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Pan M, Beratarrechea A, Poggio R, He H, Chen CS, Chen J, Irazola V, Rubinstein A, He J, Mills KT. Identifying Who Benefits the Most from a Community Health Worker-Led Multicomponent Intervention for Hypertension. Int J Hypertens 2024; 2024:6311938. [PMID: 39319334 PMCID: PMC11421940 DOI: 10.1155/2024/6311938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 08/02/2024] [Accepted: 08/29/2024] [Indexed: 09/26/2024] Open
Abstract
Background Uncontrolled hypertension is a major public health challenge in low- and middle-income countries. The Hypertension Control Program in Argentina (HCPIA) showed that a community health worker-led multicomponent intervention was effective for blood pressure (BP) reduction in resource-limited settings, but whether the intervention was equally effective across participant subgroups is unknown. Objective To identify participants who benefit the most from the HCPIA BP control intervention. Methods This secondary analysis used data from HCPIA, a successful 18-month cluster-randomized trial in 18 health centers with 1,432 low-income hypertensive patients in Argentina. Fifteen baseline characteristics were used to define subgroups. The proportion of controlled BP (<140/90 mmHg) was estimated using generalized linear mixed models with arm-by-subgroup interaction terms. The distribution of trial BP response among intervention patient subgroups was assessed. Results Participants were 53.0% female, a mean age of 56 years, and 17.4% controlled BP at baseline. After the intervention, 72.9% of intervention and 52.2% of control participants had controlled BP. The intervention was more effective in physically inactive patients (OR = 2.76, 95% CI: 1.82 and 4.21; p for interaction = 0.04), moderately active patients (OR = 3.08, 95% CI: 1.90 and 4.99; p for interaction = 0.03), and those with uncontrolled BP at baseline (OR = 2.77, 95% CI: 2.15 and 3.57; p for interaction = 0.05). Among intervention participants, 20.2% had no BP response (BP change < -4 mmHg), 41.3% had a moderate BP response (BP change: -4 mmHg to -24 mmHg), and 38.5% had a high BP response (BP change > -24 mmHg). Women (p=0.01), those who were physically inactive (p=0.03), and those not taking antihypertensive medications at baseline (p=0.001) had the greatest BP response. Conclusion The effect of the intervention was consistent across many subgroups with some key groups showing a particularly strong intervention effect. These findings could be useful for planning future hypertension control programs in low- and middle-income countries.
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Affiliation(s)
- Meng Pan
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane University, New Orleans, LA, USA
| | | | - Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Hua He
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane University, New Orleans, LA, USA
- Translational Sciences InstituteTulane University, New Orleans, LA, USA
| | - Chung-Shiuan Chen
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane University, New Orleans, LA, USA
- Translational Sciences InstituteTulane University, New Orleans, LA, USA
| | - Jing Chen
- Translational Sciences InstituteTulane University, New Orleans, LA, USA
- Department of MedicineTulane University School of MedicineTulane University, New Orleans, LA, USA
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jiang He
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane University, New Orleans, LA, USA
- Translational Sciences InstituteTulane University, New Orleans, LA, USA
- Department of MedicineTulane University School of MedicineTulane University, New Orleans, LA, USA
| | - Katherine T. Mills
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane University, New Orleans, LA, USA
- Translational Sciences InstituteTulane University, New Orleans, LA, USA
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Mbuthia GW, Mwangi J, Magutah K, Oguta JO, Ngure K, McGarvey ST. Preliminary efficacy of a community health worker homebased intervention for the control and management of hypertension in Kiambu County, Kenya- a randomized control trial. PLoS One 2024; 19:e0293791. [PMID: 39208336 PMCID: PMC11361652 DOI: 10.1371/journal.pone.0293791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/06/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION In Sub Saharan Africa, there is a growing burden of non-communicable diseases, which poses a big challenge to the resource-limited health system in these settings. OBJECTIVE The aim of this study was to determine the feasibility and preliminary efficacy of a community health workers (CHWs) home-based lifestyle interventions to improve blood pressure (BP) control and body composition among hypertensive patients in low-income populations of Kiambu County, Kenya. METHODS This was a randomized controlled trial (RCT) involving 80 patients with uncontrolled high BP (systolic BP (SBP) ≥140mmHg and/or diastolic BP (DBP) ≥90) randomized to either a CHW homebased intervention or a usual care (control) arm and followed up for 6 months. The intervention involved monthly CHW home-visits for health education and audits on behavioral risk factors that affect BP. An adapted WHO stepwise questionnaire and international physical activity questionnaire was used to collect data on behavioral cardiovascular risk factors. To assess the main outcomes of BP, body mass index (BMI) and waist-height-ratio (WHtR), a survey was conducted at baseline, 3 months, and 6 months. Data regarding univariate, bivariate and multivariate (repeated measurements between and within groups) analysis at 5% level of significance were analyzed using STATA 18. Generalized estimating equations (GEE) for repeated measures were used to estimate changes in BP, BMI and WHtR, and to examine the association between the CHW intervention and BP control. RESULTS The study revealed that 77.5% and 92.5% of the participants in usual care and intervention groups completed the follow-up, respectively. After 6 months of follow-up, there was a reduction in the mean SBP and DBP for both arms, and reductions in BMI and WHtR only in the intervention arm. The adjusted mean reduction in SBP (-8.4 mm Hg; 95% CI, -13.4 to -3.3; P = 0.001) and DBP (-5.2 mm Hg 95% CI, -8.3 to -2.0; P<0.001) were significantly higher in the intervention group compared to the control group. The proportion of participants who achieved the controlled BP target of <140/90 mm Hg was 62.2% and 25.8% for the intervention and usual care arm, respectively. The proportion with controlled BP was significantly higher in the intervention arm compared to the usual care arm after adjusting for baseline covariates (AOR 2.8, 95% CI 1.3-6.0, p = 0.008). There was no significant effect of the intervention on BMI and WHtR. CONCLUSION A home-based CHW intervention was significantly associated with reduction in BP among hypertensive patients compared to usual care. Future fully powered RCTs to test the effectiveness of such interventions among low-income populations are recommended. TRIAL REGISTRATION Trial registration number: PACTR202309530525257.
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Affiliation(s)
- Grace Wambura Mbuthia
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - James Mwangi
- School of Public Health and Community Development, Maseno University, Kisumu, Kenya
- World Health Organisation Somalia, ATMIS Protected Area, Mogandishu, Somalia
| | - Karani Magutah
- School of Medicine, College of Health Sciences, Moi University Eldoret, Eldoret, Kenya
| | - James Odhiambo Oguta
- Division of Population Health, Sheffield Centre for Health and Related Research, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom
| | - Kenneth Ngure
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Stephen T. McGarvey
- Department of Epidemiology, School of Public Health and Department of Anthropology, International Health Institute, Brown University, Providence, RI, United States of America
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Haregu T, Delobelle P, Shrestha A, Panniyammakal J, Thankappan KR, Parasuraman G, Schouw D, Ramalingam A, Issaka A, Cao Y, Levitt N, Oldenburg B. Shifting roles of community health workers in the prevention and management of noncommunicable disease during the COVID-19 pandemic: a scoping review. Health Policy Plan 2024; 39:771-781. [PMID: 38910332 PMCID: PMC11308610 DOI: 10.1093/heapol/czae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/16/2024] [Accepted: 06/22/2024] [Indexed: 06/25/2024] Open
Abstract
Community Health Workers (CHWs) play a crucial role in the prevention and management of noncommunicable diseases (NCDs). The COVID-19 pandemic triggered the implementation of crisis-driven responses that involved shifts in the roles of CHWs in terms of delivering services for people with NCDs. Strategically aligning these shifts with health systems is crucial to improve NCD service delivery. The aim of this review was to identify and describe COVID-19-triggered shifting roles of CHWs that are promising in terms of NCD service delivery. We searched Ovid Medline, Embase, CINAHL, Web of Science and CABI for Global Health for relevant articles published between 1 January 2020 and 22 February 2022. Studies that were conducted within a COVID-19 context and focused on the shifted roles of CHWs in NCD service delivery were included. We used Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to report the findings. A total of 25 articles from 14 countries were included in this review. We identified 12 shifted roles of CHWs in NCD service delivery during COVID-19, which can be categorized in three dimensions: 'enhanced' role of CHWs that includes additional tasks such as medication delivery; 'extended' roles such as the delivery of NCD services at household level and in remote communities; and 'enabled' roles through the use of digital health technologies. Health and digital literacy of people with NCDs, access to internet connectivity for people with NCDs, and the social and organizational context where CHWs work influenced the implementation of the shifted roles of CHWs. In conclusion, the roles of CHWs have shifted during the COVID-19 pandemic to include the delivery of additional NCD services at home and community levels, often supported by digital technologies. Given the importance of the shifting roles in the prevention and management of NCDs, adaptation and integration of these shifted roles into the routine activities of CHWs in the post-COVID period is recommended.
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Affiliation(s)
- Tilahun Haregu
- NCD and Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, J47/86 Old Main Building, Groote Schuur Hospital Observatory, 7925 Cape Town, South Africa
- Department of Public Health, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Abha Shrestha
- NCD and Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Psychology and Public Health, La Trobe University, Plenty Rd, Bundoora, Victoria 3086, Australia
| | - Jeemon Panniyammakal
- Achutha Menon Centre for Health Science Studies (AMCHSS), Sree Chitra Tirunal Institute of Medical Science and Technology, Trivandrum, India
| | | | | | - Darcelle Schouw
- Division of Family Medicine and Primary Care, Stellenbosch University, PO Box 241, Cape Town 8000, South Africa
| | | | - Ayuba Issaka
- NCD and Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Yingting Cao
- NCD and Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, University of Cape Town, J47/86 Old Main Building, Groote Schuur Hospital Observatory, 7925 Cape Town, South Africa
| | - Brian Oldenburg
- NCD and Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- School of Psychology and Public Health, La Trobe University, Plenty Rd, Bundoora, Victoria 3086, Australia
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Katena NA, Shamu S, Fana GT, Dewa E, Dombojena A, Rusakaniko S. Acceptability of a community health worker- led health literacy intervention on lifestyle modification among hypertensive and diabetes patients in the City of Harare, Zimbabwe. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.10.24310219. [PMID: 39040189 PMCID: PMC11261947 DOI: 10.1101/2024.07.10.24310219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Deploying community health workers (CHWs) is a vital strategy to improve health at a community level in low- and middle-income countries. Whilst there is substantial evidence on the effectiveness of CHWs interventions, there is a need for more research on the mechanisms through which these interventions work. Understanding the acceptability of these interventions is one way of assessing the mechanisms through which they work. This article examines the acceptability of a community health worker- led health literacy intervention on lifestyle modification among hypertensive and diabetes patients based on the perspectives of the CHWs, community nurses and diabetes and hypertensive patients. A qualitative study was imbedded within a cluster randomized trial to assess the effectiveness community health worker- led health literacy intervention on lifestyle modification among hypertensive and diabetes patients in the City of Harare, Zimbabwe. Data were gathered through semi-structured interviews with 3 community health nurses and 15 diabetes and hypertension patients as well as 2 focus group discussions with CHWs. Data were analyzed manually using the thematic analysis method. There was consensus that the intervention had many benefits amongst CHWs and community nurses. However, among patients, there were mixed perceptions regarding the benefits of the intervention. The main challenges that were mentioned by CHWs include resistance to advice by patients, insufficient resources, and lack of acceptance at some of the patient's homes. All participants believed the intervention was acceptable. Our study provides vital information that should be considered in upscaling CHW led interventions.
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Affiliation(s)
- Nyaradzai Arster Katena
- Global Public Health and Family Medicine Department, University of Zimbabwe, Faculty of Medicine &Health Sciences
| | - Shepherd Shamu
- Global Public Health and Family Medicine Department, University of Zimbabwe, Faculty of Medicine &Health Sciences
| | - Golden Tafadzwa Fana
- Department of Medicine, University of Zimbabwe, Faculty of Medicine& Health Sciences
| | | | | | - Simbarashe Rusakaniko
- Global Public Health and Family Medicine Department, University of Zimbabwe, Faculty of Medicine &Health Sciences
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Nguyen HL, Ha DA, Tran OT, Phan VH, Nguyen CT, Nguyen GH, Nguyen TT, Le TT, Goldberg RJ, Wang B, Tang ET, Chiriboga G, Budhwani H, Allison JJ. Conquering hypertension in Vietnam: 12- month follow up results from a cluster-randomised controlled trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101123. [PMID: 39045484 PMCID: PMC11263625 DOI: 10.1016/j.lanwpc.2024.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 07/25/2024]
Abstract
Background Approximately 20% of adults in Vietnam have hypertension, and management of this chronic condition remains challenging. This study aimed to assess the effectiveness of a multicomponent intervention in reducing blood pressure (BP) in adults with uncontrolled hypertension. Methods This cluster randomised controlled trial was conducted in sixteen communities (8 intervention and 8 comparison) in a rural setting in Vietnam (2017-2022). Consenting adults (aged ≥ 18 years) with uncontrolled hypertension were enrolled. Sixteen communities were equally randomised to an intervention or comparison group stratified by district. Consenting adults were assigned to study groups by community. The comparison arm received training sessions about hypertension prevention and management for health workers, and patient education materials. The intervention arm received training sessions about hypertension prevention and management for health workers, and patient education materials and three enhancement components including a storytelling intervention, home BP self-monitoring, and expanded community health worker services. The primary outcome was the difference in changes in patient's levels of systolic BP between the study groups over a 12-month follow-up period. Patients and outcome assessors were masked. Findings A total of 671 patients (340: intervention, 331: comparison) were enrolled in the trial. The mean age was 66 years and 45% were men. At the 12-month follow-up, the mean systolic BP declined by 18.4 mmHg in the intervention group and 3.7 mmHg in the comparison group (differential decline of 14.7 mmHg [95% CI: 11.8-17.6]). The intervention group also achieved better BP control and medication adherence than the comparison group. There were no serious adverse events related to study participation. Interpretation The results of this trial demonstrate that a multicomponent intervention can effectively reduce elevated BP in individuals with uncontrolled hypertension in Vietnam. Trial registration: This trial was registered at ClinicalTrials.gov, NCT03590691. Funding National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Hoa L. Nguyen
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Duc A. Ha
- Viet Nam Ministry of Health, 138 Giang Vo Street, Ba Dinh District, Ha Noi, Viet Nam
- Health Strategy and Policy Institute, Viet Nam Ministry of Health, 196 Lane, Ho Tung Mau Street, Cau Giay District, Ha Noi, Viet Nam
| | - Oanh T. Tran
- Health Strategy and Policy Institute, Viet Nam Ministry of Health, 196 Lane, Ho Tung Mau Street, Cau Giay District, Ha Noi, Viet Nam
| | - Van H. Phan
- Health Strategy and Policy Institute, Viet Nam Ministry of Health, 196 Lane, Ho Tung Mau Street, Cau Giay District, Ha Noi, Viet Nam
| | - Cuc T. Nguyen
- Health Strategy and Policy Institute, Viet Nam Ministry of Health, 196 Lane, Ho Tung Mau Street, Cau Giay District, Ha Noi, Viet Nam
| | - Giang H. Nguyen
- Health Strategy and Policy Institute, Viet Nam Ministry of Health, 196 Lane, Ho Tung Mau Street, Cau Giay District, Ha Noi, Viet Nam
| | - Thang T. Nguyen
- Health Strategy and Policy Institute, Viet Nam Ministry of Health, 196 Lane, Ho Tung Mau Street, Cau Giay District, Ha Noi, Viet Nam
| | - Thanh T. Le
- Health Strategy and Policy Institute, Viet Nam Ministry of Health, 196 Lane, Ho Tung Mau Street, Cau Giay District, Ha Noi, Viet Nam
| | - Robert J. Goldberg
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Elena T. Tang
- UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Germán Chiriboga
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Henna Budhwani
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, 32304, USA
| | - Jeroan J. Allison
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
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Gerber F, Gupta R, Lejone TI, Tahirsylaj T, Lee T, Sanchez-Samaniego G, Kohler M, Haldemann MI, Raeber F, Chitja M, Mathulise M, Kabi T, Mokaeane M, Maphenchane M, Molulela M, Khomolishoele M, Mota M, Masike S, Bane M, Sematle MP, Makabateng R, Mphunyane M, Phaaroe S, Basler DB, Kindler K, Burkard T, Briel M, Chammartin F, Labhardt ND, Amstutz A. Community-based management of arterial hypertension and cardiovascular risk factors by lay village health workers for people with controlled and uncontrolled blood pressure in rural Lesotho: joint protocol for two cluster-randomized trials within the ComBaCaL cohort study (ComBaCaL aHT Twic 1 and ComBaCaL aHT TwiC 2). Trials 2024; 25:365. [PMID: 38845045 PMCID: PMC11157768 DOI: 10.1186/s13063-024-08226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Arterial hypertension (aHT) is a major cause for premature morbidity and mortality. Control rates remain poor, especially in low- and middle-income countries. Task-shifting to lay village health workers (VHWs) and the use of digital clinical decision support systems may help to overcome the current aHT care cascade gaps. However, evidence on the effectiveness of comprehensive VHW-led aHT care models, in which VHWs provide antihypertensive drug treatment and manage cardiovascular risk factors is scarce. METHODS Using the trials within the cohort (TwiCs) design, we are assessing the effectiveness of VHW-led aHT and cardiovascular risk management in two 1:1 cluster-randomized trials nested within the Community-Based chronic disease Care Lesotho (ComBaCaL) cohort study (NCT05596773). The ComBaCaL cohort study is maintained by trained VHWs and includes the consenting inhabitants of 103 randomly selected villages in rural Lesotho. After community-based aHT screening, adult, non-pregnant ComBaCaL cohort participants with uncontrolled aHT (blood pressure (BP) ≥ 140/90 mmHg) are enrolled in the aHT TwiC 1 and those with controlled aHT (BP < 140/90 mmHg) in the aHT TwiC 2. In intervention villages, VHWs offer lifestyle counseling, basic guideline-directed antihypertensive, lipid-lowering, and antiplatelet treatment supported by a tablet-based decision support application to eligible participants. In control villages, participants are referred to a health facility for therapeutic management. The primary endpoint for both TwiCs is the proportion of participants with controlled BP levels (< 140/90 mmHg) 12 months after enrolment. We hypothesize that the intervention is superior regarding BP control rates in participants with uncontrolled BP (aHT TwiC 1) and non-inferior in participants with controlled BP at baseline (aHT TwiC 2). DISCUSSION The TwiCs were launched on September 08, 2023. On May 20, 2024, 697 and 750 participants were enrolled in TwiC 1 and TwiC 2. To our knowledge, these TwiCs are the first trials to assess task-shifting of aHT care to VHWs at the community level, including the prescription of basic antihypertensive, lipid-lowering, and antiplatelet medication in Africa. The ComBaCaL cohort and nested TwiCs are operating within the routine VHW program and countries with similar community health worker programs may benefit from the findings. TRIAL REGISTRATION ClinicalTrials.gov NCT05684055. Registered on January 04, 2023.
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Affiliation(s)
- Felix Gerber
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
| | | | - Thabo Ishmael Lejone
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Thesar Tahirsylaj
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Tristan Lee
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Giuliana Sanchez-Samaniego
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maurus Kohler
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maria-Inés Haldemann
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabian Raeber
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dave Brian Basler
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Kevin Kindler
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Faculty of Business, Economics and Informatics, University of Zurich, Zurich, Switzerland
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, ESH Hypertension Centre of Excellence, University Hospital Basel, Basel, Switzerland
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Matthias Briel
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Frédérique Chammartin
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Alain Amstutz
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Oslo Center for Biostatistics and Epidemiology, Oslo University Hospital, University of Oslo, Oslo, Norway
- Bristol Medical School, University of Bristol, Bristol, UK
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Fritz M, Grimm M, My Hanh HT, Koot JAR, Nguyen GH, Nguyen TPL, Probandari A, Widyaningsih V, Lensink R. Effectiveness of community-based diabetes and hypertension prevention and management programmes in Indonesia and Viet Nam: a quasi-experimental study. BMJ Glob Health 2024; 9:e015053. [PMID: 38777393 PMCID: PMC11116884 DOI: 10.1136/bmjgh-2024-015053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Non-communicable diseases (NCDs) have surpassed infectious diseases as the leading global cause of death, with the Southeast Asian region experiencing a significant rise in NCD prevalence over the past decades. Despite the escalating burden, screening for NCDs remains at very low levels, resulting in undetected cases, premature mortality and high public healthcare costs. We investigate whether community-based NCD prevention and management programmes are an effective solution. METHODS In Indonesia, we compare participants in the community-based NCD screening and management programme Pos Pembinaan Terpadu-Penyakit Tidak Menular with matched non-participants with respect to their uptake of screening activities, health-related behaviour and knowledge and metabolic risk factors. We use statistical matching to redress a possible selection bias (n=1669). In Viet Nam, we compare members of Intergenerational Self-Help Clubs, which were offered similar NCD health services, with members of other community groups, where such services were not offered. We can rely on two waves of data and use a double-difference approach to redress a possible selection bias and to measure the impacts of participation (n=1710). We discuss strengths and weaknesses of the two approaches in Indonesia and Viet Nam. RESULTS In Indonesia, participants have significantly higher uptake of screening for hypertension and diabetes (+13% from a control mean of 88% (95% CI 9% to 17%); +93% from a control mean of 48% (95% CI 79% to 108%)). In both countries, participants show a higher knowledge about risk factors, symptoms and complications of NCDs (Indonesia: +0.29 SD (0.13-0.45), Viet Nam: +0.17 SD (0.03-0.30)). Yet, the improved knowledge is only partly reflected in improved health behaviour (Viet Nam: fruit consumption +0.33 SD (0.15-0.51), vegetable consumption +0.27 SD (0.04-0.50)), body mass index (BMI) (Viet Nam: BMI -0.07 SD (-0.13 to -0.00)) or metabolic risk factors (Indonesia: systolic blood pressure: -0.13 SD (-0.26 to -0.00)). CONCLUSION Community-based NCD programmes are well suited to increase screening and to transmit health knowledge. Due to their extensive outreach within the community, they can serve as a valuable complement to the screening services provided at the primary healthcare level. Yet, limited coverage, insufficient resources and a high staff turnover remain a problem. TRIAL REGISTRATION NUMBER NCT05239572.
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Affiliation(s)
- Manuela Fritz
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
- School of Business, Economics and Information Systems, University of Passau, Passau, Germany
| | - Michael Grimm
- School of Business, Economics and Information Systems, University of Passau, Passau, Germany
- IZA Institute of Labor Economics, Bonn, Germany
| | | | - Jaap A R Koot
- Department of Health Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Thi-Phuong-Lan Nguyen
- Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City, Viet Nam
| | - Ari Probandari
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia
| | - Vitri Widyaningsih
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Central Java, Indonesia
| | - Robert Lensink
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
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Zuñiga RO, Parra-García I, Gómez-Barrera LA. Overview of the participation of community health workers in primary health care in 6 Latin American countries and a proposal for their integration into the health system: a qualitative study. Fam Pract 2024; 41:139-146. [PMID: 38300797 DOI: 10.1093/fampra/cmae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND According to some health programmes, implementing primary health care through community health workers (CHWs) facilitates the connection between community and health services in Latin America. However, these are isolated processes that face different obstacles and would benefit from an overview of the corresponding health policies and programmes. OBJECTIVE To provide an overview of CHW participation in 6 Latin American countries. METHODS This exploratory qualitative study was based on 3 sources of information: a literature review, a review of public health policy documents, and interviews with experts who have led CHW programmes in 6 Latin American countries. RESULTS The role of CHWs in Latin America and some advances in public health policies in the region were evidenced. However, limitations arising from variable implementation of the WHO guidelines on health programmes with CHWs were also apparent. CONCLUSIONS CHWs contribute to the primary healthcare processes in the 6 Latin American countries studied in versatile and comprehensive ways. However, they constitute an underutilized human resource because they must provide various services that are not always relevant in different work contexts. Therefore, we propose a classification of the CHW profile, using the level of access to healthcare services of the population they serve as the main differentiator. This way, CHWs will not have to provide a wide range of services but only those most relevant to the specific needs of each community.
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Affiliation(s)
- Rosalia Olaya Zuñiga
- School of Medicine, Universidad El Bosque, Bogota, D.C., Colombia
- School of Nursing, Universidad de Ciencias Ambientales y Aplicadas (UDCA), Bogota, D.C., Colombia
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Prust ML, Forman R, Ovbiagele B. Addressing disparities in the global epidemiology of stroke. Nat Rev Neurol 2024; 20:207-221. [PMID: 38228908 DOI: 10.1038/s41582-023-00921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities.
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Affiliation(s)
- Morgan L Prust
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Rachel Forman
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Bruce Ovbiagele
- Department of Neurology, University of California-San Francisco School of Medicine, San Francisco, CA, USA
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Nida S, Tyas ASA, Putri NE, Larasanti A, Widoyopi AA, Sumayyah R, Listiana S, Espressivo A. A systematic review of the types, workload, and supervision mechanism of community health workers: lessons learned for Indonesia. BMC PRIMARY CARE 2024; 25:82. [PMID: 38468218 PMCID: PMC10926673 DOI: 10.1186/s12875-024-02319-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Community health workers (CHWs) have demonstrated capability to improve various health indicators, however, many programmes require support in meeting their objectives due to subpar performance and a high rate of CHW attrition. This systematic review investigated the types of CHWs, their workloads, and supervision practices that contribute to their performance in different countries. METHODS The search was carried out in November 2022 in Medline, Embase, and Neliti for studies published in Indonesian or English between 1986 and 2022 that reported public health services delivered by CHWs who live and serve the community where they live but are not considered health professionals. The findings were synthesised using a thematic analysis to assess key factors influencing the performance of CHWs. RESULTS Sixty eligible articles were included in this review. CHWs were responsible for more than two diseases (n = 35) and up to fifteen, with more than eighteen activities. Their roles covered the human life cycle, from preparation for pregnancy, care for newborns, health for children, adolescents, and productive age to elderly individuals. They were also involved in improving environmental health, community empowerment, and other social issues hindering access to health services. They carried out promotive, preventive, and curative interventions. The CHW-population ratio varied from eight to tens of thousands of people. Some CHWs did not have a clear supervision system. Challenges that were often faced by CHWs included inappropriate incentives, inadequate facilities, insufficient mentoring, and supervision, many roles, and a broad catchment area. Many studies revealed that CHWs felt overburdened and stressed. They needed help to balance their significant work and domestic tasks. CONCLUSIONS Effective planning that considered the scope of work of CHWs in proportion to their responsibilities and the provision of necessary facilities were crucial factors in improving the performance of CHWs. Supportive supervision and peer-supervision methods are promising, however, any CHW supervision required a detailed protocol. This systematic review emphasised the opportunity for CHW management system improvement in Indonesia.
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Affiliation(s)
- Sofwatun Nida
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia.
| | - Agatha Swasti Ayuning Tyas
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Nidya Eka Putri
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Ayudina Larasanti
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Aldhea Ayu Widoyopi
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Rima Sumayyah
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Saetia Listiana
- Primary Health Care Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
| | - Aufia Espressivo
- Research and Policy Division, Center for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, Indonesia
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11
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Geldsetzer P, Chang AY, Meijer E, Sudharsanan N, Charu V, Kramlinger P, Haarburger R. Interviewer biases in medical survey data: The example of blood pressure measurements. PNAS NEXUS 2024; 3:pgae109. [PMID: 38525305 PMCID: PMC10959064 DOI: 10.1093/pnasnexus/pgae109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/27/2024] [Indexed: 03/26/2024]
Abstract
Health agencies rely upon survey-based physical measures to estimate the prevalence of key global health indicators such as hypertension. Such measures are usually collected by nonhealthcare worker personnel and are potentially subject to measurement error due to variations in interviewer technique and setting, termed "interviewer effects." In the context of physical measurements, particularly in low- and middle-income countries, interviewer-induced biases have not yet been examined. Using blood pressure as a case study, we aimed to determine the relative contribution of interviewer effects on the total variance of blood pressure measurements in three large nationally representative health surveys from the Global South. We utilized 169,681 observations between 2008 and 2019 from three health surveys (Indonesia Family Life Survey, National Income Dynamics Study of South Africa, and Longitudinal Aging Study in India). In a linear mixed model, we modeled systolic blood pressure as a continuous dependent variable and interviewer effects as random effects alongside individual factors as covariates. To quantify the interviewer effect-induced uncertainty in hypertension prevalence, we utilized a bootstrap approach comparing subsamples of observed blood pressure measurements to their adjusted counterparts. Our analysis revealed that the proportion of variation contributed by interviewers to blood pressure measurements was statistically significant but small: ∼ 0.24 - - 2.2 % depending on the cohort. Thus, hypertension prevalence estimates were not substantially impacted at national scales. However, individual extreme interviewers could account for measurement divergences as high as 12%. Thus, highly biased interviewers could have important impacts on hypertension estimates at the subdistrict level.
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Affiliation(s)
- Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, 3180 Porter Drive, Palo Alto, CA 94304, USA
- Department of Epidemiology and Population Health, Stanford University, 300 Pasteur Dr., Palo Alto, CA 94305, USA
- Chan Zuckerberg Biohub – San Francisco, 499 Illinois Street, San Francisco, CA 94158, USA
| | - Andrew Young Chang
- Department of Epidemiology and Population Health, Stanford University, 300 Pasteur Dr., Palo Alto, CA 94305, USA
- Division of Cardiology, Department of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, USA
- Center for Innovation in Global Health, Stanford University, 3180 Porter Drive, Palo Alto, CA 94304, USA
| | - Erik Meijer
- Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA 90089-3332, USA
| | - Nikkil Sudharsanan
- Professorship of Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Georg-Brauchle-Ring 60, 80992 Munich, Germany
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Vivek Charu
- Quantitative Sciences Unit, Department of Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94394, USA
- Department of Pathology, Stanford University, 300 Pasteur Dr., Palo Alto, CA 94305, USA
| | - Peter Kramlinger
- Department of Statistics, University of California Davis, One Shields Avenue, Davis, CA 95616, USA
| | - Richard Haarburger
- Research Training Group: Globalization and Development, Faculty of Business and Economics, Georg-August-University Göttingen, Platz d. Göttinger Sieben 3, 37073 Göttingen, Germany
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Helwig K, Niemi L, Stenuick JY, Alejandre JC, Pfleger S, Roberts J, Harrower J, Nafo I, Pahl O. Broadening the Perspective on Reducing Pharmaceutical Residues in the Environment. ENVIRONMENTAL TOXICOLOGY AND CHEMISTRY 2024; 43:653-663. [PMID: 36647735 DOI: 10.1002/etc.5563] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/23/2022] [Accepted: 01/13/2023] [Indexed: 06/17/2023]
Abstract
The present study reviews options for reducing harm from pharmaceuticals that are known to cause adverse impacts by their presence in the environment. It reviews recent global and European Union policy development, which could go further in recognizing and addressing the issue in a global context. It considers green chemistry, which can help clean up production processes but holds only long-term promise for creating "green" alternatives. It explores the potential of health promotion and disease prevention, which can contribute significantly to a reduction of the disease burden and thus the need for medicines, both for infectious and for noncommunicable disease. Eco-directed sustainable prescribing practices are reviewed, which have been adopted successfully to reduce the use of harmful pharmaceuticals. We note recent developments in medicines optimization and precision medicine, which hold promise for improving patient outcomes, saving costs, and reducing pharmaceutical use, through individually tailored prescribing whereby the patient codecides their therapy. Waste prevention through reuse or redistribution is beginning to find public support and "take-back" waste disposal schemes set up via extended producer responsibility systems have achieved high returns. Finally, the paper summarizes preferred advanced wastewater technologies, including innovative low-cost, low-energy options. In summary, although end-of-pipe options have a role to play, particularly for highly concentrated wastewaters, solutions further up the medicinal chain and disease prevention interventions, informed by a broad view of health and health care, are needed to pursue a much greater potential reduction of pharmaceuticals in the environment than can be achieved by end-of-pipe solutions alone. Environ Toxicol Chem 2024;43:653-663. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.
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Affiliation(s)
- K Helwig
- School of Computing Engineering and the Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom
| | - L Niemi
- Environmental Research Institute, University of the Highlands and Islands, Thurso, United Kingdom
| | - J-Y Stenuick
- Health Care Without Harm Europe, Brussels, Belgium
| | - J C Alejandre
- School of Computing Engineering and the Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom
| | - S Pfleger
- NHS Highland, Inverness, United Kingdom
| | - J Roberts
- School of Computing Engineering and the Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom
| | - J Harrower
- School of Computing Engineering and the Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom
| | - I Nafo
- Emschergenossenschaft and Lippeverband, Essen, Germany
| | - O Pahl
- School of Computing Engineering and the Built Environment, Glasgow Caledonian University, Glasgow, United Kingdom
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Sankar D H, Joseph J, Benny G, Surendran S, Sharma SK, Nambiar D. The role(s) of community health workers in primary health care reform in Kerala, before and during the COVID 19 pandemic: a qualitative study. FRONTIERS IN HEALTH SERVICES 2024; 4:1321882. [PMID: 38487374 PMCID: PMC10937443 DOI: 10.3389/frhs.2024.1321882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/24/2024] [Indexed: 03/17/2024]
Abstract
Background Accredited Social Health Activists (ASHA) are Community Health Workers (CHWs) employed by the National Health Mission of the Government of India to link the population to health facilities and improve maternal and child health outcomes in the country. The government of Kerala launched primary health reform measures in 2016 whereby Primary Health Centres (PHCs) were upgraded to Family Health Centres (FHCs). The COVID-19 pandemic in 2020 impacted essential health service delivery, including primary care services. The CHWs network of Kerala played a crucial role in implementing the primary care reforms and COVID-19 management efforts that followed. We carried out a study to understand the perspectives of the CHWs in Kerala about their role in the recent primary healthcare reforms and during the COVID-19 pandemic management efforts. Methods We conducted in-depth interviews (IDI) with 16 ASHAs from 8 primary care facilities in Kerala from July to October 2021. We further conducted Focus Group Discussions (FGDs) (N = 34) with population subgroups in these eight facility catchment areas and asked their opinion about the ASHAs working in their community. We obtained written informed consent from all the participants, and interview transcripts were thematically analysed by a team of four researchers using ATLAS.ti 9 software. Results Our study participants were women aged about 45 years with over 10 years of work experience as CHWs. Their job responsibilities as a frontline health worker helped them build trust in the community and local self-governments. CHWs were assigned roles of outpatient crowd management, and registration duties in FHCs. The COVID-19 pandemic increased their job roles manifold. Community members positively mentioned the home visits, delivery of medicines, and emotional support offered by the CHWs during the pandemic. The CHWs noted that the honorarium of INR 6,000 (US$73) was inconsistent and very low for the volume of work done. Conclusion The CHWs in Kerala play a crucial role in primary care reforms and COVID-19 management. Despite their strong work ethic and close relationship with local self-governments, low and irregular wages remain the biggest challenge.
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Affiliation(s)
- Hari Sankar D
- Healthier Societies, The George Institute for Global Health, New Delhi, India
| | - Jaison Joseph
- Healthier Societies, The George Institute for Global Health, New Delhi, India
| | - Gloria Benny
- Healthier Societies, The George Institute for Global Health, New Delhi, India
| | - Surya Surendran
- Healthier Societies, The George Institute for Global Health, New Delhi, India
| | | | - Devaki Nambiar
- Healthier Societies, The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Fung A, Farmer J, Borkhoff CM. Young Infants Clinical Signs Study 8-sign Algorithm for Identification of Sick Infants Adapted for Routine Home Visits: A Systematic Review and Critical Appraisal of its Measurement Properties. Glob Pediatr Health 2024; 11:2333794X231219598. [PMID: 38283299 PMCID: PMC10812101 DOI: 10.1177/2333794x231219598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 10/12/2023] [Accepted: 11/23/2023] [Indexed: 01/30/2024] Open
Abstract
Objective. The 8-sign algorithm adapted from the Young Infants Clinical Signs Study (YICSS) is widely used to identify sick infants during home visits (YICSS-home algorithm). We aimed to critically appraise the development and evidence of measurement properties, including sensibility, reliability, and validity, of the YICSS-home algorithm. Methods. Relevant studies were identified through a systematic literature search. Results. The YICSS-home algorithm has good sensibility. The algorithm demonstrated at least moderate inter-rater reliability and sensitivity ranging from 69% to 80%. However, the algorithm was developed among sick infants brought for care to a health facility and not initially developed for use by community health workers (CHWs) during home visits. Some important risk factors were omitted at item generation. Inter-CHW reliability and construct validity have not been estimated. Conclusion. Future research should build on the strengths of the YICSS-home algorithm and address its limitations to develop a new algorithm with improved predictive accuracy.
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Affiliation(s)
- Alastair Fung
- Hospital for Sick Children, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | - Cornelia M. Borkhoff
- University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children Research Institute, Toronto, ON, Canada
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Siddiqui F, Hewitt C, Jennings H, Coales K, Mazhar L, Boeckmann M, Siddiqi N. Self-management of chronic, non-communicable diseases in South Asian settings: A systematic mixed-studies review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001668. [PMID: 38190368 PMCID: PMC10773968 DOI: 10.1371/journal.pgph.0001668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024]
Abstract
Self-management is crucial in mitigating the impacts of a growing non-communicable disease (NCD) burden, particularly in Low and Middle-Income countries. What influences self-management in these settings, however, is poorly understood. We aimed to identify the determinants of self-management in the high NCD region of South Asia and explore how they influence self-management. A systematic mixed-studies review was conducted. Key electronic databases [MEDLINE (1946+), Embase (1974+), PsycInfo (1967+) and CINAHL (EBSCOhost)] in March 2022 (and updated in April 2023) were searched for studies on the self-management of four high-burden NCD groups: cardiovascular diseases, type 2 diabetes, chronic respiratory diseases and depression. Study characteristics and quantitative data were extracted using a structured template, and qualitative information was extracted using NVivo. Quality appraisal was done using the Mixed Methods Assessment Tool (MMAT). Quantitative findings were organised using the Commission on Social Determinants of Health (CSDH) framework and synthesised narratively, supported by effect direction plots. Qualitative findings were thematically synthesised. Both were integrated in a mixed synthesis. Forty-four studies (26 quantitative, 16 qualitative and 2 mixed-methods studies) were included, the majority of which were conducted in urban settings and among individuals with diabetes and cardiovascular diseases. Higher age, education, and income (structural determinants), health-related knowledge, social support and self-efficacy (psychosocial determinants), longer illness duration and physical comorbidity (biologic determinants), and the affordability of medicine (health-system determinants) were key determinants of self-management. Qualitative themes highlighted the role of financial adversity and the social and physical environment in shaping self-management.A complex interplay of structural and intermediary social determinants shapes self-management in South Asian settings. Multi-component, whole-systems approaches could boost self-management in these settings. Key areas include empowerment and education of patients and wider community, design and delivery of bespoke behavioural interventions and a stronger emphasis on supporting self-management in healthcare settings.
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Affiliation(s)
- Faraz Siddiqui
- Department of Health Sciences, Mental Health and Addictions Research Group, University of York, York, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, Mental Health and Addictions Research Group, University of York, York, United Kingdom
- Department of Health Sciences, York Trials Unit, University of York, York, United Kingdom
| | - Hannah Jennings
- Department of Health Sciences, Mental Health and Addictions Research Group, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Karen Coales
- Department of Health Sciences, Mental Health and Addictions Research Group, University of York, York, United Kingdom
| | - Laraib Mazhar
- Penn State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Melanie Boeckmann
- Department of Global Health, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Najma Siddiqi
- Department of Health Sciences, Mental Health and Addictions Research Group, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
- Bradford District Care NHS foundation trust, Bradford, United Kingdom
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Fitriadi Y, Danawati W, Sutomo AH. Health promotion intervention delivered by trained community health workers (CHWs) for obesity prevention and control among adult people: a scoping review protocol. BMJ Open 2023; 13:e072822. [PMID: 38072476 PMCID: PMC10728997 DOI: 10.1136/bmjopen-2023-072822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Obesity is one of the most common diseases and is the main risk factor for the occurrence of other non-communicable diseases, such as hypertension, diabetes, heart disease and cancer. Obesity can be prevented and controlled, especially by adopting healthy behaviours, such as increased physical activity and healthy dietary patterns. The delivery of health promotion interventions by trained community health workers (CHWs) can be applied to obesity prevention and control based on the culture and local context. Our study aimed to map the health promotion interventions delivered by trained CHWs in the context of obesity prevention and control in community settings. METHODS This scoping review (ScR) was conducted using the methodologies introduced by Arksey and O'Malley. The search strategy was conducted on electronic databases, such as MEDLINE via PubMed, Scopus, Cochrane, ProQuest, medRxiv and Clinicaltrial.gov, from 2010 until 2022 by entering the appropriate keywords. Afterwards, the title, abstract and full text were screened independently by two researchers in accordance with the inclusion and exclusion criteria. Then, the data were charted, extracted, collated, summarised and reported. ETHICS AND DISSEMINATION In this ScR, research ethics was unnecessary because this work synthesised evidence from pre-existing literature only. The results of this ScR were published in peer-reviewed journals and presented at scientific conferences. We disseminated the results using graphs, images, tables, discussions and a plain language summary.
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Affiliation(s)
- Yogi Fitriadi
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Doctoral Program of Medical and Health Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Wahyu Danawati
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Adi Heru Sutomo
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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ElSayed NA, Bannuru RR, Bakris G, Bardsley J, de Boer IH, Gabbay RA, Gockerman J, McCoy RG, McCracken E, Neumiller JJ, Pilla SJ, Rhee CM. Diabetic Kidney Disease Prevention Care Model Development. Clin Diabetes 2023; 42:274-294. [PMID: 38694240 PMCID: PMC11060626 DOI: 10.2337/cd23-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
More than one-third of people with diabetes develop diabetic kidney disease (DKD), which substantially increases risks of kidney failure, cardiovascular disease (CVD), hypoglycemia, death, and other adverse health outcomes. A multifaceted approach incorporating self-management education, lifestyle optimization, pharmacological intervention, CVD prevention, and psychosocial support is crucial to mitigate the onset and progression of DKD. The American Diabetes Association convened an expert panel to develop the DKD Prevention Model presented herein. This model addresses prevention and treatment, including screening guidelines, diagnostic tools, and management approaches; comprehensive, holistic interventions; well-defined roles for interdisciplinary health care professionals; community engagement; and future directions for research and policy.
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Affiliation(s)
- Nuha A. ElSayed
- American Diabetes Association, Alexandria, VA
- Harvard Medical School, Boston, MA
| | | | - George Bakris
- Department of Medicine, American Heart Association Comprehensive Hypertension Center, University of Chicago School of Medicine, Chicago, IL
| | - Joan Bardsley
- MedStar Health Research Institute and MedStar System Nursing, Columbia, MD
| | - Ian H. de Boer
- Division of Nephrology, University of Washington School of Medicine, Seattle, WA
| | | | | | - Rozalina G. McCoy
- Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, University of Maryland Institute for Health Computing, Rockville, MD
| | | | - Joshua J. Neumiller
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA
- Providence Medical Research Center, Providence Health Care, Spokane, WA
| | - Scott J. Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Connie M. Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Irvine, CA
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Ingenhoff R, Robertson N, Munana R, Bodnar BE, Weswa I, Sekitoleko I, Gaal J, Kirenga BJ, Kalyesubula R, Knauf F, Siddharthan T. Challenges to Implementation of Community Health Worker-Led Chronic Obstructive Pulmonary Disease (COPD) Screening and Referral in Rural Uganda: A Qualitative Study using the Implementation Outcomes Framework. Int J Chron Obstruct Pulmon Dis 2023; 18:2769-2783. [PMID: 38046984 PMCID: PMC10693197 DOI: 10.2147/copd.s420137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. The burden of COPD is expected to increase in low- and middle-income countries (LMICs). COPD screening and diagnostics tools are often inaccessible in rural settings of LMICs. To contribute to the growing body of evidence on the effectiveness of Community Health Worker (CHW) interventions, this study aims to understand the facilitators and barriers of implementing a CHW-led COPD screening and referral program in rural Uganda. Methods This qualitative study was conducted from September to October 2022 to explore Community Members, CHWs, and Healthcare Providers (HCPs) perceptions on the challenges of CHW-delivered COPD programming in Nakaseke, rural Uganda. In total, we held eight individual in-depth interviews with CHWs, ten in-depth interviews with HCPs and six focus group discussions with 34 Community Members. Research assistants audio-recorded and transcribed interviews verbatim. The implementation outcomes framework guided the thematic analysis. Results Implementation acceptability was constrained by a lack of COPD awareness, a lack of perceived utility in COPD screening as well as stigma around the diagnostic process. Limited spirometry adoption was also attributed to Community Member accessibility and willingness to participate in the COPD diagnostic referral process. The high patient volume and the complex, time-consuming diagnostic and referral process hindered successful implementation. To enhance program sustainability, all participants suggested increasing CHW support, medication access, decentralizing COPD care and upscaling follow-up of Community Members by CHWs. Conclusion CHW-led interventions remain a potentially critical tool to alleviate barriers to treatment and self-management in settings where access to care is limited. While community-based interventions can create sustainable infrastructure to improve health outcomes, formative assessments of the potential barriers prior to intervention are required. Evidence-based, localized approaches and sustained funding are imperative to achieve this.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Richard Munana
- School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Julia Gaal
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Physiology, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, FL, USA
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Diaz-Martinez J, Kallus L, Levine HM, Lavernia F, Pierre AJ, Mancilla J, Barthe A, Duran C, Kotzker W, Wagner E, Hospital MM. Community-Engaged Research (CEnR) to Address Gaps in Chronic Kidney Disease Education among Underserved Latines-The CARE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7026. [PMID: 37947582 PMCID: PMC10649949 DOI: 10.3390/ijerph20217026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Ensuring equitable chronic kidney disease (CKD) education for Latine patients with low health literacy and low English proficiency stands as a critical challenge, and the "Caridad Awareness and Education" (CARE) initiative represents our ongoing effort to address this imperative issue. In collaboration with twenty-three patients living with CKD, diabetes and/or hypertension and twelve trained Community Health Workers (CHWs) from diverse Latine subgroups, we conducted a research initiative funded by the National Kidney Foundation. Our primary objective was to co-design and test culturally tailored patient education materials (PEMs) for underserved Latine adults at risk for or diagnosed with CKD. We effectively integrated Community-Engaged Research (CEnR) principles with a Human-Centered Design (HCD) approach to create a range of CKD-PEM prototypes in Spanish. Patient preferences for printed educational materials were clear. They favored printed materials that incorporated visual content with concise text over digital, email, texts, or online resources and personalized phone outreach and the involvement of CHWs. Additionally, patients identified their unwavering commitment to their families as a forceful motivator for caring for their kidney health. Currently, a culturally and linguistically tailored CKD flipchart for one-on-one education, led by CHWs, is undergoing a pilot testing phase involving a sample of one hundred Latine patients at risk for or diagnosed with CKD. This innovative approach signifies a commitment to amplifying the insights and expertise of the Latine community afflicted by kidney health disparities, effectively embracing a CEnR to forge meaningful and impactful CKD-PEMs.
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Affiliation(s)
- Janet Diaz-Martinez
- Research Center in a Minority Institution, Florida International University (FIU-RCMI), Miami, FL 33199, USA; (E.W.); (M.M.H.)
- Robert Stempel College of Public Health and School of Social Work, Florida International University, Miami, FL 33199, USA
| | - Laura Kallus
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | | | - Frank Lavernia
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Aydevis Jean Pierre
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Jessica Mancilla
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Ale Barthe
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Carlos Duran
- Florida Kidney Physicians, Boca Raton, FL 33431, USA; (C.D.); (W.K.)
| | - Wayne Kotzker
- Florida Kidney Physicians, Boca Raton, FL 33431, USA; (C.D.); (W.K.)
| | - Eric Wagner
- Research Center in a Minority Institution, Florida International University (FIU-RCMI), Miami, FL 33199, USA; (E.W.); (M.M.H.)
- Robert Stempel College of Public Health and School of Social Work, Florida International University, Miami, FL 33199, USA
| | - Michelle M. Hospital
- Research Center in a Minority Institution, Florida International University (FIU-RCMI), Miami, FL 33199, USA; (E.W.); (M.M.H.)
- Robert Stempel College of Public Health and School of Social Work, Florida International University, Miami, FL 33199, USA
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20
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Garg A, Murphy A, Krishna A, Sahoo SK, Huffman MD, Kishore SP, Shivashankar R. Essential medicines for cardiovascular diseases in India: Rapid appraisal of policies and processes at the subnational level. THE NATIONAL MEDICAL JOURNAL OF INDIA 2023; 35:357-363. [PMID: 37167513 DOI: 10.25259/nmji_35_6_357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background The burden of cardiovascular diseases (CVDs) and response to health systems vary widely at the subnational level in India. Our study aimed to assess the variation in state-level access to medicines for CVDs by comparing the essential medicines lists (EMLs) at the national and subnational levels in India and by rapid appraisal of the existing policies and processes of drug procurement. Methods We assessed the inclusion of six classes of medicines for CVDs in the recent and publicly available national and subnational EMLs from July to September 2018 in the states of Telangana and Madhya Pradesh. We examined the drug procurement and distribution policies and processes using documentary review and five key informant interviews between March and June 2018. Results The WHO's EML, India's national EML, and 21 of 28 publicly available (75%) Indian state and Union Territory EMLs included all six classes of essential medicines for CVDs. However, some medicines were not included in the policy packages of essential medicines meant for primary health centres. Both the states used centralized tendering and decentralized distribution as part of the public sector drug procurement process. The requirement was based on the previous year's consumption. The approximate time between procurement planning and distribution was 7-8 months in both the states. Conclusion Substantial variation exists in the selection of drugs for CVDs in EMLs at the subnational level in India. Improving forecasting techniques for requirement of medicines and reducing time lags between forecasting and distribution to health facilities may allow for better access to essential medicines.
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Affiliation(s)
- Ankur Garg
- Centre for Chronic Disease Control, New Delhi, India
| | - Adrianna Murphy
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago
- Division of Food Policy, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | - Roopa Shivashankar
- Centre for Chronic Disease Control, New Delhi, India
- Resolve to Save Lives, Gurugram, Haryana, India
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21
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Chebrolu P, Chalem A, Ponticiello M, Broderick K, Vaidyanathan A, Lorenc R, Kulkarni V, Onawale A, Mathad JS, Sundararajan R. A community health worker-led program to improve access to gestational diabetes screening in urban slums of Pune, India: Results from a mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001622. [PMID: 37889879 PMCID: PMC10610081 DOI: 10.1371/journal.pgph.0001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
The World Health Organization recommends all pregnant women receive screening for gestational diabetes (GDM) with a fasting oral glucose tolerance test (OGTT). However, very few women receive recommended screening in resource-limited countries like India. We implemented a community health worker (CHW)-delivered program to evaluate if home-based, CHW-delivered OGTT would increase GDM screening in a low-resource setting. We conducted a mixed methods study in two urban slum communities in Pune, India. CHWs were trained to deliver home-based, point-of-care fasting OGTT to women in their third trimester of pregnancy. The primary outcome was uptake of CHW-delivered OGTT. Secondary outcomes included GDM prevalence and linkage to GDM care. Individual interviews were conducted with purposively sampled pregnant women, CHWs, and local clinicians to assess barriers and facilitators of this approach. From October 2021-June 2022, 248 eligible pregnant women were identified. Of these, 223 (90%) accepted CHW-delivered OGTT and 31 (14%) were diagnosed with GDM. Thirty (97%) women diagnosed with GDM subsequently sought GDM care; only 10 (33%) received lifestyle counseling or pharmacologic therapy. Qualitative interviews indicated that CHW-delivered testing was considered highly acceptable as home-based testing saved time and was more convenient than clinic-based testing. Inconsistent clinical management of GDM was attributed to providers' lack of time to deliver counseling, and perceptions that low-income populations are not at risk for GDM. Convenience and trust in a CHW-delivered GDM screening program resulted in high access to gold-standard OGTT screening and identification of a high GDM prevalence among pregnant women in two urban slum communities. Appropriate linkage to care was limited by clinician time constraints and misperceptions of GDM risk. CHW-delivered GDM screening and counseling may improve health education and access to preventive healthcare, offloading busy public clinics in high-need, low-resource settings.
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Affiliation(s)
- Puja Chebrolu
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Andrea Chalem
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Matthew Ponticiello
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kathryn Broderick
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Arthi Vaidyanathan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Rachel Lorenc
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | | | | | - Jyoti S. Mathad
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
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Gerber F, Gupta R, Lejone TI, Tahirsylaj T, Lee T, Kohler M, Haldemann MI, Räber F, Chitja M, Manthabiseng M, Khomolishoele M, Mota M, Bane M, Sematle PM, Makabateng R, Mphunyane M, Phaaroe S, Basler D, Kindler K, Seelig E, Briel M, Chammartin F, Labhardt ND, Amstutz A. Community-based type 2 diabetes care by lay village health workers in rural Lesotho: protocol for a cluster-randomized trial within the ComBaCaL cohort study (ComBaCaL T2D TwiC). Trials 2023; 24:688. [PMID: 37875943 PMCID: PMC10598965 DOI: 10.1186/s13063-023-07729-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) poses a growing public health burden, especially in low- and middle-income countries (LMICs). Task-shifting to lay village health workers (VHWs) and the use of digital clinical decision support systems (CDSS) are promising approaches to tackle the current T2D care gap in LMICs. However, evidence on the effectiveness of lay worker-led T2D care models, in which VHWs initiate and monitor drug treatment in addition to community-based screening and referral services, is lacking. METHODS We are conducting a cluster-randomized trial nested within the Community-Based Chronic Disease Care Lesotho (ComBaCaL) cohort study (NCT05596773) using the trial within cohort (TwiC) design to assess the effectiveness of a VHW-led, CDSS-assisted T2D care model in rural Lesotho. Participants are non-pregnant members of the ComBaCaL cohort study with T2D. The ComBaCaL cohort study is conducted in approximately 100 villages in two rural districts in Lesotho and is managed by trained and supervised VHWs. In intervention villages, VHWs offer a community-based T2D care package including lifestyle counselling, first-line oral antidiabetic, lipid-lowering, and antiplatelet treatment guided by a tablet-based CDSS to participants who are clinically eligible, as well as treatment support to participants who prefer or clinically require facility-based T2D care. In control clusters, all participants will be referred to a health facility for T2D management. The primary endpoint is the mean glycosylated haemoglobin (HbA1c) 12 months after enrolment. Secondary endpoints include the 10-year risk for cardiovascular events estimated using the World Health Organization risk prediction tool. DISCUSSION The trial was launched on May 13, 2023, and has enrolled 226 participants at the date of submission (October 6, 2023). To our knowledge, the trial is the first to assess task-shifting of T2D care to VHWs at the community level, including the prescription of first-line antidiabetic, lipid-lowering, and antiplatelet medication in sub-Saharan Africa, and will thus provide the missing evidence on the effectiveness of such a T2D care model in this setting. The study is operating within the established Lesotho VHW programme. Similar community health worker programmes which exist across sub-Saharan Africa may benefit from the findings. TRIAL REGISTRATION ClinicalTrials.gov NCT05743387. Registered on February 24 2023.
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Affiliation(s)
- Felix Gerber
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
| | | | - Thabo Ishmael Lejone
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Thesar Tahirsylaj
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Tristan Lee
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Maurus Kohler
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Maria Ines Haldemann
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabian Räber
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | | | | | | | | | | | | | | | - Dave Basler
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Business, Economics and Informatics, University of Zurich, Zürich, Switzerland
| | - Kevin Kindler
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- Faculty of Business, Economics and Informatics, University of Zurich, Zürich, Switzerland
| | - Eleonora Seelig
- University of Basel, Basel, Switzerland
- Clinic of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Matthias Briel
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Frédérique Chammartin
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Alain Amstutz
- Department of Clinical Research, Division of Clinical Epidemiology, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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23
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Chan KY, Srivastava N, Wang Z, Xia X, Huang Z, Poon AN, Reidpath DD. A systematic review and meta-analysis of the effectiveness of hypertension interventions in faith-based organisation settings. J Glob Health 2023; 13:04075. [PMID: 37830137 PMCID: PMC10570758 DOI: 10.7189/jogh.13.04075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Background Hypertension is the global, leading cause of mortality and is the main risk factor for cardiovascular disease. Community-based partnerships can provide cost-saving ways of delivering effective blood pressure (BP) interventions to people in resource-poor settings. Faith-based organisations (FBOs) prove important potential health partners, given their reach and community standing. This potential is especially strong in hard-to-reach, socio-economically marginalised communities. This systematic review explores the state of the evidence of FBO-based interventions on BP management, with a focus on randomised controlled trials (RCTs) and cluster RCTs (C-RCTs). Methods Seven academic databases (English = 5, Chinese = 2) and grey literature were searched for C-/RCTs of community-based interventions in FBO settings. Only studies with pre- and post-intervention BP measures were kept for analysis. Random effects models were developed using restricted maximum likelihood estimation (REML) to estimate the population average mean change and 95% confidence interval (CI) of both systolic and diastolic blood pressure (SBP and DBP). The overall heterogeneity was assessed by successively adding studies and recording changes in heterogeneity. Prediction intervals were generated to capture the spread of the pooled effect across study settings. Results Of the 19 055 titles identified, only 11 studies of fair to good quality were kept for meta-analysis. Non-significant, average mean differences between baseline and follow-up for the intervention and control groups were found for both SBP (0.78 mm of mercury (mmHg) (95% CI = 2.11-0.55)) and DBP (-0.20 mm Hg (95% CI = -1.16 to 0.75)). Subgroup analysis revealed a significant reduction in SBP of -6.23 mm Hg (95% CI = -11.21 to -1.25) for populations with mean baseline SBP of ≥140 mm Hg. Conclusions The results support the potential of FBO-based interventions in lowering SBP in clinically hypertensive populations. However, the limited evidence was concentrated primarily in Christian communities in the US More research is needed to understand the implications of such interventions in producing clinically meaningful long-term effects in a variety of settings. Further research can illuminate factors that affect success and potential expansion to sites outside the US as well as non-Christian FBOs. Current evidence is inadequate to evaluate the potential of FBO-based interventions in preventing hypertension in non-hypertensive populations. Intervention effects in non-hypertensive population might be better reflected through intermediate outcomes.
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Affiliation(s)
- Kit Yee Chan
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
| | - Noori Srivastava
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington DC, USA
| | - Zhicheng Wang
- China Development Research Foundation, Beijing, China
| | - Xiaoqian Xia
- London School of Hygiene & Tropical Medicine, London, UK
| | - Zhangziyue Huang
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Adrienne N Poon
- Department of Medicine, School of Medicine & Health Sciences, George Washington University, Washington DC, USA
| | - Daniel D Reidpath
- School of Social Sciences, Monash University, Clayton, Victoria, Australia
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Katena NA, Shamu S, Fana GT, Rusakaniko S. Effects of a Community Health Worker-Led Health Literacy Intervention on Lifestyle Modification Among Patients With Hypertension and Diabetes in the City of Harare, Zimbabwe: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47512. [PMID: 37788044 PMCID: PMC10582805 DOI: 10.2196/47512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Hypertension and diabetes are among the most common noncommunicable diseases in Zimbabwe. These 2 conditions are largely prevented and controlled by lifestyle modifications, such as healthy eating habits, physical activity, and avoiding the use of tobacco and alcohol. OBJECTIVE This study aims to evaluate the effects of a community health worker (CHW)-led health literacy intervention on lifestyle modification among patients with diabetes and hypertension in the City of Harare, Zimbabwe, in terms of (1) adherence to recommended lifestyle changes, (2) blood pressure and blood glucose levels, and (3) medication adherence. METHODS This is a 6-month-long cluster randomized controlled trial, which will be conducted in primary health care clinics in the city of Harare. A total of 14 clinics will be randomly allocated into either the intervention or control group. A total of 680 (49 participants per clinic) adult patients with hypertension and diabetes will be enrolled for the trial. Participants in the intervention arm will receive a simple health literacy intervention on lifestyle modification, which will be delivered by trained CHWs, while those in the control arm will receive usual care. The intervention consists of 4 face-to-face interactive educational sessions and monthly support visits by trained CHWs and will be carried out over a period of 6 months. The primary study outcomes will be blood pressure and blood glucose levels and levels of adherence to the recommended lifestyle modifications. Other outcomes will include adherence to medication. Data management and analysis will be done using Epi Info software, and the data will be analyzed using the intention-to-treat principle. RESULTS Recruitment of study participants commenced on June 1, 2023, and was completed on July 30, 2023. Baseline data are being collected after participants' recruitment, and the final data collection will be completed by January 31, 2024. CONCLUSIONS There is an information dearth regarding the effectiveness of CHW-led interventions for the management and control of hypertension in Zimbabwe. Our study offers an opportunity to show the effectiveness of CHWs in addressing the gaps in the management of hypertension and diabetes. The findings from our study will provide crucial evidence on the effectiveness and feasibility of a simple intervention delivered by CHWs in resource-constrained areas. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47512.
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Affiliation(s)
- Nyaradzai Arster Katena
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shepherd Shamu
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Golden Tafadzwa Fana
- Internal Medicine Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
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25
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Dhikav V, Bhati N, Kumar P. Feasibility and acceptability study of risk reduction approach for stroke prevention in primary care in Western India. J Neurosci Rural Pract 2023; 14:698-702. [PMID: 38059238 PMCID: PMC10696315 DOI: 10.25259/jnrp_35_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/04/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Stroke is among the leading cause of morbidity and mortality and prevention is the need of the hour. Risk assessment of stroke could be done at primary care. A study was hence planned to assess if an information, education, and communication (IEC) intervention module could be used to address risk factors of stroke among attendees of primary care in Western India. Materials and Methods Patients (>30 years) attending primary care center were enrolled (n = 215). Knowledge, attitude, and practice (KAP) questionnaire was administered at baseline and end line, and detailed diagnosis (hypertension and/diabetes, stroke, coronary artery disease, etc.) was noted from written records. A predesigned IEC module was administered about stroke, risk factors, and their prevention. Body mass index (BMI) and waist-to-hip ratio were taken before and after 16 weeks. Results A total of 215 participants (M: F = 85:130; mean age = 51.66 ± 13.32 years) had risk factors such as hypertension (26.7%), diabetes (32.5%), history of stroke (n = 3; = 1.39%), and 7.4% (16/215) had coronary artery disease. Before and after comparison of KAP scores indicated significant difference (62.23 ± 19.73 vs. 75.32 ± 13.03); P ≤ 0.0001). Change of waist-to-hip ratio occurred from baseline 0.91-0.9 (P ≤ 0.001). Comparison of the proportion of patients taking antihypertensives before and after IEC intervention was statistically significant (P < 0.05), indicating improvement in drug compliance. BMI comparison changed marginally (26.5 ± 4.7 vs. 26.2 ± 4.5) before and after but was not significant (P ≥ 0.05). The intervention was found to be feasible and acceptable. Conclusion IEC intervention appears to be a low-cost, feasible, and acceptable implementation model for addressing risk factors for stroke in primary care.
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Affiliation(s)
- Vikas Dhikav
- Department of Health Research, MoHFW, Government of India, ICMR-National Institute of Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Nisha Bhati
- Department of Health Research, MoHFW, Government of India, ICMR-National Institute of Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Pankaj Kumar
- Department of Health Research, MoHFW, Government of India, ICMR-National Institute of Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
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Shukla P, Priya H, Meena JK, Singh S, Bairwa M, Saini A. Readiness and Motivation of ASHAs towards Their Participation in Non-Communicable Disease Control Programmein North India:A Cross Sectional Study. Asian Pac J Cancer Prev 2023; 24:3235-3241. [PMID: 37774077 PMCID: PMC10762770 DOI: 10.31557/apjcp.2023.24.9.3235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND ASHAs (Accredited Social Health Activist)role is evolving beyond maternal and child health workers. They are engaged in NCD (Non-communicable Diseases)control activities. This study investigated their preparedness for this new task.The aim of the study was to assess the preparedness (knowledge, attitude, practices & patient navigation) of ASHAs in delivering community-based NCD prevention and control services under NPCDCS (National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke)program. And the study also assessed the challenges faced by ASHAs in fulfilling their roles and responsibilities towards common NCDs. SETTINGS AND DESIGN Cross sectional descriptive conducted in Delhi. METHOD Total 464 ASHAs randomly selected from 54 Primary Health Centres from 3 districts of Delhi. A self-administered, pre-tested, validated and piloted semi structured questionnaire was filled by enrolled ASHAs. It assessed their knowledge, attitude and practices related to NCD screening. STATISTICAL ANALYSIS USED descriptive statistics, chi square test and logistic regression analysis were used. RESULTS Two-third ASHAs had moderate to good knowledge about NCDs. They had positive inclination towards NCD screening and risk mitigation. Their practices for hypertension and diabetes screening were adequate but common cancer screening practices were inadequate. Challenges encountered in performing these tasks were lack of appropriate referral linkages, minimal supportive supervision and no ear marked incentives. CONCLUSIONS ASHAs showed willingness to work for NCD control provided they have optimum training, supportive supervision from their superiors, and screening facilities in functional state and appropriate incentives for the new tasks.
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Affiliation(s)
- Pallavi Shukla
- Department of Preventive Oncology, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences New Delhi, India.
| | - Harsh Priya
- Public Health Dentistry, CDER, AIIMS, New Delhi, India.
| | - Jitendra K Meena
- Preventive Oncology, National Cancer Insititute (NCI) Jhajjar, AIIMS, New Delhi, India.
| | | | - Mohan Bairwa
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
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Watson ED, Moosa S, Janse Van Rensburg DC, Schwellnus M, Lambert EV, Stoutenberg M. Task-Shifting: Can Community Health Workers Be Part of the Solution to an Inactive Nation? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6675. [PMID: 37681815 PMCID: PMC10487434 DOI: 10.3390/ijerph20176675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
Background: In low-to-middle income countries (LMICs), there is a growing burden of non-communicable diseases (NCDs) placing strain on the facilities and human resources of healthcare systems. Prevention strategies that include lifestyle behavior counseling have become increasingly important. We propose a potential solution to the growing burden of NCDs through an expansion of the role for community health workers (CHWs) in prescribing and promoting physical activity in public health settings. This discussion paper provides a theoretical model for task-shifting of assessment, screening, counseling, and prescription of physical activity to CHWs. Five proposed tasks are presented within a larger model of service delivery and provide a platform for a structured, standardized, physical activity prevention strategy aimed at NCDs using CHWs as an integral part of reducing the burden of NCDs in LMICs. However, for effective implementation as part of national NCD plans, it is essential that CHWs received standardized, ongoing training and supervision on physical activity and other lifestyle behaviors to optimally impact community health in low resource settings.
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Affiliation(s)
- Estelle D. Watson
- Department of Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
- Department of Exercise Science, Faculty of Science, University of Auckland, Auckland 1023, New Zealand
| | - Shabir Moosa
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
| | - Dina C. Janse Van Rensburg
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Martin Schwellnus
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0028, South Africa
| | - Estelle V. Lambert
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Department of Human Biology, Division of Research Unit for Exercise Science and Sports Medicine, Division of Physiological Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, 7700, South Africa
| | - Mark Stoutenberg
- Department of Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2193, South Africa
- College of Public Health, Temple University, Philadelphia, PA 19122, USA
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Chang AY, Rahman M, Talukder A, Shah H, Mridha MK, Hasan M, Sarker M, Geldsetzer P. Effectiveness of a community health worker-led low-sodium salt intervention to reduce blood pressure in rural Bangladesh: protocol for a cluster randomized controlled trial. Trials 2023; 24:480. [PMID: 37501102 PMCID: PMC10375753 DOI: 10.1186/s13063-023-07518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND High blood pressure is a major public health problem in low- and middle-income countries. Low-sodium salt substitute (LSSS) is a promising population-level blood pressure-lowering intervention requiring minimal behavioral change. The optimal method of delivering LSSS to individuals, however, is currently unknown. Community health workers (CHWs) have successfully been used to implement health interventions in Bangladesh and may provide a venue for the dissemination of LSSS. METHODS We aim to conduct a cluster-randomized controlled trial involving 309 households in rural Bangladesh previously identified and characterized by the BRAC James P Grant School of Public Health, BRAC University (BRAC JPGSPH). These households will be randomly assigned to three arms: (1) control, i.e., no intervention; (2) information only, i.e., community health workers will provide basic information on high blood pressure, the health consequences of excessive salt consumption, and feedback to the participant on the likely quantity of salt s/he consumes (estimated using a questionnaire); (3) free LSSS arm: the same information as in arm 2 will be provided, but participants will receive 6 months of free low-sodium salt along with education on the benefits of LSSS. One male and one female adult (age ≥ 18 years) in each household will be invited to participate, the exclusion criteria being households with members known to have high serum potassium levels, are taking medications known to elevate potassium levels (e.g., ACE inhibitors, ARBs, potassium-sparing diuretics), are already taking potassium supplements, or those who have known kidney disease or abnormal serum creatinine at baseline. The primary endpoint will be blood pressure at 6 months post-intervention. DISCUSSION Recent large clinical trials of LSSS in China and India have shown not only blood pressure improvements, but also stroke, major cardiac event, and all-cause mortality reductions. Nevertheless, how to best translate this intervention to population-level effectiveness remains unclear. Our study would test whether a community health worker-based program could be effectively used to disseminate LSSS and achieve measurable blood pressure benefits. TRIAL REGISTRATION ClinicalTrials.gov NCT05425030. Registered on June 21, 2022.
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Affiliation(s)
- Andrew Y Chang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, USA
- Center for Innovation in Global Health, Stanford University, Stanford, USA
- Stanford Cardiovascular Institute, Stanford University, Stanford, USA
| | - Mushfiqur Rahman
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Animesh Talukder
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Humyra Shah
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Malay Kanti Mridha
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mehedi Hasan
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Pascal Geldsetzer
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, USA.
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, USA.
- The Chan Zuckerberg Biohub, San Francisco, USA.
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Aron MB, Ndambo MK, Munyaneza F, Mulwafu M, Makungwa H, Nhlema B, Connolly E. A time-motion study of community health workers delivering community-based primary health care in Neno District, Malawi. HUMAN RESOURCES FOR HEALTH 2023; 21:51. [PMID: 37365561 DOI: 10.1186/s12960-023-00839-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Community health workers (CHWs) are vital resources in delivering community-based primary health care, especially in low-and-middle-income countries (LMIC). However, few studies have investigated detailed time and task assessments of CHW's work. We conducted a time-motion study to evaluate CHWs' time on health conditions and specific tasks in Neno District, Malawi. METHODS We conducted a descriptive quantitative study utilizing a time observation tracker to capture time spent by CHWs on focused health conditions and tasks performed during household visits. We observed 64 CHWs between 29 June and 20 August 2020. We computed counts and median to describe CHW distribution, visit type, and time spent per health condition and task. We utilized Mood's median test to compare the median time spent at a household during monthly visits with the program design standard time. We used pairwise median test to test differences in median time duration for health conditions and assigned tasks. RESULTS We observed 660 CHW visits from 64 CHWs, with 95.2% (n = 628) of the visits as monthly household visits. The median time for a monthly household visit was 34 min, statistically less than the program design time of 60 min (p < 0.001). While the CHW program focused on eight disease areas, pretesting with the observation tool showed that CHWs were engaged in additional health areas like COVID-19. Of the 3043 health area touches by CHWs observed, COVID-19, tuberculosis, and non-communicable diseases (NCDs) had the highest touches (19.3%, 17.6%, and 16.6%, respectively). The median time spent on sexually transmitted infections (STIs) and NCDs was statistically higher than in other health areas (p < 0.05). Of 3813 tasks completed by CHWs, 1640 (43%) were on health education and promotion. A significant difference was observed in the median time spent on health education, promotion, and screening compared to other tasks (p < 0.05). CONCLUSION This study demonstrates that CHWs spend the most time on health education, promotion, and screening per programmatic objectives but, overall, less time than program design. CHWs deliver care for a broader range of health conditions than the programmatic design indicates. Future studies should examine associations between time spent and quality of care delivery.
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Affiliation(s)
- Moses Banda Aron
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi.
| | | | | | - Manuel Mulwafu
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | - Henry Makungwa
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | | | - Emilia Connolly
- Partners In Health/Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
- Division of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH, 45267, United States of America
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45529, United States of America
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Krishna A, Murali S, Moran AE, Saxena A, Gill SS, Hering D, Kaur P. Understanding the Role of Staff Nurses in Hypertension Management in Primary Care Facilities in India: A Time-Motion Study. Prev Chronic Dis 2023; 20:E39. [PMID: 37200503 DOI: 10.5888/pcd20.220232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION India is facing a shortage of staff nurses; thus, a better understanding of nurses' workloads is essential for improving and implementing noncommunicable disease (NCD) control strategies. We estimated the proportion of time spent by staff nurses on hypertension and other NCD activities in primary care facilities in 2 states in India. METHODS We conducted a cross-sectional study in 6 purposively selected primary care facilities in Punjab and Madhya Pradesh during July through September 2021. We used a standardized stopwatch to collect data for time spent on direct hypertension activities (measuring blood pressure, counseling, recording blood pressure measurement, and other NCD-related activities), indirect hypertension activities (data management, patient follow-up calls), and non-NCD activities. We used the Mann-Whitney U test to compare the median time spent on activities between facilities using paper-based records and the Simple mobile device-based app (open-source software). RESULTS Six staff nurses were observed for 213 person-hours. Nurses spent 111 person-hours (52%; 95% CI, 45%-59%) on direct hypertension activities and 30 person-hours (14%; 95% CI, 10%-19%) on indirect hypertension activities. The time spent on blood pressure measurement (34 minutes) and documentation (35 minutes) was the maximum time on any given day. Facilities that used paper records spent more median time (39 [IQR, 26-62] minutes) for indirect hypertension activities than those using the Simple app (15 [IQR, 11-19] minutes; P < .001). CONCLUSION Our study found that hypertension activities required more than half of nurses' time in India's primary care facilities. Digital systems can help to reduce the time spent on indirect hypertension activities.
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Affiliation(s)
- Ashish Krishna
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, Tamil Nadu Housing Board, Ayapakkam, Chennai - 600077
- Resolve to Save Lives, New Delhi, India
| | - Sharan Murali
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
| | - Andrew E Moran
- Resolve to Save Lives, New York, New York
- Columbia University Irving Medical Center, New York, New York
| | - Ashish Saxena
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Sandeep Singh Gill
- Department of Health and Family Welfare Punjab, Chandigarh, Punjab, India
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Prabhdeep Kaur
- Indian Council of Medical Research - National Institute of Epidemiology, Chennai, India
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Ingenhoff R, Munana R, Weswa I, Gaal J, Sekitoleko I, Mutabazi H, Bodnar BE, Rabin TL, Siddharthan T, Kalyesubula R, Knauf F, Nalwadda CK. Principles for task shifting hypertension and diabetes screening and referral: a qualitative study exploring patient, community health worker and healthcare professional perceptions in rural Uganda. BMC Public Health 2023; 23:881. [PMID: 37173687 PMCID: PMC10176286 DOI: 10.1186/s12889-023-15704-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND A shortage of healthcare workers in low- and middle-income countries (LMICs) combined with a rising burden of non-communicable diseases (NCDs) like hypertension and diabetes mellitus has resulted in increasing gaps in care delivery for NCDs. As community health workers (CHWs) often play an established role in LMIC healthcare systems, these programs could be leveraged to strengthen healthcare access. The objective of this study was to explore perceptions of task shifting screening and referral for hypertension and diabetes to CHWs in rural Uganda. METHODS This qualitative, exploratory study was conducted in August 2021 among patients, CHWs and healthcare professionals. Through 24 in-depth interviews and ten focus group discussions, we investigated perceptions of task shifting to CHWs in the screening and referral of NCDs in Nakaseke, rural Uganda. This study employed a holistic approach targeting stakeholders involved in the implementation of task shifting programs. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically guided by the framework method. RESULTS Analysis identified elements likely to be required for successful program implementation in this context. Fundamental drivers of CHW programs included structured supervision, patients' access to care through CHWs, community involvement, remuneration and facilitation, as well as building CHW knowledge and skills through training. Additional enablers comprised specific CHW characteristics such as confidence, commitment and motivation, as well as social relations and empathy. Lastly, socioemotional aspects such as trust, virtuous behavior, recognition in the community, and the presence of mutual respect were reported to be critical to the success of task shifting programs. CONCLUSION CHWs are perceived as a useful resource when task shifting NCD screening and referral for hypertension and diabetes from facility-based healthcare workers. Before implementation of a task shifting program, it is essential to consider the multiple layers of needs portrayed in this study. This ensures a successful program that overcomes community concerns and may serve as guidance to implement task shifting in similar settings.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Richard Munana
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Julia Gaal
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Isaac Sekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Hillary Mutabazi
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tracy L Rabin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, USA
| | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Physiology, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Christine K Nalwadda
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda
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Yenit MK, Kolbe-Alexander TL, Gelaye KA, Gezie LD, Tesema GA, Abebe SM, Azale T, Shitu K, Gyawali P. An Evaluation of Community Health Workers' Knowledge, Attitude and Personal Lifestyle Behaviour in Non-Communicable Disease Health Promotion and Their Association with Self-Efficacy and NCD-Risk Perception. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095642. [PMID: 37174162 PMCID: PMC10178727 DOI: 10.3390/ijerph20095642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
Community health workers, also known as health extension workers (HEWs), play an important role in health promotion. This study evaluates HEWs' knowledge, attitude, and self-efficacy for non-communicable diseases (NCD) health promotion. HEWs (n = 203) completed a structured questionnaire on knowledge, attitude, behaviour, self-efficacy and NCD risk perception. Regression analysis was used to determine the association between self-efficacy and NCD risk perception with knowledge (high, medium, low), attitude (favourable/unfavourable) and physical activity (sufficient/insufficient). HEWs with higher self-efficacy were more likely to have high NCD knowledge (AOR: 2.21; 95% CI: 1.21. 4.07), favourable attitude towards NCD health promotion (AOR: 6.27; 95% CI: 3.11. 12.61) and were more physically active (AOR: 2.27; 95% CI: 1.08. 4.74) than those with lower self-efficacy. HEWs with higher NCD susceptibility (AOR: 1.89; 95% CI: 1.04. 3.47) and perceived severity (AOR: 2.69; 95% CI: 1.46, 4.93) had higher odds of NCD knowledge than their counterparts. Moreover, sufficient physical activity was influenced by HEWs' perceived NCD susceptibility and perceived benefits of lifestyle change. Therefore, HEWs need to adopt healthy lifestyle choices to become effective role models for the community. Our findings highlight the need to include a healthy lifestyle when training HEWs, which might increase self-efficacy for NCD health promotion.
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Affiliation(s)
- Melaku Kindie Yenit
- School of Health and Medical Sciences, Centre for Health Research, University of Southern Queensland, Ipswich, QLD 4305, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Tracy L Kolbe-Alexander
- School of Health and Medical Sciences, Centre for Health Research, University of Southern Queensland, Ipswich, QLD 4305, Australia
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town 7700, South Africa
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Solomon Mekonnen Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Telake Azale
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Kegnie Shitu
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Prajwal Gyawali
- Centre for Health Research, School of Health and Medical Sciences, University of Southern Queensland, Toowoomba, QLD 4350, Australia
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Kate MP, Samuel C, Singh S, Jain M, Kamra D, Singh GB, Sharma M, Pandian JD. Community health volunteer for blood pressure control in rural people with stroke in India: Pilot randomised trial. J Stroke Cerebrovasc Dis 2023; 32:107107. [PMID: 37003249 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/16/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE To test the hypothesis that an Accredited social health activist (ASHA), a community health volunteer in a task-sharing model can help in sustained control of systolic blood pressure (BP) in rural people with Stroke and hypertension at 6 months follow up. METHODS In this randomized trial two rural areas (Pakhowal and Sidhwan bet) with 70 and 94 villages respectively were screened for people with stroke and hypertension. They were assigned to either ASHA-assisted BP control in addition to standard-of-care (Pakhowal-intervention Group) or standard-of-care alone (Sidhwan bet- Control Group). Assessors blinded to intervention conducted the baseline and 6 months follow-up visits to measure risk factors in both the rural areas. RESULTS A total of 140 people with stroke with mean age of 63.7 ± 11.5 years and 44.3% females were randomised. The baseline systolic BP was higher in the intervention group (n = 65,173.5 ± 22.9 mmHg) compared to the control group (n = 75,163 ± 18.7 mmHg, p = 0.004). The follow-up systolic BP was lower in the intervention group compared to the control group 145 ± 17.2 mmHg and 166.6 ± 25.7 mmHg respectively (p < 0.0001). According to the intention-to-treat analysis a total of 69.2% of patients in the intervention group achieved systolic BP control compared to 18.9% in the control group patients (OR 9, 95% CI 3.9-20.3; p < 0.0001). CONCLUSION Task sharing with ASHA a community health volunteer can improve BP control in rural people with stroke and hypertension. They can also help in the adoption of healthy behaviour. CLINICAL TRIAL REGISTRATION NUMBER ctri.nic.in, CTRI/2018/09/015709.
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Affiliation(s)
- Mahesh Pundlik Kate
- Associate Professor, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 7-132C Clinical Sciences Building, 11350 83 Avenue, Edmonton, AB T6G2E3, Canada.
| | - Clarence Samuel
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - Shavinder Singh
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - Maneeta Jain
- Senior Consultant, Healthcare Financing, National Health Systems Resource Centre, India
| | - Deepshikha Kamra
- Professor, Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - G B Singh
- State Programme Officer, National Programme for Prevention of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) Programme, Government of Punjab, Chandigarh, India
| | - Meenakshi Sharma
- Scientist-G, Program Officer: Cardiovascular Diseases and Neurology, Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Jeyaraj Durai Pandian
- Professor of Neurology and Principal, Christian Medical College, Ludhiana, India; School of Nursing, University of Central Lancashire, Preston, United Kingdom; NIHR Global Health Research Group on Improving stroke care in India, United Kingdom
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Stoutenberg M, Crouch SH, McNulty LK, Kolkenbeck-Ruh A, Torres G, Gradidge PJL, Ly A, Ware LJ. Acceptability and feasibility of home-based hypertension and physical activity screening by community health workers in an under-resourced community in South Africa. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-12. [PMID: 37361288 PMCID: PMC10034884 DOI: 10.1007/s10389-023-01873-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/24/2023] [Indexed: 03/25/2023]
Abstract
Background Low-middle-income countries (LMICs) face increasing burdens from non-communicable disease (NCDs) requiring primary care task shifting to community health workers (CHWs). This study explored community members' perceptions of NCD-focused, CHW-led home visits in a historically disadvantaged township of South Africa. Methods Trained CHWs visited community member homes, performing blood pressure and physical activity (PA) screenings, followed by brief counselling and a satisfaction survey. Semi-structured interviews were conducted within 3 days of the visit to learn about their experiences. Results CHWs visited 173 households, with 153 adult community members consenting to participate (88.4%). Participants reported that it was easy to understand CHW-delivered information (97%), their questions were answered well (100%), and they would request home service again (93%). Twenty-eight follow-up interviews revealed four main themes: 1) acceptance of CHW visits, 2) openness to counselling, 3) satisfaction with screening and a basic understanding of the results, and 4) receptiveness to the PA advice. Conclusion Community members viewed CHW-led home visits as an acceptable and feasible method for providing NCD-focused healthcare services in an under-resourced community. Expanding primary care reach through CHWs offers more accessible and individualized care, reducing barriers for individuals in under-resourced communities to access support for NCD risk reduction.
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Affiliation(s)
- Mark Stoutenberg
- Department of Kinesiology, College of Public Health, Temple University, 237 Pearson Hall, 1800 North Broad, Philadelphia, Pennsylvania 19122 USA
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St. Andrews Road, Parktown, Gauteng, 2193 South Africa
| | - Simone H. Crouch
- SA MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Corner College and Clinic Road, Chris Hani Baragwanath Academic Hospital, Soweto, 1864 South Africa
| | - Lia K. McNulty
- Department of Kinesiology, College of Public Health, Temple University, 237 Pearson Hall, 1800 North Broad, Philadelphia, Pennsylvania 19122 USA
| | - Andrea Kolkenbeck-Ruh
- SA MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Corner College and Clinic Road, Chris Hani Baragwanath Academic Hospital, Soweto, 1864 South Africa
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Johannesburg, 2193 South Africa
| | - Georgia Torres
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St. Andrews Road, Parktown, Gauteng, 2193 South Africa
| | - Philippe J. L. Gradidge
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Wits Education Campus, 27 St. Andrews Road, Parktown, Gauteng, 2193 South Africa
| | - Andy Ly
- Department of Kinesiology, College of Public Health, Temple University, 237 Pearson Hall, 1800 North Broad, Philadelphia, Pennsylvania 19122 USA
| | - Lisa J. Ware
- SA MRC/Wits Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Corner College and Clinic Road, Chris Hani Baragwanath Academic Hospital, Soweto, 1864 South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Wits Education Campus, 27 St. Andrews Road, Parktown, Gauteng, 2193 South Africa
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Ajisegiri WS, Abimbola S, Tesema AG, Odusanya OO, Peiris D, Joshi R. "We just have to help": Community health workers' informal task-shifting and task-sharing practices for hypertension and diabetes care in Nigeria. Front Public Health 2023; 11:1038062. [PMID: 36778542 PMCID: PMC9909193 DOI: 10.3389/fpubh.2023.1038062] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction Nigeria's skilled health professional health workforce density is insufficient to achieve its national targets for non-communicable diseases (NCD) which include 25% reduction in the prevalence of diabetes and hypertension, particularly at the primary health care (PHC) level. This places a great demand on community health workers (CHWs) who constitute the majority of PHC workers. Traditionally, CHWs are mainly involved in infectious diseases programmes, and maternal and child health services. Their involvement with prevention and control of NCDs has been minimal. With government prioritization of PHC for combating the rising NCD burden, strengthening CHWs' skills and competencies for NCD care delivery is crucial. Methods We conducted a mixed methods study to explore the roles and practices of CHWs in the delivery of hypertension and diabetes care at PHC facilities in four states (two each in northern and southern regions) in Nigeria. We reviewed the National Standing Orders that guide CHWs' practices at the PHC facilities and administered a survey to 76 CHWs and conducted 13 focus groups (90 participants), and in-depth individual interviews with 13 CHWs and 7 other local and state government stakeholders. Results Overall, we found that despite capacity constraints, CHWs frequently delivered services beyond the scope of practice stipulated in the National Standing Orders. Such informal task-shifting practices were primarily motivated by a need to serve the community. Discussion While these practices may partially support health system functions and address unmet need, they may also lead to variable care quality and safety. Several factors could mitigate these adverse impacts and strengthen CHW roles in the health system. These include a stronger enabling policy environment to support NCD task-sharing, investment in continuous capacity building for CHWs, improved guidelines that can be implemented at the point of care, and improved coordination processes between PHC and higher-level facilities.
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Affiliation(s)
- Whenayon Simeon Ajisegiri
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Seye Abimbola
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Azeb Gebresilassie Tesema
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Olumuyiwa O. Odusanya
- Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Nigeria
| | - David Peiris
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Rohina Joshi
- School of Population Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- The George Institute for Global Health, New Delhi, India
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Ballard M, Olsen HE, Whidden C, Ressler D, Metz L, Millear A, Palazuelos D, Choudhury N, Munyaneza F, Diane R, Lue K, Bobozi PÉ, Raut A, Ramarson A, Andrianomenjanahary M, Finnegan K, Westgate C, Omwanda W, Wang L, Citrin D, Rogers A, Aron MB, Christiansen M, Watsemba A, Adamjee R, Yembrick A. Lessons from an eight-country community health data harmonization collaborative. Glob Health Action 2022; 15:2015743. [PMID: 35114900 PMCID: PMC8820809 DOI: 10.1080/16549716.2021.2015743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/03/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Community health workers (CHWs) are individuals who are trained and equipped to provide essential health services to their neighbors and have increased access to healthcare in communities worldwide for more than a century. However, the World Health Organization (WHO) Guideline on Health Policy and System Support to Optimize Community Health Worker Programmes reveals important gaps in the evidentiary certainty about which health system design practices lead to quality care. Routine data collection across countries represents an important, yet often untapped, opportunity for exploratory data analysis and comparative implementation science. However, epidemiological indicators must be harmonized and data pooled to better leverage and learn from routine data collection. METHODS This article describes a data harmonization and pooling Collaborative led by the organizations of the Community Health Impact Coalition, a network of health practitioners delivering community-based healthcare in dozens of countries across four WHO regions. OBJECTIVES The goals of the Collaborative project are to; (i) enable new opportunities for cross-site learning; (ii) use positive and negative outlier analysis to identify, test, and (if helpful) propagate design practices that lead to quality care; and (iii) create a multi-country 'brain trust' to reinforce data and health information systems across sites. RESULTS This article outlines the rationale and methods used to establish a data harmonization and pooling Collaborative, early findings, lessons learned, and directions for future research.
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Affiliation(s)
- Madeleine Ballard
- Community Health Impact Coalition, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | - Daniel Palazuelos
- Partners in Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Nandini Choudhury
- Icahn School of Medicine at Mount Sinai; Possible, New York, NY, USA
| | | | - Rene Diane
- One to One Children’s Fund, Cape Town, South Africa
| | - Kelly Lue
- Integrate Health/Santé Intégrée, Lomé, Togo
| | | | - Anant Raut
- Icahn School of Medicine at Mount Sinai; Possible, New York, NY, USA
| | | | | | | | | | | | - Leping Wang
- Department of Sociology, Boston University Graduate School of Arts & Sciences, Boston, MA, USA
| | - David Citrin
- Possible; Medic; University of Washington; Icahn School of Medicine at Mount Sinai, Seattle, WA, USA
| | - Ash Rogers
- Lwala Community Alliance, Nashville, TN, USA
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Zaman SB, Evans RG, Singh R, Singh R, Singh A, Goh TY, Singh P, De Silva N, Thrift AG. Usability and acceptability of the software ‘Arogya Sahyog’ to assess non-communicable diseases in rural India. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tesema AG, Peiris D, Abimbola S, Ajisegiri WS, Narasimhan P, Mulugeta A, Joshi R. Community health extension workers' training and supervision in Ethiopia: Exploring impact and implementation challenges for non-communicable disease service delivery. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001160. [PMID: 36962619 PMCID: PMC10021836 DOI: 10.1371/journal.pgph.0001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
Abstract
Training and supervision of health workers are critical components of any health system;thus, we assessed how they impact health extension workers' (HEWs) role in non-communicable disease (NCD) service delivery in Ethiopia's health extension program (HEP), using an in-depth qualitative study conducted in 2019.The study covered two regions-the Tigray and the South Nations, Nationalities and Peoples Region (SNNPR)-and involved the Federal Ministry of Health. We conducted twenty-seven key informant interviews with federal and regional policymakers, district health officials, health centre representatives and HEWs.Participants highlighted substantial implementation challenges with training and supervision practices delivered via the HEP. Training for NCDs lacked breadth and depth. IT was described as inconsistently delivered with variable availability within and between regions;and when available, the quality was low with scant content specific to NCDs. HEP supervision was inconsistent and, rather than being supportive, mainly focused on finding faults in HEW work practices. Supervisors themselves had skill gaps in critical areas overall, and specifically concerning NCDs. HEWs' performance appraisal encompassed too many indicators, leading to excessive complexity, which was burdensome to HEWs. This, negatively impacted HEW motivation and compromised service delivery. HEW involvement in non-HEP activities (such as promoting other government programs) often competed with their core mandates, thus affecting HEP service delivery.Efforts to address training and supervision constraints in Ethiopia's HEP should focus on improving the quality of NCD training for HEWs and supervisors, shifting from authoritative to supportive supervision, simplifying performance appraisal and reducing competing attention from other programs.
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Affiliation(s)
- Azeb Gebresilassie Tesema
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
- School of Public Health, Mekelle University, Mek’ele, Ethiopia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
| | - Seye Abimbola
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Whenayon S. Ajisegiri
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia
| | | | | | - Rohina Joshi
- School of Population Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, New Delhi, India
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Scarinci IC, Kienen N, Wiltenburg TD, Bittencourt L, Person SD. Efficacy of a Gender-Relevant Smoking Cessation Intervention Among Women in Brazil: Findings from a Group Randomized Controlled Trial. J Womens Health (Larchmt) 2022; 31:1620-1629. [PMID: 35580140 PMCID: PMC9700361 DOI: 10.1089/jwh.2021.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There is scarcity of smoking cessation programs that take gender into account during its development, implementation, and evaluation. We evaluated the efficacy of a theory-based, culturally, and gender-relevant smoking cessation intervention delivered by Community Health Workers (CHWs) among Brazilian women that augments the smoking cessation program offered through the public health system (PHS). Materials and Methods: A total of 328 women current smokers (100% cigarette smokers) were recruited across 8 towns in a tobacco producing state in Brazil between 2014 and 2017. Four towns were randomly assigned to the intervention (12 home visits by a CHW and a scheduled appointment to attend the smoking cessation program at the PHS) and four towns to the control condition (scheduled appointment to attend the cessation program at the PHS). The primary outcome was self-reported 7-day smoked tobacco abstinence at 7-month follow-up with biochemical verification. Results: Retention at 7-month follow-up was 80.7% (intervention) and 85.1% (control). Using intention-to-treat analysis, abstinence at 7-month-follow-up was 20% in the intervention arm versus 11% in the control arm. Multivariable modeling showed that participants in the intervention arm had 1.88 times the odds of self-reported smoking cessation than control participants after adjustment for depressive symptomatology, self-efficacy, and having someone in the house who smokes. Besides the intervention, only self-efficacy remained significant in the full model as a predictor of cessation. Replication of these analyses using the objective measure of carbon monoxide at a cutoff score of 8 ppm yielded similar results. Conclusions: A theory-based, culturally, and gender-relevant intervention, delivered by CHWs, can successfully promote smoking cessation among women. Clinical Trial Registration No. NCT03845413.
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Affiliation(s)
- Isabel C. Scarinci
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nadia Kienen
- Department of Psychology and Behavior Analysis, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Thaís D. Wiltenburg
- Department of Psychology and Behavior Analysis, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Lorna Bittencourt
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sharina D. Person
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Rimawi A, Shah A, Louis H, Scales D, Kheiran JA, Jawabreh N, Yunez S, Horino M, Seita A, Wispelwey B. Community Health Worker Program Outcomes for Diabetes and Hypertension Control in West Bank Refugee Camps: A Retrospective Matched Cohort Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200168. [PMID: 36316145 PMCID: PMC9622278 DOI: 10.9745/ghsp-d-22-00168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Community health worker (CHW) programs have proven effective in improving diabetes control in many locations and settings, but data on feasibility and efficacy are lacking in the Middle East and settings of chronic violence. A Palestinian CHW program, Health for Palestine (H4P), addresses chronic diseases in West Bank refugee camps. Our study assesses the feasibility and effectiveness of the program's diabetes and hypertension interventions. METHODS Data on home visits, patient retention, and blood pressure were extracted from the CHW records and analyzed. To assess diabetic patient progress, we conducted a retrospective matched cohort study using data obtained from a United Nations (UN) clinical database to analyze the trajectory of hemoglobin A1c (A1c) values. Thirty of the 47 diabetic patients in the H4P CHW program met study inclusion criteria and were each matched with 3 patients from the Bethlehem UN clinic (n=120). We tested for significance using multivariable linear regression with robust standard errors. RESULTS The average number of home visits per patient per month was 7.3 (standard deviation=4.1), and the patient retention rate was 100% over an average of 11.2 months. For hypertension patients in the CHW program (n=33), mean systolic blood pressure decreased by 7.3 mmHg (95% confidence interval [CI]=1.93, 12.25; P=.009) and mean diastolic blood pressure by 4.3 mmHg (95% CI=0.80, 7.91; P=.018) from March 2018 to November 2019. On average, diabetic patients within the CHW group experienced a 1.4 point greater decline in A1c per year compared to those in the non-CHW group, after adjusting for potential confounders (95% CI=-0.66, -2.1; P<.001). DISCUSSION The results suggest that CHW accompaniment may be an effective model for improving diabetes and hypertension control in refugee camps experiencing direct violence and extreme adversity. A low exclusion cut-off for A1c (≤6.4%) may underestimate the program's impact.
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Affiliation(s)
- Asmaa Rimawi
- Harvard T.H. Chan School of Public Health; Harvard Medical School, Boston, MA, USA
| | - Adarsh Shah
- Harvard Kennedy School, Harvard University, Cambridge, MA, USA
| | - Henry Louis
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - David Scales
- New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Jawad Abu Kheiran
- United Nations Relief and Works Agency, Arroub refugee camp, occupied Palestinian territory
| | - Nashat Jawabreh
- Makassad Hospital, East Jerusalem, occupied Palestinian territory
| | - Sofia Yunez
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Masako Horino
- United Nations Relief and Works Agency, Amman, Jordan
| | - Akihiro Seita
- United Nations Relief and Works Agency, Amman, Jordan
| | - Bram Wispelwey
- Brigham and Women's Hospital, Harvard Medical School; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Palomares Velosa JE, Riaño Sánchez S, Martínez Marín A, Cediel Becerra NM. Prevention of exposure to zoonoses in rural Latin America: Social ecological factors in a diverse regional context. One Health 2022; 15:100444. [PMID: 36277084 PMCID: PMC9582569 DOI: 10.1016/j.onehlt.2022.100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/29/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
Zoonotic diseases have serious impacts on human health and well-being, but they are often overlooked in rural Latin America. The design of effective preventive interventions is complex and requires an integrative approach from evidence-based information analyzed through robust theoretical frameworks. We conducted a systematized literature review and qualitative framework-guided thematic analysis to identify social ecological factors affecting the prevention and exposure to zoonotic diseases. Although resources for research are limited in Latin America, we found several studies with relevant results. We extracted and interpreted 8 themes as factors affecting the prevention, transmission, and exposure to zoonosis. These themes included knowledge and misconceptions, low risk perception, gaps in knowledge and communication, psychological effect of diseases, culture and traditions, inequality, disarticulated prevention programs, and organizational responsibility. Alongside this, we compiled and present the recommendations for actions to reduce the impact of zoonoses in these populations. The factors and recommendations here presented can be adapted to inform the design and improvement of preventive programs, focused on One Health and aiming to reduce the impact of zoonotic diseases in rural settings. We identified relevant social and behavioural factors affecting the prevention of Zoonotic diseases in Latin America. Knowledge, risk perceptions, and communication quality were relevant individual factors. Inequity and unarticulated programs were relevant social factors. Characterization of the context-specific social ecology can improve the development of effective interventions.
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Affiliation(s)
- Jairo Enrique Palomares Velosa
- Centro Internacional de Entrenamiento e Investigaciones Medicas - CIDEIM, Cali, valle del cauca, Colombia,Corresponding author at: Calle. 18 #122-135, Icesi University campus, building O, Cali, Valle del Cauca, Colombia.
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Manavalan P, Madut DB, Wanda L, Msasu A, Mmbaga BT, Thielman NM, Watt MH. A community health worker delivered intervention to address hypertension among adults engaged in HIV care in northern Tanzania: Outcomes from a pilot feasibility study. J Clin Hypertens (Greenwich) 2022; 24:1095-1104. [PMID: 35899325 PMCID: PMC9380132 DOI: 10.1111/jch.14518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/27/2022] [Accepted: 05/07/2022] [Indexed: 11/28/2022]
Abstract
Current care models are inadequate to address the dual epidemic of hypertension and HIV in sub‐Saharan Africa. We developed a community health worker (CHW)‐delivered educational intervention, integrated into existing HIV care to address hypertension in persons living with HIV. A detailed educational curriculum was created with five sessions: three in‐person clinic sessions and two telephone sessions. The intervention was piloted among hypertensive adults at one HIV clinic in northern Tanzania over a 4‐week period. Primary outcomes were feasibility, fidelity, and acceptability of the intervention. Secondary outcomes included hypertension care engagement and systolic and diastolic blood pressure (SBP and DBP). Among 16 eligible participants, 14 (64% women, median age of 54.5 years) were recruited into the study, and 13 (92.9%) completed all five intervention sessions. The intervention was delivered with 98.8% fidelity to the curriculum content. Hypertension care engagement improved following the intervention. At baseline, two (15.4%) participants had seen a doctor previously for hypertension, compared to 11 (84.6%) participants post‐intervention (P = .0027). No participant was using antihypertensives at baseline, compared to 10 (76.9%) post‐intervention (P = .0016). Pre‐intervention median SBP was 164 (IQR 152–170) mmHg, compared to post‐intervention SBP of 146 (IQR 134–154) mmHg (P = .0029). Pre‐intervention median DBP was 102 (IQR 86–109) mmHg, compared to post‐intervention DBP of 89 (IQR 86–98) mmHg (P = .0023). A CHW‐delivered educational intervention, integrated into existing HIV care, is feasible and holds promise in improving hypertension care engagement and reducing blood pressure. Further research is needed to evaluate the efficacy and scale‐up of our intervention.
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Affiliation(s)
- Preeti Manavalan
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, Florida, USA.,Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | - Deng B Madut
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | - Lisa Wanda
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Ally Msasu
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Blandina T Mmbaga
- Duke Global Health Institute, Durham, North Carolina, USA.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Nathan M Thielman
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | - Melissa H Watt
- Duke Global Health Institute, Durham, North Carolina, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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Prevention of Cardiovascular Diseases in Community Settings and Primary Health Care: A Pre-Implementation Contextual Analysis Using the Consolidated Framework for Implementation Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148467. [PMID: 35886317 PMCID: PMC9323996 DOI: 10.3390/ijerph19148467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/08/2022] [Accepted: 07/09/2022] [Indexed: 02/04/2023]
Abstract
Cardiovascular diseases are the world’s leading cause of mortality, with a high burden especially among vulnerable populations. Interventions for primary prevention need to be further implemented in community and primary health care settings. Context is critically important to understand potential implementation determinants. Therefore, we explored stakeholders’ views on the evidence-based SPICES program (EBSP); a multicomponent intervention for the primary prevention of cardiovascular disease, to inform its implementation. In this qualitative study, we conducted interviews and focus groups with 24 key stakeholders, 10 general practitioners, 9 practice nurses, and 13 lay community partners. We used adaptive framework analysis. The Consolidated Framework for Implementation Research guided our data collection, analysis, and reporting. The EBSP was valued as an opportunity to improve risk awareness and health behavior, especially in vulnerable populations. Its relative advantage, evidence-based design, adaptability to the needs and resources of target communities, and the alignment with policy evolutions and local mission and vision, were seen as important facilitators for its implementation. Concerns remain around legal and structural characteristics and intervention complexity. Our results highlight context dimensions that need to be considered and tailored to primary care and community needs and capacities when planning EBSP implementation in real life settings.
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Hazazi A, Wilson A. Noncommunicable diseases and health system responses in Saudi Arabia: focus on policies and strategies. A qualitative study. Health Res Policy Syst 2022; 20:63. [PMID: 35698126 PMCID: PMC9195368 DOI: 10.1186/s12961-022-00872-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Noncommunicable diseases (NCDs) are responsible for an increasing disease and economic burden in Saudi Arabia, particularly those due to chronic diseases such as diabetes and cardiovascular disease. Efforts are being made to improve chronic disease control through greater prevention and disease management. This research examines the scope, comprehensiveness and perceived effectiveness of Saudi Arabia’s national policies and strategies to prevent and control NCDs and their risk factors. Methods Semi-structured interviews were conducted with 25 managers of the Ministry of Health in Saudi Arabia. The interviewees were public health leaders, national programme directors and programme implementation staff. The interviews were transcribed and coded into key themes. Results Interviewee responses indicated a belief that Ministry of Health programmes for the prevention and control of NCDs have achieved initial success, but have not yet been adequately evaluated. Interviewees reported faster development and implementation of policies for tobacco, sugar-sweetened drinks and obesity than for physical activity. Major challenges identified included inefficient programme management and low community awareness. There was a reported need for greater emphasis on health promotion and improving the effectiveness of existing multisectoral coordination. Conclusion Effective national NCD policies and strategies have a critical role to play in the control of chronic disease epidemics. In Saudi Arabia, opportunities exist to improve the policy and strategies in response to NCDs by establishing a comprehensive surveillance system and linking epidemiological surveillance with health programme evaluation, as well as using a multisectoral and integrated approach. For better management and control of NCDs, a cohesive multisectoral collaboration with a comprehensive surveillance programme and adequate evaluation is urgently needed.
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Affiliation(s)
- Ahmed Hazazi
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, No. 2W21/Level 2, Charles Perkins Centre D17, Sydney, NSW, 2006, Australia. .,Department of Public Health, Faculty of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia.
| | - Andrew Wilson
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, The University of Sydney, No. 2W21/Level 2, Charles Perkins Centre D17, Sydney, NSW, 2006, Australia
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Odukoya OO, Jeet G, Adebusoye B, Idowu O, Ogunsola FT, Okuyemi KS. Targeted faith-based and faith-placed interventions for noncommunicable disease prevention and control in low- and middle-income countries: a systematic review protocol. Syst Rev 2022; 11:119. [PMID: 35690788 PMCID: PMC9188080 DOI: 10.1186/s13643-022-01981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) bear a disproportionately high burden of noncommunicable diseases (NCDs) with severe socioeconomic consequences. Targeted interventions that are faith-based or take place in faith-based settings are historically viable for health promotion and disease prevention programmes. However, evidence of their effectiveness often comes from high-income countries. This paper outlines the protocol for the systematic review of faith-based and faith-placed interventions for NCDs in low- and middle-income countries. OBJECTIVE To determine the effectiveness of faith-based and faith-placed interventions or interventions within faith-based settings targeted at NCDs and/or their risk factors in LMICs. METHODS We will conduct a systematic search of PubMed, Embase, Scopus, WHO Library, and grey literature to locate published and unpublished studies. We will consider quantitative studies that report on interventions (a) with faith-based components or that take place in faith-based settings (b) for the prevention and control of one or more of the top ten NCDs listed in the Global Burden of Disease or their known risk factors (c) occurring among adults aged 18 and above (d) that take place in one or more LMICs. We will screen the titles, abstracts, and full text of articles for eligibility. Included articles will be critically appraised for quality and the inclusion of faith-based components by at least two independent reviewers. Data extraction will be performed for study characteristics and findings. A meta-analysis will be used to synthesize the results; if impossible, a narrative synthesis will be performed. DISCUSSION This review will attempt to synthesize up-to-date evidence to guide effective decision-making, allocation of health resources, and the design of future trials to test the efficacy of NCD interventions in faith-based settings. The study will increase the understanding of the existing evidence, highlight the need for additional evidence, and guide possible directions for future collaborations between public health professionals and faith-based health service providers. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020186299.
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Affiliation(s)
- Oluwakemi Ololade Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria.
- Department of Family & Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA.
| | - Gursimer Jeet
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Busola Adebusoye
- Lifespan and Population Health Academics Unit, Clinical Sciences Building, City Hospital Campus, University of Nottingham, Nottingham, UK
| | - Oluwaseun Idowu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Kolawole S Okuyemi
- Department of Family & Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
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Mishra A, Singh AK, Parida SP, Pradhan SK, Nair J. Understanding Community Participation in Rural Health Care: A Participatory Learning and Action Approach. Front Public Health 2022; 10:860792. [PMID: 35734758 PMCID: PMC9207712 DOI: 10.3389/fpubh.2022.860792] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
Community participation is one of the founding pillars of primary health care. However, due to various reasons, we are yet to achieve complete integration of this component into the health system functioning in India. The objective of our study was to do a formative assessment of community participation in a rural healthcare setting by adopting participatory learning action (PLA). technique. The study participants included frontline health workers and members from local governing institutions of rural areas. The study design is qualitative in nature with a participatory approach. A number of three PLA techniques have been used as a part of this study to recognize available resources for community participation, address its barriers and facilitators, and finally devise a time-line-based action plan. Based on the this, a conceptual framework for community participation pertaining to the rural healthcare system has been developed. This study highlights the importance of understanding the psychosocial aspects of community participation among various stakeholders involved in rural health care. Lessons learned from this PLA study will be helpful in the integration of community-based participatory approach within grassroot level healthcare planning and service delivery.
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Affiliation(s)
| | | | | | - Somen Kumar Pradhan
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
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Fernández LG, Firima E, Robinson E, Ursprung F, Huber J, Amstutz A, Gupta R, Gerber F, Mokhohlane J, Lejone T, Ayakaka I, Xu H, Labhardt ND. Community-based care models for arterial hypertension management in non-pregnant adults in sub-Saharan Africa: a literature scoping review and framework for designing chronic services. BMC Public Health 2022; 22:1126. [PMID: 35658850 PMCID: PMC9167524 DOI: 10.1186/s12889-022-13467-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/13/2022] [Indexed: 12/12/2022] Open
Abstract
Background Arterial hypertension (aHT) is the leading cardiovascular disease (CVD) risk factor in sub-Saharan Africa; it remains, however, underdiagnosed, and undertreated. Community-based care services could potentially expand access to aHT diagnosis and treatment in underserved communities. In this scoping review, we catalogued, described, and appraised community-based care models for aHT in sub-Saharan Africa, considering their acceptability, engagement in care and clinical outcomes. Additionally, we developed a framework to design and describe service delivery models for long-term aHT care. Methods We searched relevant references in Embase Elsevier, MEDLINE Ovid, CINAHL EBSCOhost and Scopus. Included studies described models where substantial care occurred outside a formal health facility and reported on acceptability, blood pressure (BP) control, engagement in care, or end-organ damage. We summarized the interventions’ characteristics, effectiveness, and evaluated the quality of included studies. Considering the common integrating elements of aHT care services, we conceptualized a general framework to guide the design of service models for aHT. Results We identified 18,695 records, screened 4,954 and included twelve studies. Four types of aHT care models were identified: services provided at community pharmacies, out-of-facility, household services, and aHT treatment groups. Two studies reported on acceptability, eleven on BP control, ten on engagement in care and one on end-organ damage. Most studies reported significant reductions in BP values and improved access to comprehensive CVDs services through task-sharing. Major reported shortcomings included high attrition rates and their nature as parallel, non-integrated models of care. The overall quality of the studies was low, with high risk of bias, and most of the studies did not include comparisons with routine facility-based care. Conclusions The overall quality of available evidence on community-based aHT care is low. Published models of care are very heterogeneous and available evidence is insufficient to recommend or refute further scale up in sub-Sahara Africa. We propose that future projects and studies implementing and assessing community-based models for aHT care are designed and described according to six building blocks: providers, target groups, components, location, time of service delivery, and their use of information systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13467-4.
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Tesema AG, Peiris D, Joshi R, Abimbola S, Fentaye FW, Teklu AM, Kinfu Y. Exploring complementary and competitive relations between non-communicable disease services and other health extension programme services in Ethiopia: a multilevel analysis. BMJ Glob Health 2022; 7:e009025. [PMID: 35738842 PMCID: PMC9226884 DOI: 10.1136/bmjgh-2022-009025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Ethiopia has recently revitalised its health extension programme (HEP) to address the rising burden of non-communicable diseases (NCDs). We examined the effects of existing essential HEP services on the uptake of NCD preventive services. METHODS We applied a mixed-effect non-linear model with a logit link function to identify factors associated with a community resident's probability of receiving NCD prevention services through the HEP. The data were drawn from the Ethiopian HEP assessment Survey conducted in all regions. The analysis included 9680 community residents, 261 health extension workers (HEWs), 153 health posts, 119 health centres, 55 districts and 9 regions, which we combined hierarchically into a single database. RESULTS In the 12 months before the survey, 22% of the sample population reported receiving NCD preventive service at least once. The probability of receiving NCD prevention service increased by up to 25% (OR=1.25, CI 1.01 to 1.53) if health centres routinely gathered NCD data from health posts and by up to 48% (OR=.48, CI 1.24 to 1.78) if they provided general (ie, non-NCD specific) training to HEWs. NCD preventive service uptake also increased if the HEW held level IV qualification (OR=1.32, CI 1.06 to 1.65) and lived in the community (OR=1.24, CI 1.03 to 1.49). Conversely, if facilities delayed general performance reviews of HEWs by a month, uptake of NCD prevention services decreased by 6% (OR=0.94, CI 0.91 to 0.97). We observed that better HIV/AIDS programme performance was associated with a lower uptake of NCD preventive services (OR=0.15, CI 0.03 to 0.85). CONCLUSION Despite efforts to improve NCD services through the HEP, the coverage remains limited. A strong HEP is good for the uptake of NCD preventive services. However, integration requires a careful balance, so that the success already recorded for some existing programmes is not lost.
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Affiliation(s)
- Azeb Gebresilassie Tesema
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
| | - Seye Abimbola
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Fasil Walelign Fentaye
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ), Ethiopia office, MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Alula M Teklu
- Monitoring, Evaluation, Research, and Quality Improvement (MERQ), Ethiopia office, MERQ Consultancy PLC, Addis Ababa, Ethiopia
| | - Yohannes Kinfu
- Department of Public Health, Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Department of Health Science Metrics, University of Washington, Seattle, Washington, USA
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Ingenhoff R, Nandawula J, Siddharthan T, Ssekitoleko I, Munana R, Bodnar BE, Weswa I, Kirenga BJ, Mutungi G, van der Giet M, Kalyesubula R, Knauf F. Effectiveness of a community health worker-delivered care intervention for hypertension control in Uganda: study protocol for a stepped wedge, cluster randomized control trial. Trials 2022; 23:440. [PMID: 35610712 PMCID: PMC9128241 DOI: 10.1186/s13063-022-06403-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Over 80% of the morbidity and mortality related to non-communicable diseases (NCDs) occurs in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, particularly in sub-Saharan African settings. In Uganda, and the majority of LMICs, management of uncontrolled hypertension remains limited in constrained health systems. Intervening at the primary care level, using CHWs to improve medical treatment outcomes has not been well studied. We aim to determine the effectiveness of a CHW-led intervention in blood pressure control among confirmed hypertensive patients and patient-related factors associated with uncontrolled hypertension. METHODS We will conduct a stepped-wedge cluster randomized controlled trial study of 869 adult patients with hypertension attending two NCD clinics to test the effectiveness, acceptability, and fidelity of a CHW-led intervention. The multi-component intervention will be centered on monthly household visits by trained CHWs for a period of 1 year, consisting of the following: (1) blood pressure and sugar monitoring, (2) BMI monitoring, (3) cardiovascular disease risk assessment, (4) using checklists to guide monitoring and referral to clinics, and (5) healthy lifestyle counseling and education. During home visits, CHWs will remind patients of follow-up visits. We will measure blood pressure at baseline and 3-monthly for the entire cohort. We will conduct individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community. CONCLUSION The results of this study will inform community delivered HTN management across a range of LMIC settings. TRIAL REGISTRATION ClinicalTrials.gov NCT05068505 . Registered on October 6, 2021.
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Affiliation(s)
- Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Juliet Nandawula
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | - Trishul Siddharthan
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, USA
| | - Isaac Ssekitoleko
- MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Munana
- African Community Center for Social Sustainability, Nakaseke, Uganda
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Benjamin E Bodnar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | | | | | - Markus van der Giet
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Department of Physiology, Uganda Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Mbuthia GW, Magutah K, Pellowski J. Approaches and outcomes of community health worker's interventions for hypertension management and control in low-income and middle-income countries: systematic review. BMJ Open 2022; 12:e053455. [PMID: 35365519 PMCID: PMC8977767 DOI: 10.1136/bmjopen-2021-053455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To critically appraise the scope, content and outcomes of community health worker (CHW) interventions designed to reduce blood pressure (BP) in low-income and middle-income countries (LMICs). METHOD We performed a database search (PUBMED, EMBASE, CINAHL, PsycINFO, OpenGrey, Cochrane Central Trials Register and Cochrane Database of Systematic Reviews) to identify studies in LMICs from 2000 to 2020. Eligible studies were interventional studies published in English and reporting CHW interventions for management of BP in LMICs. Two independent reviewers screened the titles, abstracts and full texts of publications for eligibility and inclusion. Relevant information was extracted from these studies using a tailored template. Risk of bias was assessed using the Cochrane collaboration risk of bias tool. Qualitative synthesis of results was done through general summary of the characteristics and findings of each study. We also analysed the patterns of interventions and their outcomes across the studies. Results were presented in form of narrative and tables. RESULTS Of the 1557 articles identified, 14 met the predefined criteria. Of these, 12 were cluster randomised trials whereas two were pretest/post-test studies. The CHW interventions were mainly community-based and focused on behaviour change for promoting BP control among hypertensive patients as well as healthy individuals. The interventions had positive effects in the BP reduction, linkage to care, treatment adherence and in reducing cardivascular-disease risk level. DISCUSSION AND CONCLUSION The current review is limited in that, a meta-analysis to show the overall effect of CHW interventions in the management of hypertension was not possible due to the diversity of the interventions, and outcomes of the studies included in the review. Summarised outcomes of individual studies showed CHW enhanced the control and management of hypertension. Further studies are needed to indicate the impact and cost-effectiveness of CHW-led interventions in the control and management of hypertension in LMICs.
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Affiliation(s)
- Grace Wambura Mbuthia
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Karani Magutah
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Jennifer Pellowski
- International Health Institute, School of Public Health, Brown University, Providence, Rhode Island, USA
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