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Kapoor N, Haregu T, Singh K, Oommen AM, Audsley J, Gupta P, Jasper S, Mini GK, Thirunavukkarasu S, Oldenburg B. Strengthening research capacity of early-mid career researchers: Implementation and evaluation of the Excellence in Non-COmmunicable disease REsearch (ENCORE) program. J Investig Med 2024; 72:475-486. [PMID: 38378444 DOI: 10.1177/10815589241236156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
High-quality training and networking are pivotal for enhancing the research capacity of early- to mid-career researchers in the prevention and control of non-communicable diseases. Beyond building research skills, these professionals gain valuable insights from interdisciplinary mentorship, networking opportunities, and exposure to diverse cultures and health systems. Despite the significance of such initiatives, their implementation remains underexplored. Here, we describe the implementation and evaluation of the Excellence in Non-COommunicable disease REsearch (ENCORE) program, a collaborative initiative between Australia and India that was launched in 2016 and spanned a duration of 3 years. Led by a consortium that included the University of Melbourne and leading Indian research and medical institutions, ENCORE involved 15 faculty members and 20 early-mid career researchers. The program comprised various elements, including face-to-face forums, masterclasses, webinars, a health-technology conference, and roundtable events. ENCORE successfully trained the early-career researchers, resulting in over 30 peer-reviewed articles, 36 conference presentations, and the submission of seven grant applications, three of which received funding. Beyond individual achievements, ENCORE fostered robust research collaboration between Australian and Indian institutions, showcasing its broader impact on strengthening research capacities across borders.
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Affiliation(s)
- Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
- Non-Communicable Disease Unit, The Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Tilahun Haregu
- Non-Communicable Disease Unit, The Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Kavita Singh
- Public Health Foundation of India, Gurugram, Haryana, India
- Centre for Chronic Disease Control, New Delhi, New Delhi, India
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Baden-Wurttemberg, Germany
| | - Anu Mary Oommen
- Community Health Department, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Jennifer Audsley
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Priti Gupta
- Centre for Chronic Disease Control, New Delhi, New Delhi, India
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - G K Mini
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India
| | - Sathish Thirunavukkarasu
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
- Emory Global Diabetes Research Center (EGDRC), Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Wilson-Barthes M, Steingrimsson J, Lee Y, Tran DN, Wachira J, Kafu C, Pastakia SD, Vedanthan R, Said JA, Genberg BL, Galárraga O. Economic outcomes among microfinance group members receiving community-based chronic disease care: Cluster randomized trial evidence from Kenya. Soc Sci Med 2024; 351:116993. [PMID: 38781744 PMCID: PMC11180555 DOI: 10.1016/j.socscimed.2024.116993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/15/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Poverty can be a robust barrier to HIV care engagement. We assessed the extent to which delivering care for HIV, diabetes and hypertension within community-based microfinance groups increased savings and reduced loan defaults among microfinance members living with HIV. METHODS We analyzed cluster randomized trial data ascertained during November 2020-May 2023 from 57 self-formed microfinance groups in western Kenya. Groups were randomized 1:1 to receive care for HIV and non-communicable diseases in the community during regular microfinance meetings (intervention) or at a health facility during routine appointments (standard care). Community and facility care provided clinical evaluations, medications, and point-of-care testing. The trial enrolled 900 microfinance members, with data collected quarterly for 18-months. We used a two-part model to estimate intervention effects on microfinance shares purchased, and a negative binomial regression model to estimate differences in loan default rates between trial arms. We estimated effects overall and by participant characteristics. RESULTS Participants' median age and distance from a health facility was 52 years and 5.6 km, respectively, and 50% reported earning less than $50 per month. The probability of saving any amount (>$0) through purchasing microfinance shares was 2.7 percentage points higher among microfinance group members receiving community vs. facility care. Community care recipients and facility care patients saved $44.90 and $25.24 over 18-months, respectively, and the additional amount saved by community care recipients was statistically significant (p = 0.036). Overall and in stratified analyses, loan defaults rates were not statistically significantly different between community and facility care patients. CONCLUSIONS Receiving integrated care in the community was significantly associated with modest increases in savings. We did not find any significant association between community-delivered care and reductions in loan defaults among HIV-positive microfinance group members. Longer follow up examination and formal mediation analyses are warranted.
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Affiliation(s)
- M Wilson-Barthes
- Brown University School of Public Health, International Health Institute, Providence, RI, USA.
| | - J Steingrimsson
- Brown University School of Public Health, Department of Biostatistics, Providence, RI, USA
| | - Y Lee
- Brown University School of Public Health, Department of Biostatistics, Providence, RI, USA
| | - D N Tran
- Temple University, School of Pharmacy, Philadelphia, PA, USA
| | - J Wachira
- Moi University College of Health Sciences, School of Medicine, Department of Behavioral Science, Eldoret, Kenya
| | - C Kafu
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - S D Pastakia
- Purdue University College of Pharmacy, Center for Health Equity and Innovation, Indianapolis, IN, USA
| | - R Vedanthan
- New York University Grossman School of Medicine, Department of Population Health, New York, NY, USA
| | - J A Said
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - B L Genberg
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - O Galárraga
- Brown University School of Public Health, Department of Health Services, Policy and Practice; and International Institute, Providence, RI, USA
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Patil SJ, Bhayani V, Yoshida Y, Bushweller L, Udoh EO, Todorov I, Saper R, Stange KC, Bolen S. Lay advisor interventions for hypertension outcomes: A Systematic Review, Meta-analysis and a RE-AIM evaluation. Front Med (Lausanne) 2024; 11:1305190. [PMID: 38831986 PMCID: PMC11144929 DOI: 10.3389/fmed.2024.1305190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/22/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Lay advisor interventions improve hypertension outcomes; however, the added benefits and relevant factors for their widespread implementation into health systems are unknown. We performed a systematic review to: (1) summarize the benefits of adding lay advisors to interventions on hypertension outcomes, and (2) summarize factors associated with successful implementation in health systems using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Methods We systematically searched several databases, including Ovid MEDLINE, CINAHL, PsycINFO from January 1981 to May 2023. All study designs of interventions delivered solely by lay advisors for adults with hypertension were eligible. If both arms received the lay advisor intervention, the study arm with lower intensity was assigned as the low-intensity intervention. Results We included 41 articles, of which 22 were RCTs, from 7,267 screened citations. Studies predominantly included socially disadvantaged populations. Meta-analysis (9 RCTs; n = 4,220) of eligible lay advisor interventions reporting outcomes showed improved systolic blood pressure (BP) [-3.72 mm Hg (CI -6.1 to -1.3; I2 88%)], and diastolic BP [-1.7 mm Hg (CI -1 to -0.9; I2 7%)] compared to control group. Pooled effect from six RCTs (n = 3,277) comparing high-intensity with low-intensity lay advisor interventions showed improved systolic BP of -3.6 mm Hg (CI -6.7 to -0.5; I2 82.7%) and improved diastolic BP of -2.1 mm Hg (CI -3.7 to -0.4; I2 70.9%) with high-intensity interventions. No significant difference in pooled odds of hypertension control was noted between lay advisor intervention and control groups, or between high-intensity and low-intensity intervention groups. Most studies used multicomponent interventions with no stepped care elements or reporting of efficacious components. Indicators of external validity (adoption, implementation, maintenance) were infrequently reported. Discussion Lay advisor interventions improve hypertension outcomes, with high intensity interventions having a greater impact. Further studies need to identify successful intervention and implementation factors of multicomponent interventions for stepped upscaling within healthcare system settings as well as factors used to help sustain interventions.
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Affiliation(s)
- Sonal J. Patil
- Center for Health Equity, Engagement, Education, and Research (CHEEER), Department of Family Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH, United States
| | - Vishwa Bhayani
- Department of Public Health, University of Missouri, Columbia, MO, United States
| | - Yilin Yoshida
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Leila Bushweller
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Eno-Obong Udoh
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Irina Todorov
- Department of Wellness and Preventive Medicine, Primary Care Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Robert Saper
- Department of Wellness and Preventive Medicine, Primary Care Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Kurt C. Stange
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Shari Bolen
- Department of Medicine, Center for Health Care Research and Policy, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH, United States
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Birhanu MM, Zengin A, Joshi R, Evans RG, Kalyanram K, Kartik K, Riddell MA, Suresh O, Srikanth VK, Arabshahi S, Thomas N, Thrift AG. Risk factors for incident cardiovascular events and their population attributable fractions in rural India: The Rishi Valley Prospective Cohort Study. Trop Med Int Health 2024; 29:377-389. [PMID: 38403844 DOI: 10.1111/tmi.13981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE We prospectively determined incident cardiovascular events and their association with risk factors in rural India. METHODS We followed up with 7935 adults from the Rishi Valley Prospective Cohort Study to identify incident cardiovascular events. Using Cox proportional hazards regression, we estimated hazard ratios (HRs) with 95% confidence intervals (95% CI) for associations between potential risk factors and cardiovascular events. Population attributable fractions (PAFs) for risk factors were estimated using R ('averisk' package). RESULTS Of the 4809 participants without prior cardiovascular disease, 57.7% were women and baseline mean age was 45.3 years. At follow-up (median of 4.9 years, 23,180 person-years [PYs]), 202 participants developed cardiovascular events, equating to an incidence of 8.7 cardiovascular events/1000 PYs. Incidence was greater in those with hypertension (hazard ratio [HR] [95% CI] 1.73 [1.21-2.49], adjusted PAF 18%), diabetes (1.96 [1.15-3.36], 4%) or central obesity (1.77 [1.23, 2.54], 9%) which together accounted for 31% of the PAF. Non-traditional risk factors such as night sleeping hours and number of children accounted for 16% of the PAF. CONCLUSIONS Both traditional and non-traditional cardiovascular risk factors are important contributors to incident cardiovascular events in rural India. Interventions targeted to these factors could assist in reducing the incidence of cardiovascular events.
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Affiliation(s)
- Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- George Institute for Global Health, New Delhi, India
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Michaela A Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Rishi Valley Rural Health Centre, Chittoor, Andhra Pradesh, India
| | - Velandai K Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- National Centre for Healthy Ageing, Melbourne, Victoria, Australia
| | - Simin Arabshahi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Lim GP, Appalasamy JR, Ahmad B, Quek KF, Ramadas A. Peer-led lifestyle interventions for the primary prevention of cardiovascular disease in community: a systematic review of randomised controlled trials. BMC Public Health 2024; 24:812. [PMID: 38486215 PMCID: PMC10941612 DOI: 10.1186/s12889-024-18328-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/11/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Peer-led lifestyle interventions have gained recognition as effective approaches for managing and preventing chronic diseases. However, there remains a critical knowledge gap regarding the impact and effectiveness of peer-led interventions specifically in the primary prevention of cardiovascular disease (CVD). Our systematic review aims to synthesise the available evidence and evaluate the impact of peer-led lifestyle interventions, providing invaluable insights that can guide the development of peer-led strategies for preventing CVD. METHODS Systematic database searches were conducted on Ovid Medline, Embase, Cochrane Centre for Controlled Trials, PubMed and Scopus to source peer-reviewed articles published between 2013 and 2023. Reference lists of the included publications were also manually searched. RESULTS Fourteen unique randomised controlled trials were identified, of which three were pilot studies. Most of the interventions were conducted among individuals at moderate to high risk of CVD and lasted for a year. There is a variety of components in intervention delivery, including group discussions and individual counselling. Peer leader training mostly covered intervention delivery, communication, and research-specific skills. Systolic blood pressure showed the most promising CVD-related improvement, while mixed results were found for several other dietary and lifestyle behavioural outcomes. CONCLUSION Peer-led lifestyle interventions have shown varying effectiveness in cardiovascular health outcomes. The competencies and roles of peer leaders were identified to guide future intervention development with a more comprehensive approach to the primary prevention of CVD.
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Affiliation(s)
- Geok Pei Lim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | | | - Badariah Ahmad
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Kia Fatt Quek
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
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Garg S, Dewangan M, Nanda P, Sahu A, Xalxo L, Bebarta KK, Gupta V, Quereishi MJ, Sahu AK, Tandan P. Impact of community health workers on improving identification and primary care of hypertension among the urban poor - findings from Chhattisgarh state of India. BMC PRIMARY CARE 2023; 24:272. [PMID: 38093191 PMCID: PMC10717607 DOI: 10.1186/s12875-023-02231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Hypertension is a major health problem globally and in India. Around 60% of people with hypertension in India are not aware that they have the condition. Less than 30% of individuals with hypertension are on treatment. Existing studies have indicated that community health workers (CHWs) can play a useful role in expanding the care for hypertension. Evaluations are needed to study the impact when an intervention is implemented by the government in its existing large-scale CHW programme to improve the identification, regular follow-up and medication adherence for hypertension. METHODS Chhattisgarh state implemented a pilot intervention to improve screening and follow-up for hypertension by equipping Mitanin-CHWs to measure blood pressure (BP). The study design involved an intervention-group and a comparison-group of urban slum population. The survey covered 5974 individuals (30-79 years age) in intervention-group and 5131 in comparison-group. Multivariate analysis was conducted to find out the effect of intervention on the desired outcomes. RESULTS In intervention-group, 80.2% of the individuals (30-79 years age) had been screened for hypertension whereas the proportion was 37.9% in comparison-group. For 47.0% of individuals in intervention-group, Mitanin CHW was the provider who measured BP for the first time. Around 16.3% of individuals in intervention-group and 9.5% in comparison-group had been diagnosed with hypertension. Around 85.9% of hypertension cases in intervention-group and 77.0% in comparison-group were on treatment. BP had been measured in preceding 30 days for 81.8% of hypertension-cases in intervention-group and 64.3% in comparison-group. Around 70.3% of hypertension-cases in intervention-group and 55.1% in comparison-group had taken their complete medication for last seven days. Multivariate analysis showed that CHW intervention was associated significantly with improvements in all the desired outcomes. CONCLUSION Equipping the CHWs to measure BP was effective in increasing the screening and identification of hypertension, regular measurement of BP of individuals with hypertension and the adherence to medication. This shows the potential if the one-million strong work-force of Accredited-Social-Health-Activists (ASHA) CHWs in India gets equipped for this role. Governments need to provide a stronger policy push to get this materialised.
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Grants
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
- PIP 2022 National Health Mission, India
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Affiliation(s)
- Samir Garg
- State Health Resource Centre, Chhattisgarh, Raipur, India.
| | | | - Prabodh Nanda
- State Health Resource Centre, Chhattisgarh, Raipur, India
| | - Ashu Sahu
- State Health Resource Centre, Chhattisgarh, Raipur, India
| | - Lalita Xalxo
- State Health Resource Centre, Chhattisgarh, Raipur, India
| | | | - Vishnu Gupta
- State Health Resource Centre, Chhattisgarh, Raipur, India
| | | | - Anand Kumar Sahu
- State Programme Management Unit, National Health Mission, Chhattisgarh, Raipur, India
| | - Pradeep Tandan
- State Programme Management Unit, National Health Mission, Chhattisgarh, Raipur, India
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Feigin VL, Owolabi MO. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission. Lancet Neurol 2023; 22:1160-1206. [PMID: 37827183 PMCID: PMC10715732 DOI: 10.1016/s1474-4422(23)00277-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 10/14/2023]
Abstract
Stroke is the second leading cause of death worldwide. The burden of disability after a stroke is also large, and is increasing at a faster pace in low-income and middle-income countries than in high-income countries. Alarmingly, the incidence of stroke is increasing in young and middle-aged people (ie, age <55 years) globally. Should these trends continue, Sustainable Development Goal 3.4 (reducing the burden of stroke as part of the general target to reduce the burden of non-communicable diseases by a third by 2030) will not be met. In this Commission, we forecast the burden of stroke from 2020 to 2050. We project that stroke mortality will increase by 50%—from 6·6 million (95% uncertainty interval [UI] 6·0 million–7·1 million) in 2020, to 9·7 million (8·0 million–11·6 million) in 2050—with disability-adjusted life-years (DALYs) growing over the same period from 144·8 million (133·9 million–156·9 million) in 2020, to 189·3 million (161·8 million–224·9 million) in 2050. These projections prompted us to do a situational analysis across the four pillars of the stroke quadrangle: surveillance, prevention, acute care, and rehabilitation. We have also identified the barriers to, and facilitators for, the achievement of these four pillars. Disability-adjusted life-years (DALYs) The sum of the years of life lost as a result of premature mortality from a disease and the years lived with a disability associated with prevalent cases of the disease in a population. One DALY represents the loss of the equivalent of one year of full health On the basis of our assessment, we have identified and prioritised several recommendations. For each of the four pillars (surveillance, prevention, acute care, and rehabilitation), we propose pragmatic solutions for the implementation of evidence-based interventions to reduce the global burden of stroke. The estimated direct (ie, treatment and rehabilitation) and indirect (considering productivity loss) costs of stroke globally are in excess of US$891 billion annually. The pragmatic solutions we put forwards for urgent implementation should help to mitigate these losses, reduce the global burden of stroke, and contribute to achievement of Sustainable Development Goal 3.4, the WHO Intersectoral Global Action Plan on epilepsy and other neurological disorders (2022–2031), and the WHO Global Action Plan for prevention and control of non-communicable diseases. Reduction of the global burden of stroke, particularly in low-income and middle-income countries, by implementing primary and secondary stroke prevention strategies and evidence-based acute care and rehabilitation services is urgently required. Measures to facilitate this goal include: the establishment of a framework to monitor and assess the burden of stroke (and its risk factors) and stroke services at a national level; the implementation of integrated population-level and individual-level prevention strategies for people at any increased risk of cerebrovascular disease, with emphasis on early detection and control of hypertension; planning and delivery of acute stroke care services, including the establishment of stroke units with access to reperfusion therapies for ischaemic stroke and workforce training and capacity building (and monitoring of quality indicators for these services nationally, regionally, and globally); the promotion of interdisciplinary stroke care services, training for caregivers, and capacity building for community health workers and other health-care providers working in stroke rehabilitation; and the creation of a stroke advocacy and implementation ecosystem that includes all relevant communities, organisations, and stakeholders. The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Mayowa O Owolabi
- Centre for Genomics and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria; Blossom Specialist Medical Centre, Ibadan, Nigeria.
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Zaki S. Tailoring Educational Materials to Cultural Context Matters. J Med Internet Res 2023; 25:e42604. [PMID: 37930771 PMCID: PMC10660234 DOI: 10.2196/42604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/27/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Sasha Zaki
- Jinnah Sindh Medical University, Karachi, Pakistan
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9
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Sönmez N, Srinivasan K, Venkatesh R, Buell RW, Ramdas K. Evidence from the first Shared Medical Appointments (SMAs) randomised controlled trial in India: SMAs increase the satisfaction, knowledge, and medication compliance of patients with glaucoma. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001648. [PMID: 37471312 PMCID: PMC10358908 DOI: 10.1371/journal.pgph.0001648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/16/2023] [Indexed: 07/22/2023]
Abstract
In Shared Medical Appointments (SMAs), patients with similar conditions meet the physician together and each receives one-on-one attention. SMAs can improve outcomes and physician productivity. Yet privacy concerns have stymied adoption. In physician-deprived nations, patients' utility from improved access may outweigh their disutility from loss of privacy. Ours is to our knowledge the first SMA trial for any disease, in India, where doctors are scarce. In a 1,000-patient, single-site, randomized controlled trial at Aravind Eye Hospital, Pondicherry, we compared SMAs and one-on-one appointments, over four successive visits, for patients with glaucoma. We examined patients' satisfaction, knowledge, intention-to-follow-up, follow-up rates, and medication compliance rates (primary outcomes) using intention-to-treat analysis. Of 1,034 patients invited between July 12, 2016 -July 19, 2018, 1,000 (96.7%) consented to participate, and were randomly assigned to either SMAs (NSMA = 500) or one-on-one appointments (N1-1 = 500). Patients who received SMAs showed higher satisfaction (MeanSMA = 4.955 (SD 0.241), Mean1-1 = 4.920 (SD 0.326); difference in means 0.035; 95% CI, 0.017-0.054, p = 0.0002) and knowledge (MeanSMA = 3.416 (SD 1.340), Mean1-1 = 3.267 (SD 1.492); difference in means 0.149; 95% CI, 0.057-0.241, p = 0.002) than patients who received one-on-one appointments. Across conditions, there was no difference in patients' intention-to-follow-up (MeanSMA = 4.989 (SD 0.118), Mean1-1 = 4.986 (SD 0.149); difference in means 0.003; 95% CI, -0.006-0.012, p = 0.481) and actual follow-up rates (MeanSMA = 87.5% (SD 0.372), Mean1-1 = 88.7% (SD 0.338); difference in means -0.012; 95% CI, -0.039-0.015, p = 0.377). Patients who received SMAs exhibited higher medication compliance rates (MeanSMA = 97.0% (SD 0.180), Mean1-1 = 94.9% (SD 0.238); difference in means 0.020; 95% CI, 0.004-0.036, p = 0.013). SMAs improved satisfaction, learning, and medication compliance, without compromising follow-up rates or measured clinical outcomes. Peer interruptions were negatively correlated with patient satisfaction in early-trial SMAs and positively correlated with patient satisfaction in later-trial SMAs. Trial registration: The trial was registered with Clinical Trials Registry of India (https://ctri.nic.in/) with reference no. REF/2016/11/012659 and registration no. CTRI/2018/02/011998.
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Affiliation(s)
| | | | | | - Ryan W. Buell
- Harvard Business School, Harvard University, Boston, Massachusetts, United States of America
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Thapa R, Zengin A, Neupane D, Mishra SR, Koirala S, Kallestrup P, Thrift AG. Sustainability of a 12-month lifestyle intervention delivered by community health workers in reducing blood pressure in Nepal: 5-year follow-up of the COBIN open-label, cluster randomised trial. Lancet Glob Health 2023; 11:e1086-e1095. [PMID: 37349035 DOI: 10.1016/s2214-109x(23)00214-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The sustainability and scalability of limited-duration interventions in low-income and middle-income countries remain unclear. We aimed to investigate the sustainability in reduction of blood pressure through a 12-month lifestyle intervention led by community health workers to reduce blood pressure in Nepal, 4 years after the intervention ceased. METHODS The Community-Based Intervention for Control of Hypertension in Nepal (COBIN) trial was a non-blinded, cluster-randomised trial done in Kaski, Nepal. Adults aged 25-65 years were eligible. People were excluded if they declined consent, were severely ill, unlikely to be in the community throughout the intervention, or pregnant. During the 12-month intervention, female community health volunteers (FCHVs) visited participants in the intervention groups and provided lifestyle counselling and blood pressure measurement every 4 months. At the end of the 12-month intervention, systolic blood pressure was significantly lower in the intervention group than in the usual care group in all cohorts, ranging from -2·3 mm Hg (95% CI -3·8 to -0·8) lower in those with normal blood pressure to -4·9 mm Hg (-7·8 to -2·0) in the hypertensive cohort. The primary outcome for this follow-up study was a mean change in systolic blood pressure from baseline to follow-up at 60 months. We did an intention-to-treat analysis. FINDINGS Between April 1, 2015, and Dec 31, 2015, 1638 participants were recruited in COBIN (939 [57·3%] assigned to intervention and 699 [42·7%] assigned to usual care). Of the 1468 (89·6%) who completed the 12-month assessments, we followed up 1352 (92·1%) participants at 60 months, between Oct 11, 2020, and May 5, 2022. 964 (71·3%) participants were women and 388 (28·7%) were men. From baseline to 60 months, the mean systolic blood pressure increased by 10·4 mm Hg (95% CI 9·1-11·6) in the intervention group and 6·0 mm Hg (4·6-7·5) in the usual care group (adjusted mean difference 4·1 mm Hg [2·2 to 5·8]). INTERPRETATION Lifestyle counselling and blood pressure monitoring by community health workers is effective in substantially reducing blood pressure while adults are being monitored in a trial but, following cessation of the intervention, this benefit is not maintained in the long term, with potential for harm. This finding could have important implications for funders and research communities to regularly target participants for education and follow-up at an optimal timepoint to reduce any likelihood of harm. FUNDING Monash University (Melbourne, VIC, Australia) and the Jayanti Memorial Trust (Kathmandu, Nepal). TRANSLATION For the Nepali translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Rajshree Thapa
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia; Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia; Nepal Development Society, Chitwan, Bagmati Province, Nepal
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Dinesh Neupane
- Nepal Development Society, Chitwan, Bagmati Province, Nepal; Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Shiva Raj Mishra
- Nepal Development Society, Chitwan, Bagmati Province, Nepal; Epidemiology and Simulation Modelling, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sweta Koirala
- Nepal Development Society, Chitwan, Bagmati Province, Nepal
| | - Per Kallestrup
- Center for Global Health, Department of Public Health, Aarhus University, Aarhus, Midtjylland, Denmark
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
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11
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Longkumer I, Yadav S, Rajkumari S, Saraswathy KN. Trends in hypertension prevalence, awareness, treatment, and control: an 8-year follow-up study from rural North India. Sci Rep 2023; 13:9910. [PMID: 37337044 DOI: 10.1038/s41598-023-37082-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/15/2023] [Indexed: 06/21/2023] Open
Abstract
Hypertension is a major contributor to global CVD burden. LMICs including India is challenged with rising hypertension prevalence, yet limited studies are available on temporal change and incidence among community-cohorts. This study aimed to describe trends in hypertension prevalence, awareness, treatment, and control over 8 years among a rural community-cohort from Haryana, India. The study also lends towards an analysis of incidence. Adults ≥ 30 years (N = 1542) recruited during baseline cross-sectional study between 2011 and 2014 were followed up after a median 8.1 years. At endline, demographic/lifestyle characteristics and blood pressure were re-examined. Overall median SBP significantly increased from 120 mmHg at baseline to 125.5 mmHg at endline (p < 0.001), while hypertension prevalence increased from 34.4% (95% CI 32.0-36.9) to 40.4% (95% CI 37.5-43.4) (p = 0.002). Age-standardized hypertension incidence was 30.2% (95% CI 26.7-35.2) over 8 years. Among hypertensive group, awareness, treatment, and control increased from 9.6, 8.8 and 5.0% to 31.8, 27.3 and 9.6% (p < 0.05), respectively. Increasing trend in SBP and hypertension prevalence was observed as the cohort ages. This increase is supported by the high incidence of hypertension. Nevertheless, our study highlights positive trends in hypertension care cascade but poor control, suggesting that this trend may not be adequately impactful to reduce hypertension burden.
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Affiliation(s)
- Imnameren Longkumer
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India
| | - Suniti Yadav
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India
| | - Sunanda Rajkumari
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India
| | - Kallur Nava Saraswathy
- Laboratory of Biochemical and Molecular Anthropology, Department of Anthropology, University of Delhi, Delhi, 110007, India.
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12
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Tolley A, Hassan R, Sanghera R, Grewal K, Kong R, Sodhi B, Basu S. Interventions to promote medication adherence for chronic diseases in India: a systematic review. Front Public Health 2023; 11:1194919. [PMID: 37397765 PMCID: PMC10311913 DOI: 10.3389/fpubh.2023.1194919] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Cost-effective interventions that improve medication adherence are urgently needed to address the epidemic of non-communicable diseases (NCDs) in India. However, in low- and middle-income countries like India, there is a lack of analysis evaluating the effectiveness of adherence improving strategies. We conducted the first systematic review evaluating interventions aimed at improving medication adherence for chronic diseases in India. Methods A systematic search on MEDLINE, Web of Science, Scopus, and Google Scholar was conducted. Based on a PRISMA-compliant, pre-defined methodology, randomized control trials were included which: involved subjects with NCDs; were located in India; used any intervention with the aim of improving medication adherence; and measured adherence as a primary or secondary outcome. Results The search strategy yielded 1,552 unique articles of which 22 met inclusion criteria. Interventions assessed by these studies included education-based interventions (n = 12), combinations of education-based interventions with regular follow up (n = 4), and technology-based interventions (n = 2). Non-communicable diseases evaluated commonly were respiratory disease (n = 3), type 2 diabetes (n = 6), cardiovascular disease (n = 8) and depression (n = 2). Conclusions Although the vast majority of primary studies supporting the conclusions were of mixed methodological quality, patient education by CHWs and pharmacists represent promising interventions to improve medication adherence, with further benefits from regular follow-up. There is need for systematic evaluation of these interventions with high quality RCTs and their implementation as part of wider health policy. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022345636, identifier: CRD42022345636.
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Affiliation(s)
| | | | | | | | - Ruige Kong
- University of Cambridge, Cambridge, United Kingdom
| | - Baani Sodhi
- Indian Institute of Public Health-Delhi, Gurugram, India
| | - Saurav Basu
- Indian Institute of Public Health-Delhi, Gurugram, India
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13
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Kumar SM, Anandraj J, Sivanatham P, Essakky S, Nain J, Talukdar R, Loganathan V, Kar SS. Control status of hypertension in India: systematic review and meta-analysis. J Hypertens 2023; 41:687-698. [PMID: 36883453 DOI: 10.1097/hjh.0000000000003381] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND AND AIMS Uncontrolled hypertension is a major risk factor for cardiovascular diseases (CVDs). The present study aimed to conduct a systematic review and meta-analysis to estimate the pooled prevalence of control status of hypertension in India. METHODS AND RESULTS We carried out systematic search (PROSPERO No.: CRD42021239800) in PubMed and Embase published between April 2013 and March 2021 followed by meta-analysis with random-effects model. The pooled prevalence of controlled hypertension was estimated across geographic regions. The quality, publication bias and heterogeneity of the included studies were also assessed. We included 19 studies with 44 994 hypertensive population, among which 17 studies had low risk of bias. We found statistically significant heterogeneity ( P ≤ 0.05) and absence of publication bias among the included studies. The pooled prevalence of control status among patients with hypertension was 15% (95% CI: 12-19%) and among those under treatment was 46% (95% CI: 40-52%). The control status among patients with hypertension was significantly higher in Southern India 23% (95% CI: 16-31%) followed by Western 13% (95% CI: 4-16%), Northern 12% (95% CI: 8-16%), and Eastern India 5% (95% CI: 4-5%). Except for Southern India, the control status was lower among the rural areas compared with urban areas. CONCLUSION We report high prevalence of uncontrolled hypertension in India irrespective of treatment status, geographic regions and urban and rural settings. There is urgent need to improve control status of hypertension in the country.
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Affiliation(s)
- S Mathan Kumar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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14
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Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, Alsaid J, Neupane D, Kario K, Beheiry H, Brouwers S, Burger D, Charchar FJ, Cho MC, Guzik TJ, Haji Al-Saedi GF, Ishaq M, Itoh H, Jones ESW, Khan T, Kokubo Y, Kotruchin P, Muxfeldt E, Odili A, Patil M, Ralapanawa U, Romero CA, Schlaich MP, Shehab A, Mooi CS, Steckelings UM, Stergiou G, Touyz RM, Unger T, Wainford RD, Wang JG, Williams B, Wynne BM, Tomaszewski M. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovasc Res 2023; 119:381-409. [PMID: 36219457 PMCID: PMC9619669 DOI: 10.1093/cvr/cvac130] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.
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Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Kensington Campus, High Street, Sydney 2052 NSW, Australia; The George Institute for Global Health, King Street, Newton, Sydney NSW 2052, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease; North-West University, Hoffman Street, Potchefstroom 2520, South Africa
- SAMRC Development Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2000, South Africa
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Department of Renal Medicine, 8 College Rd., Singapore 169857, Singapore
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London W12 7RH, UK
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Peter M Nilsson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden
| | - Jafar Alsaid
- Ochsner Health System, New Orleans, Louisiana, USA
- Queensland University, Brisbane, Queensland, Australia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hind Beheiry
- International University of Africa, Khartoum, Sudan
| | - Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
- Department of Physiology and Anatomy, University of Melbourne, Melbourne, Victoria, Australia
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8585, Japan
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Taskeen Khan
- Department of Public Health Medicine, University of Pretoria, Pretoria, South Africa
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Elizabeth Muxfeldt
- University Hospital Clementino Fraga Filho, Hypertension Program, Universidade Federal do Rio de Janeiro, Brazil
| | - Augustine Odili
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad, India
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Kandy, Central Province, Sri Lanka
| | - Cesar A Romero
- Renal Division, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Perth, Western Australia, Australia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ching Siew Mooi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - U Muscha Steckelings
- Department of Cardiovascular & Renal Research, Institute of Molecular Medicine. University of Southern Denmark, Odense, Denmark
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rhian M Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Thomas Unger
- CARIM - Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Richard D Wainford
- Department of Pharmacology & Experimental Therapeutics and the Whitaker, Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - Brandi M Wynne
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
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15
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Kate MP, Samuel C, Singh S, Jain M, Kamra D, Singh GB, Sharma M, Pandian JD. Community health volunteer for blood pressure control in rural people with stroke in India: Pilot randomised trial. J Stroke Cerebrovasc Dis 2023; 32:107107. [PMID: 37003249 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE To test the hypothesis that an Accredited social health activist (ASHA), a community health volunteer in a task-sharing model can help in sustained control of systolic blood pressure (BP) in rural people with Stroke and hypertension at 6 months follow up. METHODS In this randomized trial two rural areas (Pakhowal and Sidhwan bet) with 70 and 94 villages respectively were screened for people with stroke and hypertension. They were assigned to either ASHA-assisted BP control in addition to standard-of-care (Pakhowal-intervention Group) or standard-of-care alone (Sidhwan bet- Control Group). Assessors blinded to intervention conducted the baseline and 6 months follow-up visits to measure risk factors in both the rural areas. RESULTS A total of 140 people with stroke with mean age of 63.7 ± 11.5 years and 44.3% females were randomised. The baseline systolic BP was higher in the intervention group (n = 65,173.5 ± 22.9 mmHg) compared to the control group (n = 75,163 ± 18.7 mmHg, p = 0.004). The follow-up systolic BP was lower in the intervention group compared to the control group 145 ± 17.2 mmHg and 166.6 ± 25.7 mmHg respectively (p < 0.0001). According to the intention-to-treat analysis a total of 69.2% of patients in the intervention group achieved systolic BP control compared to 18.9% in the control group patients (OR 9, 95% CI 3.9-20.3; p < 0.0001). CONCLUSION Task sharing with ASHA a community health volunteer can improve BP control in rural people with stroke and hypertension. They can also help in the adoption of healthy behaviour. CLINICAL TRIAL REGISTRATION NUMBER ctri.nic.in, CTRI/2018/09/015709.
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Affiliation(s)
- Mahesh Pundlik Kate
- Associate Professor, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 7-132C Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB T6G2E3, Canada.
| | - Clarence Samuel
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - Shavinder Singh
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - Maneeta Jain
- Senior Consultant, Healthcare Financing, National Health Systems Resource Centre, India
| | - Deepshikha Kamra
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - G B Singh
- State Programme Officer, National Programme for Prevention of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) Programme, Government of Punjab, Chandigarh, India
| | - Meenakshi Sharma
- Scientist-G, Program Officer: Cardiovascular Diseases and Neurology, Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Jeyaraj Durai Pandian
- Professor of Neurology and Principal, Christian Medical College, Ludhiana, India; School of Nursing, University of Central Lancashire, Preston, United Kingdom; NIHR Global Health Research Group on Improving stroke care in India, United Kingdom
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P Suseela R, Ambika RB, Mohandas S, Menon JC, Numpelil M, K Vasudevan B, Ved R, Danaei G, Spiegelman D. Effectiveness of a community-based education and peer support led by women's self-help groups in improving the control of hypertension in urban slums of Kerala, India: a cluster randomised controlled pragmatic trial. BMJ Glob Health 2022; 7:bmjgh-2022-010296. [PMID: 36384950 PMCID: PMC9670931 DOI: 10.1136/bmjgh-2022-010296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/23/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND With less than 20% of people with hypertension achieving their target blood pressure (BP) goals, uncontrolled hypertension remains a major public health problem in India. We conducted a study to assess the effectiveness of a community-based education and peer support programme led by women's self-help group (SHG) members in reducing the mean systolic BP among people with hypertension in urban slums of Kochi city, Kerala, India. METHODS A cluster randomised controlled pragmatic trial was conducted where 20 slums were randomised to either the intervention or the control arms. In each slum, participants who had elevated BP (>140/90) or were on antihypertensive medications were recruited. The intervention was delivered through women's SHG members (1 per 20-30 households) who provided (1) assistance in daily hypertension management, (2) social and emotional support to encourage healthy behaviours and (3) referral to the primary healthcare system. Those in the control arm received standard of care. The primary outcome was change in mean systolic BP (SBP) after 6 months. RESULTS A total of 1952 participants were recruited-968 in the intervention arm and 984 in the control arm. Mean SBP was reduced by 6.26 mm Hg (SE 0.69) in the intervention arm compared with 2.16 mm Hg (SE 0.70) in the control arm; the net difference being 4.09 (95% CI 2.15 to 4.09), p<0.001. CONCLUSION This women's SHG members led community intervention was effective in reducing SBP among people with hypertension compared with those who received usual care, over 6 months in urban slums of Kerala, India. TRIAL REGISTRATION NUMBER CTRI/2019/12/022252.
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Affiliation(s)
- Rakesh P Suseela
- Department of Community Medicine & Center for Public Health, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Renjini Balakrishnan Ambika
- Department of Community Medicine & Center for Public Health, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sreelakshmi Mohandas
- Department of Community Medicine & Center for Public Health, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Jaideep C Menon
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Preventive Cardiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidhyapeetham, Kochi, Kerala, India
| | | | - Beena K Vasudevan
- Department of Community Medicine & Center for Public Health, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Rajani Ved
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- National Health Systems Resource Centre, New Delhi, India
| | - Goodarz Danaei
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Donna Spiegelman
- Department of Epidemiology, Biostatistics, Nutrition and Global Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Centre for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
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Sarker MHR, Moriyama M, Rashid HU, Rahman MM, Chisti MJ, Das SK, Saha SK, Arifeen SE, Ahmed T, Faruque ASG. Chronic Kidney Disease Awareness Campaign and Mobile Health Education to Improve Knowledge, Quality of Life, and Motivation for a Healthy Lifestyle Among Patients With Chronic Kidney Disease in Bangladesh: Randomized Controlled Trial. J Med Internet Res 2022; 24:e37314. [PMID: 35969429 PMCID: PMC9412733 DOI: 10.2196/37314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low. OBJECTIVE This study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults with CKD. METHODS This study was a parallel-group (1:1), randomized controlled trial in the Mirzapur subdistrict of Bangladesh that compared 2 groups of patients with CKD. Adults with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned the intervention or control group. The intervention group received health education through a CKD awareness campaign and mobile health technologies and was observed for 6 months, whereas the control group received standard treatment. The primary outcome was the evaluation of improved scores on the CKD knowledge questionnaire, and the secondary outcomes were improved QOL and changes in the levels of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen (BUN), and albumin-to-creatinine ratio. RESULTS The study enrolled 126 patients (control: n=63; intervention: n=63) and performed intention-to-treat analysis. The analyses included repeated measures ANOVA, and the results were observed to be significantly different from within groups (P<.001), between groups (P<.001), and the interaction of group × time factor (P<.001) for knowledge score. Diastolic BP and BMI showed significant differences arising from within groups (P<.001 and P=.01, respectively) and the interaction of group × time factor (P=.001 and P=.02, respectively); food salinity and hip circumferences showed significant differences arising from within groups (P=.001 and P=.03, respectively) and between groups (P=.001 and P=.02, respectively). Moreover, systolic BP and waist circumference showed significant differences from within groups (P<.001 and P=.003, respectively). However, no significant differences were found arising from within groups, between groups, and the interactions of group × time for QOL, urine salinity, and mid-upper arm circumference. Regarding the laboratory findings, from baseline to 6 months, the mean (SD) FBS decreased by 0.51 (3.77) mmol/L in the intervention group and 0.10 (1.44) mmol/L in the control group (P=.03); however, blood urea nitrogen increased by 3.64 (7.17) mg/dL in the intervention group and 1.68 (10.10) mg/dL in the control group (P=.01). CONCLUSIONS The health education strategy, which included a campaign and mobile health, showed promise for enhancing CKD knowledge among patients with CKD. This strategy may also aid patients with CKD in controlling their FBS and BP. The combined health education initiatives give evidence for scaling them up in Bangladesh and possibly other low- and middle-income countries, particularly in rural and peri-urban settings. TRIAL REGISTRATION ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/30191.
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Affiliation(s)
- Mohammad Habibur Rahman Sarker
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Harun Ur Rashid
- Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sumon Kumar Das
- Menzies - School of Health Research, Charles Darwin University, Darwin, Australia
| | - Samir Kumar Saha
- Child Health Research Foundation, Dhaka, Bangladesh
- Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - A S G Faruque
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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18
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Gyamfi J, Vieira D, Iwelunmor J, Watkins BX, Williams O, Peprah E, Ogedegbe G, Allegrante JP. Assessing descriptions of scalability for hypertension control interventions implemented in low-and middle-income countries: A systematic review. PLoS One 2022; 17:e0272071. [PMID: 35901114 PMCID: PMC9333290 DOI: 10.1371/journal.pone.0272071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background The prevalence of hypertension continues to rise in low- and middle-income- countries (LMICs) where scalable, evidence-based interventions (EBIs) that are designed to reduce morbidity and mortality attributed to hypertension have yet to be fully adopted or disseminated. We sought to evaluate evidence from published randomized controlled trials using EBIs for hypertension control implemented in LMICs, and identify the WHO/ExpandNet scale-up components that are relevant for consideration during “scale-up” implementation planning. Methods Systematic review of RCTs reporting EBIs for hypertension control implemented in LMICs that stated “scale-up” or a variation of scale-up; using the following data sources PubMed/Medline, Web of Science Biosis Citation Index (BCI), CINAHL, EMBASE, Global Health, Google Scholar, PsycINFO; the grey literature and clinicaltrials.gov from inception through June 2021 without any restrictions on publication date. Two reviewers independently assessed studies for inclusion, conducted data extraction using the WHO/ExpandNet Scale-up components as a guide and assessed the risk of bias using the Cochrane risk-of-bias tool. We provide intervention characteristics for each EBI, BP results, and other relevant scale-up descriptions. Main results Thirty-one RCTs were identified and reviewed. Studies reported clinically significant differences in BP, with 23 studies reporting statistically significant mean differences in BP (p < .05) following implementation. Only six studies provided descriptions that captured all of the nine WHO/ExpandNet components. Multi-component interventions, including drug therapy and health education, provided the most benefit to participants. The studies were yet to be scaled and we observed limited reporting on translation of the interventions into existing institutional policy (n = 11), cost-effectiveness analyses (n = 2), and sustainability measurements (n = 3). Conclusion This study highlights the limited data on intervention scalability for hypertension control in LMICs and demonstrates the need for better scale-up metrics and processes for this setting. Trial registration Registration PROSPERO (CRD42019117750).
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Affiliation(s)
- Joyce Gyamfi
- Teachers College, Columbia University, New York, NY, United States of America
- NYU School of Global Public Health, New York, NY, United States of America
- * E-mail:
| | - Dorice Vieira
- NYU School of Global Public Health, New York, NY, United States of America
- NYU Health Sciences Library, New York, NY, United States of America
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO, United States of America
| | | | - Olajide Williams
- Columbia University Medical Center, New York, NY, United States of America
| | - Emmanuel Peprah
- NYU School of Global Public Health, New York, NY, United States of America
| | - Gbenga Ogedegbe
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, United States of America
| | - John P. Allegrante
- Teachers College, Columbia University, New York, NY, United States of America
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Sun Y, Mu J, Wang DW, Ouyang N, Xing L, Guo X, Zhao C, Ren G, Ye N, Zhou Y, Wang J, Li Z, Sun G, Yang R, Chen CS, He J. A village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trial. Lancet 2022; 399:1964-1975. [PMID: 35500594 DOI: 10.1016/s0140-6736(22)00325-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The prevalence of uncontrolled hypertension is high and increasing in low-income and middle-income countries. We tested the effectiveness of a multifaceted intervention for blood pressure control in rural China led by village doctors (community health workers on the front line of primary health care). METHODS In this open, cluster randomised trial (China Rural Hypertension Control Project), 326 villages that had a regular village doctor and participated in the China New Rural Cooperative Medical Scheme were randomly assigned (1:1) to either village doctor-led multifaceted intervention or enhanced usual care (control), with stratification by provinces, counties, and townships. We recruited individuals aged 40 years or older with an untreated blood pressure of 140/90 mm Hg or higher (≥130/80 mm Hg among those with a history of cardiovascular disease, diabetes, or chronic kidney disease) or a treated blood pressure of 130/80 mm Hg or higher. In the intervention group, trained village doctors initiated and titrated antihypertensive medications according to a standard protocol with supervision from primary care physicians. Village doctors also conducted health coaching on home blood pressure monitoring, lifestyle changes, and medication adherence. The primary outcome (reported here) was the proportion of patients with a blood pressure of less than 130/80 mm Hg at 18 months. The analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03527719, and is ongoing. FINDINGS Between May 8 and November 28, 2018, we enrolled 33 995 individuals from 163 intervention and 163 control villages. At 18 months, 8865 (57·0%) of 15 414 patients in the intervention group and 2895 (19·9%) of 14 500 patients in the control group had a blood pressure of less than 130/80 mm Hg, with a group difference of 37·0% (95% CI 34·9 to 39·1%; p<0·0001). Mean systolic blood pressure decreased by -26·3 mm Hg (95% CI -27·1 to -25·4) from baseline to 18 months in the intervention group and by -11·8 mm Hg (-12·6 to -11·0) in the control group, with a group difference of -14·5 mm Hg (95% CI -15·7 to -13·3 mm Hg; p<0·0001). Mean diastolic blood pressure decreased by -14·6 mm Hg (-15·1 to -14·2) from baseline to 18 months in the intervention group and by -7·5 mm Hg (-7·9 to -7·2) in the control group, with a group difference of -7·1 mm Hg (-7·7 to -6·5 mm Hg; p<0·0001). No treatment-related serious adverse events were reported in either group. INTERPRETATION Compared with enhanced usual care, village doctor-led intervention resulted in statistically significant improvements in blood pressure control among rural residents in China. This feasible, effective, and sustainable implementation strategy could be scaled up in rural China and other low-income and middle-income countries for hypertension control. FUNDING Ministry of Science and Technology of China.
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Affiliation(s)
- Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China.
| | - Jianjun Mu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Nanxiang Ouyang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Liying Xing
- Department of Chronic Disease Control, Disease Control and Prevention Centre of Liaoning Province, Shenyang, China
| | - Xiaofan Guo
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Chunxia Zhao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | | | - Ning Ye
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Ying Zhou
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Jun Wang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Zhao Li
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Guozhe Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | | | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Science Institute, New Orleans, LA, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Science Institute, New Orleans, LA, USA.
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Virtual management of hypertension: lessons from the COVID-19 pandemic-International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022; 40:1435-1448. [PMID: 35579481 DOI: 10.1097/hjh.0000000000003205] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 pandemic caused an unprecedented shift from in person care to delivering healthcare remotely. To limit infectious spread, patients and providers rapidly adopted distant evaluation with online or telephone-based diagnosis and management of hypertension. It is likely that virtual care of chronic diseases including hypertension will continue in some form into the future. The purpose of the International Society of Hypertension's (ISH) position paper is to provide practical guidance on the virtual management of hypertension to improve its diagnosis and blood pressure control based on the currently available evidence and international experts' opinion for nonpregnant adults. Virtual care represents the provision of healthcare services at a distance with communication conducted between healthcare providers, healthcare users and their circle of care. This statement provides consensus guidance on: selecting blood pressure monitoring devices, accurate home blood pressure assessments, delivering patient education virtually, health behavior modification, medication adjustment and long-term virtual monitoring. We further provide recommendations on modalities for the virtual assessment and management of hypertension across the spectrum of resource availability and patient ability.
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21
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Ogungbe O, Cazabon D, Ajenikoko A, Jeemon P, Moran AE, Commodore-Mensah Y. Determining the frequency and level of task-sharing for hypertension management in LMICs: A systematic review and meta-analysis. EClinicalMedicine 2022; 47:101388. [PMID: 35480075 PMCID: PMC9035722 DOI: 10.1016/j.eclinm.2022.101388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) bear a disproportionately higher burden of Cardiovascular Disease (CVD). Team-based care approach adds capacity to improve blood pressure (BP) control. This updated review aimed to test team-based care efficacy at different levels of hypertension team-based care complexity. METHODS We searched PubMed, Embase, Cochrane, and CINAHL for newer articles on task-sharing interventions to manage hypertension in LMICs. Levels of tasks complexity performed by healthcare workers added to the clinical team in hypertension control programs were categorized as administrative tasks (level 1), basic clinical tasks (level 2), and/or advanced clinical tasks (level 3). Meta-analysis using an inverse variance weighted random-effects model summarized trial-based evidence on the efficacy of team-based care on BP control, compared with usual care. FINDINGS Forty-three RCT articles were included in the meta-analysis: 31 studies from the previous systematic review, 12 articles from the updated search. The pooled mean effect for team-based care was a -4.6 mm Hg (95% CI: -5.8, -3.4, I2 = 80.2%) decrease in systolic BP compared with usual care. We found similar comparative reduction among different levels of team-based care complexity, i.e., administrative and basic clinical tasks (-4.7 mm Hg, 95% CI: -6.8, -2.2; I2 = 79.8%); and advanced clinical tasks (-4.5 mmHg, 95%CI: -6.1, -3.3; I2 = 81%). Systolic BP was reduced most by team-based care involving pharmacists (-7.3 mm Hg, 95% CI: -9.2, -5.4; I2 = 67.2%); followed by nurses (-5.1 mm Hg, 95% CI: -8.0, -2.2; I2 = 72.7%), dieticians (-4.7 mmHg, 95%CI: -7.1, -2.3; I2 = 0.0%), then community health workers (-3.3 mm Hg, 95% CI: -4.8, -1.8; I2 = 77.3%). INTERPRETATION Overall, team-based hypertension care interventions consistently contributed to lower systolic BP compared to usual care; the effect size varies by the clinical training of the healthcare team members. FUNDING Resolve To Save Lives (RTSL) Vital Strategies, Danielle Cazabon, Andrew E. Moran, Yvonne Commodore-Mensah receive salary support from Resolve to Save Lives, an initiative of Vital Strategies. Resolve to Save Lives is jointly supported by grants from Bloomberg Philanthropies, the Bill & Melinda Gates Foundation, and Gates Philanthropy Partners, which is funded with support from the Chan Zuckerberg Foundation.
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Affiliation(s)
| | - Danielle Cazabon
- Resolve to Save Lives, an initiative of Vital Strategies, New York, NY, USA
| | - Adefunke Ajenikoko
- Resolve to Save Lives, an initiative of Vital Strategies, New York, NY, USA
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Andrew E. Moran
- Resolve to Save Lives, an initiative of Vital Strategies, New York, NY, USA
- Columbia University Irving Medical Center, Columbia University, New York, New York
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Corresponding author. Yvonne Commodore-Mensah, PhD, MHS, RN, Johns Hopkins University School of Nursing, 525 N. Wolfe St. Baltimore, MD. 21205 United States
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22
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Sreelal TP, Thulaseedharan JV, Nair S, Ravindran RM, Vijayakumar K, Varma RP. Hypertension control in Kerala, India: a prescription-based study at primary and secondary level health care institutions. Indian Heart J 2022; 74:296-301. [PMID: 35644270 PMCID: PMC9453055 DOI: 10.1016/j.ihj.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022] Open
Abstract
Objective We undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India. Methods This cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One practitioner was selected from each institution. Data on institutional and provider factors were collected using a structured questionnaire. Prescriptions were photographically captured and data on disease status and drugs prescribed were recorded. Factors associated with disease control were identified using binary logistic regression. Results Totally 4679 prescriptions were included for analysis. For hypertension-only patients, control levels were 31.5% and was significantly higher in public hospitals (Adjusted odds ratio (AOR) 1.96, 95% confidence intervals (CI) 1.50–2.57). Among patients with diabetes only, diabetes control was seen in 36.6%. When both conditions were present, control was achieved in only 17.0% patients. Being prescribed two or more drugs indicated lower control, whatever the respective condition. Among antihypertensive prescriptions rationality of 26.7% were questioned, such as lack of Renin Angiotensin System (RAS) inhibitor in diabetic hypertensives, dual RAS blockage, and indication for beta-blocker monotherapy. Conclusions In this prescription-based study in Kerala, India, a majority of hypertensive patients did not have controlled blood pressure levels, particularly if diabetes coexisted. This has serious implications as Kerala is the state with the highest burden of hypertension in India. Several prescription patterns were of questionable rationality. Further research and actions on rationality of anti-hypertensive prescriptions and barriers to treatment intensification is warranted.
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Affiliation(s)
- Thekkumkara Prabhakaran Sreelal
- DM Wayanad Institute of Medical Sciences (WIMS) Medical College, Wayanad, Kerala, 673577, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India
| | - Jissa Vinoda Thulaseedharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India
| | - Sanjeev Nair
- Department of Pulmonary Medicine, Government Medical College, Thrissur, Kerala, 680596, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India
| | - Rekha Melathuparambil Ravindran
- State Health Systems Resource Centre - Kerala, Thiruvananthapuram, Kerala, 695014, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India
| | | | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, 695011, India; Health Action by People, Thiruvananthapuram, Kerala, 695011, India.
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Birhanu MM, Evans RG, Zengin A, Riddell M, Kalyanram K, Kartik K, Suresh O, Thomas NJ, Srikanth VK, Thrift AG. Absolute cardiovascular risk scores and medication use in rural India: a cross-sectional study. BMJ Open 2022; 12:e054617. [PMID: 35459666 PMCID: PMC9036467 DOI: 10.1136/bmjopen-2021-054617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We compared the performance of laboratory-based cardiovascular risk prediction tools in a low-income and middle-income country setting, and estimated the use of antihypertensive and lipid-lowering medications in those deemed at high risk of a cardiovascular event. DESIGN A cross-sectional study. SETTING The study population comprised adult residents (aged ≥18 years) of the Rishi Valley region located in Chittoor District, south-western Andhra Pradesh, India. PARTICIPANTS 7935 participants were surveyed between 2012 and 2015. We computed the 10-year cardiovascular risk and undertook pair-to-pair analyses between various risk tools used to predict a fatal or non-fatal cardiovascular event (Framingham Risk Score (FRS), World Health Organization Risk Score (WHO-RS) and Australian Risk Score (ARS)), or a fatal cardiovascular event (Systematic COronary Risk Evaluation (SCORE-high and SCORE-low)). Concordance was assessed by ordinary least-products (OLP) regression (for risk score) and quadratic weighted kappa (κw, for risk category). RESULTS Of participants aged 35-74 years, 3.5% had prior cardiovascular disease. The relationships between risk scores were quasi-linear with good agreement between the FRS and ARS (OLP slope=0.96, κw=0.89). However, the WHO-RS underestimated cardiovascular risk compared with all other tools. Twenty per cent of participants had ≥20% risk of an event using the ARS; 5% greater than the FRS and nearly threefold greater than the WHO-RS. Similarly, 16% of participants had a risk score ≥5% using SCORE-high which was 6% greater than for SCORE-low. Overall, absolute cardiovascular risk increased with age and was greater in men than women. Only 9%-12% of those deemed 'high risk' were taking lipid-lowering or antihypertensive medication. CONCLUSIONS Cardiovascular risk prediction tools perform disparately in this setting of disadvantage. Few deemed at high risk were receiving the recommended treatment.
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Affiliation(s)
- Mulugeta Molla Birhanu
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michaela Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh, India
| | - Nihal Jacob Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Velandai K Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
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Mbuthia GW, Magutah K, Pellowski J. Approaches and outcomes of community health worker's interventions for hypertension management and control in low-income and middle-income countries: systematic review. BMJ Open 2022; 12:e053455. [PMID: 35365519 PMCID: PMC8977767 DOI: 10.1136/bmjopen-2021-053455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To critically appraise the scope, content and outcomes of community health worker (CHW) interventions designed to reduce blood pressure (BP) in low-income and middle-income countries (LMICs). METHOD We performed a database search (PUBMED, EMBASE, CINAHL, PsycINFO, OpenGrey, Cochrane Central Trials Register and Cochrane Database of Systematic Reviews) to identify studies in LMICs from 2000 to 2020. Eligible studies were interventional studies published in English and reporting CHW interventions for management of BP in LMICs. Two independent reviewers screened the titles, abstracts and full texts of publications for eligibility and inclusion. Relevant information was extracted from these studies using a tailored template. Risk of bias was assessed using the Cochrane collaboration risk of bias tool. Qualitative synthesis of results was done through general summary of the characteristics and findings of each study. We also analysed the patterns of interventions and their outcomes across the studies. Results were presented in form of narrative and tables. RESULTS Of the 1557 articles identified, 14 met the predefined criteria. Of these, 12 were cluster randomised trials whereas two were pretest/post-test studies. The CHW interventions were mainly community-based and focused on behaviour change for promoting BP control among hypertensive patients as well as healthy individuals. The interventions had positive effects in the BP reduction, linkage to care, treatment adherence and in reducing cardivascular-disease risk level. DISCUSSION AND CONCLUSION The current review is limited in that, a meta-analysis to show the overall effect of CHW interventions in the management of hypertension was not possible due to the diversity of the interventions, and outcomes of the studies included in the review. Summarised outcomes of individual studies showed CHW enhanced the control and management of hypertension. Further studies are needed to indicate the impact and cost-effectiveness of CHW-led interventions in the control and management of hypertension in LMICs.
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Affiliation(s)
- Grace Wambura Mbuthia
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Karani Magutah
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Jennifer Pellowski
- International Health Institute, School of Public Health, Brown University, Providence, Rhode Island, USA
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Teshome DF, Balcha SA, Ayele TA, Atnafu A, Sisay M, Asfaw MG, Mitike G, Gelaye KA. Trained health extension workers correctly identify high blood pressure in rural districts of northwest Ethiopia: a diagnostic accuracy study. BMC Health Serv Res 2022; 22:375. [PMID: 35317798 PMCID: PMC8941748 DOI: 10.1186/s12913-022-07794-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/16/2022] [Indexed: 11/27/2022] Open
Abstract
Background Hypertension is a public health issue in Ethiopia. The vast majority of cases remain undiagnosed and untreated. Early and accurate identification of hypertension can help with timely management and reduce the risk of complications. In resource-constrained rural settings where poor access to care and a shortage of healthcare providers are major barriers, task-sharing of some primary healthcare duties from well-trained healthcare workers to community health workers has been found to be a cost-effective strategy. This study aimed to assess the ability of trained health extension workers to correctly identify high blood pressure among adults in rural areas of northwest Ethiopia. Methods A cross-sectional study was conducted in rural areas of northwest Ethiopia from June to October 2020. Trained health extension workers and health professionals measured the blood pressure of 1177 study participants using a calibrated aneroid sphygmomanometer. A Kappa test statistic was used to compare the two sets of measurements for agreement. The sensitivity, specificity, positive, and negative predictive values were used to assess the validity of health extension workers’ ability to identify high blood pressure in comparison to health professionals. Results The trained health extension workers and health professionals identified 219 (18.6%) and 229 (19.5%) of the participants with high blood pressure, respectively. The inter-rater agreement between health extension workers and health professionals for high blood pressure detection was 91.2% (k = 0.912, 95% CI: 0.88, 0.94, p-value = 0.000). The sensitivity and specificity of high blood pressure detection by health extension workers were 90.8% (95% CI: 89.6, 92.0) and 98.8% (95% CI: 98.1, 99.5), respectively. While the positive and negative predictive values were 95.0% (95% CI: 92.1, 97.9) and 97.8% (95% CI: 97.3, 98.3), respectively. Conclusions The inter-rater agreement between the trained health extension workers and health professionals on high blood pressure detection was excellent. The findings indicate that training health extension workers is a reliable and valid strategy for early detection of hypertension. Thus, the strategy can be integrated with the essential services provided by primary health care units at the village and health post level in rural settings.
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Affiliation(s)
- Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Shitaye Alemu Balcha
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekonnen Sisay
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Marye Getnet Asfaw
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getnet Mitike
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Mini GK, Sathish T, Sarma PS, Thankappan KR. Effectiveness of a School-Based Educational Intervention to Improve Hypertension Control Among Schoolteachers: A Cluster-Randomized Controlled Trial. J Am Heart Assoc 2022; 11:e023145. [PMID: 35023346 PMCID: PMC9238527 DOI: 10.1161/jaha.121.023145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background The control of hypertension is low in low- and middle-income countries like India. We evaluated the effects of a nurse-facilitated educational intervention in improving the control rate of hypertension among school teachers in India. Methods and Results This was a cluster-randomized controlled trial involving 92 schools in Kerala, which were randomly assigned equally into a usual care group and an intervention group. Participants were 402 school teachers (mean age, 47 years; men, 29%) identified with hypertension. Participants in both study groups received a leaflet containing details of a healthy lifestyle and the importance of regular intake of antihypertensive medication. In addition, the intervention participants received a nurse-facilitated educational intervention on hypertension control for 3 months. The primary outcome was hypertension control. Key secondary outcomes included systolic blood pressure, diastolic blood pressure, and the proportion of participants taking antihypertensive medications. For the primary outcome, we used mixed-effects logistic regression models. Two months after a 3-month educational intervention, a greater proportion of intervention participants (49.0%) achieved hypertension control than the usual care participants (38.2%), with an odds ratio of 1.89 (95% CI, 1.06-3.35), after adjusting for baseline hypertension control. The odds of taking antihypertensive medications were 1.6 times higher in the intervention group compared with the usual care group (odds ratio, 1.62; 95% CI, 1.08-2.45). The reduction in mean systolic blood pressure was significantly greater in the intervention group by 4.2 mm Hg (95% CI, -7.2 to -1.1) than in the usual care group. Conclusions A nurse-facilitated educational intervention was effective in improving the control and treatment rates of hypertension as well as reducing systolic blood pressure among schoolteachers with hypertension. Registration URL: https://www.ctri.nic.in; Unique Identifier: CTRI/2018/01/011402.
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Affiliation(s)
- G K Mini
- Achutha Menon Centre for Health Science StudiesSree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala India.,Global Institute of Public Health, Ananthapuri Hospitals, and Research Institute Trivandrum Kerala India.,Women's Institute for Social and Health Studies (WISHS)Women's Social and Health Studies Foundation Trivandrum Kerala India
| | | | - Prabhakaran Sankara Sarma
- Achutha Menon Centre for Health Science StudiesSree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala India
| | - Kavumpurathu Raman Thankappan
- Department of Public Health and Community Medicine Central University of Kerala, KasaragodTejaswini Hills Periye Kerala India
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Owolabi MO, Thrift AG, Mahal A, Ishida M, Martins S, Johnson WD, Pandian J, Abd-Allah F, Yaria J, Phan HT, Roth G, Gall SL, Beare R, Phan TG, Mikulik R, Akinyemi RO, Norrving B, Brainin M, Feigin VL. Primary stroke prevention worldwide: translating evidence into action. Lancet Public Health 2022; 7:e74-e85. [PMID: 34756176 PMCID: PMC8727355 DOI: 10.1016/s2468-2667(21)00230-9] [Citation(s) in RCA: 163] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 02/05/2023]
Abstract
Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course.
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Affiliation(s)
- Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marie Ishida
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sheila Martins
- Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Neurology, Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Brazil; Department of Neurology, Hospital Moinhos de Vento, Porto Alegre, Brazil; Brazilian Stroke Network, São Paulo, Brazil
| | - Walter D Johnson
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Jeyaraj Pandian
- School of Public Health, Christian Medical College, Ludhiana, Punjab, India
| | - Foad Abd-Allah
- Department of Neurology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Joseph Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Hoang T Phan
- Department of Neurology, Monash University, Melbourne, VIC, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Greg Roth
- Institute for Health Metrics Evaluation, University of Washington, Seattle, WA, USA
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Richard Beare
- Monash Health, and Peninsula Clinical School, Monash University, Melbourne, VIC, Australia; Developmental Imaging Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Thanh G Phan
- Department of Neurology, Monash University, Melbourne, VIC, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Robert Mikulik
- International Clinical Research Center, Neurology Department, St Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bo Norrving
- Department of Clinical Sciences, and Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Michael Brainin
- Department of Neuroscience and Preventive Medicine, Danube University Krems, Krems an der Donau, Austria
| | - Valery L Feigin
- Institute for Health Metrics Evaluation, University of Washington, Seattle, WA, USA; National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; Scientific and Educational Department, Research Centre of Neurology, Moscow, Russia.
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Wang W, Harhay MO. A comparative study of R functions for clustered data analysis. Trials 2021; 22:959. [PMID: 34961539 PMCID: PMC8711156 DOI: 10.1186/s13063-021-05900-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/01/2021] [Indexed: 08/26/2023] Open
Abstract
Background Clustered or correlated outcome data is common in medical research studies, such as the analysis of national or international disease registries, or cluster-randomized trials, where groups of trial participants, instead of each trial participant, are randomized to interventions. Within-group correlation in studies with clustered data requires the use of specific statistical methods, such as generalized estimating equations and mixed-effects models, to account for this correlation and support unbiased statistical inference. Methods We compare different approaches to estimating generalized estimating equations and mixed effects models for a continuous outcome in R through a simulation study and a data example. The methods are implemented through four popular functions of the statistical software R, “geese”, “gls”, “lme”, and “lmer”. In the simulation study, we compare the mean squared error of estimating all the model parameters and compare the coverage proportion of the 95% confidence intervals. In the data analysis, we compare estimation of the intervention effect and the intra-class correlation. Results In the simulation study, the function “lme” takes the least computation time. There is no difference in the mean squared error of the four functions. The “lmer” function provides better coverage of the fixed effects when the number of clusters is small as 10. The function “gls” produces close to nominal scale confidence intervals of the intra-class correlation. In the data analysis and the “gls” function yields a positive estimate of the intra-class correlation while the “geese” function gives a negative estimate. Neither of the confidence intervals contains the value zero. Conclusions The “gls” function efficiently produces an estimate of the intra-class correlation with a confidence interval. When the within-group correlation is as high as 0.5, the confidence interval is not always obtainable. Supplementary Information The online version contains supplementary material available at (10.1186/s13063-021-05900-7).
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Affiliation(s)
- Wei Wang
- Clinical Trials Methods and Outcomes Lab, Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Michael O Harhay
- Clinical Trials Methods and Outcomes Lab, Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Obesity and Cardiometabolic Risk Factors: From Childhood to Adulthood. Nutrients 2021; 13:nu13114176. [PMID: 34836431 PMCID: PMC8624977 DOI: 10.3390/nu13114176] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity has become a major epidemic in the 21st century. It increases the risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic risk factors and components of the metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction are the domain of adulthood, it is evident that the CV continuum begins very early in life. Recognition of risk factors and early stages of CV damage, at a time when these processes are still reversible, and the development of prevention strategies are major pillars in reducing CV morbidity and mortality in the general population. In this review, we will discuss the role of well-known but also novel risk factors linking obesity and increased CV risk from prenatal age to adulthood, including the role of perinatal factors, diet, nutrigenomics, and nutri-epigenetics, hyperuricemia, dyslipidemia, hypertension, and cardiorespiratory fitness. The importance of 'tracking' of these risk factors on adult CV health is highlighted and the economic impact of childhood obesity as well as preventive strategies are discussed.
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Riddell MA, Mini GK, Joshi R, Thrift AG, Guggilla RK, Evans RG, Thankappan KR, Chalmers K, Chow CK, Mahal AS, Kalyanram K, Kartik K, Suresh O, Thomas N, Maulik PK, Srikanth VK, Arabshahi S, Varma RP, D'Esposito F, Oldenburg B. ASHA-Led Community-Based Groups to Support Control of Hypertension in Rural India Are Feasible and Potentially Scalable. Front Med (Lausanne) 2021; 8:771822. [PMID: 34881267 PMCID: PMC8645590 DOI: 10.3389/fmed.2021.771822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background: To improve the control of hypertension in low- and middle-income countries, we trialed a community-based group program co-designed with local policy makers to fit within the framework of India's health system. Trained accredited social health activists (ASHAs), delivered the program, in three economically and developmentally diverse settings in rural India. We evaluated the program's implementation and scalability. Methods: Our mixed methods process evaluation was guided by the United Kingdom Medical Research Council guidelines for complex interventions. Meeting attendance reports, as well as blood pressure and weight measures of attendees and adherence to meeting content and use of meeting tools were used to evaluate the implementation process. Thematic analysis of separate focus group discussions with participants and ASHAs as well as meeting reports and participant evaluation were used to investigate the mechanisms of impact. Results: Fifteen ASHAs led 32 community-based groups in three rural settings in the states of Kerala and Andhra Pradesh, Southern India. Overall, the fidelity of intervention delivery was high. Six meetings were delivered over a 3-month period to each of the intervention groups. The mean number of meetings attended by participants at each site varied significantly, with participants in Rishi Valley attending fewer meetings [mean (SD) = 2.83 (1.68)] than participants in West Godavari (Tukeys test, p = 0.009) and Trivandrum (Tukeys test, p < 0.001) and participants in West Godavari [mean (SD) = 3.48 (1.72)] attending significantly fewer meetings than participants in Trivandrum [mean (SD) = 4.29 (1.76), Tukeys test, p < 0.001]. Culturally appropriate intervention resources and the training of ASHAs, and supportive supervision of them during the program were critical enablers to program implementation. Although highly motivated during the implementation of the program ASHA reported historical issues with timely remuneration and lack of supportive supervision. Conclusions: Culturally appropriate community-based group programs run by trained and supported ASHAs are a successful and potentially scalable model for improving the control of hypertension in rural India. However, consideration of issues related to unreliable/insufficient remuneration for ASHAs, supportive supervision and their formal role in the wider health workforce in India will be important to address in future program scale up. Trial Registration: Clinical Trial Registry of India [CTRI/2016/02/006678, Registered prospectively].
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Affiliation(s)
- Michaela A. Riddell
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - G. K. Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, India
| | - Rohina Joshi
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- George Institute for Global Health, New Delhi, India
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Rama K. Guggilla
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystok, Poland
| | - Roger G. Evans
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - Kavumpurathu R. Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Department of Public Health & Community Medicine, Central University of Kerala, Kasaragod, India
| | - Kate Chalmers
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Clara K. Chow
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Ajay S. Mahal
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Oduru Suresh
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Rishi Valley Rural Health Centre, Chittoor, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Pallab K. Maulik
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- George Institute for Global Health, New Delhi, India
| | - Velandai K. Srikanth
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, VIC, Australia
| | - Simin Arabshahi
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Ravi P. Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Fabrizio D'Esposito
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute and Larobe University, Melbourne, VIC, Australia
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Khanal MK, Bhandari P, Dhungana RR, Bhandari P, Rawal LB, Gurung Y, Paudel KN, Singh A, Devkota S, de Courten B. Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial. PLoS One 2021; 16:e0258406. [PMID: 34637478 PMCID: PMC8509872 DOI: 10.1371/journal.pone.0258406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/03/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal. METHODS We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months. RESULTS 125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01-4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63-2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p<0.001). CONCLUSIONS Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal. TRIAL REGISTRATION ClinicalTrial.gov: NCT02981251.
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Affiliation(s)
- Mahesh Kumar Khanal
- Provincial Ayurveda Hospital, Ministry of Health and Population, Lumbini Province, Nepal
| | | | - Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Pratik Bhandari
- Faculty of SEBE, Deakin University, Warun Ponds, VIC, Australia
| | - Lal B. Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney Campus, Australia
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, Australia
| | - Yadav Gurung
- Child and Youth Health Research Center, Auckland University of Technology, Auckland, New Zealand
| | - K. N. Paudel
- Province Hospital, Ministry of Social Development, Karnali Province, Surkhet, Nepal
| | - Amit Singh
- Province Hospital, Ministry of Social Development, Karnali Province, Surkhet, Nepal
| | - Surya Devkota
- Department of Cardiology, Manmohan Cardiothoracic Vascular and Transplant Centre, Institute of Medicine, Tribhuvan University, Kirtipur, Nepal
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Upoyo AS, Taufik A, Anam A, Nuriya N, Saryono S, Setyopranoto I, Pangastuti HS. Translation and Validation of the Indonesian Version of the Hypertension Self-care Profile. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: High blood pressure self-care profile (HBP-SCP) is one of the instruments that needed to evaluate education program among hypertension patients.
AIM: The purpose of the study was to translate and validate HBP-SCP into Indonesian version.
METHODS: This study involved translation, content validation, and psychometric testing. The first instrument was conducted forward and backward translation by experts. Seven expert reviewed the contents for consistency, clarity, difficulty, representativeness, and suitability for inclusion. Finally, instrument was tested for reliability and validity on 40 hypertensive patients using Cronbach’s alpha and Pearson’s moment product.
RESULTS: The final Indonesian version of HBP-SCP included behavior, motivation, and self-efficacy that each consists of 20 items questions were valid and reliable with positive expert review ratings (content validity index 0.964), internal consistency reliability coefficient ranged from 0.911 to 0.955. Items questionnaire of Indonesian version of HBP-SCP had strong correlation and significant validity (p ≤ 0.05).
CONCLUSION: Indonesian version of HBP-SCP is a valid and reliable instrument to assess behavior, motivation, and self-efficacy among hypertension patients and evaluate group based hypertension education programs in Indonesia.
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Abstract
PURPOSE OF REVIEW Hypertension (HTN) is the most prevalent risk factor for cardiovascular disease (CVD) worldwide, affecting 1.39 billion people. This review discusses recent literature regarding the global burden of HTN and emerging concepts in prevalence, treatment, and control in different regions around the globe. RECENT FINDINGS Community-based interventions and telemedicine may be useful in increasing access to care and identifying/assisting patients with HTN, especially in populations with geographical and economic barriers to healthcare. Home blood pressure monitoring is beneficial for HTN control in diverse regions. Polypills have proven benefits to decrease HTN and CVD risk. Continuation of treatment with angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers in high risk COVID-19 patients appears appropriate. SUMMARY Extensive research demonstrates that early screening/treatment, lifestyle modification, and pharmacotherapy are essential to control HTN worldwide. This review highlights recent research and novel concepts on effective interventions being used globally.
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Stephens JH, Addepalli A, Chaudhuri S, Niyonzima A, Musominali S, Uwamungu JC, Paccione GA. Chronic Disease in the Community (CDCom) Program: Hypertension and non-communicable disease care by village health workers in rural Uganda. PLoS One 2021; 16:e0247464. [PMID: 33630935 PMCID: PMC7906377 DOI: 10.1371/journal.pone.0247464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background Although hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics. Objective/Methods We describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts. Results/Conclusions Of 4283 people ages 30–69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.
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Affiliation(s)
- Joseph H. Stephens
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
- * E-mail:
| | - Aravind Addepalli
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Shombit Chaudhuri
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Abel Niyonzima
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
| | - Sam Musominali
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
| | - Jean Claude Uwamungu
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
| | - Gerald A. Paccione
- Kisoro District Hospital, Kisoro, Uganda
- Doctors for Global Health, Decatur, Georgia, United States of America
- Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York, United States of America
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35
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Nebhinani M, Saini SK. Leveraging role of non-physician health workers in prevention and control of non-communicable diseases in India: Enablers and challenges. J Family Med Prim Care 2021; 10:595-600. [PMID: 34041047 PMCID: PMC8138392 DOI: 10.4103/jfmpc.jfmpc_1516_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/17/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022] Open
Abstract
Due to upsurge of non-communicable disease (NCD) burden, there is accentuated emphasis on task sharing and shifting NCDs-related health care delivery to non-physician healthcare workers especially nursing personnel and grass root level health professionals. This narrative review summates role of non-physician health workers, highlights various enablers and challenges while engaging them in delivery of NCD services so as to prevent and control various NCDs in India. Pubmed, Google scholar databases were searched using various keywords and Mesh terminologies. In addition, reference lists of selected articles were also screened. It is concluded that with regular update of knowledge, training, and supervision, these workers can efficiently deliver promotive, preventive, curative, and rehabilitative NCD-related healthcare services to needy. While engagement of this workforce in NCDs mitigation is a transforming concept, it also has its own challenges and issues which need to be explored and addressed in order to utilize this human resource to their maximum potential.
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Affiliation(s)
- Mamta Nebhinani
- College of Nursing, All India Institute of Medical Sciences Jodhpur, Rajasthan, India
| | - Sushma K. Saini
- National Institute of Nursing Education, PGIMER, Chandigarh, India
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Ragavan RS, Joshi R, Evans RG, Riddell MA, Thankappan KR, Chow CK, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Suresh O, Thomas N, Mini GK, Srikanth VK, Maulik PK, Alim M, Guggilla RK, Busingye D, Thrift AG. Additive association of knowledge and awareness on control of hypertension: a cross-sectional survey in rural India. J Hypertens 2021; 39:107-116. [PMID: 32833918 DOI: 10.1097/hjh.0000000000002594] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether there is an interaction between knowledge about hypertension and awareness of hypertension on the treatment and control of hypertension in three regions of South India at different stages of epidemiological transition (see Video, Supplemental Digital Content 1, http://links.lww.com/HJH/B426). METHODS Using a cross-sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Chittoor. Sampling was stratified by age group and sex. We measured blood pressure and administered a questionnaire to determine knowledge and awareness of hypertension. Logistic regression was used to assess associations of awareness and knowledge about hypertension with its treatment and control in participants with hypertension, while examining for statistical interaction. RESULTS Among a total of 11 657 participants (50% male; median age 45 years), 3455 had hypertension. In analyses adjusted for age and sex, both knowledge score [adjusted odds ratio (aOR) 1.14 [95% confidence interval (CI) 1.12--1.17)] and awareness [aOR 104 (95% CI 82--134)] were associated with treatment for hypertension. Similarly, both knowledge score [aOR 1.10; 95% CI (1.08--1.12)] and awareness [aOR 13.4; 95% CI (10.7--16.7)], were positively associated with control of blood pressure in those with hypertension, independent of age and sex. There was an interaction between knowledge and awareness on both treatment and control of hypertension (P of attributable proportion <0.001 for each). CONCLUSION Health education to improve knowledge about hypertension and screening programs to improve awareness of hypertension may act in an additive fashion to improve management of hypertension in rural Indian populations.
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Affiliation(s)
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, Delhi, India
| | - Roger G Evans
- Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Australia
| | - Michaela A Riddell
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
| | - Kavumpurathu R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
- Department of Public Health & Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales
- Department of Cardiology, Westmead Hospital, Sydney
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne
| | - Ajay S Mahal
- School of Public Health and Preventive Medicine, Monash University
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh
| | - Oduru Suresh
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
- Rishi Valley Rural Health Centre, Chittoor District, Andhra Pradesh
| | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, Tamil Nadu
| | - Gomathyamma K Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India
| | - Velandai K Srikanth
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Australia
| | - Pallab K Maulik
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, Delhi, India
- George Institute for Global Health -- Oxford University, Oxford, UK
| | - Mohammed Alim
- George Institute for Global Health, Delhi, India
- Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rama K Guggilla
- Department of Population Medicine and Civilization Diseases Prevention, Faculty of Medicine with the Division of Dentistry and Division of Medical Education in English, Medical University of Bialystok, Bialystok, Poland
| | - Doreen Busingye
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
| | - Amanda G Thrift
- School of Clinical Sciences at Monash Health, Monash University, Melbourne
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Birrell F, Lawson R, Sumego M, Lewis J, Harden A, Taveira T, Stevens J, Manson A, Pepper L, Ickovics J. Virtual group consultations offer continuity of care globally during Covid-19. LIFESTYLE MEDICINE 2020; 1:e17. [PMID: 38607797 PMCID: PMC7883187 DOI: 10.1002/lim2.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/11/2020] [Indexed: 11/12/2022] Open
Abstract
Covid-19 has led to virtual care (mainly telephone consultations) becoming a default worldwide, despite well-documented shortcomings. Published evidence on virtual group consultations is limited, although interest and front-line experience have grown substantially since pandemic onset. Unpublished data are summarised showing feasibility of transitioning care to this model across different countries, care settings and conditions. An international webinar series has supported development and sharing of best practice and representative data on spread and utilisation of virtual groups. This model of care creates time and space for more questions and answers, so once engaged patients become staunch advocates. Group care supports personalised care and lifestyle medicine, which is growing very rapidly. In the current context, even healthcare providers under pressure can implement virtual group consultations. Most virtual group consultations have a facilitator, so this allows roles to be extended and support education of both students and new team members. These can confer greater access, continuity of care, peer support and timely information about Covid-19 and may result in better health outcomes. Given the rapid and widespread implementation of virtual care during this pandemic, data should be shared effectively and methodologically sound observational studies and clinical trials to test safety and effectiveness should be promoted now.
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Affiliation(s)
- Fraser Birrell
- Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal AgeingNewcastle UniversityNewcastle upon TyneUK
- Department of RheumatologyNorthumbria Healthcare NHS Foundation TrustAshingtonUK
| | - Rob Lawson
- President, European Lifestyle Medicine CouncilHaddingtonUK
- Chairman, British Society of Lifestyle Medicine, East LintonUK
| | - Marianne Sumego
- Department of Internal Medicine & GeriatricsCleveland ClinicClevelandOhio
| | - Jessica Lewis
- Department of Chronic Disease EpidemiologyYale School of Public HealthNew HavenConnecticut
| | - Angela Harden
- School of Health SciencesUniversity of LondonLondonUK
| | - Tracey Taveira
- College of PharmacyUniversity of Rhode IslandKingstonRhode Island
| | - John Stevens
- Department of Health and Human SciencesSouthern Cross UniversityLismoreNew South WalesAustralia
| | | | - Linda Pepper
- Dean of FacultyDepartment of RheumatologyNorthumbria Healthcare NHS Foundation TrustNorth ShieldsUK
| | - Jeannette Ickovics
- Yale‐NUS CollegeSingapore
- Department of Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticut
- Department of PsychologyYale UniversityNew HavenConnecticut
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Mercer T, Nulu S, Vedanthan R. Innovative Implementation Strategies for Hypertension Control in Low- and Middle-Income Countries: a Narrative Review. Curr Hypertens Rep 2020; 22:39. [PMID: 32405820 DOI: 10.1007/s11906-020-01045-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the most recent and innovative implementation strategies for hypertension control in low- and middle-income countries (LMICs). RECENT FINDINGS Implementation strategies from Latin America, Africa, and Asia were organized across three levels: community, health system, and policy/population. Multicomponent interventions involving task-shifting strategies, with or without mobile health tools, had the most supporting evidence, with policy or population-level interventions having the least, focused only on salt reduction with mixed results. More research is needed to better understand how context affects intervention implementation. There is an emerging evidence base for implementation strategies for hypertension control and CVD risk reduction in LMICs at the community and health system levels, but further research is needed to determine the most effective policy and population-level strategies. How to best account for local context in adapting and implementing these evidence-based interventions in LMICs still remains largely unknown. Accelerating the translation of this implementation research into policy and practice is imperative to improve health and save lives globally.
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Affiliation(s)
- Tim Mercer
- Department of Population Health, Division of Global Health, The University of Texas at Austin Dell Medical School, 1601 Trinity St., Bldg. B, Austin, TX, 78712, USA.
| | - Shanti Nulu
- Department of Internal Medicine, Division of Cardiology, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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39
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Thrift AG, Ragavan RS, Riddell MA, Joshi R, Thankappan KR, Chow C, Oldenburg B, Mahal AS, Kalyanram K, Kartik K, Suresh O, Mini GK, Ismail J, Gamage DG, Hasan A, Srikanth VK, Thomas N, Maulik PK, Guggilla RK, Evans RG. Hypertension in Rural India: The Contribution of Socioeconomic Position. J Am Heart Assoc 2020; 9:e014486. [PMID: 32223389 PMCID: PMC7428634 DOI: 10.1161/jaha.119.014486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Various indicators of socioeconomic position (SEP) may have opposing effects on the risk of hypertension in disadvantaged settings. For example, high income may reflect sedentary employment, whereas greater education may promote healthy lifestyle choices. We assessed whether education modifies the association between income and hypertension in 3 regions of South India at different stages of epidemiological transition. Methods and Results Using a cross‐sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Rishi Valley. Sampling was stratified by age group and sex. We measured blood pressure and anthropometry and administered a questionnaire to identify lifestyle factors and SEP, including education, literacy, and income. Logistic regression was used to assess associations between various components of SEP and hypertension, and interaction analyses were used to determine whether educational attainment modified the association between income and hypertension. Trivandrum, the region of highest SEP, had the greatest prevalence of hypertension, whereas Rishi Valley, the lowest SEP region, had the least. Overall, greater income was associated with greater risk of hypertension. In interaction analyses, there was no evidence that educational attainment modified the association between income and hypertension. Conclusions Education is widely considered to ameliorate the risk of hypertension in high‐income countries. Why this effect is absent in rural India merits investigation.
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Affiliation(s)
- Amanda G Thrift
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | | | - Michaela A Riddell
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | - Rohina Joshi
- The George Institute for Global Health University of New South Wales Australia
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala, India
| | - Clara Chow
- The George Institute for Global Health University of New South Wales Australia.,Department of Cardiology Westmead Hospital Sydney Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health University of Melbourne Carlton Australia
| | - Ajay S Mahal
- School of Public Health and Preventative Medicine Monash University Melbourne Australia.,Nossal Institute for Global Health Melbourne School of Population and Global Health University of Melbourne Carlton Australia
| | - Kartik Kalyanram
- Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - Kamakshi Kartik
- Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - Oduru Suresh
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia.,Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India
| | - G K Mini
- Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala, India.,Global Institute of Public Health Ananthapuri Hospitals and Research Institute Trivandrum Kerala India
| | - Jordan Ismail
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | | | - Aniqa Hasan
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia
| | - Velandai K Srikanth
- Peninsula Clinical School Central Clinical School Monash University Frankston Australia
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India
| | - Pallab K Maulik
- George Institute for Global Health New Delhi India.,George Institute for Global Health-Oxford University Oxford United Kingdom
| | - Rama K Guggilla
- Department of Population Medicine and Civilization Diseases Prevention Faculty of Medicine With the Division of Dentistry and Division of Medical Education in English Medical University of Bialystok Bialystok Poland
| | - Roger G Evans
- Cardiovascular Disease Program Biomedicine Discovery Institute, and Department of Physiology Monash University Melbourne Australia
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