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Meta-Analysis
. 2019 Jun;7(6):e761-e771.
doi: 10.1016/S2214-109X(19)30077-4.

Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis

T N Anand  1 , Linju Maria Joseph  1 , A V Geetha  2 , Dorairaj Prabhakaran  3 , Panniyammakal Jeemon  4
Affiliations
Meta-Analysis

Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis

T N Anand et al. Lancet Glob Health. 2019 Jun.

Erratum in

  • Correction to Lancet Glob Health 2019; 7: e761-71.
    [No authors listed] [No authors listed] Lancet Glob Health. 2019 Nov;7(11):e1499. doi: 10.1016/S2214-109X(19)30367-5. Epub 2019 Aug 28. Lancet Glob Health. 2019. PMID: 31473146 Free PMC article. No abstract available.

Abstract

Background: Task sharing for the management of hypertension could be useful for understaffed and resource-poor health systems. We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries.

Methods: We searched the Cochrane Library, PubMed, Embase, and CINAHL for studies published up to December 2018. We included intervention studies involving a task-sharing strategy for management of blood pressure and other cardiovascular risk factors. We extracted data on population, interventions, blood pressure, and task sharing groups. We did a meta-analysis of randomised controlled trials.

Findings: We found 3012 references, of which 54 met the inclusion criteria initially. Another nine studies were included following an updated search. There were 43 trials and 20 before-and-after studies. We included 31 studies in our meta-analysis. Systolic blood pressure was decreased through task sharing in different groups of health-care workers: the mean difference was -5·34 mm Hg (95% CI -9·00 to -1·67, I2=84%) for task sharing with nurses, -8·12 mm Hg (-10·23 to -6·01, I2=57%) for pharmacists, -4·67 mm Hg (-7·09 to -2·24, I2=0%) for dietitians, -3·67 mm Hg (-4·58 to -2·77, I2=24%) for community health workers, and -4·85 mm Hg (-6·12 to -3·57, I2=76%) overall. We found a similar reduction in diastolic blood pressure (overall mean difference -2·92 mm Hg, -3·75 to -2·09, I2=80%). The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure, but low for diastolic blood pressure.

Interpretation: Task-sharing interventions are effective in reducing blood pressure. Long-term studies are needed to understand their potential impact on cardiovascular outcomes and mortality.

Funding: Wellcome Trust/DBT India Alliance.

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Figures

Figure 1
Figure 1
Literature search and article inclusion SMS=short messaging service. CHW=community health worker. CKD=chronic kidney disease. LMIC=low-income and middle-income country. CVD=cardiovascular disease. SBP=systolic blood pressure. DBP=diastolic blood pressure. RCT=randomised controlled trial.
Figure 2
Figure 2
Systolic blood pressure changes with task sharing compared with usual care
Figure 3
Figure 3
Diastolic blood pressure changes with task sharing compared with usual care
See this image and copyright information in PMC

Comment in

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