients, asthma control in 87%, and diabetes control in 32%. Males had lower odds of hypertension control than females (aOR 0.70, 95% CI 0.55\u20130.90). Overweight patients and those receiving more than two antihypertensive medications also had lower odds of hypertension control. Asthma control was associated with inhaled corticosteroid use, while glycaemic control was associated with the number of prescribed medications. Qualitative findings identified health literacy, medication adherence, patient\u2013provider communication, and access to care as key influences on disease management. Disease control varied across conditions within integrated chronic care clinics in rural Malawi and was influenced by demographic, treatment-related, and contextual factors.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006629","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:34:31Z","timestamp":1785432871000},"page":"e0006629","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Disease control and its correlates among hypertensive, diabetic, and asthmatic patients enrolled in secondary-level Integrated Chronic Care Clinics in Neno District, rural Malawi"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9608-287X","authenticated-orcid":true,"given":"George Dalitso","family":"Limwado","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice Lydia","family":"Matanje","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8296-3432","authenticated-orcid":true,"given":"Victor Chigonjetso","family":"Mithi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Valeta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matamando","family":"Mwendera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bright","family":"Ngongonda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kondwani","family":"Matiya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Owen","family":"Mwale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5946-1870","authenticated-orcid":true,"given":"Henry Chimuso","family":"Phiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enoch","family":"Ndarama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limbani","family":"Thengo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses Banda","family":"Aron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kondwani","family":"Mpinga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luckson","family":"Dullie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"pgph.0006629.ref001","year":"2010"},{"key":"pgph.0006629.ref002"},{"key":"pgph.0006629.ref003","article-title":"Burden of non-communicable diseases in sub-Saharan Africa, 1990\u20132017: results from the Global Burden of Disease Study 2017","journal-title":"The Lancet Global Health"},{"issue":"9866","key":"pgph.0006629.ref004","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/S0140-6736(13)60100-2","article-title":"Non-communicable diseases: 2015 to 2025","volume":"381","author":"R Horton","year":"2013","journal-title":"The Lancet"},{"key":"pgph.0006629.ref005","author":"M Gitau","year":"2020"},{"key":"pgph.0006629.ref006","doi-asserted-by":"crossref","first-page":"255","DOI":"10.2147\/IJGM.S157987","article-title":"The increasing prevalence of non-communicable diseases in low-middle income countries: The view from Malawi","volume":"11","author":"M Gowshall","year":"2018","journal-title":"Int J Gen Med"},{"issue":"3","key":"pgph.0006629.ref007","doi-asserted-by":"crossref","first-page":"120","DOI":"10.4103\/jncd.jncd_56_22","article-title":"Prevalence of noncommunicable diseases risk factors and their determinants in Malawi: Evidence from 2017 WHO Stepwise survey","volume":"7","author":"WF Ng\u2019ambi","year":"2022","journal-title":"Int J Noncommunicable Dis"},{"key":"pgph.0006629.ref008","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/1472-6823-14-41","article-title":"Prevalence and correlates of diabetes mellitus in Malawi: Population-based national NCD STEPS survey","volume":"14","author":"KP Msyamboza","year":"2014","journal-title":"BMC Endocr Disord"},{"issue":"5","key":"pgph.0006629.ref009","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0020316","article-title":"The burden of selected chronic non-communicable diseases and their risk factors in Malawi: Nationwide STEPS survey","volume":"6","author":"KP Msyamboza","year":"2011","journal-title":"PLoS One"},{"issue":"4","key":"pgph.0006629.ref010","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.inhe.2012.09.005","article-title":"The burden of hypertension and its risk factors in Malawi: nationwide population-based STEPS survey","volume":"4","author":"KP Msyamboza","year":"2012","journal-title":"Int Health"},{"issue":"2","key":"pgph.0006629.ref011","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.gheart.2019.05.001","article-title":"Systematic review of hypertension and diabetes burden, risk factors, and interventions for prevention and control in Malawi: The NCD BRITE Consortium","volume":"14","author":"A Amberbir","year":"2019","journal-title":"Glob Heart"},{"key":"pgph.0006629.ref012","article-title":"Burden of cancer in Malawi; common types, incidence and trends: National population-based cancer registry","journal-title":"BMC Research Notes"},{"issue":"7","key":"pgph.0006629.ref013","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002952","article-title":"Factors associated with self-reported diagnosed asthma in urban and rural Malawi: Observations from a population-based study of non-communicable diseases","volume":"4","author":"AS Amoah","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"5","key":"pgph.0006629.ref014","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1136\/thoraxjnl-2020-216065","article-title":"An enhanced care package to improve asthma management in Malawian children: A randomised controlled trial","volume":"76","author":"S Rylance","year":"2021","journal-title":"Thorax"},{"issue":"1","key":"pgph.0006629.ref015","doi-asserted-by":"crossref","first-page":"33","DOI":"10.5334\/gh.1313","article-title":"Decentralization and Integration of Advanced Cardiac Care for the World\u2019s Poorest Billion Through the PEN-Plus Strategy for Severe Chronic Non-Communicable Disease","volume":"19","author":"SL Klassen","year":"2024","journal-title":"Glob Heart"},{"issue":"1","key":"pgph.0006629.ref016","doi-asserted-by":"crossref","first-page":"69","DOI":"10.5334\/aogh.3750","article-title":"Training mid-level providers to treat severe non-communicable diseases in Neno, Malawi through PEN-Plus strategies","volume":"88","author":"T Ruderman","year":"2023","journal-title":"Ann Glob Health"},{"issue":"4","key":"pgph.0006629.ref017","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.hjdsi.2015.08.002","article-title":"Leveraging HIV platforms to work toward comprehensive primary care in rural Malawi: The Integrated Chronic Care Clinic","volume":"3","author":"EB Wroe","year":"2015","journal-title":"Healthc (Amst)"},{"issue":"10","key":"pgph.0006629.ref018","article-title":"Expanding access to non-communicable disease care in rural Malawi: Outcomes from a retrospective cohort in an integrated NCD-HIV model","volume":"10","author":"EB Wroe","year":"2020","journal-title":"BMJ Open"},{"issue":"11","key":"pgph.0006629.ref019","article-title":"Economic evaluation of integrated services for non-communicable diseases and HIV: Costs and client outcomes in rural Malawi","volume":"12","author":"EB Wroe","year":"2022","journal-title":"BMJ Open"},{"issue":"8","key":"pgph.0006629.ref020","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1111\/tmi.12901","article-title":"Non-communicable diseases and HIV care and treatment: Models of integrated service delivery","volume":"22","author":"M Duffy","year":"2017","journal-title":"Trop Med Int Health"},{"issue":"3","key":"pgph.0006629.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0299904","article-title":"Integrated chronic care models for people with comorbid of HIV and non-communicable diseases in Sub-Saharan Africa: A scoping review","volume":"19","author":"R Chireshe","year":"2024","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0006629.ref022","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.healthpol.2011.10.006","article-title":"Integrated care for chronic conditions: The contribution of the ICCC Framework","volume":"105","author":"R Nu\u00f1o","year":"2012","journal-title":"Health Policy"},{"key":"pgph.0006629.ref023","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-073652","article-title":"Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa: A systematic review and meta-analysis","author":"P Otieno","year":"2023"},{"key":"pgph.0006629.ref024","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-043705","article-title":"Effects of integrated models of care for diabetes and hypertension in low-income and middle-income countries: A systematic review and meta-analysis","author":"A Rohwer","year":"2021"},{"key":"pgph.0006629.ref025"},{"key":"pgph.0006629.ref026","year":"2023"},{"key":"pgph.0006629.ref027"},{"key":"pgph.0006629.ref028"},{"key":"pgph.0006629.ref029"},{"key":"pgph.0006629.ref030"},{"issue":"4","key":"pgph.0006629.ref031","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1161\/HYPERTENSIONAHA.117.10512","article-title":"Socioeconomic status and hypertension control in sub-Saharan Africa","volume":"71","author":"M Antignac","year":"2018","journal-title":"Hypertension"},{"issue":"1","key":"pgph.0006629.ref032","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s40842-019-0077-8","article-title":"Understanding the manifestation of diabetes in sub Saharan Africa to inform therapeutic approaches and preventive strategies: A narrative review","volume":"5","author":"D Kibirige","year":"2019","journal-title":"Clin Diabetes Endocrinol"},{"issue":"4","key":"pgph.0006629.ref033","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1038\/s41574-021-00613-y","article-title":"Type 2 diabetes mellitus in sub-Saharan Africa: Challenges and opportunities","volume":"18","author":"AA Motala","year":"2022","journal-title":"Nat Rev Endocrinol"},{"issue":"3","key":"pgph.0006629.ref034","first-page":"3","article-title":"The reality of managing asthma in sub-Saharan Africa \u2013 Priorities and strategies for improving care","volume":"3","author":"K Mortimer","year":"2022","journal-title":"J Pan Afr Thorac Soc"},{"issue":"6","key":"pgph.0006629.ref035","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1016\/j.jaci.2021.10.019","article-title":"Epidemiology and management of asthma and atopic dermatitis in Sub-Saharan Africa","volume":"148","author":"C Skevaki","year":"2021","journal-title":"J Allergy Clin Immunol"},{"key":"pgph.0006629.ref036"},{"key":"pgph.0006629.ref037","first-page":"417","article-title":"Coefficient","author":"ML McHugh","year":"2018","journal-title":"The SAGE Encyclopedia of Educational Research, Measurement, and Evaluation"},{"key":"pgph.0006629.ref038","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.jclinepi.2016.11.017","article-title":"The number of primary events per variable affects estimation of the subdistribution hazard competing risks model","volume":"83","author":"PC Austin","year":"2017","journal-title":"J Clin Epidemiol"},{"issue":"11","key":"pgph.0006629.ref039","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0312258","article-title":"Seeking and receiving hypertension and diabetes mellitus care in Tanzania","volume":"19","author":"K Tani","year":"2024","journal-title":"PLoS One"},{"issue":"1","key":"pgph.0006629.ref040","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s41256-024-00368-9","article-title":"Improving hypertension control in Nigeria: Early policy implications from the Hypertension Treatment in Nigeria program","volume":"9","author":"O Ogungbe","year":"2024","journal-title":"Glob Health Res Policy"},{"issue":"7","key":"pgph.0006629.ref041","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1038\/s41371-022-00742-5","article-title":"The India hypertension control initiative\u2013early outcomes in 26 districts across five states of India, 2018\u20132020","volume":"37","author":"P Kaur","year":"2023","journal-title":"J Hum Hypertens"},{"issue":"18","key":"pgph.0006629.ref042","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1001\/jama.2022.19590","article-title":"Treatment of hypertension: A review","volume":"328","author":"RM Carey","year":"2022","journal-title":"JAMA"},{"issue":"11","key":"pgph.0006629.ref043","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1038\/s41569-021-00559-8","article-title":"Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension","volume":"18","author":"B Zhou","year":"2021","journal-title":"Nat Rev Cardiol"},{"issue":"6","key":"pgph.0006629.ref044","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s11906-022-01183-8","article-title":"Sex differences in the prevalence, outcomes and management of hypertension","volume":"24","author":"PJ Connelly","year":"2022","journal-title":"Curr Hypertens Rep"},{"issue":"1","key":"pgph.0006629.ref045","doi-asserted-by":"crossref","first-page":"33931","DOI":"10.1038\/s41598-025-09865-4","article-title":"Understanding gender variation in the risk factors of hypertension through cross sectional analysis","volume":"15","author":"S Priya","year":"2025","journal-title":"Sci Rep"},{"key":"pgph.0006629.ref046"},{"issue":"3","key":"pgph.0006629.ref047","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1136\/bmjebm-2021-111764","article-title":"Combination fixed-dose \u03b2 agonist and steroid inhaler as required for adults or children with mild asthma: A Cochrane systematic review","volume":"27","author":"I Crossingham","year":"2022","journal-title":"BMJ Evid Based Med"},{"issue":"2","key":"pgph.0006629.ref048","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0281742","article-title":"Health-related quality of life and its associated factors among patients with asthma: A multi-centered cross-sectional study in selected referral hospitals in Northwest Ethiopia","volume":"18","author":"EA Belachew","year":"2023","journal-title":"PLoS One"},{"key":"pgph.0006629.ref049"},{"issue":"1","key":"pgph.0006629.ref050","doi-asserted-by":"crossref","DOI":"10.2174\/0115733998267513231208100124","article-title":"Type 2 Diabetes mellitus in Tanzania. A narrative review of epidemiology and disease trend","volume":"21","author":"O Chillo","year":"2024","journal-title":"Curr Diabetes Rev"},{"key":"pgph.0006629.ref051"},{"key":"pgph.0006629.ref052"},{"key":"pgph.0006629.ref053"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006629","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:34:38Z","timestamp":1785432878000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006629"}},"subtitle":[],"editor":[{"given":"Ari","family":"Probandari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":53,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0006629","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]}}}