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Implementing a hypertension management programme in a rural area: local approaches and experiences from Ba-Vi district, Vietnam
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
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2011 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, 325- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Costly efforts have been invested to control and prevent cardiovascular diseases (CVD) and their risk factors but the ideal solutions for low resource settings remain unclear. This paper aims at summarising our approaches to implementing a programme on hypertension management in a rural commune of Vietnam.

METHODS: In a rural commune, a programme has been implemented since 2006 to manage hypertensive people at the commune health station and to deliver health education on CVD risk factors to the entire community. An initial cross-sectional survey was used to screen for hypertensives who might enter the management programme. During 17 months of implementation, other people with hypertension were also followed up and treated. Data were collected from all individual medical records, including demographic factors, behavioural CVD risk factors, blood pressure levels, and number of check-ups. These data were analysed to identify factors relating to adherence to the management programme.

RESULTS: Both top-down and bottom-up approaches were applied to implement a hypertension management programme. The programme was able to run independently at the commune health station after 17 months. During the implementation phase, 497 people were followed up with an overall regular follow-up of 65.6% and a dropout of 14.3%. Severity of hypertension and effectiveness of treatment were the main factors influencing the decision of people to adhere to the management programme, while being female, having several behavioural CVD risk factors or a history of chronic disease were the predictors for deviating from the programme.

CONCLUSION: Our model showed the feasibility, applicability and future potential of a community-based model of comprehensive hypertension care in a low resource context using both top-down and bottom-up approaches to engage all involved partners. This success also highlighted the important roles of both local authorities and a cardiac care network, led by an outstanding cardiac referral centre.

Place, publisher, year, edition, pages
BioMed Central, 2011. Vol. 11, 325- p.
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-51833DOI: 10.1186/1471-2458-11-325PubMedID: 21586119OAI: oai:DiVA.org:umu-51833DiVA: diva2:489504
Available from: 2012-02-03 Created: 2012-02-03 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Understanding and managing cardiovascular disease risk factors in Vietnam: integrating clinical and public health perspectives
Open this publication in new window or tab >>Understanding and managing cardiovascular disease risk factors in Vietnam: integrating clinical and public health perspectives
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Vietnam, like other low-income countries, is facing an epidemic burden of cardiovascular disease risk factors (CVDRFs). The magnitude and directions of CVDRF progression are matters of uncertainty.

Objectives: To describe the epidemiological progression of CVDRFs and the preventive effects of community lifestyle interventions, with reference to the differences in progression of CVDRF patterns between men and women.

Methods: The study was conducted during 2001-2009 in nationally representative samples and in a local setting of rural areas of Ba-Vi district, Ha-Tay province. Both epidemiological and interventional approaches were applied: (i) a population-based cross-sectional survey of 2,130 people aged ≥25 years in Thai-Binh and Hanoi; (ii) an individual participant-level meta analysis of 23,563 people aged 24-74 years from multiple similar surveys in 9 provinces around Vietnam; (iii) a 17-month cohort study of 497 patients in a hypertension management programme; (iv) a quasi-experimental trial on community lifestyle promotion integrated with a hypertension management programme, evaluated by surveys of 4,645 people in both intervention and reference communes before and after a 3-year intervention.

Main findings: (i) in the general adult population ≥25 years, CVDRFs were common, often clustered within individuals, and increased with age; (ii) the Vietnamese population is facing a growing epidemic of CVDRFs, which are generally not well managed; (iii) it is possible to launch a community intervention in low-resource settings within the scope of a commune-based patient-targeted programme on hypertension management; (iv) community health intervention with comprehensive healthy lifestyle promotion improves blood pressure and some behavioural CVDRFs.

Conclusion: Alarming increases in CVDRFs in the general population need comprehensive multi-level prevention strategies, which combine both individual high-risk and population health approaches. The commune-based hypertension-centred management programmes integrated with community health promotion are the initial but essential steps towards comprehensive and effective management of CVDRFs and should be part of an integrated and co-ordinated national program on the prevention and control of chronic diseases in low-resource settings like Vietnam.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2012. 62 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1498
Keyword
cardiovascular disease risk factors, epidemiology, prevention, hypertension, Vietnam, yếu tố nguy cơ bệnh tim mạch, dịch tễ học, dự phòng, tăng huyết áp, Việt Nam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-55132 (URN)978-91-7459-420-1 (ISBN)
Public defence
2012-06-01, Room 135, Family Medicine, Umeå University Hospital, Umeå, Sweden, 13:00 (English)
Opponent
Supervisors
Available from: 2012-05-11 Created: 2012-05-09 Last updated: 2015-04-29Bibliographically approved
2. Hypertension in Vietnam: from community-based studies to a national targeted programme
Open this publication in new window or tab >>Hypertension in Vietnam: from community-based studies to a national targeted programme
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In the context of transitional Vietnam, hypertension has been shown to be one of the ten leading causes of morbidity and mortality in hospitals. However, population-based data on hypertension are to a large extent lacking. This thesis aims to characterise the current epidemiology of hypertension in the adult Vietnamese population and provide preliminary evidence for developing effective community-based hypertension management programmes nationwide.

Methods: The study was conducted during 2002-2010. It includes two national surveys of the adult population aged 25 years and older, randomly selected in eight provinces in different regions of Vietnam, as well as a community-based programme on hypertension management in two communes of Bavi district. The survey on hypertension and associated risk factors, which included 9,832 adults, applied the WHO STEP-wise approach. The survey on hypertension-related knowledge and health seeking behaviour included 31,720 adults, using a structured questionnaire. For the community-based study, three-year follow-up data on 860 hypertensives was used to assess the effectiveness of the hypertension control model.

Main findings: Hypertension prevalence was high (overall 25.1%, 28.3% in men and 23.1% in women). The proportions of hypertensives aware, treated and controlled were unacceptably low (48.4%, 29.6% and 10.7% respectively). Most Vietnamese adults (82.4%) had good knowledge about high blood pressure. People received their information on hypertension from mass media (newspapers, radio, and especially television). Most people would choose a commune health station (75%) if seeking health care for hypertension. The programme on hypertension control was able to run independently at the commune health station. Severity of hypertension and effectiveness of treatment were the main factors influencing people’s adherence to the programme. The hypertension control programme successfully reduced blood pressure (systolic blood pressure: -2.2 mmHg in men and -7.8 mmHg in women; diastolic blood pressure: -4.3 mmHg in men and -6.8 mmHg in women), the estimated CVD 10-year risk (-2.5% in women), and increased the proportions of treatment (22% in men and 13.6% in women) and control (11% in men and 17.3% in women) among hypertensive people.

Suggestions for hypertension control: (1) Address the general population by developing community interventions, particularly salt reduction; (2) Provide interventions to individuals at high risk of a CVD event, including multi-drug treatment within patient-centred primary health care. (3) Set up a hypertension care network based in the existing health care system; (4) Improve and strengthen capacity and skills of medical staff in cardiac care, particularly staff at primary care level.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2012. 81 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1499
Keyword
Hypertension, risk factor, community, programme, Vietnam
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-55175 (URN)978-91-7459-421-8 (ISBN)
Public defence
2012-06-01, Sal 135, Allmänmedicin, Byggnad 9 A, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2012-05-11 Created: 2012-05-10 Last updated: 2015-04-29Bibliographically approved

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