Field notes from Kenya: Naweza screens for non-communicable disease

Using cell phones to reduce cardiovascular disease risk

Since 2013, Medcan has been sending teams of health care professionals and support staff to Kenya and Uganda to work with local clinics to improve quality and access to care. We call this initiative “Medcan Naweza” – Naweza means “I can” in Swahili. Our first and main program continues to be focused on prevention and treatment of noncommunicable disease (NCD). Described as a “slow-motion disaster,”[1] NCDs in low and middle-income countries are growing rapidly, with a 27% increase in NCD deaths projected in Africa over the next ten years.[2] However, the majority of health budgets (estimated at 80%) have been focused on combating communicable disease.[3]

Therefore, in 2015 Naweza began a Community Health Worker (CHW) program to assess cardiovascular disease risk in the rural community surrounding our partner clinics. The protocol was based off the World Health Organization’s guidelines for risk assessment and treatment in this specific African population. The CHWs were trained to take an individual’s blood pressure using an electronic wrist cuff, which when combined with the individual’s age, sex, smoking status and diabetes status, gave a risk level for a cardiovascular event (ie. heart attack, stroke) in the next ten years. To simplify the risk level calculation, we worked with a local computer science developer to build an SMS-based software called “AFYACHAT” that does all of the calculation automatically.

“Non-communicable diseases are rising as the leading killer worldwide,” says Dr. Michael Hawkes, a former travel health doctor at Medcan and the co-founder of Naweza. “Afya in Swahili means health. And we have found a novel well to find and treat patients with non-communicable diseases in rural Kenya. Using this technology allows the CHW to meet people in her community, who are then referred to our partner clinic, and the patient gets treatment for hypertension and diabetes.”

Discussing Afya-Chat with Dr. Michael Hawkes.

“This work was presented at an international conference – The American Society for Tropical Medicine and Hygiene — in 2016, so this is accepted and reviewed by our peers in global health research, and we have submitted a manuscript for publication in a leading public health journal.”

The CHWs text these five metrics to a designated phone number, whereby the system calculates the risk and sends an automatic text back to the CHW with the risk level. A “Green” risk level means the patient has a < 10% risk for a CV event in the next ten years, “Yellow” equals a 10 to < 20% risk, “Orange” equals 20 to < 30% risk, and “Red” equals > 30% risk.

From 2015 to 2016, Naweza community health workers screened thousands of patients using this original protocol, but began to realize that asking if a patient was diabetic was not enough. Many of the people in these communities have never had their blood glucose checked, and the initial signs of type II diabetes can be mild enough that patients may not seek treatment. Therefore, we trained the CHWs to use point-of-care blood glucose testing to assess whether an individual has undiagnosed type II diabetes for “AFYACHAT 2.0.”  The CHW takes a prick of blood from the patient and uses a special strip to collect the blood. The strip is then inserted into the machine and it gives an immediate glucose reading.

Since 2017, we have screened over 800 people with this new protocol, and we are working with our partner clinics to ensure that all patients, but especially our highest risk “Orange” and “Red” patients are receiving follow-up care and treatment. Medcan Naweza has committed to funding treatment costs for these higher risk patients.

Our study is an innovative strategy for active case-finding in a rural setting, in order to identify patients in need of lifestyle and pharmacologic interventions to reduce the risk of cardiovascular disease. By subjecting our program to the scrutiny of a scientific study, we are applying a high level of rigour to our clinical activities, and we will be able to report our findings to the scientific community for potential scalability.

The next trip will likely be January 2019 and we are looking forward to reaching our screening goal of 1,200 patients with our new protocol. At that point we will begin analyzing the data from this project with our local research partner Dr. Benard Ochieng from KEMRI.

You can read more about Naweza and blogs from our last trip here http://www.medcannaweza.com/

A brief summary of Medcan Naweza, February 2018

[1] World Health Organization (2017). Noncommunicable Diseases: the slow motion disaster. Retrieved from: http://www.who.int/publications/10-year-review/ncd/en/

[2] World Health Organization (2008). 2008-2013 action plan for the global strategy for the prevention and control of noncommunicable diseases. WHO Press, Geneva.

[3] A. de-Graft Aikins (2010). Tackling Africa’s chronic disease burden: from the local to the global. Globalization and Health, vol. 6, no. 5, 2010.

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