Key result
Higher community health worker density is linked to improved hypertension control.
Why the study?
Hypertension control in Kenya depends on the reach of community health workers into facility catchment areas, yet the causal pathway from community health worker density to effective coverage remained poorly specified.
Does community health worker density improve effective coverage of hypertension management in facility catchment areas in Kenya?
Does community health worker density improve effective coverage of hypertension management in facility catchment areas in Kenya?
Effect estimate: Exposure coefficient 0.42 (bias 0.00046)
This simulation and methodological study demonstrates that multilevel regression and ordinary least squares estimation provide a defensible basis with negligible bias for evaluating how community health worker density translates into hypertension control in Kenya.
Multilevel CHW framework for Kenyan hypertension coverage is hypothesis-generating; leaves causal pathways open pending empirical validation.
Hypertension control in Kenya depends on the reach of community health workers (CHWs) into facility catchment areas, yet the causal pathway from CHW density to effective coverage remains poorly specified. The framework is formalised as a three-level structure in which catchment areas are nested within facilities and facilities within counties, with CHW density measured at the catchment level and effective coverage defined as the proportion of diagnosed adults whose blood pressure is controlled. Identification conditions are stated for natural direct and indirect effects under sequential ignorability, and a replication-based evaluation of the ordinary least squares estimator is reported using 600 replications of 500 observations drawn from a declared data-generating process with intercept 12.0, exposure 0.42, group -3.1, severity 1.35 and error SD 4.2. The estimator recovered the exposure coefficient with negligible bias (0.00046) and empirical coverage of the nominal 95% confidence interval of 1.0, while the intercept showed bias of -0.04884 and root mean squared error of 0.86612. The framework provides a defensible basis for estimating how CHW density translates into hypertension control through facility readiness, and the estimator behaviour supports the use of multilevel regression in catchment-level analyses of this kind.
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Ochieng et al. (2026) studied Hypertension (n=500). Community health worker (CHW) density was evaluated on Effective coverage of hypertension management (proportion of diagnosed adults whose blood pressure is controlled) (Exposure coefficient 0.42 (bias 0.00046)). Community health worker density exposure (0.42) was recovered by the multilevel OLS estimator with negligible bias (0.00046) and 1.0 empirical coverage of the 95% CI for hypertension control.
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