The Role of Community Health Workers in the Management of Hypertension in Nigeria

Abstract

Background Hypertension is the number one risk factor for cardiovascular death worldwide and its prevalence has been on the increase in LMICs including Nigeria. There is an increasing awareness and recognition of the contributions of the community health workers (CHWs) in the healthcare system. This study assessed their current role in the management of hypertension and patient satisfaction with the care received. Methods A mixed method study (cross-sectional study and key informant interview) across five states in different geopolitical zones of Nigeria where 381 CHWs were selected for the study using multi-stage random sampling method and 14 patients with hypertension through purposive sampling method for key informant interview (KII) to assess the level of satisfaction with services of CHWs. Chi-square test was used to assess relationship between categorical variables. A p-value ≤ 0.05 was considered statistically significant. Thematic analysis of the text data from the KII was done using Nvivo® version 12 pro. Results A total of 381 CHWs completed the study. They were predominantly males (63%) with mean age of 40.96 ± 12.51 years. Only about one-third of the CHWs (31%) could correctly diagnose hypertension while only 15% knew the base-line investigations to be requested. Being female (FE = 9.205, p = 0.008) and resident in northwest geopolitical region (χ² = 20.920, p < 0.001) had statistically significant associations with appropriate diagnostic skills for hypertension. Being supervised by doctors is associated with appropriate knowledge of baseline investigations for hypertension (χ² = 5.534, p = 0.019). Mostly, hypertensive patients reported positive experiences and satisfaction with the services provided by the CHWs. Conclusions Community health workers currently have critical contributions in the management of hypertension in Nigeria. Hypertensive patients generally reported satisfactory experience with CHWs managing them. The services rendered by CHWs can be improved upon by adequate supervision and training.