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. 2018 Feb 15;3(1):e000577.
doi: 10.1136/bmjgh-2017-000577. eCollection 2018.

Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa

Jane Goudge  1 , Tobias Chirwa  2 , Sandra Eldridge  3 , Francesc Xavier F Gómez-Olivé  4 , Chodziwadziwa Kabudula  4 , Felix Limbani  1 , Eustasius Musenge  5 , Margaret Thorogood  2   6
Affiliations

Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa

Jane Goudge et al. BMJ Glob Health. .

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.

Keywords: South Africa; chronic care; cluster randomised trial; hypertension; lay health workers.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Allocation of clinics.
Figure 2
Figure 2
Response to survey by individuals sampled.
Figure 3
Figure 3
Number of monthly clinic visits by patients with hypertension and other chronic conditions in the control and intervention clinics.
Figure 4
Figure 4
Percentage of patients who attend the clinic on their appointed day by month.
See this image and copyright information in PMC

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