Community health workers for non-communicable diseases prevention and control in developing countries: Evidence and implications.
Community health workers for non-communicable diseases prevention and control in developing countries: Evidence and implications.
复制标题
DOI：
10.1371/journal.pone.0180640
复制
发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Singh M
中科院分区：
文献类型：
--
作者：
Jeet G;Thakur JS;Prinja S;Singh M
不同中低收入国家的非传染性疾病（NCD）预防和控制国家计划都有很强的社区组成部分。社区卫生工作者使用信息和行为方法提供非传染性疾病预防服务。开展关于改变生活方式的社区教育和人际交流，重点是非传染性疾病的初级预防，并进行筛查，作为早期诊断和管理的一部分。然而，需要确定通过社区卫生工作者提供的健康促进和筛查干预措施的有效性。该综述综合了CHW在低收入和中等收入国家（LMIC）提供的NCD初级预防干预措施的有效性证据。对利用社区卫生工作者在中低收入国家管理非传染性疾病（糖尿病、心血管疾病（CVD）、癌症、中风、慢性阻塞性肺病（COPD））的一级预防/早期检测策略的试验进行了系统性审查。检索了2000年至2015年期间的数字数据库，如PubMed、EMBASE、奥维德、科克伦图书馆、论文摘要、不同LMIC的临床试验注册网站，以查找此类出版物。我们专注于基于社区的随机对照试验和集群随机试验，没有任何出版语言限制。审查的主要结果是具有不同行为风险因素的人群的百分比变化。此外，研究了几个物理或生化参数水平的平均总体变化作为次要结局。按参与者的年龄和性别进行亚组分析，并进行敏感性分析以评估结果的稳健性。16项符合纳入标准的试验被纳入综述。持续时间、研究人群和干预内容因试验而异。研究的持续时间从针对某些风险因素的平均随访4个月到19个月不等，卫生工作者的主要职责包括健康促进、治疗依从性和随访。只有一项试验报告了全因死亡率。计算的合并效应表明戒烟率增加（RR：2.0，95%CI：1.11，3.58，中等质量证据）和收缩压降低（（MD：-4.80，95% CI：-8.12，-1.49，I2 = 93%，极低质量证据），舒张压（（MD：-2.88，95% CI：-5.65，-0.10，I2 = 96%，极低质量证据））和血糖水平（糖化血红蛋白MD：-0.83%，95% CI：-1.25，-0.41）。纳入的试验均未报告不良事件。关于利用社区保健工作者实施初级预防战略的证据仍在发展中。现有证据表明，与标准治疗相比，在卫生方案中使用CHW对中低收入国家可能有效，特别是在戒烟、血压和糖尿病控制方面。
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.
登录
查看更多内容
影响因子：
5.5
作者：
Brown, H. Shelton, III;Wilson, Kimberly J.;Reininger, Belinda
通讯作者：
Reininger, Belinda
影响因子：
3.9
作者：
Brownson, Carol A.;Hoerger, Thomas J.;Kilpatrick, Kerry E.
通讯作者：
Kilpatrick, Kerry E.
影响因子：
--
作者：
Jayakrishnan, Radhakrishnan;Uutela, Antti;Sebastian, Paul
通讯作者：
Sebastian, Paul
DOI：
10.1590/s0036-36342002000100002
发表时间：
2002-01-01
期刊：
Salud Pública de México
影响因子：
--
作者：
García-Peña, Carmen;Thorogood, Margaret;Reyes-Frausto, Sandra
通讯作者：
Reyes-Frausto, Sandra
影响因子：
3.9
作者：
DePue, Judith D.;Rosen, Rochelle K.;McGarvey, Stephen T.
通讯作者：
McGarvey, Stephen T.