A Feasibility Study On The Use Of Community Health Workers In Detection Of Cases Of Hypertension In A Rural Farming Community In Kenya

Abstract

This is a study which was carried out in one of the rural farming communities in Kenya. The objective of the study was to investigate the possibility of involving Community-Based non-medical personnel already in existence and functional in the study area in screening for hypertensives in the Community. This was done using casual indirect arterial blood pressure measurements using sphygmomanometers and stethoscopes on upper arms of adults 18 years and above in the Community, by a few Community Health Workers (CHWs) selected from among a total of 120 Community Health Workers trained in 1977 during a National Pilot Project which was a joint venture between UNICEF and Ministry of Health, Kenya. Of the 30 selected CHWs, training was given on how to use sphygmomanometers and stethoscopes on blood pressure (B.P.) measurements. The training was conducted by 5 Community Nurses (CNs) who had been trained previously by the project officer as trainers of CHWs in so far as screening for hypertensives in the community was concerned. The training session took less than one week to complete. From the screening, which was a cross-sectional study involving house-to-house survey by the trained CHWs, a total

of 3704 adults were examined and of these, more than 50% were females. All had B.P. measurements taken together with answering questions as relates to smoking and salt intake. Basing the findings on the more reliable diastolic B.P. measurements, 90 of the people in this sample had diastolic B.P. readings equal to or above 95mmHg - which constitutes 2.4% of "the sample population.

Concerning smoking and salt-intake. about 6.7% of sample population were smokers and about 93% were salt-users. Of the diastolic' hypertensives, about 7.78% were smokers and 97.78% were salt-users. Significance tests carried out in this study population did not reveal any statistical significance between smoking and elevation of B.P. and between salt intake and elevation of B.P. The sensitivity of the CHWs in the screehing process was just over 40% while the specificity was more than 60%. In conclusion, it became evident that even though the sensitivity was low, with a higher specificity, this represents a big improvement over the present situation where medical personnel only wait for hypertensives to turn up in hospital. Since many would be picked up in the Community by CHWs, what remained was for the facility (hospital) based medical personnel to confirm and manage cases of suspected hypertensives referred to them by CHWs.