A pilot study to evaluate home-based screening for the common non-communicable diseases by a dedicated cadre of community health workers in a rural setting in India

Abstract

BackgroundPopulation-based screening for the common non-communicable diseases (NCD) is recommended but is difficult to implement in the hard-to-reach areas of low resourced countries. The objective of our pilot study was to evaluate the feasibility and the efficacy of delivering NCD screening services at home by trained community health workers (CHWs). Men and women aged 30-60 years residing in rural areas of India were targeted for screening.MethodsThe CHWs made home visits to educate the participants about healthy lifestyles and symptoms of common cancers and counsel the tobacco/alcohol users to quit. They measured height, weight, blood pressure (BP) and random blood sugar for all and performed oral visual examination (OVE) to screen the tobacco/alcohol users for oral cancer. For cervical cancer screening, the women themselves provided self-collected vaginal samples that the CHWs delivered to the laboratory for high-risk Human Papillomavirus (HPV) detection. The women were not screened for breast cancer but were made aware of the common symptoms and the importance of early diagnosis. Further assessment of the screen-positive individuals and the women with breast symptoms was arranged at the nearest primary health center (PHC).ResultsThe CHWs screened 1998 men and 4997 women from 20 villages within 6 months; the refusal rate was less than 10%. High BP and sugar were detected in 32.6% and 7.5% participants respectively; hypertension and diabetes were confirmed in 42.3% and 35% respectively among those undergoing follow-up. Obesity prevalence was only 2.4%. More than 50% men were tobacco chewers. Of the total participants, 2.6% were positive on OVE, though no oral cancer was detected among them. HPV test was positive in 8.6% women and they were triaged with visual inspection after application of acetic acid (VIA) test for treatment either by thermal ablation (same visit) or by loop excision. VIA was positive in 14% of the HPV-positive women and 56.5% of them received same day ablative treatment. The VIA-negative women were advised follow up after 1 year. No breast cancer was detected among the 0.6% women complaining of breast symptoms.ConclusionsDelivery of NCD screening services at home by trained CHWs is feasible and well-accepted by our study population.

Comparative performance evaluation of different HPV tests and triaging strategies using self‐samples and feasibility assessment of thermal ablation in ‘colposcopy and treat’ approach: A population‐based study in rural China

“…However, in Chinese settings this would have led to more than 15% of the screened women being treated with consequential harms due to overtreatment and wastage of resources. Unlike an Indian study among hard-to-reach rural women, in which 25% of the self-sampling positive women failed to return for a second visit for treatment, 21 we observed a very high compliance (96%) of the screen-positive women to further evaluation and treatment. Certain amount of overtreatment is inevitable in 'colposcopy and treat' approach, 35.4% in our study, which is much lower than that for 'screen and treat' approach in which all the screen positive women are immediately treated (over 69% for both HPV primary screening or with genotyping triage).…”

Intrinsic capacity as a framework for Integrated Care for Older People (ICOPE); insights from the 10/66 Dementia Research Group cohort studies in Latin America, India and China

“…There has been interest in extending the roles of this cadre from maternal and child health, sanitation and infection control to include prevention and control of noncommunicable disease. There is early evidence of feasibility and effectiveness in cardiovascular risk reduction, detecting hypertension and diabetes(39,40), and in supporting the management of hypertension(41,42). Coordinating the integrated care of older people in the community would be a logical next step, capitalising on the CHWs unique outreach capacity and knowledge of older people and their families(43).…”

Community health workers’ involvement in the prevention and control of non-communicable diseases in Wakiso District, Uganda

“…Despite other countries having established the role of CHWs in NCDs prevention and control [20][21][22], evidence about the role of CHWs in delivering primary prevention interventions for NCDs in Uganda is limited [23]. Moreover, evidence suggests that CHWs are interested in deliveringcardiovascular disease prevention services within their communities [24] and thus it is crucial to understand their level of knowledge, attitudes and perceived role in addressingNCDs as part of the feasibility of involving them in the control of these diseases [25].…”