Task-sharing interventions for cardiovascular risk reduction and lipid outcomes in low- and middle-income countries: A systematic review and meta-analysis

Abstract

BackgroundOne of the potential strategies to improve health care delivery in understaffed low- and middle-income countries (LMICs) is task sharing, where specific tasks are transferred from more qualified health care cadre to a lesser trained cadre. Dyslipidemia is a major risk factor for cardiovascular disease but often it is not managed appropriately.ObjectiveWe conducted a systematic review with the objective to identify and evaluate the effect of task sharing interventions on dyslipidemia in LMICs.MethodsPublished studies (randomized controlled trials and observational studies) were identified via electronic databases such as PubMed, Embase, Cochrane Library, PsycINFO, and CINAHL. We searched the databases from inception to September 2016 and updated till 30 June 2017, using search terms related to task shifting, and cardiovascular disease prevention in LMICs. All eligible studies were summarized narratively, and potential studies were grouped for meta-analysis.ResultsAlthough our search yielded 2938 records initially and another 1628 in the updated search, only 15 studies met the eligibility criteria. Most of the studies targeted lifestyle modification and care coordination by involving nurses or allied health workers. Eight randomized controlled trials were included in the meta-analysis. Task sharing intervention were effective in lowering low-density lipoprotein cholesterol (−6.90 mg/dL; 95% CI −11.81 to −1.99) and total cholesterol (−9.44 mg/dL; 95% CI −17.94 to −0.93) levels with modest effect size. However, there were no major differences in high-density lipoprotein cholesterol (−0.29 mg/dL; 95% CI −0.88 to 1.47) and triglycerides (−14.31 mg/dL; 95% CI −33.32 to 4.69). The overall quality of evidence based on Grading of Recommendations Assessment, Development and Evaluation was either “low” or “very low”.ConclusionAvailable data are not adequate to make recommendations on the role of task sharing strategies for the management of dyslipidemia in LMICs. However, the studies conducted in LMICs demonstrate the potential use of this strategy especially in terms of reduction in low-density lipoprotein cholesterol and total cholesterol levels. Our review calls for the need of well-designed and large-scale studies to demonstrate the effect of task-sharing strategy on lipid management in LMICs.

Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis

“…We developed a search strategy based on a previous review 15 and modified the terms according to the database. We searched PubMed, Embase, Cochrane Library, and CINAHL with terms related to cardiovascular disease, task sharing, and LMICs (appendix pp 46–53).…”

Optimizing task-sharing in abortion care in Ghana: Stakeholder perspectives

“…(1) the motivation underlying task-sharing for abortion services; (2) their own roles in advocating for task-sharing; (3) factors that facilitated task-sharing in abortion care in Ghana; (4) barriers to tasksharing in abortion care; and (5) opportunities to task-share beyond the midwife.…”

“…1 Tasksharing can make more efficient use of the human resources currently available by reallocating tasks among healthcare workers; for example, enabling lay and midlevel healthcare professionals such as nurses, midwives, medical doctors, and community health workers to provide clinical tasks and procedures that would otherwise be restricted to higher-level cadres. 2 Ghana has expanded nurses' roles or, in some cases, has provided nurses with additional training to perform tasks that were previously ascribed to only physicians. These are generally midlevel cadres defined by the Ghana Health Service as: "the person trained to support the highly trained health professionals and can hold the fort in the absence of the professional".…”

Effectiveness of community health workers involvement in smoking cessation programme: A systematic review

“…Community-based cardiovascular health interventions in vulnerable populations has shown that the interventions aimed at decreasing blood pressure are the most promising and behavior change interventions are the most challenging [ 22 , 23 ]. Task-shifting interventions were also proven to be effective in lowering the low-density lipoprotein cholesterol (LDL) and total cholesterol [ 24 ]. In another review, significant reduction in the mean blood pressure and glycated haemoglobin levels were seen in task-shifting interventions for the CVD risk reduction in LMICs [ 24 , 25 ].…”

“…Task-shifting interventions were also proven to be effective in lowering the low-density lipoprotein cholesterol (LDL) and total cholesterol [ 24 ]. In another review, significant reduction in the mean blood pressure and glycated haemoglobin levels were seen in task-shifting interventions for the CVD risk reduction in LMICs [ 24 , 25 ].…”