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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017
172
AFRICA
Training materials were produced in English but isi-Xhosa was
used extensively to provide culturally appropriate expansion of
new, challenging concepts for the trainees.
A pre-training written test on the first morning of training
was given to determine the current knowledge the trainees
had on CVD and its risk factors and to assist in planning the
teaching accordingly. During the first week, the morning sessions
were spent in imparting knowledge about basic concepts of CVD
and related risk factors. These included basic information about
the heart and its function, hypertension, diabetes and obesity
(definitions, symptoms and risk-factor history assessment)
and nutrition using the South African food-based dietary
guidelines. The afternoon sessions focused on data-collection
skills, anthropometry measurements and training in the use of
the non-invasive risk-screening tool (Fig. 1).
Trainees were taught to measure the mid-upper arm
circumference (MUAC), used to determine the correct cuff
size for measuring blood pressure using an automated Omron
blood pressure machine
®
, as well as height and weight using an
adjustable height stick and digital scale, respectively. Trainees
were taught how to calibrate their blood pressure cuffs and
digital scales. Calculation of body mass index (BMI) using a
calculator, completion of risk-factor questionnaires through an
in-person interview, maintaining confidentiality throughout the
recruitment and screening process, assisting in the explanation
and completion of informed consent forms, and completion of
study forms for data entry were also included in the practical
training.
Men
No diabetes
Women
No diabetes
Age
(years)
Non-smoker
Smoker
Non-smoker
Smoker
SBP
(mmHg)
65–74
171–180
161–170
151–160
141–150
131–140
121–130
111–120
55–64
171–180
161–170
151–160
141–150
131–140
121–130
111–120
45–54
171–180
161–170
151–160
141–150
131–140
121–130
111–120
35–44
171–180
161–170
151–160
141–150
131–140
121–130
111–120
15–19.9 20–24.9 25–29.9 >30 15–19.9 20–24.9 25–29.9 >30 15–19.9 20–24.9 25–29.9 >30 15–19.9 20–24.9 25–29.9 >30
BMI (kg/m
2
)
BMI (kg/m
2
)
BMI (kg/m
2
)
BMI (kg/m
2
)
5-year cardiovascular risk (fatal and non-fatal)
How to use the chart
• Choose the section with the gender, diabetes and smoking status
• Find the cell that matches the patients risk-factor profile using the
age, BMI and blood pressure
• Refer to physician those with excessive blood pressure
(≥ 180 mmHg)
< 10%
31–40%
10–20%
> 40%
21–30%
Low
High
Moderate
Fig. 1.
Risk-scoring chart used by community health workers to obtain CVD risk scores.
Source: Gaziano TA, Young CR, Fitzmaurice G,
Atwood S, Gaziano JM. Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I
follow-up study cohort.
Lancet
2008;
371
: 923–931.