Abstract:
Introduction
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.
Objective
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.
Methods
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-heightratio (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.
Results
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.
