Community health worker-led interventions for cardio-metabolic diseases in India: Evidence from a systematic review and meta-analysis

Background and objectives Cardio-metabolic diseases are leading cause of disability-adjusted life years (DALYs) in India. Community health workers' (CHW) local proximity and contextual understanding enable low-cost, and sustainable health interventions. This systematic review and meta-analysis of interventional studies aimed to identify types of CHW-led interventions and their effect on cardio-metabolic diseases. Methods Studies done in India (2000-2024) were searched from PubMed, Embase and Scopus databases. Screening of studies, followed by risk of bias assessment, data extraction was done and pooled mean difference (MD), 95% confidence interval (CI) was estimated by the random effect model. Subgroup, sensitivity analysis, and meta-regression was performed along with certainty assessment using grading of recommendations assessment, development and evaluation (GRADE). Results Thirteen studies (10 randomised trial and 3 pre-post studies) involving adults (mean age ranging from 45 to 65 yr) with hypertension, diabetes, stroke, and overweight were included in systematic review and 9 studies were included in meta-analysis. The CHW-led intervention significantly reduced systolic blood pressure (n=7,114; MD -5.5 mm Hg, 95% CI -9.0 to -1.9; P=0.041; I2=79.3%), with higher effect among people with hypertension (MD -7.5 mm Hg) and body mass index (MD -0.63 kg/m2; P=0.038) in intervention group. No significant change was observed in diastolic blood pressure, fasting blood glucose, glycated haemoglobin, and lipid profiles. Sensitivity analysis revealed no differential effect, and meta-regression showed no significant covariates. GRADE certainty of evidence was low to very low for outcome variables. Interpretation and conclusions CHW-led interventions in an Indian community setting showed beneficial effect on cardiometabolic outcomes, particularly blood pressure and body mass index, though the strength of evidence ranged from weak to moderate.