Journal Article

Community health workers for non-communicable diseases prevention and control in developing countries: Evidence and implications

Jeet, Gursimer, Thakur, J. S., Prinja, Shankar, Singh, Meenu

2017

Overview

National programs for non-communicable diseases (NCD) prevention and control in different low middle income countries have a strong community component. A community health worker (CHW) delivers NCD preventive services using informational as well as behavioural approaches. Community education and interpersonal communication on lifestyle modifications is imparted with focus on primordial prevention of NCDs and screening is conducted as part of early diagnosis and management. However, the effectiveness of health promotion and screening interventions delivered through community health workers needs to be established. This review synthesised evidence on effectiveness of CHW delivered NCD primary prevention interventions in low and middle-income countries (LMICs). A systematic review of trials that utilised community health workers for primary prevention/ early detection strategy in the management of NCDs (Diabetes, cardiovascular diseases (CVD), cancers, stroke, Chronic Obstructive Pulmonary Diseases (COPD)) in LMICs was conducted. Digital databases like PubMed, EMBASE, OVID, Cochrane library, dissertation abstracts, clinical trials registry web sites of different LMIC were searched for such publications between years 2000 and 2015. We focussed on community based randomised controlled trial and cluster randomised trials without any publication language limitation. The primary outcome of review was percentage change in population with different behavioural risk factors. Additionally, mean overall changes in levels of several physical or biochemical parameters were studied as secondary outcomes. Subgroup analyses was performed by the age and sex of participants, and sensitivity analyses was conducted to assess the robustness of the findings. Sixteen trials meeting the inclusion criteria were included in the review. Duration, study populations and content of interventions varied across trials. The duration of the studies ranged from mean follow up of 4 months for some risk factors to 19 months, and primary responsibilities of health workers included health promotion, treatment adherence and follow ups. Only a single trial reported all-cause mortality. The pooled effect computed indicated an increase in tobacco cessation (RR: 2.0, 95%CI: 1.11, 3.58, moderate-quality evidence) and a decrease in systolic blood pressure ((MD: -4.80, 95% CI: -8.12, -1.49, I2 = 93%, very low-quality evidence), diastolic blood pressure ((MD: -2.88, 95% CI: -5.65, -0.10, I2 = 96%, very low-quality evidence)) and blood sugar levels (glycated haemoglobin MD: -0.83%, 95%CI: -1.25,-0.41). None of the included trials reported on adverse events. Evidence on the implementation of primary prevention strategies using community health workers is still developing. Existing evidence suggests that, compared with standard care, using CHWs in health programmes have the potential to be effective in LMICs, particularly for tobacco cessation, blood pressure and diabetes control.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Biology and life sciences / Blood / Blood pressure / Cardiovascular disease / Cardiovascular diseases / Chronic illnesses / Chronic obstructive pulmonary disease / Clinical trials / Communicable diseases / Communities / Community Health Workers / Developing Countries / Diabetes / Diabetes mellitus / Disease control / Disease prevention / Diseases / Documents / Glucose / Health care / Health education / Health Education - methods / Health promotion / Health Promotion - methods / Heart diseases / Hemoglobin / Human communication / Humans / Income / Interpersonal communication / Intervention / LDCs / Lung diseases / Medical personnel / Medical research / Medicine and Health Sciences / Methods / Mortality / Nutrition / Obstructive lung disease / Personal communication / Population studies / Practice / Prevention / Primary care / Primary Prevention - methods / Program Evaluation / Public health / Public health administration / Randomization / Randomized Controlled Trials as Topic / Reviews / Risk analysis / Risk factors / Risk taking / Screening / Sensitivity analysis / Stroke / Studies / Sugar / Tobacco / Underserved populations / Websites / Weight control / Workers / Workforce