Nairo BEAT Combating CVD in Kenya through mobile technologies

1. Triangle Global Health Case Competition March 31, 2012 NairoBEATCombating CVD in Kenya through mobile technologies Lydia Stewart Molly Hrudka Emma Johnson Shampa Panda Erica O’Brien Michael Wilson

2. Roadmap • Rheumatic Heart Disease • Pregnant Women • Eastlands, Nairobi • NairoBEAT

3. Rheumatic Heart Disease “Acute rheumatic fever and rheumatic heart disease are the leading causes of cardiovascular death during the first five decades of life in developing countries.” -American Heart Association Guidelines

4. Rheumatic Heart Disease

5. Rheumatic Heart Disease

6. At Risk: Focus on the Pregnant Woman

7. Looking to Kenya

8. Focus in Nairobi

9. Program Overview • Clinical Partnership • Mobile Outreach Program: Eastlands • Prevention, Detection, and Referral Process • Beyond Eastlands • Costs and Benefits

10. Partner Overview Carolina for Kibera: Clinical Headquarters Kenyan-Heart National Foundation: Workforce and Community Outreach Nairobi Hospital: Institutional Support and Specialized Services

11. Partner: Carolina for KiberaClinical Headquarters • Tabitha Medical Center • Located in Kibera, 15 km from Eastlands slum • Full range of clinic services • Established workforce and medical infrastructure • Facilities for child care and community education

12. Mobile Clinic • Three mobile health clinic vehicles • Focus on screening pregnant women in the Eastlands • While there for prenatal care, offer: • Echocardiograms • Blood pressure checks • HIV screenings • Education Materials Photo. CX50. Philips. http://www.healthcare.philips.com

13. Detecting Rheumatic Hearth Disease

14. Partner: The Nairobi HospitalInstitutional Support and Specialized Service • Has operating theaters to accommodate valvuloplasty • Cost covered by National Hospital Insurance Fund • 20 minutes from slums • Referral process • Staff case coordinators • Provide travel to and from Nairobi Hospital

15. Education at Mobile Clinic • Required reading of educational materials about the risk factors for rheumatic heart disease • Incorporate pictures, visual information • Explain strep -> rheumatic fever -> rheumatic disease causative chain • Rheumatic fever detection and treatment • Explain levels of severity and corresponding treatment • Hygiene – prevent spread of viruses, infections • Provide other tips for preventing CVD: • Nutrition • Exercise

16. Building Patient Relationship • Incentive program • Community garden • Located near Tabitha Medical center • Staffed by locals • ½ produce goes to market • ½ goes to repeat patients who demonstrate comprehension of educational material • Creates incentive for continuous care, improves nutrition and health behaviors

17. Beyond Eastlands: Work-Site Visits • Contract with employers • Offer routine check-ups • Perform preventative screenings • Disseminate educational materials • Important to reach other populations in Nairobi

18. Beyond Eastlands: Mass InformationKenyan-Heart • Publicity • Encourage faith leaders to publicize • Mass media campaign to increase awareness • Radio PSAs • SMS site-visit alerts and health tips

19. Role of the Health Worker • Increased cardiovascular disease specific training for workers • Train workers to use echocardiograms and interpret results • Use workers in case management role • Increase behavioral counseling role of health worker • Encourage community participation—new health workers

20. Innovative Technology • Use of portable echocardiograms • Development of CVD training software for health worker • Use of telemedicine in areas with supporting infrastructure • SMS campaign for site visit alerts and health reminders • Implementation of Care2000 ERP and EHR system

21. Budget

22. Program Evaluation • After year 1 • Assess areas of greatest disease density • Assess community and cultural response • Assess feasibility of work-site screenings • Expand to neighboring low-income areas • Assess feasibility of additional vehicle for rural clinics

23. Benefits • Estimate of total patients seen: 6,7500 • Work site patient estimates: 9,4500 • Estimated cost per patient: 59.36507937 • Early detection • Increased longevity • Increased productivity • Increased educational achievement • Healthier pregnancies

24. Sources • “A Garden in a Sack:  Experiences in Kibera, Nairobi.” Kenyan-Heart National Foundation. • “AHA Guidelines on Prevention of Rheumatic Fever and Diagnosis and Treatment of Acute Streptococcal Pharyngitis.” American Family Physician. Print. • BeLue, Rhonda et al. “An Overview of Cardiovascular Risk Factor Burden in sub-Saharan African Countries: a Socio-cultural Perspective.” Globalization and Health 5.1 (2009): 10. Web. 31 Mar. 2012. • Bovet, Pascal et al. “Distribution of Blood Pressure, Body Mass Index and Smoking Habits in the Urban Population of Dar Es Salaam, Tanzania, and Associations with Socioeconomic Status.” International Journal of Epidemiology 31.1 (2002): 240–247. Web. 31 Mar. 2012. • Deaton, Christi et al. “The Global Burden of Cardiovascular Disease.” European Journal of Cardiovascular Nursing 10 (2011): S5–S13. Web. 31 Mar. 2012. • Gillum, Richard F., and C.T. Grant. “Coronary Heart Disease in Black Populations II. Risk Factors.” American Heart Journal 104.4, Part 1 (1982): 852–864. Web. 31 Mar. 2012. • “Guide to Imaging.” Cardiology Today.

25. “Health Relief in Kibera.” CFK. Web. 31 Mar. 2012. • Maher, D. et al. “Distribution of Hyperglycaemia and Related Cardiovascular Disease Risk Factors in Low-income Countries: a Cross-sectional Population-based Survey in Rural Uganda.” International Journal of Epidemiology 40.1 (2010): 160–171. Web. 31 Mar. 2012. • Mathenge, Wanjiku, Allen Foster, and Hannah Kuper. “Urbanization, Ethnicity and Cardiovascular Risk in a Population in Transition in Nakuru, Kenya: a Population-based Survey.” BMC Public Health 10.1 (2010): 569. Web. 31 Mar. 2012. • “National Hospital Insurance Fund.” • Paolisso, Michael, and Joanne Leslie. “Meeting the Changing Health Needs of Women in Developing Countries.” Social Science & Medicine 40.1 (1995): 55–65. Web. 31 Mar. 2012. • “Rheumatic Fever and Rheumatic Heart Disease.” n. pag. Print. • “Rheumatic Heart Disease.” World Heart Federation. • “Rheumatic Heart Disease in Kenya.” World Health Federation. Sept. 2007.

26. Salman, Zeena, Gregory D. Kirk, and Mark D. DeBoer. “High Rate of Obesity-Associated Hypertension Among Primary Schoolchildren in Sudan.” International Journal of Hypertension 2011 (2010): n. pag. • Sorrentino, Matthew, and Michael Foley. “Pregnancy in Women with Mitral Stenosis.” UpToDate. • “Tabitha Medical Clinic.” eHealth-Kenya facilities. • Teo, Koon K et al. “Tobacco Use and Risk of Myocardial Infarction in 52 Countries in the INTERHEART Study: a Case-control Study.” The Lancet 368.9536 (19): 647–658. • The Nairobi Eastlands Children’s Heart Education. Print. • Vlassoff, Carol, and Claudia Garcia Moreno. “Placing Gender at the Centre of Health Programming: Challenges and Limitations.” Social Science & Medicine 54.11 (2002): 1713–1723. Web. 31 Mar. 2012.

27. Contributions • Molly researched the biology and health implications of rheumatic heart disease as relevant to Kenya. • Emma performed a broad literature review and helped research methodology behind educational mass media campaign. Further, Emma researched previous intervention strategies in comparable countries. • Erica did initial literature review on gender based and access issues associated with efficient healthcare solutions in Kenya. • Shampa compiled sources, performed initial literature review, and focused on slum intervention strategies as applied to Kenya. • Lydia worked to assess the health infrastructure, coordinate intervention strategies, and develop health worker training program.   • Michael estimated financial costs and impacts as well as providing feasible and grounded solutions.

28. Triangle Global Health Case Competition March 31, 2012 NairoBEATCombating CVD in Kenya through mobile technologies Lydia Stewart Molly Hrudka Emma Johnson Shampa Panda Erica O’Brien Michael Wilson