Strengthening primary care systems for prevention & control of cardiovascular diseases in Kenya: feasibility study of health kiosks in markets

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Non-communicable diseases (NCDs), including cardiovascular diseases (CVD) and type 2 diabetes, are a major challenge to healthcare. NCD-risk factors include raised blood pressure, diabetes, high cholesterol, smoking, and obesity. In Kenya, CVDs are the leading cause of NCD-mortality. Rising CVD-related mortality is related to ageing populations, urbanization, lifestyle changes such as unhealthy diets, lack of exercise, alcohol consumption, smoking and other environmental and social factors. The effect of these factors on health are worse in poor communities and health systems face growing challenges meeting the needs of those affected. Lack of access to health systems (e.g. primary care centres) is problematic in low-middle income countries such as Kenya. Sustainable, community-based initiatives that interface with health systems may offer a unique route to address lack of access. There is a scarcity of these initiatives, particularly in resource poor areas. Community markets are social establishments with untapped potential to promote public health messages and interventions for CVD. The Kenya Medical Research Institute (KEMRI), in collaboration with University of Nairobi, Moi University, Strathmore University and King's College London, will investigate whether Health Kiosks, manned by community health workers (CHWs) and nurses, in community markets can support prevention and management of CVD.The study will take place in Vihiga County, which faces a shortage of physicians and nurses and the challenge of providing high quality care. We will work with the county's local market traders to identify local champions to promote use of the kiosks. CHWs will be trained to conduct simple tests to assess CVD risk such as measuring blood pressure, weight, encourage people to take medication as prescribed, follow prescribed treatments and attend clinic appointments, and support behaviour change for more active lifestyle such as providing exercise plans. CHWs will be supervised by nurses who will provide feedback, probable 'diagnosis' and make referrals. Market champions will promote kiosk engagement in the community.We will also gather information on health outcomes, which together with the other findings from this study will help us plan future large-scale studies of the effectiveness of nurse and CHW-led Health Kiosks in local markets. We will conduct real-time evaluation to look at how the intervention works and for whom. If successful, the research will support guidance on how the Kenyan health system and communities can work together to combat NCDs. Transformation of the current health systems in this way will reach more vulnerable people than through the current model by providing accessible and regular health advice and support in the local community. If successful it will result in significant social and economic benefits by reducing health care costs and preventing morbidity and premature death from CVD.