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Paper Presented in the Conference
Development and evaluation of
cardiovascular risk assessment and management tools suitable for use in
primary health care in rural Andhra Pradesh
Clara Chow1*, Magnolia Cardona1, Rama Raju2,
S lyengar2, A Sukumar2, C Ravi Raju2, P
Krishnam Raju3, G S Ratnakrishna4, Uma Snehi4,
Rohina Joshi1 , K Srinath Reddy4, Bruce Neal1
1 The George Institute For International Health, University
of Sydney, Sydney, Australia; 2 Byrraju Foundation,
Hyderabad, India; 3 CARE Foundation, Hyderabad, India; 4
Center for Chronic Diseases Control, New Delhi, India.
Background
Cardiovascular disease is emerging as the leading cause of mortality in
rural India. Proven treatment and prevention strategy designed for use
in rural and remote areas are urgently required if this cardiovascular
disease epidemic is to be addressed. Fortunately there appears to be
considerable scope for the adaptation of principles already proven and
widely utilized in Western countries. Developing an evidence base that
will underpin this approach is the goal of this initiative.
Methods
We have established a collaborative partnership between researchers and
health service providers. Together we have conducted comprehensive
background work identifying cardiovascular treatment and prevention
strategies that might be suitable for use by primary health care
providers in rural Andhra Pradesh. This comprised a survey of risk
factors among over 4,000 individuals in the area, an evaluation of local
health services and systematic reviews of evidence about effective
treatment and prevention strategies for cardiovascular disease.
Results
The existing primary health care services in each village have been
identified as the best entry point for the provision of cardiovascular
care in the villages. Significant opportunities for the enhancement of
cardiovascular care have been identified by the survey of risk factors
and treatment patterns. Simple algorithms for the identification and
treatment of high risk individuals have been developed and pilot tested
alongside a health promotion campaign designed specifically for the
local community.
Conclusion
Preliminary experience suggests that cardiovascular treatment and
prevention strategies developed for higher income settings can be
adapted for use in low-income settings. The next step will be to
formally evaluate these strategies in rigorously controlled evaluations
that will provide an evidence base in support of the more widespread
implementation of these approaches in developing countries. Cluster
randomised trials are planned to achieve this.
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