Nurse-led interventions for prevention and control of noncommunicable diseases in low- and middle-income countries: A systematic review and meta-analysis

Background: Low- and middle-income countries (LMICs) face numerous challenges in the implementation of noncommunicable diseases (NCDs) prevention programs due to a shortage of health workforce. Task shifting to nurses is a viable and effective solution to address the healthcare human resource crisis. We, therefore, intend to assess the existing evidence on the effectiveness of interventions by nurses for the management of chronic NCDs in LMICs. Methods: We did a systematic review and meta-analysis of the trials that utilized nurses for the management of NCDs in LMICs. We searched PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and clinical registries of different LMICs to search for relevant literature. Meta-analysis using an inverse-variance weighted random effect model was used to summarize the findings. The study protocol was registered in the PROSPERO database (CRD42019118430). Results: We found 2097 studies from the literature search, out of which 39 studies with 15,672 participants were eligible for narrative synthesis. Result of the meta-analysis showed that nurse-led interventions were effective in the reduction of systolic blood pressure (SBP) (average pooled mean difference was -4.32 [95% (confidence interval) CI - 7.07--1.57]), diastolic blood pressure (DBP) (-3.11 mmHg; 95% CI -4.96--1.26), glycated hemoglobin (HbA1c) (-0.73; 95% CI - 1.08--0.38), fasting blood sugar (FBS) (-0.8; 95% CI -13.42--2.58), total cholesterol (TC) (-1.18; 95% CI -20.06--3.57), and triglycerides (TG) (-12.20; 95% CI - 23.52--0.87). However, there was no major significant difference in low-density lipoprotein (LDL) and high-density lipoprotein (HDL). The overall quality of evidence based on the Grading of Recommendations Assessment, Development, and Evaluations was moderate for FBS, low for SBP, DBP, HbA1c, HDL, TC, and TG, and very low for LDL. Interpretation: Nurse-led interventions as compared to usual care are effective for the management of diabetes and hypertension and can be effectively used for national NCD programs in LMICs.