High blood pressure + low awareness = 10 million deaths, every year
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, the issue of hypertension rarely grabs headlines.
World Hypertension Day is a moment in time which can perhaps shine a light on this noncommunicable disease (NCD), including some of the efforts underway in countries increasingly burdened by the burgeoning rate of NCDs.
Access Afya is the primary health innovation company I founded in 2012 to provide an end-to-end model for primary care tailored for urban informal settlements. Akiba ya Roho, which means ‘save your heart’ in Swahili, is a co-creation product of Access Afya and Boehringer Ingelheim. Together, we are creating NCD centers of excellence across Kenya. Our model combines 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 what is found in established market economies. Akiba ya Roho is attempting to solve an incredibly complex healthcare 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 with more deaths attributed to NCDs than to communicable diseases. In Kenya, more than 13 percent of cause-specific deaths are attributed to cardiovascular diseases.
Despite the impact 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
61 percent of urban Africans live in slums, and research taken in a Kenyan slum showed that residents had limited knowledge about hypertension and its complications—and as a result, they did not seek out preventive measures. The results of this study are consistent with Access Afya’s findings: over 55 percent of our patients never had their blood pressure checked before. Of those screened, 14 percent were hypertensive and 37 percent were pre-hypertensive.
The prevalence of NCDs such as hypertension and diabetes in informal settlements is exacerbated by the poor diets high in processed and 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 it, but it’s 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 is interested in taking a more holistic approach to hypertension and diabetes and 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, 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 to source 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 by delivering healthcare in informal settlements, I’m proud that the Access Afya program is making a dent in the global NCD challenge. Our end-to-end patient care has decreased maximum and average blood pressures for patients over a one-year period, moving 20 percent 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 our findings to better solve global health challenges like the rise in NCDs.
Collaboration to drive innovation is core to our ethos at Access Afya, and Access Afya is proud to have been selected as a Solver with MIT Solve, a network of global innovators working to solve global challenges. Solve has supported Access Afya’s work through strategic introductions to the MIT community and is an invaluable connection as we seek partners to help drive our goals.
I firmly believe that these cross-border, cross-institution collaborations will bring about the patient awareness and healthcare innovation needed to combat the rising pressure of hypertension and NCDs worldwide. As we recognize World Hypertension Day, consider how you can help reduce NCDs... and take a moment to get your blood pressure checked!
Learn more at www.accessafya.com
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
Photo courtesy of Access Afya