Assessing Cardiovascular Disease Burden in Rural Uganda and Informing Future Interventions

This senior thesis seeks to investigate cardiovascular disease (CVD) risk in a rural region in Uganda and to use insights from field experience and the literature to explore possible interventions. The thesis research involved a total of 232 participants, including village residents (142), market workers (50), religious leaders (20), and village health workers (VHTs) (20). The village sample data are part of a larger longitudinal study, conducted under the Community Health Collaboration project of the Student Research Training Program (SRT) at Duke University. Recruitment for the other three cohorts of market workers, religious leaders, and VHTs began with this current study, conducted in the summer of 2016. The current study continued the biometric assessments of CVD risk within the village cohort and extended the testing to market workers. A total of 192 individuals participated in these three biometric assessments of their body mass index (BMI), systolic and diastolic blood pressure, and fasting blood glucose. In addition, the research team conducted surveys using an interview format with all four cohorts. The survey assessed demographic information, lifestyle factors, CVD perceptions, and CVD knowledge, and religious influences on CVD. Overall, the biometric findings show substantial CVD risk in the village sample and the persistence of risk for individuals over time, as evidenced by the results from longitudinal, linear mixed-effect models. Beyond this high, persistent CVD risk for villagers, the market workers had even higher CVD risk as evidenced by elevated BMI and fasting blood glucose. The elevated CVD risk for market workers is possibly due to differences in lifestyle factors including diet and exercise that are associated with urbanization. The survey results show near unanimous agreement among participants that CVD is a problem in their community. Despite the overall concern, the findings expose inaccuracies in knowledge about CVD across all cohorts. Regarding the role of religion, more than 90% of participants across all cohorts believe that religion can alleviate CVD symptoms. Further questioning about religion and CVD reflected a broad array of direct and indirect interpretations of the role of religion. Exploratory regression analyses, which link survey data to CVD risk indicators, yielded results that have implications for tailoring CVD interventions to rural Uganda. To further connect the findings to intervention strategies, the discussion summarizes the method and results of a literature review on possible CVD interventions. The literature review advances three principal categories of intervention: education, policy, and programming. For each of these categories, the study findings together with the literature review provide the basis for recommending three integrative strategy for CVD intervention: VHT CVD education programs, policy reform to address CVD medication stock-outs, and religiously-based CVD programs. The strategies have promise for reducing CVD risk and improving the lives of individuals in rural Uganda.