Assessing cardiovascular disease risk factor screening inequalities in India using Lot Quality Assurance Sampling.
Cardiovascular diseases
India
Lot quality assurance sampling
Mass screening
Primary health care
Risk factors
Socioeconomic factors
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
25 Nov 2020
25 Nov 2020
Historique:
received:
05
08
2020
accepted:
10
11
2020
entrez:
26
11
2020
pubmed:
27
11
2020
medline:
15
5
2021
Statut:
epublish
Résumé
Cardiovascular diseases (CVDs) are the leading cause of mortality in India. India has rolled out Comprehensive Primary Health Care (CPHC) reforms including population based screening for hypertension and diabetes, facilitated by frontline health workers. Our study assessed blood pressure and blood sugar coverage achieved by frontline workers using Lot Quality Assurance Sampling (LQAS). LQAS Supervision Areas were defined as catchments covered by frontline workers in primary health centres in two districts each of Uttar Pradesh and Delhi. In each Area, 19 households for each of four sampling universes (males, females, Above Poverty Line (APL) and Below Poverty Line (BPL)) were visited using probability proportional to size sampling. Following written informed consent procedures, a short questionnaire was administered to individuals aged 30 or older using tablets related to screening for diabetes and hypertension. Using the LQAS hand tally method, coverage across Supervision Areas was determined. A sample of 2052 individuals was surveyed, median ages ranging from 42 to 45 years. Caste affiliation, education levels, and occupation varied by location; the sample was largely married and Hindu. Awareness of and interaction with frontline health workers was reported in Uttar Pradesh and mixed in Delhi. Greater coverage of CVD risk factor screening (especially blood pressure) was seen among females, as compared to males. No clear pattern of inequality was seen by poverty status; some SAs did not have adequate BPL samples. Overall, blood pressure and blood sugar screening coverage by frontline health workers fell short of targeted coverage levels at the aggregate level, but in all sites, at least one area was crossing this threshold level. CVD screening coverage levels at this early stage are low. More emphasis may be needed on reaching males. Sex and poverty related inequalities must be addressed by more closely studying the local context and models of service delivery where the threshold of screening is being met. LQAS is a pragmatic method for measuring program inequalities, in resource-constrained settings, although possibly not for spatially segregated population sub-groups.
Sections du résumé
BACKGROUND
BACKGROUND
Cardiovascular diseases (CVDs) are the leading cause of mortality in India. India has rolled out Comprehensive Primary Health Care (CPHC) reforms including population based screening for hypertension and diabetes, facilitated by frontline health workers. Our study assessed blood pressure and blood sugar coverage achieved by frontline workers using Lot Quality Assurance Sampling (LQAS).
METHODS
METHODS
LQAS Supervision Areas were defined as catchments covered by frontline workers in primary health centres in two districts each of Uttar Pradesh and Delhi. In each Area, 19 households for each of four sampling universes (males, females, Above Poverty Line (APL) and Below Poverty Line (BPL)) were visited using probability proportional to size sampling. Following written informed consent procedures, a short questionnaire was administered to individuals aged 30 or older using tablets related to screening for diabetes and hypertension. Using the LQAS hand tally method, coverage across Supervision Areas was determined.
RESULTS
RESULTS
A sample of 2052 individuals was surveyed, median ages ranging from 42 to 45 years. Caste affiliation, education levels, and occupation varied by location; the sample was largely married and Hindu. Awareness of and interaction with frontline health workers was reported in Uttar Pradesh and mixed in Delhi. Greater coverage of CVD risk factor screening (especially blood pressure) was seen among females, as compared to males. No clear pattern of inequality was seen by poverty status; some SAs did not have adequate BPL samples. Overall, blood pressure and blood sugar screening coverage by frontline health workers fell short of targeted coverage levels at the aggregate level, but in all sites, at least one area was crossing this threshold level.
CONCLUSION
CONCLUSIONS
CVD screening coverage levels at this early stage are low. More emphasis may be needed on reaching males. Sex and poverty related inequalities must be addressed by more closely studying the local context and models of service delivery where the threshold of screening is being met. LQAS is a pragmatic method for measuring program inequalities, in resource-constrained settings, although possibly not for spatially segregated population sub-groups.
Identifiants
pubmed: 33238995
doi: 10.1186/s12913-020-05914-y
pii: 10.1186/s12913-020-05914-y
pmc: PMC7687829
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1077Subventions
Organisme : Harvard T.H. Chan School of Public Health
ID : BLSCHP-1602-1
Références
PLoS One. 2016 Feb 19;11(2):e0149824
pubmed: 26895419
Int J Cardiol. 2015;187:519-24
pubmed: 25846664
BMJ. 2018 Nov 7;363:k4247
pubmed: 30404896
PLoS One. 2015 Jul 08;10(7):e0127199
pubmed: 26154083
PLoS One. 2013 Nov 19;8(11):e79726
pubmed: 24260293
Lancet Diabetes Endocrinol. 2017 Aug;5(8):585-596
pubmed: 28601585
PLoS One. 2019 Mar 26;14(3):e0213708
pubmed: 30913216
Lancet. 2011 Feb 26;377(9767):760-8
pubmed: 21227489
Natl Med J India. 2010 Sep-Oct;23(5):267-73
pubmed: 21250580
BMC Public Health. 2008 Jul 16;8:240
pubmed: 18631382
Soc Sci Med. 2006 Sep;63(6):1648-60
pubmed: 16764978
Global Health. 2012 Apr 25;8:9
pubmed: 22533895
BMJ Open. 2016 Jul 27;6(7):e010085
pubmed: 27466234
Indian J Community Med. 2011 Dec;36(Suppl 1):S13-22
pubmed: 22628905
J Epidemiol Community Health. 2017 Jun;71(6):550-557
pubmed: 27974445
Glob Health Action. 2015 Oct 09;8:27526
pubmed: 26455491
BMC Public Health. 2012 Jun 22;12:474
pubmed: 22726343
Glob Heart. 2019 Dec;14(4):355-365
pubmed: 31523014
Front Public Health. 2016 Jan 07;3:282
pubmed: 26779475
Health Policy Plan. 2015 Sep;30(7):837-43
pubmed: 25063699
Lancet Glob Health. 2018 Dec;6(12):e1339-e1351
pubmed: 30219317
Indian J Public Health. 2015 Jul-Sep;59(3):232-3
pubmed: 26354403
Proc Natl Acad Sci U S A. 2007 Oct 9;104(41):16263-8
pubmed: 17923677
Natl Med J India. 2012 Mar-Apr;25(2):65-7
pubmed: 22686710
Lancet. 2015 Dec 12;386(10011):2422-35
pubmed: 26700532
BMJ Glob Health. 2018 Jun 29;3(3):e000859
pubmed: 29989065
BMC Health Serv Res. 2014 Oct 02;14:451
pubmed: 25274447
SSM Popul Health. 2019 Feb 02;9:100372
pubmed: 31998823
Trop Med Int Health. 2014 Oct;19(10):1237-48
pubmed: 25134414
BMC Public Health. 2012 Apr 26;12:306
pubmed: 22537240
Circulation. 2016 Apr 19;133(16):1605-20
pubmed: 27142605
PLoS One. 2013 Jul 15;8(7):e68219
pubmed: 23869213
Am J Public Health. 2018 Apr;108(4):464-471
pubmed: 29470118
Best Pract Res Clin Obstet Gynaecol. 2015 Jan;29(1):32-42
pubmed: 25199858
Health Policy Plan. 2015 Mar;30(2):181-6
pubmed: 24463334
Health Policy Plan. 2017 Feb;32(1):79-90
pubmed: 27515405
PLoS Med. 2018 Jun 19;15(6):e1002581
pubmed: 29920517
Lancet. 2011 Jan 29;377(9763):413-28
pubmed: 21227486
Glob Heart. 2015 Dec;10(4):273-80
pubmed: 26410401
Hum Resour Health. 2019 Oct 22;17(1):73
pubmed: 31640722
Int J Epidemiol. 2006 Dec;35(6):1522-9
pubmed: 16997852
Asia Pac J Public Health. 2016 Jan;28(1 Suppl):77S-85S
pubmed: 26316502
J Infect Dis. 2014 Nov 1;210 Suppl 1:S333-40
pubmed: 25316852
Natl Med J India. 2017 Sep-Oct;30(5):249-254
pubmed: 29916423
Glob Health Action. 2018;11(1):1438840
pubmed: 29589512
Trop Med Int Health. 2014 Oct;19(10):1226-36
pubmed: 25039710
MMWR Suppl. 2006 Apr 28;55(1):16-9
pubmed: 16645577
Int J Epidemiol. 2013 Oct;42(5):1431-5
pubmed: 23920139