With epidemiological transition, stroke is emerging as an important cause of death and disability in rural India and perpetuates poverty. Community-based interventions that controlled cardiovascular risk factors using well-established medications and lifestyle changes have reduced stroke mortality in developed countries. However, well tested community-based interventions to reduce the stroke mortality in rural areas of India as well as other developing countries are lacking. Stroke mortality in such areas can be potentially reduced in a cost effective manner by using simple guideline-based treatments of cardiovascular risk factors using generic medicines and increasing awareness about stroke. However, delivering such a care in rural areas where there is minimal awareness about stroke and its risk factors, economic resources are limited and healthcare for these problems in not easily available is logistically challenging.  

This study aims to address these challenges. In this cluster randomized, parallel group, two arm trial we will assess the effect of a healthcare delivery intervention package to control cardiovascular risk factors on stroke mortality. The study will be conducted in an underdeveloped rural area of central India. Thirty two villages will be randomly assigned to the intervention arm and will receive the healthcare delivery intervention while other 32 villages will be assigned to the control arm and will receive enhanced usual care in the form of health education on harmful effects of tobacco at the beginning and at the end of the intervention. The intervention will last for 3.5 years. The intervention will be jointly delivered by a village-based community health worker and a visiting outreach physician. It is a “3 plus 3” intervention in which the outreach physician will provide medical treatment for 3 conditions-hypertension, diabetes and secondary prophylaxis of stroke while the community health worker will provide lifestyle modification counseling to reduce 3 risk factors- salt, tobacco and alcohol use. In the intervention area all the individuals 50 years of age and above will be screened for hypertension, glycosuria and stroke by a village health worker at the beginning of the intervention. These patients will be evaluated by an outreach physician who will confirm the diagnoses and provide guideline-based medical treatment and follow up. The community health workers will follow these patients to promote medication compliance and provide lifestyle modification advice for reducing the risk factors discussed above.