No abstract

Introduction: Community Health Workers play an important role in supporting patients with chronic non-communicable diseases (NCDs), therefore they need to be constantly updated with current knowledge to enable them to perform their activities effectively. The purpose of this study was to assess the knowledge of NCDs risk factors among Community Health Workers (CHWs) in South Africa. Methodology: A triple “A” approach (assessment, analysis, and action) was used among 40 CHWs working with patients with chronic non-communicable diseases. All CHWs gave voluntary, informed consent in writing and verbally before they were allowed to participate in the study. For the initial assessment, CHWs completed a questionnaire to assess knowledge about the knowledge of NCDs. The questionnaire was analysed to determine their baseline performance. The findings of the assessment identified shortcomings in the knowledge of CHWs, specifically on diabetes and hypertension knowledge. Feedback was given to the CHWs followed by a short training on healthy living, focusing on the risk factors associated with NCDs (diabetes and hypertension). Training of CHWs was conducted using an adapted national training programme together with CHW prevention of healthy lifestyle modules designed by experts from the School of Public Health, University of the Western Cape. All statistical tests were two-tailed, and p<.05 was considered statistically significant. Results: The majority (97.5%) of the CHWs who had their knowledge assessed were women. Fifty-five percent (55%) were within age 30-45 years, while 45% were between the ages 46-60 years. The majority of the participants had secondary school education (92.5%) and 1-15 years of experience (97.5%) as CHWs. The results of the post-training assessment revealed that 48.5%, 63.6%, 42.4%, 72.7%, 42.5%, 57.6%, and 18.2% had poor knowledge of diabetes, hypertension, diabetes complications, hypertension complications, advice for diabetic patient, advice for hypertension, and nutrition advice of NCDs, respectively. Regression analysis showed that those with higher education levels were significantly highly likely to be knowledgeable about hypertension complications (OR=19.6, CI=1.14, 336.0). Conclusion: There was poor knowledge of risk factors for NCDs among CHWs. An association exists between the knowledge of risk factors for NCDs and education levels among the participants. There is a need for regular refresher training programs for CHWs to upscale their knowledge about NCDs, coupled with frequent review of CHWs program and curriculum.

IntroductionLow and middle-income countries like South Africa are experiencing major increases in burden of non-communicable diseases such as diabetes and cardiovascular conditions. However, evidence-based interventions to address behavioural factors related to these diseases are lacking. Our study aims to adapt the CDC’s National Diabetes Prevention Program (DPP) within the context of an under-resourced urban community in Cape Town, South Africa.Methods/analysisThe new intervention (Lifestyle Africa) consists of 17 weekly sessions delivered by trained community health workers (CHWs). In addition to educational and cultural adaptations of DPP content, the programme adds novel components of text messaging and CHW training in Motivational Interviewing. We will recruit overweight and obese participants (body mass index ≥25 kg/m2) who are members of 28 existing community health clubs served by CHWs. In a 2-year cluster randomised control trial, clubs will be randomly allocated to receive the intervention or usual care. After year 1, usual care participants will also receive the intervention and both groups will be followed for another year. The primary outcome analysis will compare percentage of baseline weight loss at year 1. Secondary outcomes will include diabetes and cardiovascular risk indicators (blood pressure, haemoglobin A1C, lipids), changes in self-reported medication use, diet (fat and fruit and vegetable intake), physical activity and health-related quality of life. We will also assess potential psychosocial mediators/moderators as well as cost-effectiveness of the programme.Ethics/disseminationEthical approval was obtained from the University of Cape Town and Children’s Mercy. Results will be submitted for publication in peer-reviewed journals and training curricula will be disseminated to local stakeholders.Trial registration number NCT03342274.

Background Low- and middle-income countries (LMICs) are experiencing major increases in diabetes and cardiovascular conditions linked to overweight and obesity. Lifestyle interventions such as the United States National Diabetes Prevention Program (DPP) developed in high-income countries require adaptation and cultural tailoring for LMICs. The objective of this study was to evaluate the efficacy of Lifestyle Africa, an adapted version of the DPP tailored for an underresourced community in South Africa compared to usual care. Methods and findings Participants were residents of a predominantly Xhosa-speaking urban township of Cape Town, South Africa characterized by high rates of poverty. Participants with body mass index (BMI) ≥ 25 kg/m2 who were members of existing social support groups or “clubs” receiving health services from local nongovernmental organizations (NGOs) were enrolled in a cluster randomized controlled trial that compared Lifestyle Africa (the intervention condition) to usual care (the control condition). The Lifestyle Africa intervention consisted of 17 video-based group sessions delivered by trained community health workers (CHWs). Clusters were randomized using a numbered list of the CHWs and their assigned clubs based on a computer-based random allocation scheme. CHWs, participants, and research team members could not be blinded to condition. Percentage weight loss (primary outcome), hemoglobin A1c (HbA1c), blood pressure, triglycerides, and low-density lipoprotein (LDL) cholesterol were assessed 7 to 9 months after enrollment. An individual-level intention-to-treat analysis was conducted adjusting for clustering within clubs and baseline values. Trial registration is at ClinicalTrials.gov (NCT03342274). Between February 2018 and May 2019, 782 individuals were screened, and 494 were enrolled. Participants were predominantly retired (57% were receiving a pension) and female (89%) with a mean age of 68 years. Participants from 28 clusters were allocated to Lifestyle Africa (15, n = 240) or usual care (13, n = 254). Fidelity assessments indicated that the intervention was generally delivered as intended. The modal number of sessions held across all clubs was 17, and the mean attendance of participants across all sessions was 61%. Outcome assessment was completed by 215 (90%) intervention and 223 (88%) control participants. Intent-to-treat analyses utilizing multilevel modeling included all randomized participants. Mean weight change (primary outcome) was −0.61% (95% confidence interval (CI) = −1.22, −0.01) in Lifestyle Africa and −0.44% (95% CI = −1.06, 0.18) in control with no significant difference (group difference = −0.17%; 95% CI = −1.04, 0.71; p = 0.71). However, HbA1c was significantly lower at follow-up in Lifestyle Africa compared to the usual care group (mean difference = −0.24, 95% CI = −0.39, −0.09, p = 0.001). None of the other secondary outcomes differed at follow-up: systolic blood pressure (group difference = −1.36; 95% CI = −6.92, 4.21; p = 0.63), diastolic blood pressure (group difference = −0.39; 95% CI = −3.25, 2.30; p = 0.78), LDL (group difference = −0.07; 95% CI = −0.19, 0.05; p = 0.26), triglycerides (group difference = −0.02; 95% CI = −0.20, 0.16; p = 0.80). There were no unanticipated problems and serious adverse events were rare, unrelated to the intervention, and similar across groups (11 in Lifestyle Africa versus 13 in usual care). Limitations of the study include the lack of a rigorous dietary intake measure and the high representation of older women. Conclusions In this study, we found that Lifestyle Africa was feasible for CHWs to deliver and, although it had no effect on the primary outcome of weight loss or secondary outcomes of blood pressure or triglycerides, it had an apparent small significant effect on HbA1c. The study demonstrates the potential feasibility of CHWs to deliver a program without expert involvement by utilizing video-based sessions. The intervention may hold promise for addressing cardiovascular disease (CVD) and diabetes at scale in LMICs. Trial registration ClinicalTrials.gov NCT03342274.

No abstract