Feasibility of Managing Diabetes Patients Identified Through Community Screening in Rural Ethiopia.

ABSTRACT Objective: To assess the feasibility of diagnosing, enrolling, and managing adults with type 2 diabetes at the primary healthcare level using the WHO Package of Essential Non communicable Disease Interventions (WHO PEN) approach, following identification through community based screening in rural Ethiopia. Design: Single arm, pre post clinical feasibility study. Setting: Primary healthcare facility in Shebedino district, Sidama National Regional State, rural Ethiopia, between September 2024 and February 2025. Participants: 35 adults with newly diagnosed type 2 diabetes, identified through community-based screening and diagnosed according to the WHO and American Diabetes Association criteria. Interventions: A six-month WHO-PEN based intervention comprising metformin based pharmacologic treatment, lifestyle counselling, and health system strengthening. Outcome measures: Feasibility across four domains (acceptability, implementation fidelity, practicality, and preliminary clinical signal); HbA1c change from baseline to six months, analysed using the Wilcoxon signed-rank test and McNemars test. Results: All 35 patients completed the six-month follow up. At baseline, 6(17 %) had comorbid hypertension, 5 (14%) had elevated total cholesterol, 14 (40%) had low HDL cholesterol, 24 (69%) were underweight. Median HbA1c decreased from 52.0 mmol/mol (IQR: 50, 56.0) at baseline to 43.0 mmol/mol (IQR: 42.0, 46.0) at six months (reduction of 9.0 mmol/mol; p <0.001). By six months, 30 of 35 (85.7%) had HbA1c below the control threshold, versus 20 (57%) at baseline (p=0.002). Conclusion: Community identified adults with type 2 diabetes could be successfully diagnosed, linked to care, and retained using the WHO PEN approach at a rural primary healthcare facility, with substantial improvement in glycaemic control. The absence of a control group precludes causal attribution. Medication was not adjusted for patients with persistent hyperglycaemia despite scheduled reviews, indicating a priority need to strengthen implementation of established practices rather than studying further efficacy. Keywords: Type 2 diabetes; WHO-PEN; HbA1c; primary healthcare; community screening; feasibility study; Ethiopia