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Specificity and Sensitivity of Low Cost CVD / Diabetes Risk Stratification Strategies

By Nachiket Mor | 21 Mar, 2013

In our work in rural India we use WHO's STEPwise survelliance tool. While steps 1 and 2 of the WHO STEPwise surveillance tool record behavioural data and anthropometric measurements, both of which can be collected non-invasively, step 3 involving measurement of biochemical parameters is both invasive and expensive.Therefore, performing step 3 on a community-wide basis might not be feasible. Our protocol entails identifying individuals who are at “high risk” (having two or more risk factors for CVDs from steps 1 and 2), and directing them to our primary care facilities, where further testing (step 3) can be performed. Before launching on a full-fledged effort to ascertain the Type 1 and Type 2 errors associated with this approach I wanted to reach out to all of you for information on other researchers / practitioners that may have already done this kind of work and on papers that may already have been published on this issue.



Nachiket Mor Replied at 4:25 AM, 25 Mar 2013

I have not heard from back from the members of this community but in the meanwhile was able to access the NICE Public Health Guidance Number 38 which uses the Cambridge Risk Score (and not the WHO STEPwise protocol) but clearly recommends that blood tests be carried out only for high risk cohorts. I was also able to connect with Dr. Griffin – he is the original developer of the Cambridge Risk Score (CRS). He was very supportive and shared with us a great deal of material on how the CRS has been used in actual field settings. Our thought now is to now run a field based effort in one of our clinics in rural Tamil Nadu to actually calibrate the risk scores in our field settings using OGTT (and / or HbA1C) results as an end-point. If there are medical interns / physicians that are interested in helping us do this carefully please do let me know. I understand that there is a paucity of such research for the “Thrifty phenotype” South Asian Communities.

Mohammed Ali Replied at 6:23 AM, 25 Mar 2013

Dear Dr. Mor,
You may also want to consider using India-specific scores. Dr. Mohan's group have developed one as has Dr. Ramachandran's group.

A validation of these in a rural population will be excellent.

Nachiket Mor Replied at 7:48 AM, 25 Mar 2013

Dr. Mohammed: I would be grateful if you could point me to the specific
papers by these doctors that have their India-specific scores. Once we have
the data I would imagine that it would be an easy task to do this on
multiple scoring indicators.

Maggie Sullivan Replied at 2:25 PM, 26 Mar 2013

Working in low-resource settings, I am always looking for reliable non-invasive biometric tools. However after reviewing the abstract for the CRS, I thought it was interesting that this tool does not have any advantage over BMI alone.

Attached resource:

Nachiket Mor Replied at 10:05 PM, 26 Mar 2013

Dear Maggie:

We intend to do this work carefully for a rural Tamil Nadu population and
given the whole presence of a "thrifty phenotype" in South Asian populations
we may well discover that we have some newer insights into these cut-offs
and the validity of these tools. In any case we will measure all the
parameters carefully and then seek answers to the kinds of questions that
you have raised.

Sree Tiruvayipati Replied at 11:23 PM, 26 Mar 2013

Hello Nachiket,
Working in Dept.Of Community Medicine as Asst.Professor in Chennai, we are planning community based Diabetes screening and education programs.I would like to be involved AND VERY MUCH INTERESTED in your initiatives, kindly let me be involved.
Looking forward for your reply.
Dr.Sree T.Sucharitha

Nachiket Mor Replied at 3:21 AM, 27 Mar 2013

I am glad to see an interest from Dr. Sucharita on this. In addition to partnerships with individual researchers we would eager to hire somebody strong that would be interested in taking charge of entire research verticle. We have the patients, we have the clinics, we have the Health Records, and good data. What we need now is a good head of research -- any nationality is welcome to explore this idea -- English language is the only requirement.

Nachiket Mor Replied at 4:00 AM, 27 Mar 2013

My email address is -- just incase somebody wants to write to directly on this last issue.

Nachiket Mor Replied at 1:29 AM, 28 Mar 2013

Dr.Sucharitha: it is great to learn of your interest. The best person to
talk to you about this would be Dr. Zeena Johar (PRESIDENT,ICTPH;
MD&CEO,SUGHAVAZHVU) (). Please free to write to her

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.