Cardiovascular risk factor reduction by community health workers in rural India: A cluster randomized trial.

BACKGROUND: There is a need to identify and test low-cost approaches for cardiovascular disease (CVD) risk reduction that can enable health systems to achieve such a strategy. OBJECTIVE: Community health workers (CHWs) are an integral part of health-care delivery system in lower income countries. Our aim was to assess impact of CHW based interventions in reducing CVD risk factors in rural households in India. METHODS: We performed an open-label cluster-randomized trial in 28 villages in 3 states of India with the household as a unit of randomization. Households with individuals at intermediate to high CVD risk were randomized to intervention and control groups. In the intervention group, trained CHWs delivered risk-reduction advice and monitored risk factors during 6 household visits over 12 months. Households in the non-intervention group received usual care. Primary outcomes were a reduction in systolic BP (SBP) and adherence to prescribed BP lowering drugs. RESULTS: We randomized 2312 households (3261 participants at intermediate or high risk) to intervention (1172 households) and control (1140 households). At baseline prevalence of tobacco use (48.5%) and hypertension (34.7%) were high. At 12 months, there was significant decline in SBP (mmHg) from baseline in both groups- controls 130.3 ±â€¯21 to 128.3 ±â€¯15; intervention 130.3 ±â€¯21 to 127.6 ±â€¯15 (P < .01 for before and after comparison) but there was no difference between the 2 groups at 12 months (P = .18). Adherence to antihypertensive drugs was greater in intervention vs control households (74.9% vs 61.4%, P = .001). CONCLUSION: A 12-month CHW-led intervention at household level improved adherence to prescribed drugs, but did not impact SBP. To be more impactful, a more comprehensive solution that addresses escalation and access to useful therapies is needed.

Innovations in nutrition education and global health: the Bangalore Boston nutrition collaborative.

BACKGROUND: India has a wide range of nutrition and health problems which require professionals with appropriate skills, knowledge and trans-disciplinary collaborative abilities to influence policy making at the national and global level. METHODS: The Bangalore Boston Nutrition Collaborative (BBNC) was established as collaboration between St. John's Research Institute (SJRI), Harvard School of Public Health and Tufts University, with a focus on nutrition research and training. The goals of the BBNC were to conduct an interdisciplinary course, develop web-based courses and identify promising Indian students and junior faculty for graduate training in Boston. RESULTS: From 2010, an annual two-week short course in nutrition research methods was conducted on the SJRI campus taught by international faculty from Indian and US universities. More than 100 students applied yearly for approximately 30 positions. The course had didactic lectures in the morning and practical hands-on sessions in the afternoon. Student rating of the course was excellent and consistent across the years. The ratings on the design and conduct of the course significantly improved (p <0.001) from 2010 to 2012. Through open-ended questions, students reported the main strengths of the course to be the excellent faculty and practical "hands-on" sessions. A web based learning system TYRO, was developed, which can be used for distance learning. Four faculty members/graduate students from SJRI have visited Boston for collaborative research efforts. CONCLUSION: The BBNC has become a well-established capacity building and research training program for young professionals in nutrition and global health. Efforts are ongoing to secure long term funding to sustain and expand this collaboration to deliver high quality nutrition and global health education enabled by information and communication technologies.

Daily methionine requirements of healthy Indian men, measured by a 24-h indicator amino acid oxidation and balance technique.

BACKGROUND: The 1985 FAO/WHO/UNU upper requirement for the sulfur-containing amino acids in healthy adults, which was set at 13 mg . kg(-)(1) . d(-)(1), is based on nitrogen balance studies in Western subjects. Short-term tracer-based studies also estimated a mean requirement of 13 mg . kg(-)(1) . d(-)(1), but whether this estimate is applicable to healthy populations worldwide is unknown. OBJECTIVE: Using a 24-h indicator amino acid oxidation and balance method with 7 test methionine intakes (3, 6, 9, 13, 18, 21, and 24 mg . kg(-)(1) . d(-)(1)), we assessed methionine requirements in healthy, well-nourished Indians. DESIGN: Twenty-one healthy, well-nourished Indian men were studied during each of 3 randomly assigned 7-d diet periods in which methionine intakes (diet devoid of cysteine) were equally placed on either side of the putative mean methionine requirement of 13 mg . kg(-)(1) . d(-)(1). Twenty-four-hour indicator amino acid oxidation and balance were measured on day 7 by using a 24-h [(13)C]leucine tracer infusion. The breakpoint in the relation between these values and the methionine intake was determined. RESULTS: Two-phase linear regression of daily leucine oxidation against methionine intake estimated a breakpoint in the response curve at a methionine intake of 14 mg . kg(-)(1) . d(-)(1) (95% CI: 11, 23 mg . kg(-)(1) . d(-)(1)). The breakpoint estimated from the leucine balance-methionine intake relation was 15 mg . kg(-)(1) . d(-)(1) (95% CI: 11, 27 mg . kg(-1) . d(-1)). CONCLUSIONS: From the 24-h indicator amino acid oxidation and balance approach, a mean methionine requirement, in the absence of cysteine intake, of 15 mg . kg(-1) . d(-1) is proposed for healthy, well-nourished Indian adults. This requirement is similar to that established in Western adults.