ArticleBMJ global health2018
Can lay health workers support the management of hypertension? Findings of a cluster randomised trial in South Africa.
Article in BMJ global health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 6 of them syntheses that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 6 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Pooled it
- Lay advisor interventions for hypertension outcomes: A Systematic Review, Meta-analysis and a RE-AIM evaluation.Frontiers in medicine · 2024Pooled it
- Pooled it
- Non-pharmacological interventions to achieve blood pressure control in African patients: a systematic review.BMJ open · 2022Pooled it
- Optimizing observer performance of clinic blood pressure measurement: a position statement from the Lancet Commission on Hypertension Group.Journal of hypertension · 2019Guideline
- 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.The Lancet. Global health · 2019Pooled it
- Trial
- Effect of a patient-centered hypertension delivery strategy on all-cause mortality: Secondary analysis of SEARCH, a community-randomized trial in rural Kenya and Uganda.PLoS medicine · 2021Trial
- Improving uptake and completion of pulmonary rehabilitation in COPD with lay health workers: feasibility of a clinical trial.International journal of chronic obstructive pulmonary diseaseTrial
- Understanding the role and organization of health workers delivering non-communicable disease management in primary care in low- and middle-income countries: a scoping review.BMC primary care · 2025Article
- An integrated support model for lay health care workers to improve clients' retention in HIV care.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2025Article
- Physical activity and ageing: The role of physiotherapy in promoting healthy ageing.The South African journal of physiotherapy · 2025Review
- Challenges in non-communicable disease mitigation among community health workers: A scoping review.Journal of public health in Africa · 2025Review
- Task-sharing for non-communicable disease prevention and control in low- and middle-income countries in the context of health worker shortages: A systematic review.PLOS global public health · 2025Article
- Leadership, cohesion, and stress in primary care facilities and retention in chronic care in rural northeast South Africa before and during the COVID-19 pandemic: A longitudinal study.Journal of global health · 2024Article
- Physical activity interventions implemented for older people in Sub-Saharan Africa: a scoping review.BMJ open · 2024Article
- Understanding Gaps in the Hypertension and Diabetes Care Cascade: Systematic Scoping Review.JMIR public health and surveillance · 2024Article
- Feasibility and acceptability of a contextualized physical activity and diet intervention for the control of hypertension in adults from a rural subdistrict: a study protocol (HYPHEN).Pilot and feasibility studies · 2024Article
- Task Sharing and Task Shifting (TSTS) in the Management of Africans with Hypertension: A Call For Action-Possibilities and Its Challenges.Global heart · 2024Review
- Does a youth intern programme strengthen HIV service delivery in South Africa? An interrupted time-series analysis.Journal of the International AIDS Society · 2023Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
introductionIn low/middle-income countries with substantial HIV and tuberculosis epidemics, health services often neglect other highly prevalent chronic conditions, such as hypertension, which as a result are poorly managed. This paper reports on a study to assess the effect on hypertension management of lay health workers (LHW) working in South African rural primary healthcare clinics to support the provision of integrated chronic care.
methodsA pragmatic cluster randomised trial with a process evaluation in eight rural clinics assessed the effect of adding two LHWs supporting nurses in providing chronic disease care in each intervention clinic over 18 months. Control clinics continued with usual care. The main outcome measure was the change in the difference of percentage of clinic users who had elevated cardiovascular risk associated with high blood pressure (BP) before and after the intervention, as measured by two cross-sectional population surveys.
resultsThere was no improvement in BP control among users of intervention clinics as compared with control clinics. However, the LHWs improved clinic functioning, including overall attendance, and attendance on the correct day. All clinics faced numerous challenges, including rapidly increasing number of users of chronic care, unreliable BP machines and cuffs, intermittent drug shortages and insufficient space.
conclusionLHWs improved the process of providing care but improved BP control required improved clinical care by nurses which was compromised by large and increasing numbers of patients, the dominance of the vertically funded HIV programme and the poor standards of equipment in clinics. TRIAL REGISTRATION NUMBER: ISRCTN12128227.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.