DHAKA, Feb 20, 2020 (BSS) – A tri-nation research has suggested that the Control of Blood Pressure and Risk Attenuation (COBRA) intervention can be a potential solution for controlling blood pressure and preventing deaths from heart attack and stroke in Bangladesh.
The findings of the study titled ‘Control of Blood Pressure and Risk Attenuation – Bangladesh, Pakistan, Sri Lanka (COBRA-BPS)’ were published in the prestigious New England Journal of Medicine today, said an icddr,b press release here.
The COBRA-BPS trial, co-conducted by icddr,b, Aga Khan University, Pakistan, the University of Kelanyia, Sri Lanka and coordinated by Duke-National University of Singapore revealed that regular home visits by community healthcare workers to monitor patients’ blood pressure (BP) along with lifestyle coaching to them could effectively control high blood pressure.
The COBRA-BPS study is a cluster randomised trial that evaluated the effectiveness of the multi-component intervention among 2,550 individuals with hypertension living in 30 rural communities in Bangladesh, Pakistan and Sri Lanka between 2016 and 2019.
In Bangladesh the trial was implemented by icddr,b in Munshiganj and Tangail districts among 895 hypertensive individuals in close collaborations with the Non-Communicable Disease (NCD) Control Programme, Directorate General of Health Services (DGHS) and the Ministry of Health Family Welfare.
In the COBRA intervention areas six Health Assistants (HAs) measured blood pressure of 447 study patients at homes using a digital blood pressure machine and provided education for promotion of lifestyle.
The HAs referred patients with uncontrolled blood pressure to selected sub district hospitals where doctors treated those patients following a treatment protocol and mobilized supplies of anti-hypertensive drugs for the patients.
Dr Aliya Naheed, study’s principal investigator in Bangladesh and the country lead, said the overall deaths due to heart attack or stroke were lower in patients receiving intervention suggesting that the COBRA intervention can be a potential solution for controlling blood pressure and preventing deaths from heart attack and stroke, the leading causes of premature deaths in Bangladesh.
“We look forward to obtaining all out support from the government for scaling up this low cost strategy for effective control of blood pressure in rural areas in Bangladesh.” Dr Naheed added.
Professor Dr AHM Enayet Hussain, Director General of Medical Education and Chair of the COBRA Advisory Committee in Bangladesh, said “COBRA intervention helped us to identify a large bulk of patients suffering from hypertension in rural areas, women in particular, and provide high quality treatment”.
He added: “We have taken into account the learning of COBRA for prevention and control of non-communicable diseases in Bangladesh”.
Professor Tazeen H Jafar, lead investigator from the Health Services and Systems Research Programme at Duke-NUS Medical School, Singapore, said community health workers are an integral part of the primary care infrastructure for the successful door to door delivery of maternal and child healthcare in South Asia – as well as China, Mexico, and Africa.
Dr John David Clemens, iccdr,b’s Executive Director and Co-country lead in Bangladesh, said the implemented strategies in the COBRA-BPS trial have the potential to offer sustainable and low cost solutions for effective blood pressure lowering that can be integrated in the public healthcare systems in Bangladesh and other South Asian countries and could save thousands of lives.
This is the first multi-country trial of its kind that sets a credible example of South-South research collaboration. Nonetheless, similar results were achieved in all three countries with COBRA intervention suggesting that the intervention has validity across South Asian settings.
The COBRA-BPS strategy is a service model introduced on top of the existing services provided from the government rural primary healthcare facilities, and its success has demonstrated a potential pathway of quality of services for hypertension and other noncommunicable diseases in Bangladesh.
Data suggests that programme delivery cost for scaling up the COBRA intervention in Bangladesh would be only 0.60 US dollar or equivalent to Taka 51 per patient annually.