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Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa
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Goudge, Jane, Chirwa, Tobias, Eldridge, Sandra, Gómez-Olivé, F. Xavier, Kabudula, Chodziwadziwa, Limbani, Felix, Musenge, Eustasius and Thorogood, Margaret (2018) Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa. BMJ Global Health, 3 (1). e000577. doi:10.1136/bmjgh-2017-000577
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WRAP-can-lay-health-workers-hypertension-South-Africa-Thorogood-2018.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (2219Kb) | Preview |
Official URL: http://dx.doi.org/10.1136/bmjgh-2017-000577
Abstract
Introduction
In low/middle-income countries with substantial HIV and tuberculosis epidemics, health services often neglect other highly prevalent chronic conditions, such as hypertension, which as a result are poorly managed. This paper reports on a study to assess the effect on hypertension management of lay health workers (LHW) working in South African rural primary healthcare clinics to support the provision of integrated chronic care.
Methods
A pragmatic cluster randomised trial with a process evaluation in eight rural clinics assessed the effect of adding two LHWs supporting nurses in providing chronic disease care in each intervention clinic over 18 months. Control clinics continued with usual care. The main outcome measure was the change in the difference of percentage of clinic users who had elevated cardiovascular risk associated with high blood pressure (BP) before and after the intervention, as measured by two cross-sectional population surveys.
Results
There was no improvement in BP control among users of intervention clinics as compared with control clinics. However, the LHWs improved clinic functioning, including overall attendance, and attendance on the correct day. All clinics faced numerous challenges, including rapidly increasing number of users of chronic care, unreliable BP machines and cuffs, intermittent drug shortages and insufficient space.
Conclusion
LHWs improved the process of providing care but improved BP control required improved clinical care by nurses which was compromised by large and increasing numbers of patients, the dominance of the vertically funded HIV programme and the poor standards of equipment in clinics.
Trial registration number
ISRCTN12128227.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine | ||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Community health aides -- South Africa, Hypertension -- Diagnosis -- South Africa, Hypertension -- Treatment -- South Africa, Hypertension -- Prevention -- South Africa | ||||||
| Journal or Publication Title: | BMJ Global Health | ||||||
| Publisher: | British Medcial Journal | ||||||
| ISSN: | 2059-7908 | ||||||
| Official Date: | 15 February 2018 | ||||||
| Dates: |
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| Volume: | 3 | ||||||
| Number: | 1 | ||||||
| Article Number: | e000577 | ||||||
| DOI: | 10.1136/bmjgh-2017-000577 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access | ||||||
| RIOXX Funder/Project Grant: |
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