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

包括心血管疾病和2型糖尿病在内的非传染性疾病是医疗保健面临的重大挑战。非传染性疾病的危险因素包括血压升高、糖尿病、高胆固醇、吸烟和肥胖。在肯尼亚，心血管疾病是导致非传染性疾病死亡的主要原因。心血管疾病相关死亡率的上升与人口老龄化、城市化、不健康饮食等生活方式的改变、缺乏锻炼、饮酒、吸烟以及其他环境和社会因素有关。这些因素对健康的影响在贫困社区更为严重，卫生系统在满足受影响人群的需求方面面临越来越大的挑战。在肯尼亚等中低收入国家，缺乏获得卫生系统（例如初级保健中心）的机会是一个问题。可持续的、以社区为基础的举措与卫生系统相结合，可能为解决缺乏获取途径的问题提供一条独特途径。这些倡议缺乏，特别是在资源贫乏地区。社区市场是具有未开发潜力的社会机构，可促进心血管疾病的公共卫生信息和干预措施。肯尼亚医学研究所（KEMRI）与内罗毕大学、莫伊大学、斯特拉斯莫尔大学和伦敦国王学院合作，将调查社区市场中由社区卫生工作者和护士管理的卫生服务站是否能够支持心血管疾病的预防和管理。这项研究将在维希加县进行，该县面临着医生和护士短缺以及提供高质量护理的挑战。我们将与该县的当地市场贸易商合作，确定当地的倡导者，以推广使用售货亭。医护人员会接受培训，以进行简单的测试来评估心血管疾病的风险，例如测量血压和体重，鼓励市民遵医嘱服药、遵医嘱治疗和到诊所就诊，以及支持市民改变生活习惯，例如提供运动计划。卫生保健员将由护士监督，护士将提供反馈、可能的“诊断”和转介。市场领军者将促进kiosk在社区中的参与。我们还将收集有关健康结果的信息，这些信息与本研究的其他发现一起，将有助于我们计划未来在当地市场上对护士和卫生工作者领导的健康服务站的有效性进行大规模研究。我们将进行实时评估，看看干预措施是如何起作用的，对谁起作用。如果取得成功，这项研究将为肯尼亚卫生系统和社区如何共同努力抗击非传染性疾病提供指导。通过这种方式对现有卫生系统进行改革，通过在当地社区提供可获得和定期的卫生咨询和支持，将比目前的模式惠及更多的弱势群体。如果成功，它将通过降低卫生保健费用和预防心血管疾病的发病率和过早死亡，产生重大的社会和经济效益。

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.