Disease control and its correlates among hypertensive, diabetic, and asthmatic patients enrolled in secondary-level Integrated Chronic Care Clinics in Neno District, rural Malawi

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 <140/90 mmHg (<130/80 mmHg for hypertensive diabetics), HbA1c < 7% 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 0.55-0.90). 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-provider 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.