Effect of a community-based intervention for cardiovascular risk factor control on stroke mortality in rural Gadchiroli, India: study protocol for a cluster randomised controlled trial

Abstract

BackgroundStroke has emerged as a leading cause of death in rural India. However, well-tested healthcare interventions to reduce stroke mortality in rural under-resourced settings are lacking. The aim of this study is to evaluate the effect of a community-based preventive intervention on stroke mortality in rural Gadchiroli, India.MethodsThe study is a two-arm, parallel group, cluster randomised controlled trial in which 32 villages will be randomised to the intervention and the enhanced usual care (EUC) arm. In the intervention arm, individuals ≥50 years of age will be screened for hypertension, diabetes and stroke by trained Community Health Workers (CHWs). Screened individuals who are positive will be referred to a mobile outreach clinic which will visit the intervention villages periodically. A physician in the clinic will confirm the diagnosis, provide guideline-based treatment and follow up patients. The CHWs will make home visits once a month to ensure medication compliance and counsel patients to reduce salt consumption and quit tobacco and alcohol. In the EUC arm, households will be provided information on the ill effects of tobacco use and steps to quit it. Individuals from both the arms will have access to the government’s national programme for the prevention and control of non-communicable diseases, where treatment for hypertension, diabetes and preventive treatment after stroke is available at the nearest primary health centres (PHCs). The intervention will be implemented for 3.5 years. The primary outcome will be a reduction in stroke mortality in the last 2.5 years of the intervention.DiscussionThis trial will provide important information regarding the feasibility and effect of a community-based preventive intervention package on stroke mortality in a rural under-resourced setting and can inform India’s non-communicable diseases prevention and control programme. If successful, such an intervention can be scaled up in the rural regions of India and other countries.Trial registrationClinical Trials Registry of India: CTRI/2015/12/006424. Registered on 8 December 2015.

Leveraging role of non-physician health workers in prevention and control of non-communicable diseases in India

“…in North India have highlighted role of community health workers in the effective management of stroke through community-based preventive intervention. Proper training and guidance further helped these workers to assume their role as a “health facilitators,” “health advertising agent,” or “health role model.”[ 29 ]…”

Preparedness of primary & secondary care health facilities for the management of non-communicable diseases in tribal population across 12 districts in India

“…A randomized control trial 16 is ongoing in a tribal district of Gadchiroli, India, to estimate the effectiveness of community-based interventions for screening and managing cardiovascular diseases. The model is proposed to reduce stroke mortality in rural areas where access to healthcare is difficult 16 .…”

“…A randomized control trial 16 is ongoing in a tribal district of Gadchiroli, India, to estimate the effectiveness of community-based interventions for screening and managing cardiovascular diseases. The model is proposed to reduce stroke mortality in rural areas where access to healthcare is difficult 16 . Jan Swasthya Sahyog , an NGO based in Chhattisgarh that caters to tribal districts in the region, is also working on several community-based interventions for NCDs.…”

Gaps in secondary prevention among stroke survivors in rural Gadchiroli, India: a community-based cross-sectional study

“…The present study was nested in a cluster randomised controlled trial to assess the effect of a community-based intervention to reduce stroke deaths in rural Gadchiroli and was a part of a baseline assessment of risk factors and secondary prevention of stroke among stroke survivors 15 . The trial was conducted in 64 villages selected randomly from 86 villages in the service area of SEARCH in Gadchiroli district.…”