Effectiveness of a screening programme in identifying individuals with increased risk of cardiovascular disease in South Africa

Peer, Nasheeta; Balakrishna, Yusentha; Villiers, Anniza de; Crickmore, Christelle; Mungal-Singh, Vash

doi:10.1093/pubmed/fdx012

Cited by 4 publications

(2 citation statements)

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“…Among the most pressing of priorities is raising awareness of disease among those affected. In response to this realization, multiple prior programs have implemented health system referrals after community-based screenings for BP and DM [8][9][10][11][12][13][14]. Such programs have the benefit of bringing healthcare screenings out of congested primary healthcare clinics and into communities and individuals who might otherwise rarely interface with the formal health sector.…”

Section: Discussionmentioning

confidence: 99%

“…In response to the growing burden of undiagnosed DM and HTN in South Africa, there are increased efforts to enhance disease detection through screening. This includes routine clinic-based screening for NCDs [7], but also community-based or community healthcare worker-led screening for those not captured by the formal healthcare system [8][9][10][11][12][13][14]. Such initiatives are often implemented using cross-sectional screening followed by referral to local primary healthcare clinic services for individuals with abnormal results.…”

Section: Introductionmentioning

confidence: 99%

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Pitfalls of Single Measurement Screening for Diabetes and Hypertension in Community-Based Settings

et al. 2021

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Background: Cross-sectional screening programs are used to detect and refer individuals with non-communicable diseases to healthcare services. We evaluated the positive predictive value of cross-sectional measurements for Diabetes Mellitus (DM) and hypertension (HTN) as part of a community-based disease screening study, 'Vukuzazi' in rural South Africa. Methods: We conducted community-based screening for HTN and DM using the World Health Organization STEPS protocol and glycated haemoglobin A1c (HbA1c) testing, respectively. Nurses conducted follow-up home visits for confirmatory diagnostic testing among individuals with a screening BP above 140/90 mmHg and/or HbA1c above 6.5% at the initial screen, and without a prior diagnosis. We assessed the positive predictive value of the initial screening, compared to the follow up measure. We also sought to identify a screening threshold for HTN and DM with greater than 90% positive predictive value. results: Of 18,027 participants enrolled, 10.2% (1,831) had a screening BP over 140/90 mmHg. Of those without a prior diagnosis, 871 (47.6%) received follow-up measurements. Only 51.2% (451) of those with completed follow-up measurements had a repeat BP>140/90 mmHg at the home visit and were referred to care. To achieve a 90% correct referral rate, a systolic BP threshold of 192 was needed at first screening. For DM screening, 1,615 (9.0%) individuals had an HbA1c > 6.5%, and of those without a prior diagnosis, 1,151 (71.2%) received a follow-up blood glucose. Of these, only 34.1% (395) met criteria for referral for DM. To ensure a 90% positive predictive value i.e. a screening HbA1c of >16.6% was needed. conclusions: A second home-based screening visit to confirm a diagnosis of DM and HTN reduced health system referrals by 48% and 66%, respectively. Two-day screening programmes for DM and HTN screening might save individual and healthcare resources and should be evaluated carefully in future cost effectiveness evaluations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pitfalls of Single Measurement Screening for Diabetes and Hypertension in Community-Based Settings

et al. 2021

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HbA1c comparable to fasting glucose in the external validation of the African Diabetes Risk Score and other established risk prediction models in Black South Africans

Royce,

Cronjé,

Kengne

et al. 2024

BMC Endocr Disord

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Background The use of non-invasive risk scores to detect undiagnosed type 2 diabetes (T2D) ensures the restriction of invasive and costly blood tests to those most likely to be diagnosed with the disease. This study assessed and compared the performance of the African Diabetes Risk Score (ADRS) with three other diabetes risk prediction models for identifying screen-detected diabetes based on fasting plasma glucose (FPG) or glycated haemoglobin (HBA1c). Methods Age, sex, waist circumference, body mass index, blood pressure, history of diabetes and physical activity levels from the SA-NW-PURE study were used to externally validate the ADRS and other established risk prediction models. Discrimination was assessed and compared using C-statistics and nonparametric methods. Calibration was assessed using calibration plots, before and after recalibration. Results Nine hundred and thirty-seven participants were included; 14% had prevalent undiagnosed T2D according to FPG and 26% according to HbA1c. Discrimination was acceptable and was mostly similar between models for both diagnostic measures. The C-statistics for diagnosis by FPG ranged from 0.69 for the Simplified FINDRISC model to 0.77 for the ADRS model and 0.77 for the Simplified FINDRISC model to 0.79 for the ADRS model for diagnosis by HbA1c. Calibration ranged from acceptable to good, though over- and underestimation were present. All models improved significantly following recalibration. Conclusions The models performed comparably, with the ADRS offering a non-invasive way to identify up to 79% of cases. Based on its ease of use and performance, the ADRS is recommended for screening for T2D in certain Black population groups in South Africa. HbA1c as a means of diagnosis also showed comparable performance with FPG. Therefore, further validation studies can potentially use HbA1c as the standard to compare to.

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Apparent Temperature Modifies the Effects of Air Pollution on Cardiovascular Disease Mortality in Cape Town, South Africa

Olutola

Mwase

Shirinde

et al. 2023

Climate

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Cardiovascular disease (CVD) is the top cause of mortality and a main contributor to disability globally. The evidence so far is varied on whether cold or heat modifies the CVD effects of air pollution. Weather conditions and air pollution sources and levels are different in different countries. Studies in low-and middle-income countries are lacking. Mortality data were obtained from Statistics South Africa. Air pollution and meteorological data were obtained from the South African Weather Service. A time-stratified case–crossover epidemiological design was applied. The association between air pollutants (PM10, NO2 and SO2) and CVD mortality was investigated using conditional logistic regression models. Susceptibility by sex and age groups was investigated. In total, 54,356 CVD deaths were included in the 10-year study. The daily PM10, NO2 and SO2 levels exceeded the daily WHO guidelines on 463, 421 and 8 days of the 3652 days, respectively. Higher air pollution risks were observed in this study compared to those reported in meta-analyses. In general, the elderly and females seemed to be vulnerable to air pollutants, especially at high and moderate apparent temperature levels. Harvesting effects were observed at longer lags. The results can be used to develop an early warning system for the city.

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Effectiveness of a screening programme in identifying individuals with increased risk of cardiovascular disease in South Africa

Cited by 4 publications

References 11 publications

Pitfalls of Single Measurement Screening for Diabetes and Hypertension in Community-Based Settings

Pitfalls of Single Measurement Screening for Diabetes and Hypertension in Community-Based Settings

HbA1c comparable to fasting glucose in the external validation of the African Diabetes Risk Score and other established risk prediction models in Black South Africans

Apparent Temperature Modifies the Effects of Air Pollution on Cardiovascular Disease Mortality in Cape Town, South Africa

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