A village health worker intervention to reduce cardiovascular disease risk in remote areas of armed conflict in Myanmar: Results from a feasibility study in three villages
Cardiovascular disease (CVD) is a leading cause of death in low-income countries and those affected by armed conflict, including Myanmar. Community health worker interventions can effectively address CVD risk factors but have not been tested among displaced populations in active conflict zones.
This feasibility study tested a village health worker (VHW) care model to identify individuals at high CVD risk and deliver care in conflict-affected regions of Karen State, Myanmar. Following a village census, trained VHWs and medics screened individuals aged 40 or over for CVD risk factors in three villages. Eligible individuals had hypertension, diabetes, calculated CVD risk over 10%, or a history of heart attack or stroke, confirmed during a second visit. VHWs visited households every 3–6 weeks for two months to monitor blood pressure, glucose, medication adherence and side effects, and deliver medic-prescribed medications.
CVD teams screened 294 individuals, conducted confirmatory visits with 132, enrolled all 97 eligible participants, and completed two home visits with 94 patients. Several prescription errors were made, halting medication initiation; root cause analysis identified opportunities to improve pre-testing of electronic tools and strengthen clinician CVD training. The proportion of eligible participants receiving antihypertensive or statin medications increased from 23% to 56%. Among those with hypertension, the proportion achieving blood pressure control below 140/90 mmHg increased from 22.9% to 65.7%. Qualitative assessment revealed support for the care model.
A VHW care model for CVD in remote villages in Myanmar experiencing armed conflict is feasible and can increase medication access.
This article relates to R2HC funded study Implementation of a community-led strategy to reduce cardiovascular disease risk among conflict-affected populations in eastern Myanmar