Heart Disease project piloted in two sites

Despite awareness that hypertension, stroke and diabetes are significant public health problems in Ghana, prevention and care services for these heart-related  diseases, also known as cardiovascular diseases (CVDs) are not widely available.
The WHO estimates that in 2008, 36.4 per cent of Ghanaians were hypertensive and 36.4 per cent were either overweight or obese.

In 2009, a non-profit human development organisation, FHI 360, in partnership with the Ministry of Health (MoH) and the Ghana Police Service, launched a pilot project to determine the prevalence of CVDs and associated risk factors in two communities.

The project was implemented in the Police Hospital, an urban tertiary hospital for surrounding communities in Accra, and Atua Hospital, a district hospital serving a semi-rural community.

The two sites serve as catchment areas for about 25,000 people.

Other objectives of the project were to strengthen the capacity of the facilities to manage CVDs, initiate facility and community-based primary and secondary prevention activities and engage policy makers in the primary prevention of CVDs and non-communicable diseases (NCDs) in general.

Risk factors assessment

The pilot project took off with an assessment of biological and behavioural NCDs’ risk factors within the pilot communities and a baseline health facility assessment to assess the preparedness of the two hospitals to provide CVDs’ preventive services.

The survey demonstrated a high level of NCD risk in the pilot communities. Thirty-three per cent of men and 57 per cent of women, survey of 2,400 adults studied, were either overweight or obese and 32.8 per cent of adults (18-65+yrs) had elevated blood pressure rising up to 55 per cent in the 46-60 year age group.

The facility assessment showed that most staff had not received adequate training or did not have the requisite skills to provide optimal CVD services. Basic equipment such as electronic blood pressure apparatus, electrocardiogram machine, weight and height measuring devices were either not in proper working condition or missing altogether.

As a result, the facilities did not have the capacity to identify CVD risk factors. Lastly, standard operating procedures, guidelines, job aids and client education materials were not available.

Based on the results of the assessment, FHI 360 provided the two hospitals with basic equipment to support CVD screening. These included electronic blood pressure apparatus, weight and height measuring devices and electrocardiogram machine.

In addition, 60 providers, including doctors, nurses, pharmacists, nutritionists, technicians and biomedical scientists, received training in primary and secondary prevention of CVDs.

CVD screening at OPD

At a seminar to disseminate the results of the first phase of the pilot project in Accra recently, Ms Olivia Aglah-Dotse, CVD Project Coordinator of FHI 360, said screening for heart-related diseases actively started in mid-August 2011.

“Approximately, 400 clients accessing outpatient services at the sites are screened for CVD risk factors every week,” adding that counselling and health education on healthy eating and lifestyle are provided alongside the screening.

Ms Aglah-Dotse said clients with elevated risks were prescribed anti-hypertensive medications and underwent an echocardiogram, if indicated.

“Between August 2011 and September 2012, over 16,000 clients were screened in Atua and Police hospitals. Preliminary results indicated that in Atua Hospital, 22 per cent of those screened were pre-hypertensive and 33 per cent were hypertensive. In the Police Hospital, 42 per cent of clients were pre-hypertensive and 32 per cent were hypertensive.” she stated.

Community- based campaign

The screening was followed by a community-based behaviour change campaign to promote healthy lifestyles.

The campaign, which had the  slogan “From your heart to theirs,” focused on the education of female heads of households  who were the primary decision makers on what the family consumed, as well as determining their health seeking behaviour.

Ms Aglah-Dotse said a key activity of the project was the promotion of physical activity within the project communities through music, dancing and group aerobics instruction from a professional trainer and educational activities.

Furthermore, clients screened for CVD risk factors are sent SMS  on healthy living and those identified at risk for CVD or who are currently being treated for CVD are also sent SMS as appointment reminders and treatment adherence support.

“Over 1200 clients have provided cell phone numbers to facilitate this project,” Ms Aglah-Dotse indicated.

Second phase

Ms Aglah-Dotse said as part of the second phase of the project, an Adult Health Card had been developed in order to enhance client NCD awareness, ownership in health monitoring and healthy living.

“All clients with an NCD risk factor will receive an adult health record which the client will retain.  The record will track an individual’s biomedical NCD risk factors- blood pressure, cholesterol level, BMI and blood sugar level over a ten year span, and includes healthy living messages,” she added.

The Country Director of FHI 360, Dr Henry N. Nagai, also said the MOH and the Police Service were interested in eventually scaling up the programme to other parts of the country.

He said during the next phase, licensed chemical sellers would be engaged and trained to dispense prescribed medication and educate patients on treatment adherence, monitor the use of CVD drugs in the communities, offer blood pressure and BMI screening and enter screening data into Adult Health Cards.

Retired nurses would also be recruited to provide CVD prevention and early detection services in the communities and to also phone clients to counsel them.

By Rosemary Ardayfio/Daily Graphic/Ghana