By Felix Achanda
Cardiovascular diseases (CVDs) contribute to 25 percent of hospital admissions and are the second largest killer in the country with 13 percent fatalities, a Ministry of Health report shows.
To manage and improve outcomes, the ministry rolled out the Kenya National Guidelines for Cardiovascular Diseases Management, saying lack of guidelines may have hindered effective treatment.
“Lack of standards may have enabled an environment for error and poor coordination in the provision of services as healthcare providers relied on information from outside our borders,” said Dr. Loise Nyanjau, a CVDs officer at MOH.
According to Dr. Joseph Kibachio, head of the Division of Non-Communicable Diseases, the guidelines provide a big milestone in the management of CVDs in the country.
He urged all health workers and partners to adopt and implement the guidelines as the country strives towards halting and reversing the burden of CVDs.
CVDs are infections that affect the circulatory system. In advanced stages those diseases are hard to manage thus the ministry emphasizes on prevention and proper medication.
“CVDs are highly preventable. Avoidance of health risks such as tobacco use and adherence to proper diabetes and hypertension treatment can avert the vast majority of CVDs experienced today,” said Nyanjau.
The guidelines are divided into four stages.
Tier one, which targets the entire population with the aim to prevent/lower CVDs risk factors, says that community health volunteers who are the core resource persons at this level are to be well trained and provided with kits designed to assess CVDs risk factors.
The kits should include blood pressure machine, glucometer and strips, weighing scale, tape measure waist charts and body mass index (BMI) charts.
The guidelines also notes that community extension workers should be trained in CVDs matters in order to coordinate the management of the diseases at this stage.
CVDs risk can be highly reduced with early detection and prompt treatment.
CVDs risk factors such as hypertension, diabetes and already established diseases need early detection and management using drugs as appropriate,” reads part of the guidelines.
The health personnel involved at this stage should do a public awareness campaign on CVDs risk management, offer screening for the diseases risk factors and provide lifestyle interventions such as tobacco cessation, encourage people to take healthy diets and partake in physical exercises for those found to be high or already having CVDs risks.
Tier two targets people with one or more CVDs risk factors with the aim of preventing the risks from leading to development of CVDs. Health personnel at this level should carry out CVDs risk assessment tests including blood pressure levels, BMI, urinalysis and total cholesterol management.
“Majority of the risk factors of CVDs lead to atheroscleous, which is the narrowing and thickening of arteries which is caused by deposition of fatty material, cholesterol and other substances in the walls of the vessels which in turn leads to reduction of blood flow to end organs such as the heart, brain, kidneys and limbs,” read part of the guideline.
Health staff at this stage should also offer counselling on the disease risk factors and if they have patients with high risks of contacting CVDs or those already with the disease they should refer them to specialist health facilities.
The directive identified coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic fever, congential heart disease and venous thrombo-embolism as high burden CVDs. High pretension is revealed as the biggest risk factor in the development of CVDs by the guideline.
Hypertension is a medical condition on which blood pressure levels are persistently elevated and if it’s not detected and treatment commences early may lead one to suffer from stroke, coronary heart disease, chronic kidney failure and death.
Diagnosis of hypertension is subject to correct measurement of blood pressure. Once the condition is detected it can be managed by adequate control of blood pressure and the control of other risk factors such as use of narcotics, obesity, high dietary salt, stress, heavy alcohol consumption and tobacco use.
Late detection of diseases hampers the fight against CVDs.
“Low levels of early detection results in majority of patients unknowingly developing the disease and being detected at advanced stages where treatment is expensive, highly specialized and usually disabling,” said Dr Nyanjau.
She also pointed out that although several hospitals had established cardiac units within their premises, a lack of specialized personnel made it hard to properly manage the diseases.
Tier three and four targets people with early stages and those with advanced stages of the diseases, with the aim of preventing CVDs progression, recurrence and reducing complications or disabilities.
Medics should provide in-depth analysis of CVDs and offer expertise treatment. When dealing with Rheumatic Heart Disease (RHD), the most commonly acquired disease in developed countries, the ministry notes that accurate diagnosis of the disease is important. Diagnosis depends on detecting myocardis, pericarditis and valve regurgitation.
Over diagnosis (making people patients unnecessarily by identifying problems that were never going to cause harm) of RHD will lead to unnecessary treatment over a long time while under diagnosis (failure to recognize or correctly diagonise a disease) leads to further RHD attacks, cardiac damage and premature death.
In a move to aid early detection of CVDs risk factors and CVDs the ministry recommends community healthy volunteers to be trained on the use of blood pressure machine, glucomenter and strips, weighing scale, tape measure, waist/hip charts and body mass index charts.
Community health extension workers are to be trained on the CVDs and given the mandate to coordinate the fight against those diseases in their various regions.