High blood pressure + Low awareness = 10 million deaths, every year.
High blood pressure + Low awareness = 10 million deaths, every year.
Why the world needs to care about World Hypertension Day, 17th May.
Hypertension, otherwise known as high blood pressure, is a leading cause of cardiovascular diseases worldwide; it’s estimated that it indirectly kills more than 10 million people every year. Indeed, by 2025 the number of adults living with high blood pressure is estimated to increase to approximately 1.56 billion, with more than two-thirds living in low and middle-income situations.
But while these stats are enough to raise anyone’s blood pressure, hypertension rarely grabs the headlines, an ‘upper arm blood pressure monitor’ not delivering the visual wow factor demanded by 24/7 media.
World Hypertension Day is a moment in time then which can perhaps shine a light on this Non Communicable Disease, and some of the efforts underway in countries increasingly burdened by the burgeoning rate of NCDs. Akiba ya Roho, which means ‘save your heart’, is a co-creation product of Access Afya and Boehringer Ingelheim; Access Afya being the primary health innovation company I founded in 2012 which provides an end-to-end model for primary care tailored for urban informal settlements. Together we are creating NCD centres of excellence across Kenya, our model combining retail pharmacies, clinics, telemedicine, and digital tools for health providers to deliver health consultations, lab work and medication at a low cost.
High income, low income, everyone is feeling the pressure
It’s interesting to note that the prevalence of hypertension in Sub-Saharan Africa is as high as that found in established market economies. Akiba Ya Roho is attempting to solve an incredibly complex health care issue that is proving hard to manage in high income countries, let alone in a low-income country for people specifically living below the poverty line.
In Africa, there has been a great shift of disease burden from communicable diseases to NCDs, and this is expected to increase in the next decade resulting in more deaths attributed to NCDs than to communicable diseases. In Kenya, more than 13% of cause specific deaths are attributed to cardiovascular diseases.
Despite the burden that unmanaged hypertension and resulting cardiovascular diseases have on the health system, only recently has there been a shift in focus on awareness, prevention and management of hypertension. While the government has outlined initiatives and protocols that focus on these key areas, there is still more that can be done, especially in the informal settlements where we work.
Tackling high blood pressure in informal settlements
If 61% of urban Africans live in slums. Research undertaken in a Kenyan slum showed that residents had limited knowledge about hypertension and it’s complications, and as a result they did not seek out preventive measures such as screening. The results of this study are consistent with findings by Access Afya that over 55% of people AA screened for NCDs had never had their blood pressure checked. Access Afya drives awareness through immersive community screening by community health volunteers guided by a mobile phone application, and quick follow-up for those with escalated pressure at Access Afya clinics. Of those screened, 14% were found to have be hypertensive and 37% were prehypertensive.
The prevalence of NCDs such as hypertension and diabetes in informal settlements is exacerbated by the poor diets high in processed / salty foods, physical inactivity, as well as increased alcohol consumption and tobacco use. Compounding these factors are cultural beliefs, taboos and misconceptions that community members have concerning hypertension.
Prevention: cheaper than the cure
As is always the case, prevention of NCDs such as hypertension is much cheaper than curing, but also more difficult. Not only is there a lack of awareness of the illness, but pre-hypertensive patients may not yet have symptoms, so encouraging lifestyle change can be challenging.
Access Afya would like to take a more holistic approach to hypertension and diabetes, expanding our NCD program to reach pre-hypertensive patients with prevention strategies such as weight loss programs. Through our data we have identified 4,313 prehypertensive patients who would benefit from a prevention program thus reducing the burden of disease to their families and the health system, but in order to develop this new arm of the program, we will need additional funding and expertise including nutritionists and healthy lifestyle management consultants.
Share knowledge, solve problems: Access Afya + MIT Solve
In spite of the challenges faced delivering healthcare in informal settlements, I’m proud that the Access Afya program is making a dent in the global NCD challenge, its end-to-end patient care enabling maximum and average blood pressures to decrease over a one-year period, moving 20% of our patients out of clinical hypertension. I have worked with Ashoka and Boehringer Ingelheim on the development of this NCD model, and we at Access Afya are open to sharing its findings globally in order for disparate knowledge sets to combine to better solve global health challenges like the rise in NCDs.
Collaboration to drive innovation is core to our ethos at Access Afya, and one reason why Access Afya was selected as part of 2019 MIT Solvers, a network of global innovators working to solve global challenges in health, learning and sustainability. Solve has supported Access Afya’s work through strategic introductions to the MIT community, its connectivity invaluable as we seek partners to help drive our ambitions in preventative applications for hypertension.
I firmly believe that it is these cross-border, cross-institution collaborations that will bring about the patient awareness and healthcare innovation required to better combat the rising pressure of hypertension and NCDs worldwide. So today, spare a thought for World Hypertension Day, consider how you could contribute to the effort to reduce NCDs... and take a moment to get your blood pressure checked!
Learn more at www.accessafya.com
Reference
Rossier, C., Soura, A. B., Duthé, G., & Findley, S. (2014). Non-Communicable Disease Mortality and Risk Factors in Formal and Informal Neighborhoods, Ouagadougou, Burkina Faso: Evidence from a Health and Demographic Surveillance System. PloS one, 9(12), e113780. doi:10.1371/journal.pone.0113780
Van de Vijver, Steven et al. “Cardiovascular prevention model from Kenyan slums to migrants in the Netherlands.” Globalization and health vol. 11 11. 7 Mar. 2015, doi:10.1186/s12992-015-0095-y