Teshome Destaw Fetene, Balcha Shitaye Alemu, Ayele Tadesse Awoke, Atnafu Asmamaw, Mitike Getnet, Gelaye Kassahun Alemu
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.
Trials. 2025 May 19;26(1):163. doi: 10.1186/s13063-025-08862-2.
Uncontrolled hypertension is the leading cause of cardiovascular and cerebrovascular diseases in Ethiopia. Early detection and referral of hypertensive patients for clinical care is critical for initiating lifestyle changes and antihypertensive medications. This study aimed to evaluate the effects of health extension workers led home-based multicomponent intervention on linkage to hypertension care in patients with hypertension in rural districts of northwest Ethiopia.
A parallel group, cluster randomized controlled trial was conducted in 20 rural communities. A total of 456 (228 in the intervention and 228 in the control clusters) participants were enrolled and followed for nine months. Participants in the intervention clusters received the interventions (home health education, behavioral and medication adherence counseling, and referral to nearby health facility) four times every other month for 40-60 min. The primary outcome was clinical linkage for hypertension care and the secondary outcome was initiation of antihypertensive treatment. Generalized estimating equation was used to evaluate the intervention's effect using an intention-to-treat approach. Effect sizes of relative benefit increases, absolute benefit increases, and attributable benefit were used. All statistical analyses were two-sided with a p-value of < 0.05.
The overall average systolic and diastolic blood pressure at baseline were 145.81 (± 13.89) mmHg and 87.11 (± 7.42) mmHg, respectively. The proportion of linkage to hypertension care increased from 11.0% at baseline to 66.2% at 9 months in the intervention group and from 12.3 to 39.7% in the control group, with an absolute benefit increase of 27.5% (95% CI: 19.6%, 35.4%; P-value < 0.001). The attributable benefit associated with the intervention was 40.1% (95% CI 20.7%, 59.5%) which means that more than a third of linkage to hypertension care was due to the HEWs led home-based multicomponent intervention. However, it is noteworthy that only 10.3% of patients initiated antihypertensive medication.
In this study, health extension workers led home-based multicomponent interventions that provided home health education, behavioral counseling, and referral to a nearby health facility to improve linkage to hypertension care. A multicomponent intervention implemented on a large scale is likely to improve linkage to hypertension care and reduce hypertension-related morbidity and mortality in the country.
PACTR202102729454417.
在埃塞俄比亚，未得到控制的高血压是心血管和脑血管疾病的主要病因。对高血压患者进行早期检测并转诊至临床护理机构，对于启动生活方式改变和抗高血压药物治疗至关重要。本研究旨在评估由健康推广工作者主导的家庭多组分干预措施对埃塞俄比亚西北部农村地区高血压患者高血压护理衔接的影响。
在20个农村社区进行了一项平行组整群随机对照试验。共纳入456名参与者（干预组228名，对照组228名），并随访9个月。干预组的参与者每隔一个月接受4次干预（家庭健康教育、行为和药物依从性咨询以及转诊至附近医疗机构），每次40 - 60分钟。主要结局是高血压护理的临床衔接，次要结局是开始抗高血压治疗。采用广义估计方程，使用意向性分析方法评估干预效果。使用相对获益增加、绝对获益增加和归因获益的效应量。所有统计分析均为双侧检验，p值<0.05。
基线时总体平均收缩压和舒张压分别为145.81（±13.89）mmHg和87.11（±7.42）mmHg。干预组高血压护理衔接比例从基线时的11.0%增加到9个月时的66.2%，对照组从12.3%增加到39.7%，绝对获益增加27.5%（95%CI：19.6%，35.4%；P值<0.001）。与干预相关的归因获益为40.1%（95%CI 20.7%，59.5%），这意味着超过三分之一的高血压护理衔接归因于由健康推广工作者主导的家庭多组分干预措施。然而，值得注意的是，只有10.3%的患者开始服用抗高血压药物。
在本研究中，由健康推广工作者主导的家庭多组分干预措施提供了家庭健康教育、行为咨询以及转诊至附近医疗机构，以改善高血压护理的衔接。大规模实施的多组分干预措施可能会改善该国高血压护理的衔接，并降低与高血压相关的发病率和死亡率。
PACTR202102729454417。
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