Feasibility and Acceptability of Diabetes and Hypertension Screening and Diagnosis by Community Health Workers in Rural Lesotho: A Mixed-Methods Pilot Study

Introduction:
Across Africa, community health workers (CHWs) have become an important cadre in prevention and care services. Community‑based service delivery models largely overlook non‑communicable diseases (NCDs). Although Lesotho`s Village health worker program is well established, it currently offers no NCD services. This pilot study assessed the feasibility and acceptability of CHW‑led home‑based screening and diagnosis for arterial hypertension and diabetes mellitus in rural Lesotho.

Methods:
This mixed‑methods pilot study involved 10 CHWs from 10 rural villages in two districts of Lesotho. From March 2022 to December 2023, the CHWs enrolled and screened all eligible and consenting participants of their villages for hypertension (using automated blood pressure (BP) measurements) and diabetes (using capillary blood glucose measurements) in a door‑to‑door approach. All participants aged ≥18 years were eligible for hypertension screening; those aged ≥40 years or with a body mass index (BMI) ≥25 kg/m2 were eligible for diabetes screening. 10 purposively sampled participants were interviewed with subsequent qualitative thematic analysis.

Results:
In the 10 villages, CHWs visited a total of 687 households and enrolled 1811 participants (median age 24 years (interquartile range (IQR): 11‑25.5 years), 56.5% female, median BMI 23.4kg/m2). Among 803 participants eligible for diabetes screening, 788 (98%) were screened. Overall, 28 (3%) had impaired fasting glucose and 42 (5.3%) had diabetes. Among 1091 participants eligible for hypertension screening, 998 (91.5%) were screened, 50 (5%) had high normal BP, and 268 (26.9%) had hypertension. All participants interviewed expressed a high level of acceptance and appreciation for CHW‑led screening and diagnosis of diabetes and hypertension.

Conclusion:
In this pilot study in Lesotho, CHW‑led screening and diagnosis of hypertension and diabetes was highly acceptable and feasible, achieving >90% screening coverage. These results support larger‑scale studies and encourage further exploration across diverse regions to assess the impact of CHW‑led screening and diagnosis for NCDs.