Information poverty: CVD risk factor

Lack of access to reliable health information about diagnosing and managing common health issues is causing "scandalously high levels of ineffective and dangerous health care," according to a new article that summarizes a literature review conducted for ProCor. "Information needs of health workers in developing countries: a literature review with a focus on Africa," is available open access in Human Resources for Health (www.human-resources-health.com/content/7/1/30).

When ProCor launched the Ashanti-ProCor Project in 2007, our first step was to commission a literature review by two expert colleagues, Dr. Neil Pakenham-Walsh, coordinator of Global Healthcare Information Network, and Dr. Fred Bukachi, a Kenyan physician.

The review was important for several reasons. We knew it was essential to begin with a solid grounding in what was already known, in order to maximize the effectiveness of our efforts. Its findings and recommendations were invaluable in the planning and ongoing development of the Ashanti-ProCor Project. We utilized a combination of qualitative and quantitative data collection and we are assessing information needs within the broader context of local epidemiology and health care services.

The review affirmed the lack of accessible, useful, high quality information about cardiovascular disease for health care workers around the world, and the devastating health consequences. Only 15 of 1762 titles and abstracts retrieved by a Medline database search of relevant keywords pertained to CVDs and/or diabetes - less than 1%. Clearly, little is known about the CVD information needs of health workers, and our project is addressing a critical communication research need.

We also hoped that the review could benefit others in the global health and development communities. With ProCor's encouragement, Dr. Pakenham-Walsh and Dr. Bukachi adapted the review for a global audience and we are pleased that their article is freely available through the open access journal Health for Human Resources. We are grateful to them for the immensely rich results of their research, and for their powerful call to action.

The review illustrates the consequences of lack of accurate information about CVD prevention and treatment:

• South African physicians reported that most of their undergraduate training focused on hospital treatment of acute complications of diabetes rather than practical diabetes management in a primary-care setting. Many did not know the benefits of insulin for poorly controlled type 2 diabetes, and some believed that insulin was not beneficial in obese patients.
• In India, patients and medical practitioners "displayed a lack of comprehension of the need for constant disease monitoring and consistent approaches to tight glycaemic control."
• Over 60% of Saudi Arabian physicians and nurses in a large teaching hospital had poor knowledge of basic techniques of blood pressure measurement (recording of diastolic BP, position of the arm, rate for deflating the cuff, etc).
• In Nigeria, drug prescription patterns were not evidence based and cost effective and about half of the 1000 patients studied were unaware of the beneficial effects of physical activity and avoidance of smoking.
• Ninety-six percent of Egyptian diabetics studied had poor knowledge of how to control the disease, attributed to inadequate health education by health workers.
• In Pakistan, more than 60% of practitioners in urban areas relied on representatives from pharmaceutical companies for updates on information about antihypertensive medications; almost 80% used incorrect blood pressure cutoff values to diagnose hypertension in patients older than 60 years; and over 40% of general practitioners inappropriately prescribed sedatives as their preferred treatment for hypertension.

While the results of the article are alarming, they are not surprising to anyone who has listened to Dr. Bernard Lown's clarion call for increased access to information about preventive CVD strategies, or read the dialogue among ProCor's email network members.

The Ashanti-ProCor Project, based in Ghana, is ProCor's first opportunity to directly connect with the global community that is burdened with cardiovascular disease. We have spent the past two years listening - an act that epitomizes the Lown Cardiovascular Center's clinical philosophy, but is too rarely practiced in international development. By building relationships with a wide range of health care workers in the Ashanti region of Ghana, we have learned valuable lessons about their health information needs. We have already incorporated some of these lessons to strengthen ProCor's information services and to influence the global dialogue on CVD policy, practice, and funding.

To the best of our knowledge, no one has ever invested this type of time and effort in analyzing which kinds of frontline health care workers can best influence the CVD epidemic, how they access information, or what kind of information they need.

"Information needs of health workers in developing countries: a literature review with a focus on Africa," is freely available (www.human-resources-health.com/content/7/1/30), and we encourage its wide dissemination among organizations and individuals who can join us in addressing this challenge.

Catherine Coleman
Editor in Chief, ProCor

Note: Healthcare Information by 2015 (HIFA2015) is a campaign and knowledge network with more than 2200 members from 142 countries worldwide. Members include health workers, publishers, librarians, information technologists, researchers, social scientists, journalists, policymakers and others - all working together towards the HIFA2015 goal. To learn more about the Healthcare Information for All by 2015 Campaign, visit www.hifa2015.org.

Date Posted: 22 April 2009