Referral outcomes of individuals identified at high risk of cardiovascular disease by community health workers in Bangladesh, Guatemala, Mexico, and South Africa

Glob Health Action. 2015 Apr 7;8:26318. doi: 10.3402/gha.v8.26318. eCollection 2015.


Background: We have found that community health workers (CHWs) with appropriate training are able to accurately identify people at high cardiovascular disease (CVD) risk in the community who would benefit from the introduction of preventative management, in Bangladesh, Guatemala, Mexico, and South Africa. This paper examines the attendance pattern for those individuals who were so identified and referred to a health care facility for further assessment and management.

Design: Patient records from the health centres in each site were reviewed for data on diagnoses made and treatment commenced. Reasons for non-attendance were sought from participants who had not attended after being referred. Qualitative data were collected from study coordinators regarding their experiences in obtaining the records and conducting the record reviews. The perspectives of CHWs and community members, who were screened, were also obtained.

Results: Thirty-seven percent (96/263) of those referred attended follow-up: 36 of 52 (69%) were urgent and 60 of 211 (28.4%) were non-urgent referrals. A diagnosis of hypertension (HTN) was made in 69% of urgent referrals and 37% of non-urgent referrals with treatment instituted in all cases. Reasons for non-attendance included limited self-perception of risk, associated costs, health system obstacles, and lack of trust in CHWs to conduct CVD risk assessments and to refer community members into the health system.

Conclusions: The existing barriers to referral in the health care systems negatively impact the gains to be had through screening by training CHWs in the use of a simple risk assessment tool. The new diagnoses of HTN and commencement on treatment in those that attended referrals underscores the value of having persons at the highest risk identified in the community setting and referred to a clinic for further evaluation and treatment.

Keywords: Bangladesh; Guatemala; Mexico; South Africa; cardiovascular risk assessment; community health workers; low-middle income countries; referral outcomes.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Bangladesh
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / therapy*
  • Community Health Workers / organization & administration*
  • Female
  • Guatemala
  • Humans
  • Hypertension / diagnosis
  • Hypertension / therapy
  • Male
  • Mexico
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Poverty / statistics & numerical data
  • Program Evaluation
  • Referral and Consultation / organization & administration*
  • Referral and Consultation / statistics & numerical data*
  • Risk Assessment / methods
  • South Africa