Community-based screening for cardiovascular risk using a novel mHealth tool in rural Kenya

J Innov Health Inform. 2018 Oct 31;25(3):176-182. doi: 10.14236/jhi.v25i3.1012.

Abstract

Background: An increasing burden of cardiovascular disease (CVD) in low-resource settings demands innovative public health approaches.

Objectives: To design and test a novel mHealth tool for use by community health workers (CHWs) to identify individuals at high CVD risk who would benefit from education and/or pharmacologic interventions.

Methods: We designed and implemented a novel two-way mobile phone application, "AFYACHAT," to rapidly screen for CVD risk in rural Kenya. AFYACHAT collects and stores SMS text message data entered by a CHW on a subject's age, sex, smoking, diabetes, and systolic blood pressure, and returns as SMS text message the category of 10-year CVD risk: "GREEN" (<10% 10 year risk of cardiovascular event), "YELLOW" (10 to <20%), "orange"(20 to <30%), or "RED" (≥30%). CHWs were equipped and trained to use an automated blood pressure device and the mHealth tool.

Results: Five CHWs screened 2,865 subjects in remote rural communities in Kenya over a 22 month period (2015-17). The median age of subjects was 50 (IQR 43 to 60) and 1581 (55%) were female. Point prevalence of hypertension (systolic blood pressure>140mmHg), diabetes, and tobacco use were 23%, 3.2%, and 22%, respectively. Overall, the 10-year risk of CVD among patients was <10% in 2778 (97%) patients, 10 to <20% in 65 (2.3%), 20 to <30% in 12 (0.4%), and ≥30% in 10 (0.2%).

Conclusion: We have developed a mHealth tool that can be used by CHWs to screen for CVD risk factors, demonstrating proof-of-concept in rural Kenya.

Keywords: Africa; cardiovascular disease; mHealth.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / epidemiology*
  • Community Health Workers / organization & administration*
  • Developing Countries*
  • Diabetes Mellitus / epidemiology
  • Female
  • Humans
  • Hypertension / epidemiology
  • Kenya / epidemiology
  • Male
  • Middle Aged
  • Risk Factors
  • Rural Health Services / organization & administration*
  • Sex Factors
  • Smoking / epidemiology
  • Telemedicine / organization & administration*
  • Text Messaging