Evaluation of community health workers’ training for community-based cardiovascular disease risk factors screening in rural Morogoro, Tanzania

Abstract

Introduction: Community Health Workers (CHWs) have significantly improved maternal and child health outcomes in low and middle-income countries (LMICs). There is growing evidence of their expanding role in providing health education to enhance public knowledge of cardiovascular disease (CVD) risk factors. We evaluated the effects of a short training for CHWs on their knowledge of risk factors and warning signs for heart attack and stroke, unhealthy dietary habits, and appropriate actions to be taken in the event of CVD-related emergencies. Methods: This evaluation was conducted as part of a cluster-randomised controlled trial of CHWs interventions to reduce blood pressure in rural Morogoro, Tanzania. A written content knowledge test was administered before and after the training to assess changes in CHWs’ knowledge. Pre- and post-training comparisons of mean scores and proportions were performed using a paired samples t-test and Fisher’s exact test, respectively. A minimum post-training knowledge pass mark was set at 75%. Results: Before training, less than half (44.4%) of the CHWs scored above the passing mark, indicating limited knowledge. After the training, all CHWs scored above the passing mark. We observed significantly improved mean knowledge scores for risk factors and warning signs for heart attack and stroke, and healthy dietary habits (all p<0.001). Increase in mean knowledge score for appropriate actions to take in case of CVD-related emergency did not reach statistical significance. The proportion of participants demonstrating good knowledge of CVD risk factors increased from 44.4% to 100%(p<0.001)., while that of warning signs for CVD increased from 16.7% to 100.0% (p<0.001). Conclusions: A short, focused training program significantly enhanced CHWs’ knowledge of CVDs. Given the rising burden of CVD risk factors, trained CHWs provide an opportunity to tackle the problem at the community level by providing health education, promoting healthy lifestyles, and supporting routine screening for early detection and referral of individuals at high risk for CVD. Trial registration: PACTR201801002959401