Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Health Serv Res. 2022 Mar 22;22(1):375. doi: 10.1186/s12913-022-07794-w.
Hypertension is a public health issue in Ethiopia. The vast majority of cases remain undiagnosed and untreated. Early and accurate identification of hypertension can help with timely management and reduce the risk of complications. In resource-constrained rural settings where poor access to care and a shortage of healthcare providers are major barriers, task-sharing of some primary healthcare duties from well-trained healthcare workers to community health workers has been found to be a cost-effective strategy. This study aimed to assess the ability of trained health extension workers to correctly identify high blood pressure among adults in rural areas of northwest Ethiopia.
A cross-sectional study was conducted in rural areas of northwest Ethiopia from June to October 2020. Trained health extension workers and health professionals measured the blood pressure of 1177 study participants using a calibrated aneroid sphygmomanometer. A Kappa test statistic was used to compare the two sets of measurements for agreement. The sensitivity, specificity, positive, and negative predictive values were used to assess the validity of health extension workers' ability to identify high blood pressure in comparison to health professionals.
The trained health extension workers and health professionals identified 219 (18.6%) and 229 (19.5%) of the participants with high blood pressure, respectively. The inter-rater agreement between health extension workers and health professionals for high blood pressure detection was 91.2% (k = 0.912, 95% CI: 0.88, 0.94, p-value = 0.000). The sensitivity and specificity of high blood pressure detection by health extension workers were 90.8% (95% CI: 89.6, 92.0) and 98.8% (95% CI: 98.1, 99.5), respectively. While the positive and negative predictive values were 95.0% (95% CI: 92.1, 97.9) and 97.8% (95% CI: 97.3, 98.3), respectively.
The inter-rater agreement between the trained health extension workers and health professionals on high blood pressure detection was excellent. The findings indicate that training health extension workers is a reliable and valid strategy for early detection of hypertension. Thus, the strategy can be integrated with the essential services provided by primary health care units at the village and health post level in rural settings.
高血压是埃塞俄比亚的一个公共卫生问题。绝大多数病例未被诊断和治疗。早期准确识别高血压有助于及时管理并降低并发症风险。在资源有限的农村地区，医疗服务获取途径差和医疗保健提供者短缺是主要障碍，将部分初级保健职责从经过培训的医疗保健工作者分担给社区卫生工作者已被证明是一种具有成本效益的策略。本研究旨在评估经过培训的卫生推广工作者在埃塞俄比亚西北部农村地区正确识别成年人高血压的能力。
2020 年 6 月至 10 月在埃塞俄比亚西北部农村地区进行了一项横断面研究。经过培训的卫生推广工作者和卫生专业人员使用校准的无液血压计测量了 1177 名研究参与者的血压。使用 Kappa 检验统计量比较了两组测量结果的一致性。灵敏度、特异性、阳性预测值和阴性预测值用于评估与卫生专业人员相比，卫生推广工作者识别高血压的能力的有效性。
经过培训的卫生推广工作者和卫生专业人员分别识别出 219 名（18.6%）和 229 名（19.5%）患有高血压的参与者。卫生推广工作者和卫生专业人员之间高血压检测的评分者间一致性为 91.2%（k=0.912，95%CI：0.88，0.94，p 值=0.000）。卫生推广工作者高血压检测的灵敏度和特异性分别为 90.8%（95%CI：89.6，92.0）和 98.8%（95%CI：98.1，99.5）。阳性预测值和阴性预测值分别为 95.0%（95%CI：92.1，97.9）和 97.8%（95%CI：97.3，98.3）。
经过培训的卫生推广工作者和卫生专业人员之间在高血压检测方面的评分者间一致性非常好。研究结果表明，培训卫生推广工作者是早期发现高血压的可靠且有效的策略。因此，该策略可以与农村地区基层医疗保健单位提供的基本服务相结合。
