The Sontolon Foundation, in collaboration with Rajshahi Medical College and the Bangladesh Medical Association of North America (BMANA – Louisiana Chapter), has pioneered a community-supported approach to managing chronic diseases such as hypertension and diabetes in Khoriapara—a marginalized rural community in northwestern Bangladesh.
Grounded in design ethnography, this initiative empowers residents to co-create sustainable health solutions by leveraging local knowledge, social networks, and digital tools.
Hypertension: Screening, Intervention & Outcomes
1. Screening and Community Engagement
All residents aged ≥30 years were screened door-to-door within the resident-defined community boundary. Health workers, trained by Rajshahi Medical College physicians, used validated digital BP monitors. Out of 260 residents screened, 20 individuals were diagnosed with hypertension. Two community committees were formed through a door-to-door consent process:
• Health Committee – managed operations, medication delivery, and data collection.
• Inclusion Committee – ensured fairness, conflict resolution, and participation of marginalized residents.
2. Intervention and Monitoring
Virtual health education sessions via Zoom and household visits emphasized salt reduction, exercise, and medication adherence. Treatment followed a cost-sensitive protocol: amlodipine as first-line; ACE/ARB or beta-blockers when affordable; and statins for high cardiovascular risk. Biweekly BP readings were uploaded via Google Docs, and physicians remotely supervised adjustments.
3. Outcomes (2020–2022)
• Systolic BP ↓ 27 mmHg, Diastolic ↓ 9.9 mmHg (p < 0.05)
• 100% treatment adherence by study end
• Women’s committees and local exercise sessions improved engagement
• Community-managed system with strong ownership and minimal external support
Diabetes: Screening, Intervention & Outcomes
1. Screening (June 2022–May 2024)
All adults aged ≥18 years were screened for fasting plasma glucose. Among 366 participants:
• 9.2% had diabetes
• 12.8% had prediabetes
• 78% were non-diabetic
Diabetic participants were typically older (median 53 years), predominantly female (77%), with low income and education. Common symptoms included frequent urination, weakness, weight loss, and blurry vision.
2. Intervention and Support Model
Weekly group education sessions were adapted from the Ochsner Health Diabetes Management Guide. Health workers and women’s committee members conducted home visits and organized group exercise sessions. Treatment used metformin as first-line therapy, followed by linagliptin, sulfonylureas, alpha-glucosidase inhibitors, or insulin. Expensive drugs (SGLT2 inhibitors, GLP-1 agonists) were excluded due to cost. A community cost-sharing model reduced financial barriers. Shared insulin storage addressed cold-chain gaps.
3. Outcomes (2022–2024)
• Fasting glucose ↓ from 9.7 → 6.7 mmol/L
• Postprandial glucose ↓ from 11.5 → 7.9 mmol/L (p < 0.0001)
• 19 mild hypoglycemia events resolved; 6 deaths unrelated to medication
• Enhanced community awareness and equitable access to care
Broader Impact
• Over 600 residents screened for hypertension and diabetes
• Locally elected committees manage ongoing monitoring and education
• Demonstrated how community agency, ethnographic insights, and affordable digital tools can sustain chronic disease management
Publications & Recognition
• Noor A. Developing Conceptual Framework and Methodological Considerations in Community-Supported Chronic Disease Management. Journal of Global Health Reports, 2024.
• Noor A. et al. A Pilot Project on a Community-Supported Approach to Blood Pressure Management. Archives of Public Health (under review).
• Shojon M. et al. Community-Supported Initiative for Diabetes Screening and Management in a Rural Community in Bangladesh. ADA 2025 Scientific Sessions Poster #A-4085.
Partners: Sontolon Foundation | Rajshahi Medical College | BMANA – Louisiana Chapter