Abstract
BackgroundAlthough 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/MethodsWe 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/ConclusionsOf 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.
Highlights
GeneralIn 2017, non-communicable diseases (NCDs), primarily cardiovascular diseases (CVDs), cancer and chronic respiratory disease, were responsible for 74% of deaths worldwide, with over three quarters of NCD deaths occurring in low- and middle-income countries [1]
We describe the operation of Chronic Disease in the Community (CDCom), a 10-year comprehensive program employing village health workers (VHWs) to screen and manage hypertension and other NCDs at a community level
While males were more likely than females to have stage 1 hypertension (26% vs 20%), the rate of stage 2 hypertension was 5% in both sexes. One percent of those screened had been previously diagnosed with hypertension and 84% with systolic blood pressure (SBP) >160 were unaware of having hypertension
Summary
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, serve as the primary providers at monthly village-based NCD clinics. 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. Hypertension and non-communicable disease care by village health workers in rural Uganda. 2) VHWs are able to screen patients for hypertension, and to manage their disease in monthly village-based clinics. We expect that our datainformed 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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