Perceived cardiovascular disease risk and tailored communication strategies among rural and urban community dwellers in Rwanda: a qualitative study

Niyibizi, Jean Berchmans; Okop, Kufre; Nganabashaka, Jean Pierre; Umwali, Ghislaine; Rulisa, Stephen; Ntawuyirushintege, Seleman; Tumusiime, David; Nyandwi, Alypio; Ntaganda, Evariste; Delobelle, Peter; Levitt, Naomi; Munganyinka, Charlotte Bavuma

doi:10.1186/s12889-022-13330-6

Cited by 9 publications

(18 citation statements)

References 18 publications

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“…The underestimation of CVD risk among community members was reported in previous studies conducted in other settings [12,27,28]. The misestimation of CVD risk among the community members was recorded in South Africa [25].The CVD risk underestimation recorded in the present study can be linked to poor understanding of the concept of CVD risk, which was reported among rural and urban community members in a previous study conducted in Rwanda [4]. Moreover, this poor understanding of CVD risk can be one of the contributors to low attendance at health facilities, as reported in a study conducted in South Africa [26].The low attendance at heath facilities observed in this study can also be explained by the low proportion of study participants who were very welling to attend a health facility for a medical check-up to rule out any heart disease.…”

Section: Discussionsupporting

confidence: 51%

“…This study provided proof that CHWs can screen their fellow community members for (high) CVD risk, and community members accepted being screened by CHWs for (high) CVD risk in Rwanda. This is not surprising, since in one qualitative study recently conducted in Rwanda, community members expressed a need to be screened by CHWs for CVD risk [4]. A strong positive correlation between CVD risk scores measured by CHWs and CVD risk scores measured by nurses is proof that CHWs have the potential to conduct CVD risk screening using mobile-technology.…”

Section: Discussionmentioning

confidence: 99%

“…This study was conducted in rural and urban communities conveniently sampled from the Burera district, Northern Province, and Gasabo district, City of Kigali. As reported in our previous (qualitative) study that investigated how community members perceive themselves and what communication strategies they prefer in regard to CVD risk among rural and urban residents [4], the term 'community' refers, in this study, to the catchment area of a health center (HC) providing NCDs (including CVD) services.…”

Section: Settings Community Health Worker Selection and Participantsmentioning

confidence: 99%

“…If no appropriate action is taken, the burden of the CVD pandemic will keep increasing in LMICs and become irrepressible as these countries go through an epidemiological transition and as the proportion of the elderly in populations rises [3]. To reverse the growing CVD burden in LMICs, robust and evidence-based prevention strategies must be developed [4]. Early identification and treatment of those with high CVD risk may lessen the burden brought on by CVD [5].…”

Section: Introductionmentioning

confidence: 99%

“…To the best of our knowledge, no study has been conducted yet in Rwanda to test or pilot the CHW-led CVD risk screening using the non-laboratory-based tool as a basis of evidence-based risk in this approach or further research. Importantly, a recent qualitative study reported that rural and urban community members in Rwanda prefer to be screened by CHWs for CVD risk [4]. Thus, the CHW-led CVD risk screening and referral study was warranted in the context of Rwanda.…”

Section: Introductionmentioning

confidence: 99%

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Community Health Worker-Led Cardiovascular Disease Risk Screening and Referral for Care and Further Management in Rural and Urban Communities in Rwanda

Niyibizi

Ntawuyirushintege

Nganabashaka

et al. 2023

IJERPH

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Cardiovascular disease (CVD) is a global health issue. Low- and middle-income countries (LMICs) are facing early CVD-related morbidity. Early diagnosis and treatment are an effective strategy to tackle CVD. The aim of this study was to assess the ability of community health workers (CHWs) to screen and identify persons with high risks of CVD in the communities, using a body mass index (BMI)-based CVD risk assessment tool, and to refer them to the health facility for care and follow-up. This was an action research study conducted in rural and urban communities, conveniently sampled in Rwanda. Five villages were randomly selected from each community, and one CHW per each selected village was identified and trained to conduct CVD risk screening using a BMI-based CVD risk screening tool. Each CHW was assigned to screen 100 fellow community members (CMs) for CVD risk and to refer those with CVD risk scores ≥10 (either moderate or high CVD risk) to a health facility for care and further management. Descriptive statistics with Pearson’s chi-square test were used to assess any differences between rural and urban study participants vis-à-vis the key studied variables. Spearman’s rank coefficient and Cohen’s Kappa coefficient were mainly used to compare the CVD risk scoring from the CHWs with the CVD risk scoring from the nurses. Community members aged 35 to 74 years were included in the study. The participation rates were 99.6% and 99.4% in rural and urban communities, respectively, with female predominance (57.8% vs. 55.3% for rural and urban, p-value: 0.426). Of the participants screened, 7.4% had a high CVD risk (≥20%), with predominance in the rural community compared to the urban community (8.0% vs. 6.8%, p-value: 0.111). Furthermore, the prevalence of moderate or high CVD risk (≥10%) was higher in the rural community than in the urban community (26.7% vs. 21.1%, p-value: 0.111). There was a strong positive correlation between CHW-based CVD risk scoring and nurse-based CVD risk scoring in both rural and urban communities, 0.6215 (p-value < 0.001) vs. 0.7308 (p-value = 0.005). In regard to CVD risk characterization, the observed agreement to both the CHW-generated 10-year CVD risk assessment and the nurse-generated 10-year CVD risk assessment was characterized as “fair” in both rural and urban areas at 41.6% with the kappa statistic of 0.3275 (p-value < 001) and 43.2% with kappa statistic of 0.3229 (p-value =0.057), respectively. In Rwanda, CHWs can screen their fellow CMs for CVD risk and link those with high CVD risk to the healthcare facility for care and follow-up. CHWs could contribute to the prevention of CVDs through early diagnosis and early treatment at the bottom of the health system.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Settings Community Health Worker Selection and Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Community Health Worker-Led Cardiovascular Disease Risk Screening and Referral for Care and Further Management in Rural and Urban Communities in Rwanda

Niyibizi

Ntawuyirushintege

Nganabashaka

et al. 2023

IJERPH

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Blood pressure screening in Mata Sector, a rural area of Rwanda

Hunjan,

Umulisa,

Parati

et al. 2024

J Hum Hypertens

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In rural sub-Saharan Africa, knowledge of non-communicable diseases such as high blood pressure (BP) is rather limited. This report provides information about a BP screening in Mata Sector, a rural region in Southern Province of Rwanda. Community-based, house-to-house screening was performed between February and July 2020 on more than 7000 inhabitants. The screening was conducted by a local team composed by 20 community health care workers, five community health care supervisors, and one nurse with hypertension surveillance training. BP and heart rate were recorded after 5 min of resting, using a validated automated oscillometric OMRON M6 IT-HEM-7322-E monitor with Intelli Wrap Cuff (HEM-FL31-E) technology. The mean of the second and third value was retained. BP was normal (<140/90 mm Hg) in 6340 (88%) and elevated in 863 (12%) participants with 95% of unawareness. Grade 1 (140–159/90–99 mm Hg) hypertensive BP readings were detected in 697 (81%), grade 2 (160–179/100–109 mm Hg) in 134 (16%), and grade 3 (≥180/≥110 mm Hg) in 32 (3.7%) individuals. The prevalence of hypertensive readings was significantly age-dependent. Additionally, a slightly greater proportion of participants with high BP (14% versus 11%) had a body mass index (BMI) ≥ 25.0 kg/m2. Also resting heart rate was higher in individuals with high BP (82 versus 77 beats/min). Although individuals identified with occasionally elevated BP values need further confirmatory measurements to establish the diagnosis of hypertension, these data suggest that high BP represents a noteworthy and preventable reason of concern within sub-Saharan Africa.

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Multi-country collaborative citizen science projects to co-design cardiovascular disease prevention strategies and advocacy: findings from Ethiopia, Malawi, Rwanda, and South Africa

Okop,

Kedir,

Kasenda

et al. 2023

BMC Public Health

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Background Cardiovascular diseases (CVD) were responsible for 20.5 million annual deaths globally in 2021, with a disproportionally high burden in sub-Saharan Africa (SSA). There is growing evidence of the use of citizen science and co-design approaches in developing interventions in different fields, but less so in the context of CVD prevention interventions in SSA. This paper reports on the collaborative multi-country project that employed citizen science and a co-design approach to (i) explore CVD risk perceptions, (ii) develop tailored prevention strategies, and (iii) support advocacy in different low-income settings in SSA. Methods This is a participatory citizen science study with a co-design component. Data was collected from 205 participants aged 18 to 75 years in rural and urban communities in Malawi, Ethiopia and Rwanda, and urban South Africa. Fifty-one trained citizen scientists used a mobile app-based (EpiCollect) semi-structured survey questionnaire to collect data on CVD risk perceptions from participants purposively selected from two communities per country. Data collected per community included 100–150 photographs and 150–240 voice recordings on CVD risk perceptions, communication and health-seeking intentions. Thematic and comparative analysis were undertaken with the citizen scientists and the results were used to support citizen scientists-led stakeholder advocacy workshops. Findings are presented using bubble graphs based on weighted proportions of key risk factors indicated. Results Nearly three in every five of the participants interviewed reported having a relative with CVD. The main perceived causes of CVD in all communities were substance use, food-related factors, and litter, followed by physical inactivity, emotional factors, poverty, crime, and violence. The perceived positive factors for cardiovascular health were nutrition, physical activity, green space, and clean/peaceful communities. Multi-level stakeholders (45–84 persons/country) including key decision makers participated in advocacy workshops and supported the identification and prioritization of community-specific CVD prevention strategies and implementation actions. Citizen science-informed CVD risk screening and referral to care interventions were piloted in six communities in three countries with about 4795 adults screened and those at risk referred for care. Health sector stakeholders indicated their support for utilising a citizen-engaged approach in national NCDs prevention programmes. The citizen scientists were excited by the opportunity to lead research and advocacy. Conclusion The collaborative engagement, participatory learning, and co-designing activities enhanced active engagement between citizen scientists, researchers, and stakeholders. This, in turn, provided context-specific insights on CVD prevention in the different SSA settings.

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Perceived cardiovascular disease risk and tailored communication strategies among rural and urban community dwellers in Rwanda: a qualitative study

Cited by 9 publications

References 18 publications

Community Health Worker-Led Cardiovascular Disease Risk Screening and Referral for Care and Further Management in Rural and Urban Communities in Rwanda

Community Health Worker-Led Cardiovascular Disease Risk Screening and Referral for Care and Further Management in Rural and Urban Communities in Rwanda

Blood pressure screening in Mata Sector, a rural area of Rwanda

Multi-country collaborative citizen science projects to co-design cardiovascular disease prevention strategies and advocacy: findings from Ethiopia, Malawi, Rwanda, and South Africa

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