Figure 1
Catchment area of the study in western Kenya, with Turbo and Kosirai Divisions highlighted.
Table 1
Characteristics of the study population, divided into those primarily managed by a nurse versus clinical officer.
| Nurse (N = 180) | Clinical Officer (N = 871) | Total (N = 1051) | P Value | |
|---|---|---|---|---|
| Age in years, mean ± SD | 60.1 ± 13.9 | 60.7 ± 13.0 | 60.6 ± 13.2 | 0.58 |
| Gender | 0.84 | |||
| Female (%) | 119 (66.1) | 569 (65.3) | 688 (65.5) | |
| Male (%) | 61 (33.9) | 302 (34.7) | 363 (34.5) | |
| Facility type | <0.0001 | |||
| Health center (%) | 4 (2.2) | 871 (100) | 875 (83.3) | |
| Dispensary (%) | 176 (97.8) | 0 (0) | 176 (16.7) | |
| Health center | <0.0001 | |||
| Kosirai (%) | 36 (20.0) | 571 (65.6) | 607 (57.8) | |
| Turbo (%) | 144 (80.0) | 300 (34.4) | 444 (42.2) | |
| Baseline SBP in mmHg, mean ± SD | 166.2 ± 22.2 | 166.1 ± 27.9 | 166.1 ± 27.0 | 0.94 |
| Baseline DBP in mmHg, mean ± SD | 95.8 ± 13.3 | 96.3 ± 14.5 | 96.2 ± 14.3 | 0.66 |
Figure 2
Loess plot of mean SBP over time, demonstrating early reduction in SBP in both the nurse and clinical officer groups, maintained during the follow-up period.
Table 2
Results of the piecewise linear spline model for SBP change over time, with knot at three months. Model parameter estimates based on piecewise linear mixed-effect models with random intercept and slopes and a knot placed at three months, adjusted by age, sex, and healthcare center. The estimate values indicate the absolute change in SBP (mmHg) per month, except for the ‘other variables,’ which are for the entire follow-up period.
| Estimate (95% CI) | P Value | |
|---|---|---|
| Slope before three months | ||
| Nurse | –4.95 (–6.55 to –3.35) | <0.0001 |
| Clinical Officer | –5.28 (–5.99 to –4.57) | <0.0001 |
| Nurse-Clinical Officer | 0.33 (–1.42 to 2.08) | 0.71 |
| Slope after three months | ||
| Nurse | –0.44 (–0.97 to 0.10) | 0.11 |
| Clinical Officer | 0.17 (–0.07 to 0.40) | 0.16 |
| Nurse-Clinical Officer | –0.60 (–1.19 to –0.02) | 0.04 |
| Change in slope from before to after three months | ||
| Nurse | 4.51 (2.54 to 6.49) | <0.0001 |
| Clinical Officer | 5.45 (4.58 to 6.31) | <0.0001 |
| Nurse-Clinical Officer | –0.93 (–3.09 to 1.22) | 0.40 |
| Other variables | ||
| Age (per year) | 0.23 (0.14 to 0.32) | <0.0001 |
| Sex (men vs. women) | 0.84 (–1.67 to 3.35) | 0.5122 |
| Facility (Turbo vs. Kosirai) | –6.83 (–9.29 to –4.38) | <0.0001 |
Table 3
Results of the zero-inflated Poisson model for BP control over time. Model parameter estimates based on a zero-inflated Poisson model adjusted by age, sex, and healthcare center. Only patients with more than one visit are included (n = 753).
| Zero-Inflated Model | OR (95% CI) | P Value |
|---|---|---|
| Nurse vs. Clinical Officer | 1.32 (0.57, 3.09) | 0.52 |
| Poisson Model | RR (95% CI) | P Value |
| Nurse vs. Clinical Officer | 0.80 (0.67, 0.97) | 0.02 |