The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure , but low for diastolic blood pressure .
INTERPRETATION Task-sharing interventions are effective in reducing blood pressure .
BACKGROUND Task sharing for the management of hypertension could be useful for understaffed and re source -poor health systems .
We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries .
Effectiveness of a group diabetes education programme in underserved communities in South Africa: pragmatic cluster randomized control trial
Abstract Background Diabetes is an important contributor to the burden of disease in South Africa and prevalence rates as high as 33 % have been recorded in Cape Town . Previous studies show that quality of care and health outcomes are poor . The development of an effective education programme should impact on self-care , lifestyle change and adherence to medication ; and lead to better control of diabetes , fewer complications and better quality of life . Methods Trial design : Pragmatic cluster r and omized controlled trial Participants : Type 2 diabetic patients attending 45 public sector community health centres in Cape Town Interventions : The intervention group will receive 4 sessions of group diabetes education delivered by a health promotion officer in a guiding style . The control group will receive usual care which consists of ad hoc advice during consultations and occasional educational talks in the waiting room . Objective : To evaluate the effectiveness of the group diabetes education programme Outcomes : Primary outcomes : diabetes self-care activities , 5 % weight loss , 1 % reduction in HbA1c . Secondary outcomes : self-efficacy , locus of control , mean blood pressure , mean weight loss , mean waist circumference , mean HbA1c , mean total cholesterol , quality of life R and omisation : Computer generated r and om numbers Blinding : Patients , health promoters and research assistants could not be blinded to the health centre ’s allocation Numbers r and omized : Seventeen health centres ( 34 in total ) will be r and omly assigned to either control or intervention groups . A sample size of 1360 patients in 34 clusters of 40 patients will give a power of 80 % to detect the primary outcomes with 5 % precision . Altogether 720 patients were recruited in the intervention arm and 850 in the control arm giving a total of 1570 . Discussion The study will inform policy makers and managers of the district health system , particularly in low to middle income countries , if this programme can be implemented more widely . Trial registerPan African Clinical Trial Registry
The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure , but low for diastolic blood pressure .
INTERPRETATION Task-sharing interventions are effective in reducing blood pressure .
BACKGROUND Task sharing for the management of hypertension could be useful for understaffed and re source -poor health systems .
We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries .