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Katena NA, Shamu S, Fana GT, Rusakaniko S. Effects of a Community Health Worker-Led Health Literacy Intervention on Lifestyle Modification Among Patients With Hypertension and Diabetes in the City of Harare, Zimbabwe: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47512. [PMID: 37788044 PMCID: PMC10582805 DOI: 10.2196/47512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Hypertension and diabetes are among the most common noncommunicable diseases in Zimbabwe. These 2 conditions are largely prevented and controlled by lifestyle modifications, such as healthy eating habits, physical activity, and avoiding the use of tobacco and alcohol. OBJECTIVE This study aims to evaluate the effects of a community health worker (CHW)-led health literacy intervention on lifestyle modification among patients with diabetes and hypertension in the City of Harare, Zimbabwe, in terms of (1) adherence to recommended lifestyle changes, (2) blood pressure and blood glucose levels, and (3) medication adherence. METHODS This is a 6-month-long cluster randomized controlled trial, which will be conducted in primary health care clinics in the city of Harare. A total of 14 clinics will be randomly allocated into either the intervention or control group. A total of 680 (49 participants per clinic) adult patients with hypertension and diabetes will be enrolled for the trial. Participants in the intervention arm will receive a simple health literacy intervention on lifestyle modification, which will be delivered by trained CHWs, while those in the control arm will receive usual care. The intervention consists of 4 face-to-face interactive educational sessions and monthly support visits by trained CHWs and will be carried out over a period of 6 months. The primary study outcomes will be blood pressure and blood glucose levels and levels of adherence to the recommended lifestyle modifications. Other outcomes will include adherence to medication. Data management and analysis will be done using Epi Info software, and the data will be analyzed using the intention-to-treat principle. RESULTS Recruitment of study participants commenced on June 1, 2023, and was completed on July 30, 2023. Baseline data are being collected after participants' recruitment, and the final data collection will be completed by January 31, 2024. CONCLUSIONS There is an information dearth regarding the effectiveness of CHW-led interventions for the management and control of hypertension in Zimbabwe. Our study offers an opportunity to show the effectiveness of CHWs in addressing the gaps in the management of hypertension and diabetes. The findings from our study will provide crucial evidence on the effectiveness and feasibility of a simple intervention delivered by CHWs in resource-constrained areas. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47512.
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Affiliation(s)
- Nyaradzai Arster Katena
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Shepherd Shamu
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Golden Tafadzwa Fana
- Internal Medicine Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
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Eddy KE, Vogel JP, Zahroh RI, Bohren MA. Factors affecting use of magnesium sulphate for pre-eclampsia or eclampsia: a qualitative evidence synthesis. BJOG 2021; 129:379-391. [PMID: 34520111 PMCID: PMC9291451 DOI: 10.1111/1471-0528.16913] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
Background Hypertensive disorders account for 14% of global maternal deaths. Magnesium sulphate (MgSO4) is recommended for prevention and treatment of pre‐eclampsia/eclampsia. However, MgSO4 remains underused, particularly in low‐ and middle‐income countries (LMICs). Objective This qualitative evidence synthesis explores perceptions and experiences of healthcare providers, administrators and policy‐makers regarding factors affecting use of MgSO4 to prevent or treat pre‐eclampsia/eclampsia. Search strategy We searched MEDLINE, EMBASE, Emcare, CINAHL, Global Health and Global Index Medicus, and grey literature for studies published between January 1995 and June 2021. Selection criteria Primary qualitative and mixed‐methods studies on factors affecting use of MgSO4 in healthcare settings, from the perspectives of healthcare providers, administrators and policy‐makers, were eligible for inclusion. Data collection and analysis We applied a thematic synthesis approach to analysis, using COM‐B behaviour change theory to map factors affecting appropriate use of MgSO4. Main results We included 22 studies, predominantly from LMICs. Key themes included provider competence and confidence administering MgSO4 (attitudes and beliefs, complexities of administering, knowledge and experience), capability of health systems to ensure MgSO4 availability at point of use (availability, resourcing and pathways to care) and knowledge translation (dissemination of research and recommendations). Within each COM‐B domain, we mapped facilitators and barriers to physical and psychological capability, physical and social opportunity, and how the interplay between these domains influences motivation. Conclusions These findings can inform policy and guideline development and improve implementation of MgSO4 in clinical care. Such action is needed to ensure this life‐saving treatment is widely available and appropriately used. Tweetable abstract Global qualitative review identifies factors affecting underutilisation of MgSO4 for pre‐eclampsia and eclampsia. Global qualitative review identifies factors affecting underutilisation of MgSO4 for pre‐eclampsia and eclampsia. This article includes Author Insights, a video abstract available at https://vimeo.com/manage/videos/623192027 Linked article This article is commented on by LA Magee, p. 392 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16971.
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Affiliation(s)
- K E Eddy
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.,Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - J P Vogel
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - R I Zahroh
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - M A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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Bellad MB, Goudar SS, Mallapur AA, Sharma S, Bone J, Charantimath US, Katageri GM, Ramadurg UY, Mark Ansermino J, Derman RJ, Dunsmuir DT, Honnungar NV, Karadiguddi C, Kavi AJ, Kodkany BS, Lee T, Li J, Nathan HL, Payne BA, Revankar AP, Shennan AH, Singer J, Tu DK, Vidler M, Wong H, Bhutta ZA, Magee LA, von Dadelszen P. Community level interventions for pre-eclampsia (CLIP) in India: A cluster randomised controlled trial. Pregnancy Hypertens 2020; 21:166-175. [PMID: 32554291 PMCID: PMC7471838 DOI: 10.1016/j.preghy.2020.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Pregnancy hypertension is associated with 7.1% of maternal deaths in India. The objective of this trial was to assess whether task-sharing care might reduce adverse pregnancy outcomes related to delays in triage, transport, and treatment. STUDY DESIGN The Indian Community-Level Interventions for Pre-eclampsia (CLIP) open-label cluster randomised controlled trial (NCT01911494) recruited pregnant women in 12 clusters (initial four-cluster internal pilot) in Belagavi and Bagalkote, Karnataka. The CLIP intervention (6 clusters) consisted of community engagement, community health workers (CHW) provided mobile health (mHeath)-guided clinical assessment, initial treatment, and referral to facility either urgently (<4 h) or non-urgently (<24 h), dependent on algorithm-defined risk. Treatment effect was estimated by multi-level logistic regression modelling, adjusted for prognostically-significant baseline variables. Predefined secondary analyses included safety and evaluation of the intensity of mHealth-guided CHW-provided contacts. MAIN OUTCOME MEASURES 20% reduction in composite of maternal, fetal, and newborn mortality and major morbidity. RESULTS All 14,783 recruited pregnancies (7839 intervention, 6944 control) were followed-up. The primary outcome did not differ between intervention and control arms (adjusted odds ratio (aOR) 0.92 [95% confidence interval 0.74, 1.15]; p = 0.47; intraclass correlation coefficient 0.013). There were no intervention-related safety concerns following administration of either methyldopa or MgSO4, and 401 facility referrals. Compared with intervention arm women without CLIP contacts, those with ≥8 contacts suffered fewer stillbirths (aOR 0.19 [0.10, 0.35]; p < 0.001), at the probable expense of survivable neonatal morbidity (aOR 1.39 [0.97, 1.99]; p = 0.072). CONCLUSIONS As implemented, solely community-level interventions focussed on pre-eclampsia did not improve outcomes in northwest Karnataka.
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Affiliation(s)
- Mrutunjaya B Bellad
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India.
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Ashalata A Mallapur
- S Nijalingappa Medical College, HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Navanagar, Bagalkot, 587102 Karnataka, India
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Jeffrey Bone
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Umesh S Charantimath
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Geetanjali M Katageri
- S Nijalingappa Medical College, HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Navanagar, Bagalkot, 587102 Karnataka, India
| | - Umesh Y Ramadurg
- S Nijalingappa Medical College, HSK (Hanagal Shree Kumareshwar) Hospital and Research Centre, Navanagar, Bagalkot, 587102 Karnataka, India
| | - J Mark Ansermino
- Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Richard J Derman
- Global Affairs, 1020 Walnut Street, Thomas Jefferson University, Philadelphia 19107, USA
| | - Dustin T Dunsmuir
- Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Narayan V Honnungar
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Chandrashekhar Karadiguddi
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Avinash J Kavi
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Bhalachandra S Kodkany
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Tang Lee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Jing Li
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Hannah L Nathan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Beth A Payne
- Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Amit P Revankar
- KLE Academy of Higher Education and Research's J N Medical College, Nehru Nagar, Belagavi, 590010 Karnataka, India
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Domena K Tu
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada; Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Hubert Wong
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, 525 University Avenue, Suite 702, Toronto M5G 2L3, Canada; Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver, BC V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK
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Nagraj S, Kennedy SH, Norton R, Jha V, Praveen D, Hinton L, Hirst JE. Cardiometabolic Risk Factors in Pregnancy and Implications for Long-Term Health: Identifying the Research Priorities for Low-Resource Settings. Front Cardiovasc Med 2020; 7:40. [PMID: 32266293 PMCID: PMC7099403 DOI: 10.3389/fcvm.2020.00040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/03/2020] [Indexed: 12/17/2022] Open
Abstract
Cardiometabolic disorders (CMDs), including ischemic heart disease, stroke and type 2 diabetes are the leading causes of mortality and morbidity in women worldwide. The burden of CMDs falls disproportionately on low and middle-income countries (LMICs), placing substantial demands on already pressured health systems. Cardiometabolic disorders may present up to a decade earlier in some LMIC settings, and are associated with high-case fatality rates. Early identification and ongoing postpartum follow-up of women with pregnancy complications such as hypertensive disorders of pregnancy (HDPs), and gestational diabetes mellitus (GDM) may offer opportunities for prevention, or help delay onset of CMDs. This mini-review paper presents an overview of the key challenges faced in the early identification, referral and management of pregnant women at increased risk of CMDs, in low-resource settings worldwide. Evidence-based strategies, including novel diagnostics, technology and innovations for early detection, screening and management for pregnant women at high-risk of CMDs are presented. The review highlights the key research priorities for addressing cardiometabolic risk in pregnancy in low-resource settings.
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Affiliation(s)
- Shobhana Nagraj
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, Oxford, United Kingdom
| | - Stephen H Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Robyn Norton
- The George Institute for Global Health, Oxford, United Kingdom.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Vivekananda Jha
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, New Delhi, India.,Manipal Academy of Higher Education, Manipal, India
| | | | - Lisa Hinton
- The Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.,THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, United Kingdom
| | - Jane E Hirst
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, Oxford, United Kingdom
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Joshi R, Pakhare A, Kumar S, Khadanga S, Joshi A. Improving the capacity of nurses for non-communicable disease service delivery in India: how do they fare in comparison to doctors? EDUCATION FOR PRIMARY CARE 2019; 30:230-236. [PMID: 31154948 DOI: 10.1080/14739879.2019.1619097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
India has witnessed a major shift in morbidity to non-communicable diseases (NCDs) in the last few decades. The service delivery for these long-term conditions has been physician-centred up till now. There is a recent move towards shared care, and nurses are being engaged in the delivery of NCD care. This study was performed in the context of a composite training initiative involving nurses and doctors. Our aim was to compare the performance of nurses with doctors to determine which skills need to be emphasised in future educational programmes. Baseline and end-training knowledge assessments were available from training records. In 2014, of a total of 387 participants from one state in India, 153 were followed up to assess long-term retention of knowledge in various NCD training domains. We found that despite a lower baseline, nurses had a similar attrition in knowledge after training compared to doctors. Results of our study emphasised that nurses can be trained for the primary care needs of NCDs and that both nurses and doctors have retraining needs.
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Affiliation(s)
- Rajnish Joshi
- Department of Medicine, All India Institute of Medical Sciences , Bhopal , India
| | - Abhijit Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences , Bhopal , India
| | - Sanjeev Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences , Bhopal , India
| | - Sagar Khadanga
- Department of Medicine, All India Institute of Medical Sciences , Bhopal , India
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences , Bhopal , India
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Goldenberg RL, McClure EM, Belizán JM. Translating research evidence into practice: a report from the 2 nd International Conference on Maternal and Newborn Health from KLE University - Belagavi, India. Reprod Health 2018; 15:99. [PMID: 29945629 PMCID: PMC6019996 DOI: 10.1186/s12978-018-0523-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Jawaharlal Nehru Medical College (JNMC) Women's and Children's Health Research Unit (WCHRU) of the Karnataka Lingayat Education (KLE) Academy of Higher Education and Research Deemed-to-be-University and its collaborators convened the '2nd International Conference on Maternal and Newborn Health -Translating Research Evidence to Practice' to address the common theme of improving maternal and newborn health in low- and middle- income countries (LMIC). This supplement, including 16 manuscripts, reflects much of the research presented at the conference, including analyses of the state of knowledge, as well as completed, ongoing and planned research in these areas conducted by the WCHRU in India together with many collaborators across high-income and LMIC. The first paper reviews maternal, fetal and neonatal mortality in low-income countries, considers their causes, as well as evidence for potential interventions to reduce mortality. A second paper addresses near miss maternal mortality. Several manuscripts address the research conducted by WCHRU and their colleagues in a multi-center research network. One study examines rates of miscarriage and medically terminated pregnancy in India and the risk factors for these occurrences. Another paper addresses stillbirth and its risk factors, both in India as well as in other LMIC. Haemorrhage and preeclampsia/eclampsia, important causes of maternal mortality, stillbirth and neonatal morbidity in LMIC, are addressed in a series of papers summarizing trials of interventions to reduce improve outcomes associated with these conditions. Poor maternal and infant nutritional status, which contribute to adverse outcomes, are addressed through papers which describe a number of important studies that the WCHRU and their colleagues have conducted to attempt to improve nutritional status. Another paper describes a study to investigate causes of stillbirth and deaths among preterm births, which will utilize new techniques to investigate the infectious causes of these deaths. Finally, the supplement addresses the process for dissemination of research results to inform public policy. Together these manuscripts represent a body of research to inform interventions to reduce maternal, fetal and newborn mortality and illustrates what a dedicated research group together with institutional support can accomplish.
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Affiliation(s)
| | - Elizabeth M McClure
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC, USA.
| | - José M Belizán
- Institute for Clinical Effectiveness (IECS-CONICET, Buenos Aires, Argentina
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