international journal of educational management

International Journal of Educational Management

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The set of journals have been ranked according to their SJR and divided into four equal groups, four quartiles. Q1 (green) comprises the quarter of the journals with the highest values, Q2 (yellow) the second highest values, Q3 (orange) the third highest values and Q4 (red) the lowest values.

The SJR is a size-independent prestige indicator that ranks journals by their 'average prestige per article'. It is based on the idea that 'all citations are not created equal'. SJR is a measure of scientific influence of journals that accounts for both the number of citations received by a journal and the importance or prestige of the journals where such citations come from It measures the scientific influence of the average article in a journal, it expresses how central to the global scientific discussion an average article of the journal is.

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Evolution of the total number of citations and journal's self-citations received by a journal's published documents during the three previous years. Journal Self-citation is defined as the number of citation from a journal citing article to articles published by the same journal.

Evolution of the number of total citation per document and external citation per document (i.e. journal self-citations removed) received by a journal's published documents during the three previous years. External citations are calculated by subtracting the number of self-citations from the total number of citations received by the journal’s documents.

International Collaboration accounts for the articles that have been produced by researchers from several countries. The chart shows the ratio of a journal's documents signed by researchers from more than one country; that is including more than one country address.

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Ratio of a journal's items, grouped in three years windows, that have been cited at least once vs. those not cited during the following year.

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Evolution of the number of documents cited by public policy documents according to Overton database.

Evoution of the number of documents related to Sustainable Development Goals defined by United Nations. Available from 2018 onwards.

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The International Journal of Educational Management is welcoming submissions!

About the journal

The International Journal of Educational Management (IJEM) provides those interested in the effective management of the educational process with a broad overview of developments and best practice in the field, with particular reference to how new ideas can be applied worldwide.

As the whole structure and philosophy of education goes through a sea-change, and as budgets are cut, educational managers need to keep abreast of new developments in order to maximize their resources and determine the most appropriate management strategy for their institution.

The journal explores research in the following areas:

• Innovation in educational management across the spectrum
• The development of educational delivery mechanisms
• Creation of an environment in which the management of resources provides the most efficient outputs
• Sharing of new initiatives, with an international application

IJEM  addresses the increasingly complex role of the educational manager, offering international perspectives on common problems and providing a forum for the sharing of ideas, information and expertise.

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To submit your research, please visit the journal’s  ScholarOne  website.

In preparing papers, authors are asked to follow the standard IJEM Author Guidelines, which are available  here .

If you have any questions about the submission process, please contact a member of the IJEM Editorial Team:

Brian Roberts [email protected]

Commissioning Editor

Danielle Crow [email protected]

International Journal of Educational Management

The International Journal of Educational Management (IJEM) publishes original research reports and theoretical papers that add to knowledge and understanding of educational management issues in Nigeria and the world at large. Scholarly papers are therefore welcome on the following Educational Management areas, among others:

• Administration
• Supervision
• Human Resource Management
• Economics of Education
• Facilities/Resource Management
• Policy Analysis and Evaluation
• Information and Communication Technology
• Education Laws
• and other Educational  Management areas

Current Issue

Vol. 9 No. 1 (2011): International Journal of Educational Management (IJEM)

Published: 2022-01-17

School Organizational Climate and Teachers' Productivity in Lagos State Secondary Schools

Multimedia and the management of open and distance learning for teacher education in nigerian universities, attaining effectiveness in primary education in kwara state through school-based management, relationship between management styles and performances of professional athletes in kwara state colleges of education, nigeria, the role of basic education in the attainment of vision 20: 2020.

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--> International Journal of Higher Education Management

About the journal

The International Journal of Higher Education Management (IJHEM), is a refereed journal that seeks to be a scholarly conduit by which academic papers concerning the realm of higher education, and its leadership and management in particular, are put into the public domain. IJHEM provides an authoritative source of information for academicians, policy makers and professionals. The journal promotes the advancement, understanding, and practice of enlightened and effective management in higher education, including the ways those in leadership roles are ensuring innovative approaches to teaching and learning whether on site, or via the medium of online/distance learning. The journal is peer reviewed and serves as a key research platform. IJHEM is committed to publishing articles that inform best practice in the education of students, their teachers and lecturers, with particular emphasis on those charged with ensuring that institutions are managed with foresight and run in a manner that best serves a diverse range of stakeholders.....

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International Journal of Educational Management and Development Studies

About the Journal

International Journal of Educational Management and Development Studies (IJEMDS) is an open access refereed journal focused on educational leadership, educational management, teaching and learning across all disciplines and levels, internationalization of education, transnational education and societal issues on educational development. The field of education has been continuously evolving as influenced by its nature and the societal factors. As the journal celebrates the very dynamic and complex nature of education, it provides educators and researchers a platform for their research findings. This allows researchers to apply multiple designs to describe, analyze and evaluate the history, current issues and the future direction of education in regional and international contexts.   

The journal employs rigorous double-blind review to ensure quality publications. Authors receive formative feedback through feedforward communication approach. It is the prime objective of the reviewers to help authors improve the quality of the papers. As the journal promotes internationalization and collaboration, the multi-dimensional perspectives of the author and reviewers add high value to the research article. Moreover, the journal has solid support system for copyediting and formatting. The journal ensures that the research articles are within the standards of international publication.

The journal covers, but not limited to, the following:

• Educational management and leadership;
• Current trends and issues on education and educational management;
• Curriculum development, teaching and learning pedagogies, assessment and student cognitive development;
• Social issues relevant to the societal and educational development;
• Challenges and strategies in nation building and development;
• Comparative studies on nation and nation building; and
• Inequality and social justice.

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16 International Development Studies students receive 2024 Faculty of Arts Internship Awards

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Please join us in congratulating 16 International Development Studies students -recipients of the 2024 Faculty of Arts Internship Awards.

Simone Poku, U0, International Development Studies

Simone Poku is a first-year student at McGill, eagerly embarking on her academic journey in International Development and Communication Studies. Motivated by the desire to delve deeper into the intricacies of international development, Simone will be interning with CAMFED Toronto this summer. CAMFED is an international NGO dedicated to eradicating poverty and empowering girls through education. Simone aims to conduct meaningful research, refine her skills and broaden her scope on CAMFED’s innovative strategies throughout her internship.

Taïna Dushime, U3, International Development Studies

Taïna Dushime is a third-year student at McGill University majoring in International Development and minoring in Health Geography. Interning at the United Nations High Commissioner for Refugees (UNHCR Canada), she will be working with seasoned professionals dedicated to ensuring the rights of refugees, forcibly displaced communities, and stateless people. Fueled by her passion for human rights advocacy and experience in digital marketing, Taïna will be working on different UNHCR initiatives including interviews with previous asylum-seekers, educational projects for younger demographics, and various other storytelling campaigns highlighting contributions of refugees in Quebec and Canada.

Plem Kijamba, U2, International Development Studies and Political Science

Plem will be interning at the UNHCR (Montréal office), which is the UN Refugee Agency, with a mandate to provide international protection to refugees and to work with states for durable solutions to the problem of refugees. As an intern, Plem will contribute to the advancement of research on protection of minors, detention, and border issues, represent UNHCR at awareness-raising events, etc. This is also an opportunity for Plem to learn more about international legal frameworks that protect refugees and how they can be upheld.

Lake Liu, U3, International Development and East Asian Studies

Lake Liu is a fourth-year honours student majoring in International Development and East Asian Studies. This summer, she is interning with the Funding and Outreach Department at CKUT, McGill’s non-profit radio station. Lake will assist with grant-writing to secure funding sources, organize fundraising events and help with donor communications. As a music and pop culture enthusiast, Lake is excited for the chance to further CKUT’s mission to amplify diverse voices in radio.

Lucy Baretto, U3, International Development Studies

Lucy (she/her) is finishing her third year at McGill majoring in International Development Studies and minoring in Indigenous Studies and Social Entrepreneurship. She is excited to be interning with Comm-Un this summer, a Montreal collective/organization committed to empowering housed and unhoused community members in Milton-Parc. Lucy is looking forward to growing both as an individual and a professional at Comm-Un while gaining hands-on experience in community organizing, grant writing, budgeting, and much more.

Sara Saleem Daredia, U2, International Development Studies

Sara Saleem Daredia, a U2 student majoring in International Development with a minor in Environment, will intern with Ibex Media Network (IMN) in Pakistan. As an intern at Ibex Media Network (IMN), Sara will serve as a pivotal link between the media outlet and environmental and social development partners like the Aga Khan Rural Support Program (AKRSP), the Gilgit-Baltistan Environmental Protection Agency (GB-EPA), and the United Nations Development Program (UNDP). Her responsibilities will include assessing and reporting on Community-based Block Plantation Projects' impact, creating educational videos on farming technologies, and advocating for climate awareness through various media. Sara’s role merges academic knowledge with practical application in climate change mitigation and sustainable development.

Sarah Elobaid Ahmed, U3, International Development and World Islamic & Middle Eastern Studies

Sarah is a U3 student majoring in International Development and World Islamic & Middle Eastern Studies. She will be interning at The Upstream Journal, a human rights and social justice magazine based in Montreal. This summer, she will engage in research, interviewing, writing/editing articles, and recording a podcast episode. With a background in activism and NGO experience, Sarah looks forward to applying her skills to the Upstream team while exploring a career in journalism.

Sarah Feng, U2, International Development Studies

Sarah is a second-year student pursuing an Honours International Development degree with a minor in Philosophy. This summer, she will be serving as a Canadian Program Intern for Equitas – The International Centre for Human Rights Education, an organization dedicated to fostering more equitable and inclusive communities through nationwide programming addressing discrimination, empowering youth facing barriers, and engaging decision-makers. Sarah is eager to contribute to Equitas’ program management, communication projects, and the development of educational tools.

Lauren Kandalaft, U3, International Development Studies

Lauren Kandalaft is a third-year student pursuing a Bachelor of Arts with a major in International Development and minors in Communication Studies and Social Entrepreneurship. This summer, she will be serving as a Citizen Engagement Education Intern at Éduconnexion in Montreal. Throughout her internship within this non-governmental organization, she will work towards fulfilling Éduconnexion's mission by participating in projects seeking to support marginalized communities and assisting the organization in its creation of communication and educational tools.

Angela Zhai, U1, International Development Studies and Computer Science

Angela is a first-year undergraduate student majoring in International Development and Computer Science at McGill University. She will be interning with Festival Accès Asie, a Montreal-based festival that promotes Asian cultures and traditions through various art forms. Angela is looking forward to immersing herself in a multicultural environment and she’s excited to witness firsthand the power the arts can have in preserving heritage. She hopes to learn more about event coordination through her internship.

Bhavya Kalra, U1, International Development and Gender, Sexuality and Feminist Studies

Bhavya Kalra is a U1 student majoring in International Development and Gender, Sexuality, and Feminist Studies. This summer, she will intern at Pinay Quebec, an organization that champions the rights of Filipina domestic workers and caregivers. During the internship, she will engage closely with the community, developing tailored capacity-building initiatives and collaborating with stakeholders to design custom training programs. This experience will enhance her professional growth and reinforce a commitment to the arts and social advocacy.

Clio Bailey, U3, International Development Studies

Clio is a fourth year Honours International Development student with minors in Hispanic Studies and Social Studies of Medicine. This summer, she will be interning with the Permanent Mission of Canada to the International Organizations in Vienna (VPERM). She looks forward to learning more about careers in diplomacy and is most excited to work at the UN Office on Drugs and Crime (UNODC).

Julia De Oliveira Lima Gaspar, U3, International Development Studies

Júlia is an upcoming third-year student in International Development Studies, Economics, and Hispanic Studies. Originally from Brazil, with roots from Portugal, Julia is thrilled to enter the diplomatic field. This summer, she will be interning at the Consulate General of Portugal in Montreal.

Marie-Alex Depuydt, U2, International Development and Political Science

Marie-Alix is pursuing a Joint Honors Political Science and International Development Studies degree with a minor in Economics. This summer, she will be interning at Fipra International, a public affair consulting firm in Brussels. With the European elections approaching, she aims to gain experience by monitoring and working with clients to gain a deeper understanding of EU public affairs. Marie-Alix is eager to grasp a more comprehensive understanding of EU regulatory affairs through this internship.

Ava Francin, U1, International Development Ava is a first-year student at McGill pursuing a major International Development and minor in French. She’ll be completing her first internship at the Office of Congresswoman Lois Frankel this summer. Working as an intern for the US Congress provides her a chance to gain firsthand experience in the legislative process and comprehend the impact of domestic policies on international development efforts. Ava is eager to contribute and gain hands-on experience in public policy.

Molly Door, U3, International Development and African Studies

Molly Dorr is in her fourth year at McGill, pursuing a Joint Honours degree in International Development Studies and African Studies. She will be interning with Amplio, a non-profit whose mission is to increase literacy rates in marginalized communities across the world. Molly is thankful for the opportunity to learn from an experienced team and work to better the lives of others

We invite you to have a look at the full list of recipients and their bios at: https://www.mcgill.ca/arts-internships/2024-award-recipients .

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Knowledge and management of insect pests affecting Gynandropsis gynandra [(L.) Briq (Cleomaceae)] among vegetable growers in Benin

• Original Research Article
• Published: 29 August 2024

Cite this article

• Rachidi A. Francisco   ORCID: orcid.org/0000-0003-4576-9481 1 , 2 , 3 ,
• Nicodème V. Fassinou Hotegni 2 ,
• Dêêdi E. O. Sogbohossou 2 ,
• Carlos A. Houdegbe 2 ,
• Enoch G. Achigan-Dako 2 &
• Aimé H. Bokonon-Ganta 3  

Spider plant ( Gynandropsis gynandra ) is a traditional leafy vegetable with the potential to address malnutrition and food insecurity in Africa. To date, little is known about farmers’ perception and knowledge of pests and diseases affecting this plant species and their management practices in Africa. This study aimed at assessing farmers’ perceptions and knowledge of insect pests in Benin in order to develop a sustainable pest management scheme for spider plant cultivation. One hundred and eighty (180) farmers were interviewed using a semi-structured questionnaire, group discussions, and direct field observations through ethno-entomological surveys in August and September 2017. The results from the survey indicated insect pests as the main constraints for spider plant cultivation in southern Benin. Three groups of insect pests were recorded on spider plant; these included lepidopteran larvae [pod borer ( Hellula undalis )], aphids ( Lipaphis erysimi ), and green vegetable bug ( Acrosternum millieri ). This indicated that farmers had a good knowledge of insect pests which varied significantly across municipalities. The result of the ordered probit regression showed that among all socio-economic variables, only “education level” and “farm size” had respectively negative and positive significant relationships with farmers’ knowledge. Although most farmers did not actually control insect pests on spider plant, some of them (15.05% at Djakotomey) used chemical pesticides. Based on our results, we propose that an Integrated Pest Management scheme including the use of botanical pesticides and resistant varieties combined with good agronomic practices should be developed and shared with farmers through participatory farmers’ field schools.

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Raw data supporting this study's findings are available from the corresponding author upon reasonable request.

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Acknowledgements

This study was financially and technically supported by the WOTRO Applied Research Fund (Project Number W.08.270.350) project of the Genetics, Biotechnology and Seed Science Unit (GBioS) and the Agricultural Entomology Laboratory (LEAg) at the Faculty of Agronomic Sciences of the University of Abomey-Calavi. We sincerely thank the farmers who kindly agreed to participate in this survey. We are equally grateful to Georg Goergen (PhD) from the International Institute of Tropical Agriculture (IITA-Benin) who help identify insect species.

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Francisco, R.A., Fassinou Hotegni, N., Sogbohossou, D.E.O. et al. Knowledge and management of insect pests affecting Gynandropsis gynandra [(L.) Briq (Cleomaceae)] among vegetable growers in Benin. Int J Trop Insect Sci (2024). https://doi.org/10.1007/s42690-024-01344-z

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Preliminary efficacy of a community health worker homebased intervention for the control and management of hypertension in Kiambu County, Kenya- a randomized control trial

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Validation, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya

Roles Conceptualization, Methodology, Visualization, Writing – review & editing

Affiliations School of Public Health and Community Development, Maseno University, Kisumu, Kenya, World Health Organisation Somalia, ATMIS Protected Area, Mogandishu, Somalia

Roles Conceptualization, Formal analysis, Methodology, Writing – review & editing

Affiliation School of Medicine, College of Health Sciences, Moi University Eldoret, Eldoret, Kenya

Roles Formal analysis, Software, Validation, Visualization, Writing – review & editing

Affiliation Division of Population Health, Sheffield Centre for Health and Related Research, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom

Roles Conceptualization, Project administration, Supervision, Writing – review & editing

Roles Conceptualization, Formal analysis, Methodology, Supervision, Visualization, Writing – review & editing

Affiliation Department of Epidemiology, School of Public Health and Department of Anthropology, International Health Institute, Brown University, Providence, RI, United States of America

• Grace Wambura Mbuthia, 
• James Mwangi, 
• Karani Magutah, 
• James Odhiambo Oguta, 
• Kenneth Ngure, 
• Stephen T. McGarvey

• Published: August 29, 2024
• https://doi.org/10.1371/journal.pone.0293791
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Introduction

In Sub Saharan Africa, there is a growing burden of non-communicable diseases, which poses a big challenge to the resource-limited health system in these settings.

The aim of this study was to determine the feasibility and preliminary efficacy of a community health workers (CHWs) home-based lifestyle interventions to improve blood pressure (BP) control and body composition among hypertensive patients in low-income populations of Kiambu County, Kenya.

This was a randomized controlled trial (RCT) involving 80 patients with uncontrolled high BP (systolic BP (SBP) ≥140mmHg and/or diastolic BP (DBP) ≥90) randomized to either a CHW homebased intervention or a usual care (control) arm and followed up for 6 months. The intervention involved monthly CHW home-visits for health education and audits on behavioral risk factors that affect BP. An adapted WHO stepwise questionnaire and international physical activity questionnaire was used to collect data on behavioral cardiovascular risk factors. To assess the main outcomes of BP, body mass index (BMI) and waist-height-ratio (WHtR), a survey was conducted at baseline, 3 months, and 6 months. Data regarding univariate, bivariate and multivariate (repeated measurements between and within groups) analysis at 5% level of significance were analyzed using STATA 18. Generalized estimating equations (GEE) for repeated measures were used to estimate changes in BP, BMI and WHtR, and to examine the association between the CHW intervention and BP control.

The study revealed that 77.5% and 92.5% of the participants in usual care and intervention groups completed the follow-up, respectively. After 6 months of follow-up, there was a reduction in the mean SBP and DBP for both arms, and reductions in BMI and WHtR only in the intervention arm. The adjusted mean reduction in SBP (-8.4 mm Hg; 95% CI, -13.4 to -3.3; P = 0.001) and DBP (-5.2 mm Hg 95% CI, -8.3 to -2.0; P<0.001) were significantly higher in the intervention group compared to the control group. The proportion of participants who achieved the controlled BP target of <140/90 mm Hg was 62.2% and 25.8% for the intervention and usual care arm, respectively. The proportion with controlled BP was significantly higher in the intervention arm compared to the usual care arm after adjusting for baseline covariates (AOR 2.8, 95% CI 1.3–6.0, p = 0.008). There was no significant effect of the intervention on BMI and WHtR.

A home-based CHW intervention was significantly associated with reduction in BP among hypertensive patients compared to usual care. Future fully powered RCTs to test the effectiveness of such interventions among low-income populations are recommended.

Trial registration

Trial registration number: PACTR202309530525257 .

Citation: Mbuthia GW, Mwangi J, Magutah K, Oguta JO, Ngure K, McGarvey ST (2024) Preliminary efficacy of a community health worker homebased intervention for the control and management of hypertension in Kiambu County, Kenya- a randomized control trial. PLoS ONE 19(8): e0293791. https://doi.org/10.1371/journal.pone.0293791

Editor: Patricia Khashayar, Gent University, BELGIUM

Received: October 18, 2023; Accepted: February 6, 2024; Published: August 29, 2024

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: This research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No. G-19-57145), Sida (Grant No:54100113), Uppsala Monitoring Center, Norwegian Agency for Development Cooperation (Norad), and by the Wellcome Trust [reference no. 107768/Z/15/Z] and the UK Foreign, Commonwealth & Development Office, with support from the Developing Excellence in Leadership, Training and Science in Africa (DELTAS Africa) programme. The statements made and views expressed are solely the responsibility of the authors. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

In Sub Saharan Africa (SSA), there is a growing burden of non-communicable diseases (NCDs), which poses a big challenge to the resource limited health systems in these settings [ 1 – 3 ]. Further, management of cardiovascular diseases (CVDs) in low resource settings is difficult due to limited human and financial resources. There is a need for research to explore innovative, cost effective, and contextually relevant primary care interventions to control BP levels and other cardiovascular risks factors amidst the growing dual burden of infectious and NCDs in SSA [ 4 ].

Community health workers (CHWs) also known as community health volunteers or community health promoters are an affordable and sustainable solution for behavioural intervention delivery, and an important linkage between community and health care system[ 5 ]. In light of critical shortages in the health workforce in low and medium income countries (LMICs), CHWs, defined as members of a community with minimal formal training on health problems who provide basic health and medical care to their community, are increasingly recognized as an essential part of the health workforce needed to achieve public health goals [ 6 – 9 ].

The CHWs may remove barriers to BP control and medication adherence due to cultural, educational, and language differences between community members and the health care system [ 10 ]. A systematic review on the effectiveness of CHWs interventions for management of hypertension in the United States showed significant improvement in BP control particularly among the poor, urban minority communities [ 11 ]. Similarly, community health workers home-based interventions have shown positive impact in the management and control of hypertension in LMICs [ 12 – 16 ]. Another systematic review in LMICs reported positive effects of CHW interventions on improved linkage of patients to care, reduction of BP, improving adherence of patients to medication and the overall reduction in the CVD risk score [ 17 ].

Hypertension is the leading risk factor for deaths due to CVDs and as such, the World Health Organization (WHO) targets to have a worldwide 25% reduction in its prevalence by the year 2025 [ 18 ]. The 2015 STEPwise survey shows 24% of Kenyans either had elevated BP or were on treatment for hypertension. Only 8% of the hypertensive persons were on treatment, and among them, only 4.6% had controlled BP [ 19 ]. Based on literature, modification of lifestyle factors can delay onset of hypertension and can contribute to lowering of BP in treated patients [ 20 , 21 ]. Systematic reviews have shown efficacy of interventions focused on physical activity [ 22 , 23 ] and dietary approaches to stop hypertension [ 24 – 26 ] in lowering BP among adults with or without hypertension in different settings.

One of the ways to address the emerging burden of hypertension could be through home BP monitoring and lifestyle interventions led by CHWs. However, the feasibility and effectiveness of CHWs primary health intervention in the control of hypertension in Kenya is not well explored. Previous research conducted in Western Kenya demonstrated efficacy of CHWs intervention in improving linkage to hypertension health care [ 12 ] in the general population. However, there is a lack of uptake of evidence-based community based CHWs interventions for reduction of BP in the Kenyan settings. There is a need for further studies to support primary health interventions geared towards control of hypertension and CVD outcomes among hypertensive patients in the Nairobi metropolitan area where the current study is set. While previous CHWs hypertension interventions in LMICs have focused on screening and health education, the current study proposes to adapt a multicomponent evidence-based lifestyle intervention that incorporates behaviour change communication and practical individualized lifestyle interventions to reduce high BP and other CVD risks among low-income population in Kiambu County. The aim of this study is to test the feasibility and preliminary efficacy of a CHW-led lifestyle homebased intervention for BP reduction among hypertensive patients.

Research design

This was a randomized controlled trial (RCT). Participants from two primary health care facilities were randomized to either the CHW-led homebased intervention or the usual care arm. Randomisation was at facility level. Those assigned to the intervention arm were advised to continue receiving their usual care. The intervention was implemented for 6 months with outcome assessment after 3rd and 6th month.

The study was conducted in Kiambu County, Kenya. The county is in the Central Kenyan highlands with an altitude ranging from 1,400 m to 1,800 m above sea level. The county is situated between latitude 0°75’ and 1°20’ south of the equator and longitudes 36°54’ and 36°85’ east. Specifically, the study took place in two level 3 primary health care (PHC) facilities in Juja and Ruiru Sub-counties. The two Sub-counties are predominantly urban and are located in the outskirts of the capital city and within Nairobi metropolitan region.

Study population

We selected patients with high BP (systolic ≥140 mmHg and/or diastolic ≥90 mmHg measured on at least 2 separate screening measurements), aged 18 years and above, receiving primary care from the twolevel 3 PHC facilities and available to be followed up for 6 months. Participants commenced on antihypertensive medications were also included. Elderly hypertensive patients aged above 70 years, hypertensive patients already on hypertension follow-up and management elsewhere or wished to relocate from the study area during the study period were excluded.

Sample size and power calculation

With changes in BP as the primary outcome, we calculated a sample of 52 participants for the 2 arms (26 in each). This would show changes in BP between the intervention and control arms at a significance level of 0.05 for a two-sided test with 80% statistical power of finding a large effect ( Cohen’s d = 0.80). This study was underpowered to find significantly small effect ( Cohen’s d = 0.30) and moderate effect ( Cohen’s d = 0.50). However, we were able to calculate an effect size and show the direction of its impact. After adjusting for 20% loss to follow-up, the total sample was 62 participants.

Sampling and participant’s recruitment

The participants were consented at Ruiru and Juja level 3 primary health facilities following referral from a community-based door-to-door BP screening in the study area ( Fig 1 ). The two primary health facilities were in 2 different sub-counties where home blood pressure screening took place and participants were referred to the appropriate facility in their respective Sub-counties The recruitment took place from October to November 2022. Participants with high BP (systolic ≥140 mmHg and/or diastolic ≥90 mmHg) were given a referral note to either Juja or Ruiru primary health facility. After clinician’s assessment and commencement of management, participants with high BP willing to participate were recruited into the study. For the purposes of the pilot RCT only 40 participants were recruited in each facility. Simple random sampling (two folded papers bearing the name of the two facilities were tossed and one picked at random became the intervention facility) was used to allocate the two PHC facilities (and the patients receiving care there) to either the control usual care or CHW home-based intervention arms.

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https://doi.org/10.1371/journal.pone.0293791.g001

Study procedure

The research assistants completed a baseline assessment for the eligible participants. Intervention: The community health workers were trained to coach patients on lifestyle modification, home BP-monitoring, and medication adherence during a 2-day interactive training session followed by onsite field return demonstrations. The CHW were taught culturally appropriate behavioral change related to hypertension based on the Centers for Disease Control(CDC) CHW training manual for preventing heart disease and stroke [ 27 ]. Before the actual intervention, several mock intervention sessions were done and critiqued to ensure CHW ability to deliver intervention content consistently. Additionally, the research assistants (qualified nurse) made monthly supervisory visits and sat in the intervention sessions to ensure that home visits and intervention were delivered effectively. Those in the intervention arm received a home based community health worker–led intervention (health coaching, home BP monitoring, BP audit and feedback) implemented over a period of 6 months. This entailed two home visits by the trained CHWs during the first month after randomisation, followed by monthly follow-up visits for a period of 6 months. The initial visit was a 90-minute home visit to discuss general knowledge about hypertension and offer tailored counselling on lifestyle modification as well as set PA targets. Subsequent monthly visit was focused on social support, goal setting, BP, and weight monitoring. Participants in the intervention arm were also encouraged to adhere to the usual care by attending the prescribed clinic visits for hypertension at the primary health care facility.

The CHWs were trained to adapt the counselling based on individual participant needs by emphasizing on actions to be taken based on hypertension risk factors identified. Subsequent monthly visits were focused on social support, goal setting, BP, and weight monitoring. For motivation, the CHW were paid the Ministry of Health recommended monthly stipend for CHW of approximately 60 USD per month.

The participants in the control arm received the usual care, which included monthly clinic visits to the health facility and medical management as prescribed by the clinicians. Participants in this arm did not have home visits by CHW.

To assess the outcome of the intervention, home-based surveys were conducted by two trained research assistants (who were not part of nor had relationship with the CHWs team) to evaluate the participants at baseline, 3 months, and 6 months. The research assistants were blinded to the randomization status of the participants. The home visits for evaluation were scheduled during the first half of the day to minimize the effect of diurnal variations in BP.

Data collection

An adapted WHO stepwise questionnaire was used to collect information on demographic characteristics and health behaviours (smoking, alcohol drinking, diet and physical activity (PA)) of participants at baseline and follow-up visits. The international PA questionnaire (IPAQ) [ 28 ] was used to collect data on PA. Three BP measurements, body weight, height and waist circumference were obtained at each data collection visit by outcome assessors masked to intervention assignment. Blood pressure was measured using a digital (Omron M1) BP machine according to American Heart Association Guidelines. The guidelines include resting seated for 5 minutes prior to monitoring, abstaining from smoking, drinking, and exercise 30 minutes prior, and recording three measurements each time the monitor is used and an average obtained [ 29 ]. Weight was measured using a bathroom scale (CAMRY Mechanical scale, BR9012, Shanghai, China) with the subject in light clothing and without shoes.

The primary outcomes were the differences in systolic and diastolic BP (SBP and DBP respectively) changes from baseline to the 6 month follow-up survey while secondary outcomes included the proportion of patients with controlled hypertension (BP <140/90 mm Hg) according to the Kenyan national guidelines [ 30 ], body composition–body mass index (BMI) [ 31 ], and waist height ratio (WHtR) [ 32 ]. The outcome measures were assessed at baseline, 3 months, and 6 months of follow-up. Physically active was defined as having attained 150 minutes of moderate PA or 75 minutes of vigorous PA each week.

Statistical analysis

The Stata 18 software (Stata Corporation, College Station, Texas, USA) was used for data ( S3 File ) entry and analysis. Descriptive statistics were used for participants’ characteristics. Categorical data were analyzed and reported in frequency and percentages. Independent samples t-test was used to determine whether baseline characteristics (continuous variables) differed significantly between the control and the usual care arms at baseline while differences in the categorical variables between the arms were analyzed using a test for 2-sample differences in proportions. The mean changes in BP and BMI were first estimated with using paired t-test for the difference between end line and baseline measurements.To account for repeated BP and BMI measurements, we used the generalized estimating equations (GEE) model for repeated measures using gaussian identity link function while adjusting for baseline characteristics; antihypertensive treatment and demographic characteristics. The GEE model was also used to examine the association between the CHW intervention with BP control (BP less than 140/90mmHg) and normal BMI(BMI 18.5–24.9kg/m2), specifying logit link function and reporting odds ratios, after controlling for baseline BP, baseline BMI, baseline WHtR, age, sex, and use of antihypertensive medication. We selected the GEE model because it is a population average model that does not rely on probability distribution assumptions [ 33 ]. However, we used the mixed effects models as sensitivity analyses for our estimates of the intervention effect ( S1 Table ). Statistical significance was considered at P < 0.05.

Ethical considerations

The study proposal ( S2 File ) was approved by Jomo Kenyatta University of Agriculture and Technology (JKUAT) Institutional scientific and ethical review committee (approval number JKU/IERC/02316/0652) [ S4 File ]. Similarly, research permit was obtained from the National Commission of Science, Technology, and Innovation before commencement of the study (license number NACOSTI/P/22/19977). Confidentiality and anonymity of patients was guaranteed by excluding unique identifiers from the data collected from participants. Participation in the study was on voluntary basis and written informed consent was obtained from the participants before data collection.

This study is registered in the Pan African Clinical Trial Registry database, registration number PACTR202309530525257.

A total of 80 participants (40 in each arm) were recruited in the study. Of these, 31(77.5%) of the participants in usual care and 37(92.5%) in the intervention arm completed the follow-up ( Fig 1 ). The mean age of the participants was 46.8±11.1 years and ranged from 25–68 years. At baseline, the mean SBP, DBP and BMI were 155.7 mmHg, 97.1 mmHg and 29.7 kg/m 2 , and 151.7 mmHg, 95.7 mmHg, 29.3 kg/m 2 for the usual care and intervention arm respectively. A majority of the participants were physically active in both arms with 81% and 90% in the intervention and usual care arm respectively, reporting having achieved at least 75 minutes of vigorous intensity or 150 minutes of moderate intensity activity per week. Only 4(6%) of the participants smoked cigarettes and a quarter 17(25%) consumed alcohol. At baseline, approximately half of the respondents, 56.8% in the intervention and 45.2% in the usual care arms, were on antihypertensive treatment. There were no statistically significant differences in the baseline characteristics between the two arms ( Table 1 ).

https://doi.org/10.1371/journal.pone.0293791.t001

Implementation and adherence to the intervention

Implementation and adherence to the usual care was assessed through the attendance of health facility follow-up visits for both arms. A third, 25(62.5%) of the participants in the usual care attended all the prescribed six health facility follow-up visits while six participants attended five visits and nine participants attended less than four clinic visits. On the other hand, 28(70%) of the participants in the intervention arm completed all the six prescribed health facility follow-up visits while seven participants attended five visits and five participants attended less than 4 visits.

In addition to the usual care, the intervention arm received monthly home visits by the CHW for a period of 6 months. A majority (92.5%) received all the planned home visits while the rest only completed 33% of the home visits and were not available for outcome assessment thus were lost to follow-up. Using a health education checklist ( S1 File ) the initial visit was focused on general knowledge about hypertension and tailored counselling on lifestyle modifications on PA and diet (reduction of salt intake, increase fruits and vegetables and reduction of deep fried foods) as well as goal setting. Subsequent monthly visits were focused on BP and weight audits, review on achievement of at least 150 minutes of moderate PA and counselling on diet and treatment adherence (for those on anti-hypertensives). Thirty-one (77.5%) of the participants in the usual care arm were available for the 3 home visits focused on outcome assessments while 5 and 4 participants were available for one and two visits, respectively.

Blood pressure and body composition outcomes

Table 2 presents the mean measurements of the sample at different time points. After 6 months of follow-up, there was a reduction in the mean SBP, DBP in all the arms and a reduction in BMI and WHtR only among the intervention arm ( Table 2 ).

https://doi.org/10.1371/journal.pone.0293791.t002

The mean SBP in the intervention arm reduced by 19 mm Hg (95% CI -21.04 to -16.9), while in the usual care arm it had reduced by 7.9 mm Hg (95% CI -11.8 to -4.0). Similarly, the mean unadjusted DBP fell by 9.9 mm Hg (95% CI -13.1 to -6.6) in the intervention arm and 3.8 mmHg (95% CI -8.5 to -0.9) in the usual care arm ( Fig 2 ). The mean BMI increased by 0.40 kg/m 2 in the usual care arm whereas in the intervention arm it reduced by –0.90 kg/m 2 . Similarly, the mean WHtR in the usual care arm increased by 0.003 while that of the intervention arm reduced by -0.02 as shown in table two.

https://doi.org/10.1371/journal.pone.0293791.g002

Between group differences in mean changes

Table 3 presents the difference in the net changes in BP, BMI and WHtR between the intervention groups. The adjusted mean reduction in SBP was 8.4 mm Hg greater in the intervention group than in the control group (95% CI, -13.4 to -3.3; P = 0.001) while the adjusted mean reduction in DBP in the intervention arm compared to the control {5.2 mm Hg (95% CI, -8.3 to -2.0; P<0.001)} ( Table 3 ). However, the observed adjusted net mean difference in BMI (-1.5; 95% CI, -3.7 to 0.6; P = 0.158) and WHtR (0.0; 95% CI, -0.03 to 0.03; P = 0.999) between the two groups were not statistically significant.

https://doi.org/10.1371/journal.pone.0293791.t003

The proportions of participants who achieved the controlled BP target of <140/90 mm Hg were 62.2% (23) and 25.8% (8) for the intervention and usual care arms, respectively. The odds of attaining blood pressure control in the intervention arm were significantly higher compared to the usual care arm after adjusting for baseline BMI, baseline WHtR, age, gender and being on antihypertensive drugs (AOR 2.8, 95% CI 1.3–6.0, p = 0.008) ( Table 4 ) . However, we did not observe a significant difference in the odds of normal BMI between the treatment arms (AOR 2.5, 95% CI 0.6–10.4, p = 0.181) ( Table 4 ).

https://doi.org/10.1371/journal.pone.0293791.t004

Adverse outcome

There were no adverse outcomes (deaths) reported during the study.

Our study provides evidence that a homebased lifestyle and BP monitoring intervention, delivered by CHWs, was more effective in reducing SBP and DBP and in improving control of hypertension in low-income urban population, compared to usual care. The completion rates of the follow-up were favorable for both the usual care (77%) and intervention arms (92%), indicating the feasibility of implementing such interventions among an urban population. The better completion rates for the intervention group may be attributed to the interest among the participants cultivated through the regular CHW home visits and audits of the progress that was not the case in the usual care arm.

After 6 months of follow-up, the study showed a significantly greater reduction in the mean adjusted SBP and DBP among the intervention than the usual care arm. Our findings are consistent with other studies[ 14 , 16 , 33 ] on the effect of lay health worker intervention programs for control of BP in LMICs. Our findings compare to those in a study done in Nepal with CHWs home-monitoring and education, which found 4.9mmHg and 2.6 mmHg greater decrease in SBP and DBP, respectively, for the intervention arm compared to usual care arm after one year of follow-up [ 14 ]. Similarly, a study done in Argentina among low-income population showed that participants with uncontrolled hypertension who participated in a community health worker–led multicomponent intervention had 6.6 and5.4 mmHg greater decrease in SBP and DBP, respectively, than did patients who received usual care after 18 months of follow-up [ 16 ].The personalised health education and BP audits delivered by home visits in the current study might have encouraged participants to adopt healthy lifestyles and adhere to physicians instructions leading to controlled BP. Additionally, the CHW intervention comprised components that are evidence-based for lowering BP. These included regular home BP audits [ 34 ], encouraging lifestyle changes of increased PA and losing weight [ 35 ] as well as encouraging adherence to antihypertensive drugs for those on treatment [ 36 ].

The current study showed a reduction in BMI and WHtR in the intervention arm, compared to slight increase in the usual care arm. However, we did not observe a significant difference in the mean change BMI and WHtR between the treatment arms. Our findings are consistent with those of Gamage et al (2020) and He et al (2017) that showed a CHW-led intervention for control of hypertension had no effect on BMI and WHR [ 16 , 33 ]. Our findings could be attributed to the short period of follow-up of six, which may not have resulted in significant changes in body weight to affect the body composition measures.

This feasibility study had some limitations. First, the duration of the intervention was limited to 6 months, and therefore, it is difficult to determine the extent to which changes in BP and body composition could be sustained. Additionally, we cannot predict the effect of the intervention after 6 months. Secondly, as a feasibility study with limited resources, we recruited a small sample size. However, the findings are crucial in informing the design of a fully powered RCT. Thirdly, the study may have had measurement bias for anthropometric measurements, but this was minimized through training of the enumerators on standard procedures and their support supervision. We also did not account for any potential differences in the quantity or quality of usual care received by participants in both arms at their respective health facilities. Fourthly, there was a difference in the number of participant on anti-hypertensive treatment at baseline that could have been a source of bias, however this difference was not statistically significant and the use of anti-hypertensive was adjusted for in the multivariate model. Finally, given that this was a feasibility study, we did not monitor adherence to antihypertensive treatment and longitudinal changes in health behaviours that could be attributed to the changes in blood pressure.

The strengths of the study are that, to the best of our knowledge, this is the first study investigating the feasibility and effectiveness of CHW home-delivered interventions for the reduction of BP among a poor urban population in Kenya. Secondly, the baseline and follow-up outcome assessment surveys were done by independent outcome assessors and the key BP outcome was measured using an automated device to minimize the risk of assessor’s bias. Thirdly, the study has been reported following the Consolidated Standards of Reporting Trials (CONSORT) guidelines ( S5 File ).

A CHW home based lifestyle intervention was effective in reducing BP and had a higher proportion of controlled hypertension compared to the usual care. These findings add to the body of knowledge on task-shifting interventions for treating high BP in LMICs. In particular, the study showed that utilization of CHWs from the already existing health-care systems of PHC in Kenya for management of hypertension is feasible in urban low-income settings of Kiambu County. However, the current findings are only based on a small sample derived from a Kenyan population and therefore future studies with much larger sample sizes and collected at other geographical areas to test the effectiveness of such interventions are recommended.

Supporting information

S1 table. a mixed effects model (using random effects)..

https://doi.org/10.1371/journal.pone.0293791.s001

S1 File. Education checklist.

https://doi.org/10.1371/journal.pone.0293791.s002

S2 File. Trial proposal.

https://doi.org/10.1371/journal.pone.0293791.s003

S3 File. Data set.

https://doi.org/10.1371/journal.pone.0293791.s004

S4 File. Ethical approval.

https://doi.org/10.1371/journal.pone.0293791.s005

S5 File. CONSORT-2010 checklist.

https://doi.org/10.1371/journal.pone.0293791.s006

Acknowledgments

Our special thanks go to the participants in this study for their invaluable contributions to this study. We thank the community health workers who conducted the intervention. We also thank the Sub-county management teams for their assistance during the data collection

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Please note you do not have access to teaching notes, school discipline, school uniforms and academic performance.

International Journal of Educational Management

ISSN : 0951-354X

Article publication date: 8 August 2016

The purpose of this paper is to examine the role of school discipline in achieving academic performance. The study aims to clarify the role of permissive vis-à-vis authoritative teaching styles with an overarching hypothesis that better discipline leads to better academic performance. The authors also probe whether uniformed students have better discipline.

Design/methodology/approach

The authors analyse Organisation for Economic Co-operation and Development’s Programme for International Student Assessment data on school discipline dimensions: students listening well, noise levels, teacher waiting time, students working well, class start time. Analysis of variance (ANOVA) with post hoc analysis on five geographic groups established by Baumann and Winzar (2016) was applied to test for geographic differences (Europe, Americas, Far East Asia, Rest of Asia, Anglo-Saxon cluster) in school discipline. ANOVA was further used to test for school discipline and academic performance. Third, t -tests on five discipline dimensions were run to test for differences between students who wear uniforms and those who do not.

The results demonstrate differences in school discipline across five geographic clusters, with East Asia leading the way. The authors demonstrate significant differences in discipline for low, medium and high performing students. Peak-performing students have the highest level of discipline. Students wearing a uniform listen better with lower teacher waiting times.

Originality/value

Students peak perform when teachers create a disciplined atmosphere where students listen to teachers, where noise levels in the classroom are low and they do not have to wait to start class and teach. Good discipline allows students to work well and this ultimately leads to better academic performance. Uniforms contribute to better discipline in everyday school operations. The findings support that in general, implementing school uniforms at schools might enhance discipline and allow for better learning. The authors recommend keeping uniforms where they are already used and to consider introducing uniforms where they are not yet common.

• Academic performance
• Confucianism
• Geographic clusters
• School discipline
• School uniform

Baumann, C. and Krskova, H. (2016), "School discipline, school uniforms and academic performance", International Journal of Educational Management , Vol. 30 No. 6, pp. 1003-1029. https://doi.org/10.1108/IJEM-09-2015-0118

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