title: Task Shifting the Management of Non-Communicable Diseases to Nurses in Kibera, Kenya: Does It Work?
abstract: BACKGROUND
  In sub-Saharan Africa there is an increasing need to leverage available health care workers to provide care for non-communicable diseases (NCDs). This study was conducted to evaluate adherence to Médecins Sans Frontières clinical protocols when the care of five stable NCDs (hypertension, diabetes mellitus type 2, epilepsy, asthma, and sickle cell) was shifted from clinical officers to nurses.
  
  
  METHODS
  Descriptive, retrospective review of routinely collected clinic data from two integrated primary health care facilities within an urban informal settlement, Kibera, Nairobi, Kenya (May to August 2014).
  
  
  RESULTS
  There were 3,554 consultations (2025 patients); 733 (21%) were by nurses out of which 725 met the inclusion criteria among 616 patients. Hypertension (64%, 397/616) was the most frequent NCD followed by asthma (17%, 106/616) and diabetes mellitus (15%, 95/616). Adherence to screening questions ranged from 65% to 86%, with an average of 69%. Weight and blood pressure measurements were completed in 89% and 96% of those required. Laboratory results were reviewed in 91% of indicated visits. Laboratory testing per NCD protocols was higher in those with hypertension (88%) than diabetes mellitus (67%) upon review. Only 17 (2%) consultations were referred back to clinical officers.
  
  
  CONCLUSIONS
  Nurses are able to adhere to protocols for managing stable NCD patients based on clear and standardized protocols and guidelines, thus paving the way towards task shifting of NCD care to nurses to help relieve the significant healthcare gap in developing countries.
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: David
authors.initials: D
authors.lastname: Some
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.|Médecins Sans Frontières, Operational Research Unit, Brussels, Belgium.
authors.forename: Jeffrey K
authors.initials: JK
authors.lastname: Edwards
authors.affiliation: Médecins Sans Frontières, Operational Research Unit, Brussels, Belgium.
authors.forename: Tony
authors.initials: T
authors.lastname: Reid
authors.affiliation: Médecins Sans Frontières, Operational Research Unit, Brussels, Belgium.
authors.forename: Rafael
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: College of Health Sciences, Department of Obstetrics and Gynaecology, University of Nairobi, Kenya.
authors.forename: Rose J
authors.initials: RJ
authors.lastname: Kosgei
authors.affiliation: Chester University, Chester, United Kingdom.
authors.forename: Ewan
authors.initials: E
authors.lastname: Wilkinson
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Bienvenu
authors.initials: B
authors.lastname: Baruani
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.|Médecins Sans Frontières, Operational Research Unit, Brussels, Belgium.
authors.forename: Walter
authors.initials: W
authors.lastname: Kizito
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Kelly
authors.initials: K
authors.lastname: Khabala
authors.affiliation: Médecins Sans Frontières, Operational Research Unit, Brussels, Belgium.
authors.forename: Safieh
authors.initials: S
authors.lastname: Shah
authors.affiliation: Ministry of Health, Non Communicable Diseases Control Unit, Nairobi, Kenya.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kibachio
authors.affiliation: Ministry of Health, Sub County Medical Officer of Health, Nairobi, Kenya.
authors.forename: Phylles
authors.initials: P
authors.lastname: Musembi
mesh_terms: D000293:Adolescent; D000328:Adult; D003141:Communicable Diseases; D019468:Disease Management; D005260:Female; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009726:Nurses; D012189:Retrospective Studies; D055815:Young Adult
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