Effectiveness of community–based hypertension intervention program in a resource poor rural settings in Tamil Nadu, India

J. Stanley Michael; Bharti Omesh K; Sood Rajesh K; Archana Phull

Volume : VI, Issue : III, March - 2016

Effectiveness of community–based hypertension intervention program in a resource poor rural settings in Tamil Nadu, India

J. Stanley Michael, Bharti Omesh K, Sood Rajesh K, Archana Phull

Abstract :

Background: We conducted a pilot study to determine whether blood pressure control in primary care setting could be improved with the use of community–based volunteers by counselling and monitoring of the hypertensive patients. Methods: We conducted an intervention study with the base–line and followed up blood pressure (BP) measurements among patients with hypertension in two villages of Thiruvallur district, Tamil Nadu. Primary care physician and health workers initiated treatment with either drugs or life style modification (LSM) using WHO protocol for Cardiovascular Disease risk management. Trained community volunteers counselled the patients on LSM and monitored BP monthly. We compared mean systolic Blood Pressure (SBP) and diastolic Blood Pressure (DBP) and proportion with BP control at baseline and follow up. We calculated adjusted Odds Ratios (AOR) and 95% confidence intervals (95%CI) for factors associated with lack of blood pressure control and non compliance to regular drugs. Results: We included 599 patients from Nemam and Gudapakkam villages. Of these, we assessed 571 (95%) at the fourth month post–intervention. Of the 571 patients at the baseline, 163 (29%) were on regular treatment, 73 (13%) were irregular and 52 (9%) had started and stopped drugs. Among 571 patients on LSM, 83% had reduced salt and 61% had reduced oil/fried foods. Most commonly adopted combinations of LSM were reduced salt and oil (60%) and reduced salt and non–vegetarian food (34%). At follow up almost 50% of the patients were on LSM and similar proportion was on LSM and drugs. Difficulty in adhering to LSM changes was experienced by 192 (34%). At follow up, patients on monotherapy were (n=153, 27%), on two drugs (n=107, 19%) and on three drugs (n=11, 2%). Overall proportion with BP control increased from 22% to 49%. Overall mean SBP & DBP decline was 9.4 and 3.9 mmHg respectively. In multivariate analysis, lack of BP control was mainly associated with male sex (2.6;1.43 – 4.75 ), difficulty in adhering to LSM (2.1; 1.14¬3.88}, non– compliance to regular drug intake (4.9; 2.67–8.9). Conclusions: Protocol based approach and use of trained community volunteers to monitor blood pressure and counselling of patients on LSM achieved blood pressure control and increased compliance to drugs due to continuous monitoring and sustained drug supply