Prevention of Coronary Artery Diseases in Urban Slums of Lahore through Advocacy and Behavioral Change
Dr. Tahseen’s work is a plan to understand how general advocacy and counseling towards changing general habits and practices can reduce the risks of heart related diseases in a community. As a pilot, the research is targeted towards a small section of Lahore, Union Council 120 that has a population of 25,000. The research not only relies on a time-bound study but also a sustainability plan to ensure that the effectiveness of the program can be studied over a longer period.
The goal of this project was to find out and reduce the prevalence of Coronary Heart Diseases and their risk factors among dwellers of an urban slum of Lahore by active interventions and advocacy based on theoretical model of social cognition in the community, mainly by identifying and changing the behaviour of high risk individuals above the age of 30 years in particular. The advocacy campaign was carried out in the Union Council 120/122 of Mughalpura, Lahore, comprising of population of almost 50,000 individuals. After determining the burden of cardiovascular risk factors through an initial baseline survey, the objectives were to reduce the average Body Mass Index (BMI), mean systolic blood pressure by 10%. The objectives were also to increase the physical activity level by 10% and consumption of fruits and vegetables by 20%. Informed consent was sought for surveys and project activities from Chairman of Union Councils (UC 120 and 122) and community elders. Mapping of the area for socio-cultural aspects was done. Training sessions of field staff were carried out by senior faculty of Community Medicine Department of Shalamar Medical College, Lahore. Survey teams were supervised by senior faculty members of the department. An initial baseline survey was followed by project intervention and later an end-line survey was carried out using WHO Steps Questionnaire to collect data along with anthropometric assessment of blood pressure, random blood sugar level, height, weight and waist measurements. Data entry and analysis was done in SPSS version 20. The respondents screened out high risk population were properly guided to Shalamar Institute of Diabetes and Endocrine Research (SIDER) and cardiology department for treatment initiation at Shalamar Hospital. Health messages and communication activities included banners, hoardings pamphlets along sending short message services (SMS) texts to 1000 high risk individuals of the community. Health related messages were also broadcasted as ticker on televisions via local cable service available in the community. Direct health messages were also delivered by our doctors, local community health workers and trained field workers.
The project achieved most of its objectives for the given year in the allocated budget. A remarkable reduction of 33% smoked cigarettes was achieved in just one year. A significant reduction of 50% oral tobacco use noted. A 10% increase in consumption of vegetable was noted among people in the target population. The average consumption of fruits was increased by more than 10 % in all the categories. There was a beneficial increase of 9.6% and 26% in mild and moderate physical activity respectively among the target population. An additional 36% reduction in the frequency of systolic hypertension was also achieved. A 9% decrease in average BMI of the target population was observed. In this project, the number of individuals identified as Diabetics during the baseline and end-line survey were almost the same. The behaviour change counseling requires extended duration of social intervention. Though the extent of communal intervention in this project was in months, but it managed to achieve the desired outcomes of yearly extent.