Task Shifting the Management of Non-Communicable Diseases to Nurses in Kibera, Kenya: Does It Work?

David Some, Jeffrey K Edwards, Tony Reid, Rafael Van den Bergh, Rose J Kosgei, Ewan Wilkinson, Bienvenu Baruani, Walter Kizito, Kelly Khabala, Safieh Shah, Joseph Kibachio, Phylles Musembi, David Some, Jeffrey K Edwards, Tony Reid, Rafael Van den Bergh, Rose J Kosgei, Ewan Wilkinson, Bienvenu Baruani, Walter Kizito, Kelly Khabala, Safieh Shah, Joseph Kibachio, Phylles Musembi

Abstract

Background: In sub-Saharan Africa there is an increasing need to leverage available health care workers to provide care for non-communicable diseases (NCDs). This study was conducted to evaluate adherence to Médecins Sans Frontières clinical protocols when the care of five stable NCDs (hypertension, diabetes mellitus type 2, epilepsy, asthma, and sickle cell) was shifted from clinical officers to nurses.

Methods: Descriptive, retrospective review of routinely collected clinic data from two integrated primary health care facilities within an urban informal settlement, Kibera, Nairobi, Kenya (May to August 2014).

Results: There were 3,554 consultations (2025 patients); 733 (21%) were by nurses out of which 725 met the inclusion criteria among 616 patients. Hypertension (64%, 397/616) was the most frequent NCD followed by asthma (17%, 106/616) and diabetes mellitus (15%, 95/616). Adherence to screening questions ranged from 65% to 86%, with an average of 69%. Weight and blood pressure measurements were completed in 89% and 96% of those required. Laboratory results were reviewed in 91% of indicated visits. Laboratory testing per NCD protocols was higher in those with hypertension (88%) than diabetes mellitus (67%) upon review. Only 17 (2%) consultations were referred back to clinical officers.

Conclusion: Nurses are able to adhere to protocols for managing stable NCD patients based on clear and standardized protocols and guidelines, thus paving the way towards task shifting of NCD care to nurses to help relieve the significant healthcare gap in developing countries.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. NCD patient inclusion criteria for…
Fig 1. NCD patient inclusion criteria for nurse task shifting within primary care clinics in Kibera, Nairobi, Kenya (May-August 2014).

References

    1. Ayah R, Joshi D, Wanjiru R, Njau EK, Otieno CF, Njeru EK, et al. A population-based survey of prevalence of diabetes and correlates in an urban slum community in Nairobi, Kenya. BMC Public Health 2013;13: 371 10.1186/1471-2458-13-371
    1. Kenya Ministry of Health. Kenya Health Policy 2012–2030. Available:
    1. Kenya Ministry of Health. Kenya National Diabetes Strategy 2010–2015. Available:
    1. World Health Organization. Treat Train Retrain. Task shifting: Global recommendations and guidelines Geneva, Switzerland: WHO; 2007. Available:
    1. World Health Organization. The World Health Report 2006 Working together for health. Geneva, Switzerland: WHO; 2006. Available:
    1. Zachariah R, Ford N, Phillips M, Lynch S, Massaquoi M, Janssens V, et al. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg 2009;103: 549–558. 10.1016/j.trstmh.2008.09.019
    1. Kosgei R, Wools-Kaloustian K, Braistein P, Sidle JE, Sang E, Gitau JN, et al. Task shifting in HIV clinics, Western Kenya. East Afr Med J 2010;87: 7.
    1. World Medical Association. World Medical Association Resolutions on task shifting from the medical profession. Available:
    1. Coleman R, Gill G, Wilkinson D. Non-communicable disease management in resource-poor settings: a primary care model from rural South Africa. Bull World Health Organ 1998;76: 633–640.
    1. Gill GV, Price C, Shandut D, Dedicoat M, Wilkinson D. Clinical care and delivery an effective system of nurse-led diabetes care in rural Africa. Diabetic Med 2008;25: 606–611.
    1. Kengne A.P.; Awah P.K.; Fezeu L.L.; Sobngwi E.; Mbanya J.C. Primary health care for hypertension by nurses in rural and urban sub-Saharan Africa. J Clin Hypertens 2009;11: 564–572.
    1. Kenya National Bureau of Statistics. Kenya Population and Housing Census, 2009 Survey. Available:
    1. Khabala K, Edwards JK, Bienvenu B, Sirengo M, Musembi P, Kosgei RJ, et al. Medication Adherence Clubs: a potential solution to managing large numbers of stable patients with multiple chronic diseases in-informal settlements. Experience from Kibera, Nairobi Kenya. Trop Med Int Health 2015; 10.1111/tmi.12539
    1. Médecins San Frontières Belgium Kibera Project. Untangling the web. MSF internal report 2009.
    1. Unger A, Riley LW. Slum Health: From Understanding to Action. PLoS Med 2007;4:e295: 10.1371/journal.pmed
    1. Sobry A, Kizito W, Van den Bergh R, Tayler-Smith K, Isaakidis P, Cheti E, et al. Caseload, management and treatment outcomes of patients with hypertension and/or diabetes mellitus in a primary health care programme in an informal setting. Trop Med Int Health 2013; 10.1111/tmi.1221
    1. Mant J. Process versus outcome indicators in the assessment of quality of health care. Int J Qual Health Care 2001;13: 475–480.
    1. Daniels ME, Donilon TE, Bollyky TJ. The emerging global health crisis noncommunicable diseases in low- and middle-income countries Council Foreign Relations; 2014; Available:
    1. Ogedegbe G, Gyamfi J, Plange-Rhule J, Surkis A, Rosenthal DM, Airhihenbuwa C, et al. Task shifting interventions for cardiovascular risk reduction in low-income and middle-income countries: a systematic review of randomised controlled trials. BMJ Open 2014;4: 10.1136/bmjopen-2014-005983
    1. Kredo T, Adeniyi FB, Bateganya M, Pienaar ED. Task shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy. Cochrane Database Sys Rev 2014;7: 10.1002/14651858.CD007331.pub3
    1. Alemayehu YK, Bushen OY, Muluneh AT. Evaluation of HIV/AIDS clinical care quality: the case of a referral hospital in North West Ethiopia. Int J Qual Health Care 2009;21: 356–62. 10.1093/intqhc/mzp030
    1. Kirkman MS, Williams SR, Caffrey HH, Marrero DG. Impact of a Program to Improve Adherence to Diabetes Guidelines by Primary Care Physicians. Diabetes Care 2002;25: 1946–1951.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться