survival and the quality of life of persons who have developed CVD. Appropriately focused research will be necessary to meet each of these goals.

This chapter discusses key areas of research for effective CVD prevention and control in developing countries. Recommendations are presented in bold type both here and in the Executive Summary.


There are four criteria to be used in setting priorities for investing in CVD R&D in developing countries:

  1. Investments should have a large-scale impact on populations that include men and women, all socioeconomic groups, and various regions of a country. Incremental implementation may be necessary in many countries.

  2. Investments in a country should involve methods and processes (but not necessarily results) that are broadly transferable to other low- and middle-income countries.

  3. Investments should yield results within a time frame of 5-10 years, although evaluation may be desirable over a longer term.

  4. Investments should focus on measurable data that use, for the most part, established epidemiologic, health policy, economic, and social behavioral methodologies.

The main categories of research activity and key recommendations within these categories follow.

Improve Knowledge of the Size of the CVD Burden in Developing Countries

Vital Registration

A sample registration system collects vital statistics on a sample of the population in each state. Such systems are incomplete or nonexistent for many developing countries. About 18 percent of global CVD mortality occurs in China, where the sample registration covers only about 10 percent of the population or about 100 million people in rural and urban settings. About 17 percent of global CVD mortality occurs in India, which has no complete registration system. Registration of vital statistics and cause of death is generally lacking for Africa, Middle Eastern countries, and Asian islands (Murray and Lopez, 1997b).

There are several options for vital registration, the key for each being complete coverage of all deaths, including those from CVD, classified at least by age and sex. Priority assistance should be given to countries that currently lack vital

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