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Cited by 184Health Promotion and Cardiovascular PreventionCardiovascular Health and Risk FactorsBlood Pressure and Hypertension Studies

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An assessment of community health workers' ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: an observational study

Open access
Gaziano, Thomas A, Abrahams-Gessel, Shafika, Denman, Catalina A, Montano, Carlos Mendoza, Khanam, Masuma, Puoane, Thandi, Levitt, Naomi S·2015·The Lancet Global Health
DOI 10.1016/s2214-109x(15)00143-6PMC PMC4795807
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Abstract

BACKGROUND: Cardiovascular disease contributes substantially to the non-communicable disease (NCD) burden in low-income and middle-income countries, which also often have substantial health personnel shortages. In this observational study we investigated whether community health workers could do community-based screenings to predict cardiovascular disease risk as effectively as could physicians or nurses, with a simple, non-invasive risk prediction indicator in low-income and middle-income countries. METHODS: This observation study was done in Bangladesh, Guatemala, Mexico, and South Africa. Each site recruited at least ten to 15 community health workers based on usual site-specific norms for required levels of education and language competency. Community health workers had to reside in the community where the screenings were done and had to be fluent in that community's predominant language. These workers were trained to calculate an absolute cardiovascular disease risk score with a previously validated simple, non-invasive screening indicator. Community health workers who successfully finished the training screened community residents aged 35-74 years without a previous diagnosis of hypertension, diabetes, or heart disease. Health professionals independently generated a second risk score with the same instrument and the two sets of scores were compared for agreement. The primary endpoint of this study was the level of direct agreement between risk scores assigned by the community health workers and the health professionals. FINDINGS: Of 68 community health worker trainees recruited between June 4, 2012, and Feb 8, 2013, 42 were deemed qualified to do fieldwork (15 in Bangladesh, eight in Guatemala, nine in Mexico, and ten in South Africa). Across all sites, 4383 community members were approached for participation and 4049 completed screening. The mean level of agreement between the two sets of risk scores was 96·8% (weighted κ=0·948, 95% CI 0·936-0·961) and community health workers showed that 263 (6%) of 4049 people had a 5-year cardiovascular disease risk of greater than 20%. INTERPRETATION: Health workers without formal professional training can be adequately trained to effectively screen for, and identify, people at high risk of cardiovascular disease. Using community health workers for this screening would free up trained health professionals in low-resource settings to do tasks that need high levels of formal, professional training.

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Figure 1 Risk scoring chart How to use the chart: (1) choose the section with the patient’s sex, diabetes, and smoking status; (2) find the cell that matches the patient’s risk factor profile using age, BMI, and blood pressure; (3) refer to physician those with excessive blood pressure (>180 mm Hg).
Figure 1 Risk scoring chart How to use the chart: (1) choose the section with the patient’s sex, diabetes, and smoking status; (2) find the cell that matches the patient’s risk factor profile using age, BMI, and blood pressure; (3) refer to physician those with excessive blood pressure (>180 mm Hg).CC BY-NC-ND · PubMed Central
Figure 2 Enrolment algorithm *Please note that the referral aim of the study is covered elsewhere.
Figure 2 Enrolment algorithm *Please note that the referral aim of the study is covered elsewhere.CC BY-NC-ND · PubMed Central
Figure 3 Distribution of community health worker risk scores categories by country
Figure 3 Distribution of community health worker risk scores categories by countryCC BY-NC-ND · PubMed Central

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Metadata

Authors
Gaziano, T. A., Abrahams-Gessel, S., Denman, C. A., Montano, C. M., Khanam, M., Puoane, T., & Levitt, N. S.
Affiliations
  • Brigham and Women's Hospital (US)
  • El Colegio de Sonora (MX)
  • Institute of Nutrition of Central America and Panama (GT)
  • International Centre for Diarrhoeal Disease Research (BD)
  • University of the Western Cape (ZA)
  • University of Cape Town (ZA)
Corresponding author
Gaziano, Thomas A
ORCID
Venue
The Lancet Global Health
Publisher
Elsevier BV
Published
2015-09
Volume
3
Issue
9
Pages
e556-e563
ISSN
2214-109X (ISSN-L)
DOI
10.1016/s2214-109x(15)00143-6
PMC
PMC4795807
OpenAlex
W1953019363
Cited by
184
References
25
Citations by year
2026: 9 · 2025: 14 · 2024: 11 · 2023: 8 · 2022: 27 · 2021: 20 · 2020: 14 · 2019: 19 · 2018: 17 · 2017: 22 · 2016: 18 · 2015: 5
FWCI
22.11
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Global Health (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Bushehr University of Medical Sciences Repository (Bushehr University of Medical Sciences) (acceptedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion, cc-by-nc-nd)
  • PubMed Central (acceptedVersion, cc-by-nc-nd)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • eCite Digital Repository (University of Tasmania) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Figshare (submittedVersion, cc-by-nc-nd)
Funders
  • U.S. Public Health Service (HHSN268200900030C)
  • National Heart, Lung, and Blood Institute (HHSN268200900030C)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
community health workers, cardiovascular risk prediction, non-communicable diseases, low- and middle-income countries, community-based screening, health workforce shortage, non-invasive risk assessment, Bangladesh, Guatemala, Mexico, South Africa
MeSH terms
Adult, Aged, Bangladesh, Cardiovascular Diseases, Clinical Competence, Community Health Workers, Education, Medical, Female, Guatemala, Humans, Male, Mass Screening, Mexico, Middle Aged, Risk Factors, South Africa, Risk Assessment

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