An assessment of community health workers’ ability toudscreen for cardiovascular disease risk with a simple,udnon-invasive risk assessment instrument in Bangladesh,udGuatemala, Mexico, and South Africa: an observational study

摘要

Background Cardiovascular disease contributes substantially to the non-communicable disease (NCD) burden in lowincomeudand middle-income countries, which also often have substantial health personnel shortages. In thisudobservational study we investigated whether community health workers could do community-based screenings toudpredict cardiovascular disease risk as eff ectively as could physicians or nurses, with a simple, non-invasive riskudprediction indicator in low-income and middle-income countries.udMethods This observation study was done in Bangladesh, Guatemala, Mexico, and South Africa. Each site recruited atudleast ten to 15 community health workers based on usual site-specifi c norms for required levels of education andudlanguage competency. Community health workers had to reside in the community where the screenings were doneudand had to be fl uent in that community’s predominant language. These workers were trained to calculate an absoluteudcardiovascular disease risk score with a previously validated simple, non-invasive screening indicator. Communityudhealth workers who successfully fi nished the training screened community residents aged 35–74 years without audprevious diagnosis of hypertension, diabetes, or heart disease. Health professionals independently generated a secondudrisk score with the same instrument and the two sets of scores were compared for agreement. The primary endpointudof this study was the level of direct agreement between risk scores assigned by the community health workers and theudhealth professionals.udFindings Of 68 community health worker trainees recruited between June 4, 2012, and Feb 8, 2013, 42 were deemedudqualifi ed to do fi eldwork (15 in Bangladesh, eight in Guatemala, nine in Mexico, and ten in South Africa). Across alludsites, 4383 community members were approached for participation and 4049 completed screening. The mean level ofudagreement between the two sets of risk scores was 96·8% (weighted κ=0·948, 95% CI 0·936–0·961) and communityudhealth workers showed that 263 (6%) of 4049 people had a 5-year cardiovascular disease risk of greater than 20%.udInterpretation Health workers without formal professional training can be adequately trained to eff ectively screen for,udand identify, people at high risk of cardiovascular disease. Using community health workers for this screening wouldudfree up trained health professionals in low-resource settings to do tasks that need high levels of formal, professionaludtraining.