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NHMRC

Australian Smart Phone Research to Combat Chronic Disease in Lower and Middle Income Countries

Summary media release information

Date: 
12 June 2012
Type: 
Media Release
Contact for further information: 
David Cooper 02 6217 9121 or 0422 008 512

A worldwide initiative to prevent and treat chronic diseases that affect millions of people has been given a boost of $5 million by the Australian Government. The research projects include evaluating whether an Australian-developed smartphone system will assist Indian rural healthcare workers detect and manage hypertension and cardiovascular risk.

NHMRC Chief Executive Officer Professor Warwick Anderson today announced funding for five leading Australian research teams which will be part of an international initiative coordinated by the Global Alliance for Chronic Disease (GACD).

The National Health and Medical Research Council (NHMRC) represents Australia in the important work undertaken by the GACD to address chronic disease in developing countries. Hypertension is the GACD’s first major joint research priority.

Research by The George Institute for Global Health and the Monash University will focus on prevention of high blood pressure in lower and middle income countries, and assess the effectiveness of early interventions, including preventative and control-based approaches.

Funding for the research projects will also cover: 

  • Trialling a three-in-one blood pressure lowering pill that simplifies the patient’s treatment regimen and improves health outcomes.
  • Development of national salt reduction interventions.
  • Overcoming barriers in the prevention treatment of high blood pressure in developing countries.

“Chronic diseases such as cancer, heart disease and chronic respiratory diseases are the leading cause of mortality in the world,” Professor Anderson said.

“The Australian Government, through the NHMRC, is joining forces with countries including the UK, United States, and Canada to respond to the growing threat posed by chronic disease.”

“The research findings will help lower and middle income countries, such as India and the Pacific Islands.”

According to the World Health Organisation, chronic diseases represented 63% of all deaths internationally in 2008. Low and middle income countries bear nearly 80% of the burden from diseases like cardiovascular disease, diabetes, cancer and chronic respiratory diseases.

“Australia and other developed nations have made progress in reducing the incidence of high blood pressure and related health problems,” NHMRC Chief Executive Officer Professor Warwick Anderson said.

“The task now is to work with our sister research funding bodies in the GACD to translate our findings so we can help reduce the global incidence and impact of chronic diseases.”

Founded in 2009, the GACD comprises seven of the world’s leading health research funding organisations. Collectively these organisations manage an estimated 80% of all public health research funding. 

More information on Global Alliance for Chronic Diseases funding.

Media contact

David Cooper

0422 008 512 or 02 6217 9121
 

About the Global Alliance for Chronic Disease (GACD)

The GACD was established in 2009 to support clear priorities for a coordinated research effort that will address chronic non-communicable diseases, a growing health crisis now reaching world epidemic proportions. Experts estimate that, unless action is stepped up, 388 million people worldwide will die of one or more such diseases within the next decade.

The GACD group includes the NHMRC, the Canadian Institutes of Health Research, the UK based Medical Research Council and the US based National Institutes of Health.

GACD Hypertension Research Projects world map

 

International GACD statement 

The GACD members have also released an international statement on the landmark research initiative to implement high blood pressure prevention and control programs in 15 low and middle-income countries (LMICs): http://www.ga-cd.org/img/HypertensionReleaseFINAL.pdf

NHMRC Funding Recipients and Projects

Country:

India

Funding Institution:

National Health and Medical Research Council, Australia

Administrating Institution:

The George Institute for Global Health

LMIC Institution:

The George Institute for Global Health

Research Title:

A smartphone-based clinical decision support system for primary health care workers in rural India.

Principal Investigatori:

Dr David Peiris

LMIC Principal Investigatorii:

Dr Pallab Maulik (George Institute)

Funding Amount:

$930,259

Research Duration:

3 years

Summary:

High blood pressure can cause a number of serious heart and blood vessel diseases that are life threatening. This is a rapidly increasing health problem in India where the health care system is under resourced to fight the problem.

The HealthTracker smartphone research will enhance the efficiency and capacity of the family doctor and other health care workers. The system has been adapted for android based smart phones phones due to their low cost and high accessability.

The smartphone system is modelled on the PC based HealthTracker patient records software used by GPs in NSW and QLD. The Australian solution extracts information from the patient’s health record. Health Tracker calculates the patient’s absolute risk of heart attack or stroke and then automatically synthesises recommendations from all relevant guidelines to provide tailored management advice specific to the patient’s circumstances.

Following the pilot intervention in rural Andhra Pradesh, a larger study in 45 villages in will be conducted.

GACD Mobile App workflow graphic

 

Country:

India

Funding Institution:

National Health and Medical Research Council, Australia

Administrating Institution:

Monash University

LMIC Institutions:

  • The George Institute for Global Health
  • Christian Medical College (CMC), Vellore
  • Sree Chitra Tirunal Institute for Medical Sciences and   Technology (SCTIMST)

Research Title:

Improving the control of hypertension in rural India: Overcoming the barriers to diagnosis and effective treatment

Principal Investigator:

Professor Amanda Thrift

LMIC Principal Investigator:

  • Dr Pallab Maulik (George Institute)
  • Professor Nihal Thomas (CMC)
  • Professor Kavumpurathu Thankappan (SCTIMST)

Funding Amount:

$1,033,805

Research Duration:

3 years

Summary:

High blood pressure (hypertension) is increasing in prevalence in urban regions of developing countries, but little is known about its emergence in more rural regions, where 70% of the population still resides.  There are significant barriers to the diagnosis and treatment of high blood pressure in rural regions although defining, understanding and thus addressing these remains problematic.

In regions where economic and other transitions are more advanced, there is a greater prevalence of hypertension and hypertension-related factors such as obesity and physical inactivity.

This proposal is focussed on three diverse rural regions in India, each of which is at a different stage of economic and social transition.  This application brings a common approach across differing settings to assess whether barriers to hypertension control in rural regions of India are similar and whether interventions to improve control are applicable across these, and other resource poor, settings in India and other countries.

With the planned multi-site study the researcher team will be able to examine how the barriers to diagnosis and management differ between settings, and how gender, socioeconomic deprivation, and education impact upon the diagnosis and management of hypertension. This information will enable us to develop an intervention program that is suitable across rural regions, and thus contribute to disease prevention at a global level.

 

Country:

India

Funding Institution:

National Health and Medical Research Council, Australia

Administrating Institution:

The George Institute for Global Health

LMIC Institutions:

  • The George Institute for Global Health
  • Centre for Chronic Disease Control

Research Title:

Improving blood pressure control using a simplified treatment strategy including a three-in-one blood pressure lowering pill in Indian patients.

Principal Investigatori:

Professor Anushka Patel

LMIC Principal Investigatorii:

  • Dr Pallab Maulik (George Institute)
  • Dr Dorairaj Prabhakaran (CCDC)

Funding Amount:

$1,067,559

Research Duration:

3 years

Summary:

High blood pressure is a major contributor to the extent of heart and related diseases in India, particularly in urban settings where prevalence may be as high as 40%, with control of high blood pressure as low as 38%.  The use of multiple medications and complex and costly treatment regimens to achieve blood pressure control likely represents a significant barrier to patient adherence. 

Combining two or more blood pressure lowering drugs in a single tablet has been shown to be effective in improving control and improving patient acceptance and adherence to prescribed medications.  Simplified treatment programs for increasing blood pressure lowering medications have also been shown to be effective by addressing the clinician’s focus on outcome improvement as well as improving patient acceptability. 

Although fewer side-effects can be expected from low dose combination therapies, tailoring medication dosing to the individual is more difficult. This issue needs to be addressed in a relatively poorly resourced healthcare environment as often seen in India. This research will investigate whether use of a simplified three-in-one low dose blood pressure lowering pill, compared to usual care, can improve blood pressure control in patients with mild- moderate high blood pressure.  It will also investigate patient and clinician acceptability and cost effectiveness of such a treatment strategy. 

 

Country:

India

Funding Institution:

National Health and Medical Research Council, Australia

Administrating Institution:

The George Institute for Global Health

LMIC Institution(s):

  • The George Institute for Global Health
  • Public Health Foundation of India

Research Title:

Developing a national salt reduction program for India.

Principal Investigatori:

Professor Bruce Neal

LMIC Principal Investigatorii:

  • Dr Pallab Maulik (George Institute)
  • Dr Dorairaj Prabhakaran (CCDC)

Funding Amount:

$912,437

Research Duration:

3 years

Summary:

This research will precede and support the development of a national salt reduction program for India as part of a strategy to lower blood pressure in people at risk of serious heart and related diseases. The researcher team will first do a stakeholder analysis including government, industry, consumers and non-governmental organisations. This will be followed by cross-sectional population surveys of 1600 individuals in urban and rural areas of North and South India. 

These surveys will estimate baseline mean daily salt consumption through the collection of 24-hour urine samples, the main sources of salt in the Indian diet using 24hr dietary recall methods and population knowledge about the effects of salt on health by questionnaire. The team will then conduct a systematic survey of the salt content of processed foods for sale in major retail outlets. 

The formulation of a locally relevant implementation program will be done in conjunction with members of State and National governments, academia, the food industry, health care providers, civil society and other relevant organisations identified by the research. The potential impact of this work is enormous with the implementation of a modestly effective salt reduction program in India projected to have the same impact as plausible smoking cessation initiatives.

 

Country:

Fiji and Samoa

Funding Institution:

National Health and Medical Research Council, Australia

Administrating Institution:

The George Institute for Global Health

LMIC Institution:

Fiji National University

Research Title:

Cost effectiveness of salt reduction interventions in Pacific Islands.

Principal Investigatori:

Dr Jacqui Webster

LMIC Principal Investigatorii:

Dr Wendy Snowdon

Funding Amount:

$1,045,593

Research Duration:

3 years

Summary:

There is broad consensus that diets high in salt are bad for health and reducing salt intake is a cost effective strategy for reducing the burden of diseases such as high blood pressure. Available data indicates that salt intake in the Pacific Islands is too high and that the World Health Organisation has been promoting the development of salt reduction strategies in Pacific Island Countries. Consultations to develop strategies have been initiated in several countries.

However, accurate assessments of sodium consumption patterns upon which such strategies can be based on and subsequently monitored are missing. This proposal is for funding to obtain accurate baseline information to inform the development and evaluation of interventions to reduce population sodium intake in Fiji and Samoa.

Phase I will consist of a baseline assessment of sodium intake, consumer knowledge and behaviour and sodium levels in foods, alongside an assessment of the most effective channels to change behaviour of consumers and the food industry. Phase II will use this information to develop a comprehensive policy response with interventions targeted at (i) stores (ii) caterers and bakers (iii) food manufacturers (iv) consumers. Phase III will quantify the effectiveness of the national sodium reduction efforts by repeating the measurements done at the baseline assessment phase.

The findings from these surveys will then be used as the basis for policy review and program re-development. Whilst there is a growing body of international evidence about the effectiveness of strategies to reduce sodium, there is little work applying the lessons to developing countries generally or the Pacific Islands in particular. This project will address the urgent need for a more accurate assessment of sodium consumption patterns. This will not only ensure strategies are developed based on the best available evidence but also that the impact of subsequent interventions can be assessed.
 

Researcher biographies
 

Professor Amanda Thrift

Monash University

Head of the Epidemiology Unit, Stroke and Ageing Research Centre, Dept of Medicine

NHMRC Senior Research Fellow

Professor Amanda Thrift gained her PhD in epidemiology from Monash University in 1995. Her interests are in the field of epidemiology of stroke and vascular disease, and their risk factors, particularly relating to disadvantaged regions. Professor Thrift is a past President of the Stroke Society of Australasia.

 

Dr David Peiris

The George Institute for Global Health

Program Head, Primary Health Care Research, Renal & Metabolic Division

Dr David Peiris is Program Head for Primary Health Care Research and has worked as a general practitioner in Aboriginal Community Controlled Health Services for the past 15 years. He is an Associate Professor in the School of Medicine at University of Western Sydney. He holds a Master of International Public Health and a PhD at the University of Sydney.

Dr Peiris is a current NHMRC- Heart Foundation Translating Research into Practice Fellow. His research interests are in building better primary care systems for marginalised populations. He is particularly interested in the use of clinical decision support systems and other innovative e-health strategies to assist health professionals and consumers in the delivery of high quality primary health care.

 

Professor Anushka Patel

The George Institute, India

Executive Director

Chief Scientist

Anushka is a Professor in the Sydney Medical School and a cardiologist at Royal Prince Alfred Hospital. She completed her undergraduate medical training at the University of Queensland, and her training in cardiology (leading to Fellowship of the Royal Australian College of Physicians) in Sydney. She has a Master of Science degree in Epidemiology from Harvard University and a PhD in Medicine from the University of Sydney. Anushka also currently holds an Australian National Health & Medical Research Council Senior Research Fellowship.

 

Professor Bruce Neal

The George Institute for Global Health

Senior Director

Chair, Australian Division of World Action on Salt and Health

Professor Bruce Neal is a Senior Director at The George Institute for Global Health, Professor of Medicine at the University of Sydney and Chair of the Australian Division of World Action on Salt and Health. Bruce completed his medical training at Bristol University in the UK in 1990 and spent four years in clinical posts. Prior to taking up his position at the Institute in 1999, he worked as an epidemiologist at the Clinical Trials Research Unit in Auckland, New Zealand, where he completed his PhD in Medicine.

Professor Neal leads a program of vascular research at the Institute and is supported in his work by the National Health and Medical Research Council and the Australian Research Council through Program Grant and Fellowship funding. Bruce has a longstanding interest in the environmental determinants of high blood pressure and the potential for changes in the food supply to deliver health gains.

 

Dr Jacqui Webster

The George Institute for Global Health

Senior Project Manager, Food Policy

Co-ordinator Australian Division of World Action on Salt and Health

Dr Jacqui Webster is Head of the Food Policy Group and co-ordinates the Australian Division of World Action on Salt and Health.  He main research interests are salt reduction and food reformulation strategies with an emphasis on translation of policy and practice to low and middle income countries. Jacqui completed her Masters in International Development in Leeds, UK (1993) and her PhD in salt reduction and public health at the University of Sydney (2011). 

Dr Webster previously co-ordinated the UK government's salt reduction strategy and is a frequent consultant to the World Health Organisation on salt reduction. Jacqui also currently holds a National Heart Foundation and Stroke Foundation Postdoctoral Research Fellowship Award.

 

Page last updated on 28 August 2012