A PhD project from Center for Global Health at Department of Public Health at Aarhus University has demonstrated the effectiveness of female community health volunteers (FCHVs) in reducing blood pressure at the community level in Nepal.

2017.12.12 | Helle Horskjær Hansen

Every year 10 million people die due to hypertension worldwide. Over 85% of these deaths occur in low and middle-income countries (LMICs). In Nepal, about one in four adults have high blood pressure, and approximately half of them do not know they have it. Approximately five people die due to hypertension-related causes every hour and many of these deaths can easily be prevented.

Forty three FCHVs from Lekhnath Municipality of Nepal were trained as part of the intervention. They were equipped with an electronic blood pressure device, scales and a tape measure as part of a PhD project from Aarhus University. Together with the equipment, they were given a five-day course on screening blood pressure and measuring height and weight, as well as training so they could provide counselling on heathy lifestyles and diet. FCHVs did home visit three times a year for over 1000 households.

The report of the study has just been published in the Lancet Global Health, with a podcast where the lead author of the report discusses the prospects of the intervention to change hypertension management program practices at the community level.

"We have managed to reduce blood pressure amongst the local people who participated in the intervention, both for those who already had raised blood pressure, but also those who had blood pressure within the normal range. At first glance it might look like a small reduction of -4.90 mmHg, but we know from other studies that a reduction like this leads to a significant decrease in cardiovascular diseases and mortality", explains Per Kallestrup, who is associate professor, PhD at the Department of Public Health, Aarhus University and supervisor of the PhD project.

More specifically, a reduction of 5 mmHg reduces the death of strokes by 14 per cent, death of coronary heart disease by 9 per cent and mortality from all causes of death by 7 per cent. The project is carried by Dinesh Neupane, who together with Per Kallestrup initiated the project in 2013.

"Our intervention also prevents new cases of high blood pressure. There was a 53 per cent higher prevalence of new cases of high blood pressure in the control group compared to the intervention group," explains Dinesh Neupane. 

Life-style diseases in low-income countries

Management of blood pressure should not be limited to those classified as hypertensive. It is important to keep blood pressure under control for everyone. This will significantly reduce the risk of cardiovascular diseases, and any disabilities and mortality as a consequence of it.

Per Kallestrup calls the project operational research and emphasises that it has availed crucial evidence on an approach for community based prevention of chronic diseases for low and middle income countries (LMICs).

"We worked with a population group that is witnessing a surge in risk factors for non- communicable diseases (NCDs) in a low income country that is otherwise easily overlooked by the existing health sector programs which does not yet prioritize NCDs. Resources are scarce in Nepal, therefore empowering female community health volunteers for hypertension management provides a major economic imperative to supplement the inadequate and  costly specialist workforce", he says.

Per Kallestrup has no doubt. The work will strengthen Nepal’s current response to  NCD risk factors through the training and deployment of FCHVs at the frontline of the health system.

The researchers have an ambition to establish a research centre in Nepal that will focus on lifestyle diseases, as they are a neglected area of research in Nepal and other LMICs.
"In recent years, LMICs have experienced an explosive growth in chronic diseases. It is absolutely necessary to develop sustainable models to meet these challenges", says Per Kallestrup.

Background for the results

The study is an open-label, large cluster-randomised trial

The study is financed by Aarhus University, Jayanti Memorial Trust and Nepal Development Society

Partners: Patan Academy of Health Science, Nepal; University of New South Wales, Australia; Johns Hopkins University, USA; University of Southern Denmark, Denmark. The project was implemented within the Ministry of Health system. The field activities were carried out through a Nepal based NGO called-Nepal Development Society

Read the scientific article here Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN): an open-label, cluster-randomised trial

Contact

Associate Professor, PhD, Per Kallestrup

Aarhus University, Department of Public Health

(+45) 8716 8552

Email: per.kallestrup@ph.au.dk