A new WHO/Europe study reveals that improved blood-pressure control at the primary health-care level in Tajikistan can be achieved in 12 months using WHO tools. Elevated blood pressure is a condition directly linked to many cardiovascular diseases, which are prevalent in the country.
“This is an important study that shows that even in a relatively low-resource setting, it is possible to achieve and demonstrate change in clinical practice that can be of benefit to patient health,” says Dr Jill Farrington, Regional Medical Officer, Cardiovascular Diseases and Diabetes, WHO/Europe.
The study, published in BMC Health Services Research, examines the implementation and evaluation of essential interventions for the management of hypertension and the prevention of cardiovascular diseases in primary health care.
Disease burden requiring action
The burden of cardiovascular diseases in Tajikistan makes the detection and management of risk factors in primary health-care settings particularly crucial.
The most recent WHO-endorsed STEPwise approach to surveillance (STEPS) report revealed that one third of people in Tajikistan have never had their blood pressure measured, and more than 30% of the population has elevated blood pressure. Findings of the report also showed that over three quarters of the population with elevated blood pressure are not receiving appropriate treatment.
Noncommunicable diseases (NCDs) are the leading cause of death in the WHO European Region. The risk of premature mortality from the 4 major NCDs (cardiovascular diseases, diabetes, cancer and chronic respiratory diseases) is high in Tajikistan, with men being disproportionally affected.
Pilot study to improve cardiovascular health
In 2018, Tajikistan piloted and evaluated the newly developed WHO package of essential NCD interventions (PEN) related to healthy lifestyles, evidence-based treatment protocols, access to essential medicines and technology, risk-based management, team care and task sharing, and systems for monitoring (HEARTS). The WHO PEN/HEARTS technical package aims to provide a strategic approach to improving cardiovascular health using simplified clinical guidelines.
Together with WHO/Europe and the WHO Country Office in Tajikistan, the Ministry of Health and Social Protection convened a national steering group tasked with adapting, piloting and evaluating the technical package with a particular focus on systems monitoring, building sustainable and scalable approaches, and integrating with other health system reforms.
To achieve this, a study that included a complex intervention was developed and piloted in one region of Tajikistan with the participation of 19 primary health-care centres. The study consisted of:
- the adaptation of WHO PEN/HEARTS clinical algorithms for hypertension and diabetes;
- a 2-day training course for 120 doctors and nurses on the prevention and management of cardiovascular disease risk factors;
- supportive supervision visits;
- clinical decision support tools; and
- quality-improvement support.
After 12 months, blood pressure control significantly improved, as did the assessment of risk factors including blood pressure measurement and smoking status, and prescription of statins and triple therapy.
In the long run, these improvements could translate into significant reductions in premature death from NCDs, including heart disease. This is essential for building an evidence-based health-care system in Tajikistan, and for aligning with the Sustainable Development Goals and the WHO European Programme of Work 2020–2025 to leave no one behind.
The project was financially supported by grants from the United States Centers for Disease Control and Prevention (CDC), and the governments of Denmark, Germany and the Russian Federation.