Feasibility of Community Health Worker based cardiovascular risk reduction strategies in urban slums of Bhopal: Rationale and design of community based study

In urban India, about 35-40% of all adults have hypertension and about 10-15% have diabetes mellitus. National Program for Prevention and Control of Diabetes, Cancer and Stroke (NPCDCS) launched by Government of India has envisaged to screen all adults aged 30 years and above for presence of hypertension and diabetes mellitus in the community through population-based screening, initiate positively screened and diagnosed on drug therapy, and follow them up for treatment adherence. In this context, the current study aims to estimate burden of high cardiovascular disease (CVD) risk and to evaluate feasibility of community health workers-based strategies in reducing CVD among adults living in urban slums. We have identified and trained CHWs from within the urban slum communities in Bhopal, in chronic disease identification, skills in self-care and adherence promotion skills. At-risk individuals were linked to public health facilities as outlined under NPCDCS. Primary outcome is assessment of burden of high cardiovascular risk and its determinants. Secondary outcome is feasibility of community health worker-based adherence promotion. Between November 2017 and June 2018, CHWs in 14 urban slum clusters, screened a total of 6178 individuals out of which 4781 (77.43%) attended confirmation camp. Around 2393 (38.8%) were current tobacco users (smoking and/or smokeless), and 4697 (76.1%) has a sedentary lifestyle. Out of 758 (12.3%) known hypertensives, 354 (46.7%) had controlled hypertension whereas out of 333 (5.4%) known diabetes patients, 169 (57.5%) has controlled level of diabetes. In 813 (15%) out of 5416 and 151 (3.4%) out of 4486 adults, hypertension and diabetes was newly detected respectively. Results of this study have a potential to strengthen NPCDCS across all urban areas of the country. This manuscript describes detailed protocol of the study and presents baseline summary of CVD risk factor burden in urban slums of Bhopal.