+NairoBEAT

Combating CVD in Kenya through mobile technologies

Triangle GlobalHealth CaseCompetition

March 31, 2012

Molly Hrudka Emma Johnson Shampa Panda Erica O’Brien Michael WilsonLydia Stewart

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

Strep Throat & Scarlet Fever

Rheumatic Fever

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 Kibera

Clinical 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

• Counseling• Antibiotic regimen

mild case

• Antibiotic regimen• Referral to Specialist

moderate case

• Percutaneous mitral balloon valvotomy – (valvuloplasty )

severe case

14+Partner: The Nairobi Hospital

Institutional 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

Security and Insurance of medical equipment 40000

Vehicle operating, insurance, maintenance and upkeep 100000

Staff salaries 60000

Private security costs for vehicle 100000

Partnership cost paid to partners to cover costs 70000

Operating costs including garden 50000

Total per year 420000

Total per truck over three years 1260000

Vehicle upfront 300000

Medical Equipment upfront including Echocardiogram 300000

10000

1870000 5610000

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.

+NairoBEAT

Combating CVD in Kenya through mobile technologies

Triangle GlobalHealth CaseCompetition

March 31, 2012

Molly Hrudka Emma Johnson Shampa Panda Erica O’Brien Michael WilsonLydia Stewart