This week on PLOS TGH – we hand over to Dr Duncan Matheka and his group, for their second post on Rheumatic Heart Disease in Kenya.
Rheumatic heart disease (RHD) has been long neglected in the developing countries – yet a ‘preventable’ disease that is easy to manage only if detected early. We hereby highlight a number of multi-sectoral initiatives mainly targeted at the Kenyan communities towards combating RHD.
1. RHD Family Support Clubs
RHD Family Support Clubs are a useful way of promoting holistic RHD care in Kenya. Kenya launched the Nairobi RHD Patient Support Club on Saturday 8th March 2014 at the School of Medicine, University of Nairobi. The club has adapted a person-centred model that has been effectively used by CLAN (Caring and Living as Neighbours – an Australian NGO) to improve quality of life for children and adolescents living with a range of chronic health conditions in low-income settings in the Asia Pacific region. CLAN utilizes a rights-based, community development framework for action, and focuses multisectoral, internationally collaborative action on five key pillars:
(1) Affordable access to medicine (monthly penicillin) and equipment (echocardiography) (2) Education (of children with RHD and their families, health care professionals, policy makers and the national and international community), research and advocacy
(3) Optimal Medical Management (through primary, secondary and tertiary prevention)
(4) Establishment and development of Kenyan RHD family support clubs
(5) Reducing financial burdens on and promoting financial independence of families living with RHD.
Support clubs offer material, moral, and psychological support within a cost-effective, strategic, sustainable, health system strengthening, multi-disciplinary approach. Successful engagement of a broad network of national and international multi-sectoral organizations around the Kenyan RHD support club launch of 8th March 2014 established the Kenyan RHD Community as a visual hub for ongoing person-centred health care in the country. The many and varied stakeholders engaged around the RHD Club meeting took up roles to support and work in partnership with the RHD community over the longer term, to ensure no affected child will: go without their monthly injection of penicillin; be lost to follow-up; miss out on education due to this disease; have their life cut short because they cannot access medical services; or suffer unnecessarily because of a lack of understanding of the best ways to manage RHD. Moreover, it offers an impetus for more sustained national action to reduce the prevalence of RHD in Kenya.
Early indications suggest support clubs as modelled in the Asia Pacific region have potential for empowering families and communities in Kenya to engage with a broad range of partners around a united vision of improved quality of life for children who are living with RHD in Kenya. Moreover, the club offers the members an opportunity to advocate for their needs collectively, while encouraging and supporting each other.
2. Education and Creating awareness
Health professionals have been travelling nationally to provide talks to primary school-going children in Kenya. In one program, student education utilized innovative technology (an interactive digital module) so as to optimally engage the children and promote learning about RHD (Kozicharow et al, 2013). The module developed by WiRED international (a US-based non-profit organization working in Kenya) had simplified animated presentations linking sore throat, rheumatic fever, and RHD, as well as prevention strategies. The module also introduced questions throughout the presentations to students and provided instant feedback to reinforce key concepts. WiRED promotes the vision that educating children at an early age has long-term benefits, because most children will retain key messages as they grow older, and pass the messages on to their families and peers during school holidays (Céspedes et al., 2013, Kozicharow et al, 2013). Teachers are also targeted during the training sessions so that they can act as reference points for the students who are in constant contact with them.
In Kenya, the Kenyan Heart National Foundation has also used its School-based ‘Talking Walls’ campaign to educate school-going children on prevention and control of RHD (Kenyan Heart website).
3. Screening and early diagnosis
Mater Hospital in Nairobi, Kenya runs a school-based rheumatic fever and RHD prevention outreach program which offers diagnostic, preventive, educational and curative services to primary and secondary school children in various parts of the country (Jowi, 2012).
4. Advocacy and Streamlining Healthcare Infrastructure
As part of Non-Communicable Disease (NCD) prevention and care activities in Kenya, the Kenyan Ministry of Health (MOH) in collaboration with World Health Organization (WHO), World Heart Federation and NCD Alliance Kenya (NCDAK), is holding a stakeholders forum to work out best modalities of incorporating RHD within healthcare services in Kenya. The purpose of holding this forum is to increase awareness of the continuing burden of RHD and the need to specifically include RHD prevention and control as part of broader NCD initiatives. RHD prevention and control needs specific initiatives not addressed in the common risk factors approach by global and Kenyan NCD action plans, nor the current Kenyan National Health Sector Strategic plan.
5. Opportunity with healthcare decentralization
Kenya is currently undergoing decentralization of government functions, including healthcare, which means that there is a renewed opportunity to integrate RHD care into other regions of the country and build an overall healthier Kenya. As 47 counties of Kenya absorb the healthcare mandate, it is expected that greater community involvement will result in tailored healthcare for each region. Devolution will facilitate more straight-forward avenues for advocacy on NCDs at the county-level, as the decision-makers in government will be more localized and have so far demonstrated themselves as easier to communicate with. County health policymakers are usually also native to the communities that they serve and have a more vested interest in improved health outcomes in their designated regions, than the previous national level decision-makers – hence more community involvement, empowerment and development.
6. Role of multi-sectoral partnerships
For both healthcare devolution and expanded care for RHD, there is a push to build private-public partnerships. Both public and private healthcare providers must have a seat at the policy table and work together, as multi-sectoral action will have the biggest impact within communities. Yet, the need to safeguard public health (using a rights-based approach) must be emphasized and the terms of such partnerships critically evaluated and monitored. For instance, the World Heart Federation is partnering with Kenyan organizations (Kenyan Heart National Foundation, Kenya Cardiac Society, etc) to streamline healthcare provision for RHD patients.
In conclusion, besides the foregoing, there is need for more initiatives to combat RHD in Kenya by increasing community awareness and involvement and ensuring better healthcare infrastructure – thus promoting primary and secondary prevention of rheumatic fever and RHD.
- Kozicharow A, Ghuman S. Rheumatic heart disease project in Kenya tests WiRED training program. Available from: http://www.wiredinternational.org/kenya/kenya_RHDprojectTestsWiRED.html [cited 22 October 2013].
- Céspedes J, Briceño G, Farkouh ME, Vedanthan R, Baxter J, Leal M, et al. Targeting preschool children to promote cardiovascular health: cluster randomized trial. Am J Med 2013; 126: 27–35.
- Kenyan Heart Website: http://www.kenyanheart.or.ke/talkingWalls.html
- Jowi Christine Awuor. 2012. “African Experiences of Humanitarian Cardiovascular Medicine: A Kenyan Perspective.” Cardiovascular Diagnosis and Therapy 2 (3): 231–39. doi:10.3978/j.issn.2223-3652.2012.07.04.
Dr. Duncan M. Matheka is a Kenyan Medical Doctor and Public Health Researcher. He is the African Representative of Young Professionals Chronic Disease Network (YPCDN) and the Nairobi RHD Club Coordinator. Twitter @duncoh1
Dr. Laura Musambayi is a Kenyan Medical Doctor and the Nairobi RHD Club Assistant Coordinator.
Mohamed A. Omar is a fourth year medical student at the University of Nairobi, Kenya.
Dr Kate Armstrong is the Founder and President of CLAN (Caring & Living As Neighbours) and the Executive Secretary of NCD Child (a global coalition committed to integrating children and adolescents within the global NCD, health and development discourse). Twitter @ncdchild