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Cardiovascular prevention model from Kenyan slums to migrants in the Netherlands.

van de Vijver S, Oti S, Moll van Charante E, Allender S, Foster C, Lange J, Oldenburg B, Kyobutungi C, Agyemang C - Global Health (2015)

Bottom Line: Based on these similarities it was suggested by several policymakers that the model from Nairobi can be applied to other vulnerable populations such as African migrants in high-income countries.The model can be contextualized to the local situation by adapting the key steps of the model to the local settings.The involvement and support of African communities' infrastructures and health care staff is crucial, and the most important enabler for successful implementation of the model in migrant communities in high-income countries.Once these stakeholders have expressed their interest, the impact of the adapted intervention can be measured through an implementation research approach including collection of costs from health care providers' perspective and health effects in the target population, similar to the study design for Nairobi.

View Article: PubMed Central - PubMed

Affiliation: African Population and Health Research Center, Nairobi, Kenya. svijver@aphrc.org.

ABSTRACT
Cardiovascular diseases (CVD) are the main cause of morbidity and mortality worldwide. As prevention and treatment of CVD often requires active screening and lifelong follow up it is a challenge for health systems both in high-income and low and middle-income countries to deliver adequate care to those in need, with efficient use of resources.We developed a health service model for primary prevention of CVD suitable for implementation in the Nairobi slums, based on best practices from public health and the private sectors. The model consists of four key intervention elements focusing on increasing awareness, incentives for promoting access to screening and treatment, and improvement of long-term adherence to prescribed medications. More than 5,000 slum dwellers aged ≥35 years and above have been screened in the study resulting in more than 1000 diagnosed with hypertension and referred to the clinic.Some marginalized groups in high-income countries like African migrants in the Netherlands also have low rates of awareness, treatment and control of hypertension as the slum population in Nairobi. The parallel between both groups is that they have a combination of risky lifestyle, are prone to chronic diseases such as hypertension, have limited knowledge about hypertension and its complications, and a tendency to stay away from clinics partly due to cultural beliefs in alternative forms of treatment, and lack of trust in health providers. Based on these similarities it was suggested by several policymakers that the model from Nairobi can be applied to other vulnerable populations such as African migrants in high-income countries. The model can be contextualized to the local situation by adapting the key steps of the model to the local settings.The involvement and support of African communities' infrastructures and health care staff is crucial, and the most important enabler for successful implementation of the model in migrant communities in high-income countries. Once these stakeholders have expressed their interest, the impact of the adapted intervention can be measured through an implementation research approach including collection of costs from health care providers' perspective and health effects in the target population, similar to the study design for Nairobi.

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Framework showing steps from awareness of cardiovascular risk factors in risk group towards long term compliance with controlled blood pressure.
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Fig1: Framework showing steps from awareness of cardiovascular risk factors in risk group towards long term compliance with controlled blood pressure.

Mentions: In spite of the tremendous need, access to healthcare and social services are generally lacking in these settings. To address some of these health challenges in slum communities in Africa, two public health research organizations, the African Population and Health Research Center (APHRC) and the Amsterdam Institute for Global Health and Development (AIGHD) have collaborated on a joint program. Between 2011 and 2012, they have developed a health service package for primary prevention of CVD suitable for implementation in the Nairobi slums, in collaboration with a private sector partner, the Boston Consulting Group (BCG) [7]. The aim of this “hybrid” collaboration was to integrate public and private sector approaches in order to develop an innovative health service delivery package for CVD prevention for the urban poor on the African continent. As resources are limited in these settings it was essential that the final model should be affordable, feasible, and cost-effective. A conceptual framework was developed based on previous studies on CVD risk factors in this setting [8-10], a comprehensive literature review on the effectiveness of community based CVD prevention programs in LMICs [11], and the local experiences of an intervention project to improve patient access to treatment for hypertension and diabetes in primary care settings in the slums of Nairobi (Figure 1).Figure 1


Cardiovascular prevention model from Kenyan slums to migrants in the Netherlands.

van de Vijver S, Oti S, Moll van Charante E, Allender S, Foster C, Lange J, Oldenburg B, Kyobutungi C, Agyemang C - Global Health (2015)

Framework showing steps from awareness of cardiovascular risk factors in risk group towards long term compliance with controlled blood pressure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4363048&req=5

Fig1: Framework showing steps from awareness of cardiovascular risk factors in risk group towards long term compliance with controlled blood pressure.
Mentions: In spite of the tremendous need, access to healthcare and social services are generally lacking in these settings. To address some of these health challenges in slum communities in Africa, two public health research organizations, the African Population and Health Research Center (APHRC) and the Amsterdam Institute for Global Health and Development (AIGHD) have collaborated on a joint program. Between 2011 and 2012, they have developed a health service package for primary prevention of CVD suitable for implementation in the Nairobi slums, in collaboration with a private sector partner, the Boston Consulting Group (BCG) [7]. The aim of this “hybrid” collaboration was to integrate public and private sector approaches in order to develop an innovative health service delivery package for CVD prevention for the urban poor on the African continent. As resources are limited in these settings it was essential that the final model should be affordable, feasible, and cost-effective. A conceptual framework was developed based on previous studies on CVD risk factors in this setting [8-10], a comprehensive literature review on the effectiveness of community based CVD prevention programs in LMICs [11], and the local experiences of an intervention project to improve patient access to treatment for hypertension and diabetes in primary care settings in the slums of Nairobi (Figure 1).Figure 1

Bottom Line: Based on these similarities it was suggested by several policymakers that the model from Nairobi can be applied to other vulnerable populations such as African migrants in high-income countries.The model can be contextualized to the local situation by adapting the key steps of the model to the local settings.The involvement and support of African communities' infrastructures and health care staff is crucial, and the most important enabler for successful implementation of the model in migrant communities in high-income countries.Once these stakeholders have expressed their interest, the impact of the adapted intervention can be measured through an implementation research approach including collection of costs from health care providers' perspective and health effects in the target population, similar to the study design for Nairobi.

View Article: PubMed Central - PubMed

Affiliation: African Population and Health Research Center, Nairobi, Kenya. svijver@aphrc.org.

ABSTRACT
Cardiovascular diseases (CVD) are the main cause of morbidity and mortality worldwide. As prevention and treatment of CVD often requires active screening and lifelong follow up it is a challenge for health systems both in high-income and low and middle-income countries to deliver adequate care to those in need, with efficient use of resources.We developed a health service model for primary prevention of CVD suitable for implementation in the Nairobi slums, based on best practices from public health and the private sectors. The model consists of four key intervention elements focusing on increasing awareness, incentives for promoting access to screening and treatment, and improvement of long-term adherence to prescribed medications. More than 5,000 slum dwellers aged ≥35 years and above have been screened in the study resulting in more than 1000 diagnosed with hypertension and referred to the clinic.Some marginalized groups in high-income countries like African migrants in the Netherlands also have low rates of awareness, treatment and control of hypertension as the slum population in Nairobi. The parallel between both groups is that they have a combination of risky lifestyle, are prone to chronic diseases such as hypertension, have limited knowledge about hypertension and its complications, and a tendency to stay away from clinics partly due to cultural beliefs in alternative forms of treatment, and lack of trust in health providers. Based on these similarities it was suggested by several policymakers that the model from Nairobi can be applied to other vulnerable populations such as African migrants in high-income countries. The model can be contextualized to the local situation by adapting the key steps of the model to the local settings.The involvement and support of African communities' infrastructures and health care staff is crucial, and the most important enabler for successful implementation of the model in migrant communities in high-income countries. Once these stakeholders have expressed their interest, the impact of the adapted intervention can be measured through an implementation research approach including collection of costs from health care providers' perspective and health effects in the target population, similar to the study design for Nairobi.

Show MeSH
Related in: MedlinePlus