High rates of voluntary clinic attendance among community members screened with high cardiovascular disease risk scores in the rural and urban communities of Adama, Ethiopia.
Community level screening, referral and care intervention for the rising burden of cardiovascular diseases (CVD) and its risk factors in sub-Saharan Africa has been advocated. However, very low completed referral rates among those identified at risk has been reported. The goal of the current study was to use a citizen science-based approach to identify and refer those at high CVD risk to local health clinics, assess the referral rates in each community, and explore reasons for non-attendance by urban or rural location.
Twelve trained health extension workers (HEWs) screened 772 community members aged ≥ 35 year from 10 randomly selected health clinic catchment areas in an urban and a rural community in Adama district and Addis Ababa, Ethiopia with a mobile app-based on the Framingham 10-year CVD risk algorithm. HEWs also provided simple educational tools to support communicating CVD risk and counselling, and referral of at-risk persons for further care. Participants were followed up for four weeks after referral.
The proportions of participants with high (> 20%), moderate (10-20%), and pooled moderate and high risk (> 10%) were 6.0%, 12.6%, and 18.5% respectively. The most common risk factors identified included hypertension, diabetes mellitus (DM), and tobacco use. Of the 143 at risk participants identified, 124 were interviewed at 4-weeks follow-up (86.7%), and 80/124 (64.5%) voluntarily attended a local clinic for further assessment and management; rural at-risk participants (n = 42) had higher rates of follow-up (72.4%) compared with urban (57.6%) dwellers (p = 0.08). Those without prior hypertension or diabetes had lower rates of follow-up (57.1%) compared to those with at least one of these risk factors (74.1%, p = 0.05). The most common reasons for not attending clinic were inconvenience (63.4%), feeling fine (24.4%), and financial challenge (12.2%).
We observed high rates of voluntary clinic attendance among community members screened with moderate to high CVD risk scores in both rural and urban communities of Ethiopia. These findings imply that this novel approach may be useful for scaling up CVD risk screening in regions of Ethiopia.
Twelve trained health extension workers (HEWs) screened 772 community members aged ≥ 35 year from 10 randomly selected health clinic catchment areas in an urban and a rural community in Adama district and Addis Ababa, Ethiopia with a mobile app-based on the Framingham 10-year CVD risk algorithm. HEWs also provided simple educational tools to support communicating CVD risk and counselling, and referral of at-risk persons for further care. Participants were followed up for four weeks after referral.
The proportions of participants with high (> 20%), moderate (10-20%), and pooled moderate and high risk (> 10%) were 6.0%, 12.6%, and 18.5% respectively. The most common risk factors identified included hypertension, diabetes mellitus (DM), and tobacco use. Of the 143 at risk participants identified, 124 were interviewed at 4-weeks follow-up (86.7%), and 80/124 (64.5%) voluntarily attended a local clinic for further assessment and management; rural at-risk participants (n = 42) had higher rates of follow-up (72.4%) compared with urban (57.6%) dwellers (p = 0.08). Those without prior hypertension or diabetes had lower rates of follow-up (57.1%) compared to those with at least one of these risk factors (74.1%, p = 0.05). The most common reasons for not attending clinic were inconvenience (63.4%), feeling fine (24.4%), and financial challenge (12.2%).
We observed high rates of voluntary clinic attendance among community members screened with moderate to high CVD risk scores in both rural and urban communities of Ethiopia. These findings imply that this novel approach may be useful for scaling up CVD risk screening in regions of Ethiopia.
Authors
Kedir Kedir, Okop Okop, Ayele Ayele, Getachew Getachew, Dereje Dereje, Hailu Hailu, Geremew Geremew, Levitt Levitt, Howe Howe
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