PMID- 33238995
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20210514
IS  - 1472-6963 (Electronic)
IS  - 1472-6963 (Linking)
VI  - 20
IP  - 1
DP  - 2020 Nov 25
TI  - Assessing cardiovascular disease risk factor screening inequalities in India 
      using Lot Quality Assurance Sampling.
PG  - 1077
LID - 10.1186/s12913-020-05914-y [doi]
LID - 1077
AB  - 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: 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: 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: 
      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.
FAU - Nambiar, Devaki
AU  - Nambiar D
AUID- ORCID: 0000-0001-5682-6109
AD  - George Institute for Global Health, 311-312, Third Floor, Elegance Tower, Plot 
      No. 8, Jasola District Centre, New Delhi, 110025, India. 
      devaki.nambiar@gmail.com.
AD  - Faculty of Medicine, University of New South Wales, Sydney, Australia. 
      devaki.nambiar@gmail.com.
AD  - Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, 
      India. devaki.nambiar@gmail.com.
AD  - Bernard Lown Scholars for Cardiovascular Health Program, Harvard T. H. Chan 
      School of Public Health, Boston, USA. devaki.nambiar@gmail.com.
FAU - Bhaumik, Soumyadeep
AU  - Bhaumik S
AD  - George Institute for Global Health, 311-312, Third Floor, Elegance Tower, Plot 
      No. 8, Jasola District Centre, New Delhi, 110025, India.
AD  - Faculty of Medicine, University of New South Wales, Sydney, Australia.
FAU - Pal, Anita
AU  - Pal A
AD  - Department of Education and Education Technology, University of Hyderabad, 
      Hyderabad, India.
FAU - Ved, Rajani
AU  - Ved R
AD  - Bernard Lown Scholars for Cardiovascular Health Program, Harvard T. H. Chan 
      School of Public Health, Boston, USA.
AD  - National Health Systems Resource Centre, New Delhi, India.
LA  - eng
GR  - BLSCHP-1602-1/Harvard T.H. Chan School of Public Health/
PT  - Journal Article
DEP - 20201125
PL  - England
TA  - BMC Health Serv Res
JT  - BMC health services research
JID - 101088677
SB  - IM
MH  - Adult
MH  - *Cardiovascular Diseases/diagnosis/epidemiology
MH  - Female
MH  - Humans
MH  - India/epidemiology
MH  - *Lot Quality Assurance Sampling
MH  - Male
MH  - Middle Aged
MH  - Quality Assurance, Health Care
MH  - Risk Factors
MH  - Sampling Studies
PMC - PMC7687829
OTO - NOTNLM
OT  - Cardiovascular diseases
OT  - India
OT  - Lot quality assurance sampling
OT  - Mass screening
OT  - Primary health care
OT  - Risk factors
OT  - Socioeconomic factors
COIS- The authors declare that they have no competing interests.
EDAT- 2020/11/27 06:00
MHDA- 2021/05/15 06:00
PMCR- 2020/11/25
CRDT- 2020/11/26 05:29
PHST- 2020/08/05 00:00 [received]
PHST- 2020/11/10 00:00 [accepted]
PHST- 2020/11/26 05:29 [entrez]
PHST- 2020/11/27 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2020/11/25 00:00 [pmc-release]
AID - 10.1186/s12913-020-05914-y [pii]
AID - 5914 [pii]
AID - 10.1186/s12913-020-05914-y [doi]
PST - epublish
SO  - BMC Health Serv Res. 2020 Nov 25;20(1):1077. doi: 10.1186/s12913-020-05914-y.