College of Medicine and Health Sciences, University of Rwanda, Kigali 4285, Rwanda.
Global Public Health, Karolinska Institute, 171 77 Stockholm, Sweden.
Int J Environ Res Public Health. 2023 Apr 25;20(9):5641. doi: 10.3390/ijerph20095641.
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, -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%, -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%, -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 (-value < 0.001) vs. 0.7308 (-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 (-value < 001) and 43.2% with kappa statistic of 0.3229 (-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.
心血管疾病（CVD）是一个全球性的健康问题。中低收入国家（LMICs）正面临着与心血管疾病相关的早期发病。早期诊断和治疗是应对 CVD 的有效策略。本研究的目的是评估社区卫生工作者（CHWs）使用基于身体质量指数（BMI）的 CVD 风险评估工具在社区中筛查和识别具有 CVD 高风险人群的能力，并将其转介到医疗机构进行护理和随访。这是在卢旺达农村和城市社区进行的一项行动研究，采用便利抽样。从每个社区随机选择 5 个村庄，每个选定的村庄确定一名 CHW，并对其进行基于 BMI 的 CVD 风险筛查工具的 CVD 风险筛查培训。每个 CHW 被分配筛查 100 名社区成员（CMs）的 CVD 风险，并将 CVD 风险评分≥10（中度或高度 CVD 风险）的人转介到医疗机构进行护理和进一步管理。采用描述性统计和 Pearson's chi-square 检验评估农村和城市研究参与者在关键研究变量方面的差异。Spearman's rank 系数和 Cohen's Kappa 系数主要用于比较 CHWs 的 CVD 风险评分与护士的 CVD 风险评分。纳入 35 至 74 岁的社区成员。农村和城市社区的参与率分别为 99.6%和 99.4%，女性居多（农村和城市分别为 57.8%和 55.3%，-值：0.426）。在接受筛查的参与者中，7.4%有高 CVD 风险（≥20%），农村社区的高 CVD 风险比例高于城市社区（农村和城市分别为 8.0%和 6.8%，-值：0.111）。此外，农村社区中度或高度 CVD 风险（≥10%）的患病率高于城市社区（农村和城市分别为 26.7%和 21.1%，-值：0.111）。在农村和城市社区，基于 CHW 的 CVD 风险评分与基于护士的 CVD 风险评分之间存在强烈的正相关，分别为 0.6215（-值 < 0.001）和 0.7308（-值 = 0.005）。关于 CVD 风险特征，在农村和城市地区，CHW 生成的 10 年 CVD 风险评估和护士生成的 10 年 CVD 风险评估的观察一致性均为“中度”，kappa 统计值分别为 0.3275（-值 < 001）和 0.3229（-值 = 0.057）。在卢旺达，CHWs 可以为他们的社区成员筛查 CVD 风险，并将那些有高 CVD 风险的人转介到医疗机构进行护理和随访。CHWs 可以通过在底层卫生系统进行早期诊断和早期治疗，为预防 CVD 做出贡献。
