College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
School of Public Health and Community Development, Maseno University, Kisumu, Kenya.
PLoS One. 2024 Aug 29;19(8):e0293791. doi: 10.1371/journal.pone.0293791. eCollection 2024.
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.
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.
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.
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.
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 number: PACTR202309530525257.
在撒哈拉以南非洲地区，非传染性疾病负担不断增加，这对这些地区资源有限的卫生系统构成了巨大挑战。
本研究旨在确定社区卫生工作者（CHW）基于家庭的生活方式干预措施在改善肯尼亚基安布县低收入人群高血压患者血压控制和身体成分方面的可行性和初步疗效。
这是一项随机对照试验（RCT），共纳入 80 名血压未得到控制的高血压患者（收缩压（SBP）≥140mmHg 和/或舒张压（DBP）≥90mmHg），随机分为 CHW 基于家庭的干预组或常规护理（对照组），并随访 6 个月。干预措施包括每月由 CHW 进行家庭访视，进行健康教育，并对影响血压的行为风险因素进行审核。采用经过改编的世界卫生组织逐步问卷和国际体力活动问卷，收集行为心血管风险因素的数据。在基线、3 个月和 6 个月时进行调查，以评估血压、体重指数（BMI）和腰高比（WHtR）的主要结局。使用 STATA 18 分析具有统计学意义的单变量、双变量和多变量（组内和组间重复测量）分析的数据。使用广义估计方程（GEE）进行重复测量，以估计血压、BMI 和 WHtR 的变化，并检验 CHW 干预与血压控制之间的关系。
研究显示，常规护理组和干预组分别有 77.5%和 92.5%的参与者完成了随访。经过 6 个月的随访，两组的平均 SBP 和 DBP 均有所下降，而只有干预组的 BMI 和 WHtR 有所下降。干预组 SBP（-8.4mmHg；95%CI，-13.4 至-3.3；P=0.001）和 DBP（-5.2mmHg；95%CI，-8.3 至-2.0；P<0.001）的平均降低幅度明显高于对照组。干预组血压控制目标（<140/90mmHg）的参与者比例为 62.2%，常规护理组为 25.8%。在调整基线协变量后，干预组的血压控制比例明显高于常规护理组（AOR 2.8，95%CI 1.3-6.0，p=0.008）。干预对 BMI 和 WHtR 没有显著影响。
与常规护理相比，基于家庭的 CHW 干预措施与高血压患者的血压降低显著相关。建议开展更大型的、完全有效的随机对照试验，以检验此类干预措施在低收入人群中的有效性。
试验注册号：PACTR202309530525257。
