Cardiovascular prevention model from Kenyan slums to migrants in the Netherlands

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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-015-0095-y) contains supplementary material, which is available to authorized users.

Community-Based Healthcare for Migrants and Refugees: A Scoping Literature Review of Best Practices

“…Studies were conducted from 2012 to 2017 (12/13) in the USA (5/13), Europe (2/13), multiple countries (2/13), Canada, Australia, Middle East, and Latin America [100][101][102][103][104][105][106][107][108][109][110][111][112]. Target populations pertained to immigrants (mostly women of various descents), refugees, migrants, and ethnic minorities, some of which were further defined as diabetic.…”

“…Community-based strategies for the management of the following were discussed: cancer screening [100][101][102][103][104], diabetes mellitus [99,[105][106][107][108], cardiovascular disease prevention [109,110], and other chronic diseases [111,112]. Cancer-mostly breast cancer-prevention tools involved culturally tailored, narrative educational videos [100], pictograph-enhanced instructions [102], and patient-centered strategies [103,104].…”

“…Core elements of the described practices are culturally and linguistically sensitive education [103,104,109,112], involvement and support of the migrant communities' infrastructures [110], awareness-raising about health risks [101], outreach approaches through families and community peers [101,105,111], facilitating the "community voice", intersectional collaboration, and funding [101].…”

Review of the reverse innovation series in globalization and health – where are we and what else is needed?

“…First, researchers have contributed examples of high value innovative practice in LICs that HIC health systems would benefit from adopting whether due to their improved effectiveness, access, cost or quality of care. Examples include community engagement strategies [4], cardiovascular protection interventions [5], reflecting on the epistemological roots of social epidemiology [6], novel and effective hospital accreditation systems [7], leveraging families to ensure person centredness in healthcare [8], task-shifting to community health workers at scale [9] and high-value opportunities in frugal surgical innovations [10]. For many, these are paradigmatic shifts in approaches to care, others are simple interventions that the reflexive practitioner would recognise as common sense.…”

Poliovirus Receptor: More than a simple viral receptor

“…In 2015, there were fewer than 100 reported cases of poliomyelitis with only two countries, Afghanistan and Pakistan, reporting endemic transmission (Cochi et al, 2016). Although political instability has limited full vaccination efforts, it is a strong possibility that wild-type poliovirus transmission could be eradicated within the next decade (Cochi et al, 2016; Kennedy et al, 2015). …”