Feasibility and quality of cardiovascular disease prevention within a community-based health insurance program in rural Nigeria: an operational cohort study.
OBJECTIVE
To assess the feasibility of providing guideline-based cardiovascular disease (CVD) prevention care within the context of a community-based health insurance program (CBHI) in rural Nigeria.


METHODS
A prospective operational cohort study was conducted in a primary healthcare clinic in rural Nigeria, participating in a CBHI program. The insurance program provided access to care and improved the quality of the clinics participating in the program, including CVD prevention guideline implementation. Insured adults at risk of CVD were consecutively included upon clinic attendance. The primary outcome was quality of care determined by scoring of quality indicators on patient files of the cohort, 1.5 year after guideline implementation.


RESULTS
Of the 368 screened patients, 349 were included and 323 (93%) completed 1 year of follow-up. The majority of patients (331, 95%) had hypertension. Process indicators showed that 114/115 (99%) new hypertension cases had a record of CVD risk assessment and 249/333 (75%) eligible cases a record of lifestyle advice. Outcome indicators showed that in 292/328 (64%) hypertension cases, blood pressure was on target. Barriers to care included limited human resources, limited affordability of diagnostic tests and multidrug regimes for the healthcare provider, frequent doctor's appointments, and inefficient drug supplies.


CONCLUSIONS
Implementation of CVD prevention care within the context of a CBHI program resulted in high-quality care in rural sub-Saharan Africa, comparable to high-income countries. However, guideline implementation was resource-intense and specific recommendations were not feasible. Simple models of care delivery are needed for rapid scale-up of CVD prevention services in sub-Saharan Africa.
aDepartment of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands bDepartment of Epidemiology and Community Health, University of Ilorin Teaching Hospital, Ilorin, Nigeria cDepartments of Internal and Vascular Medicine dDepartment of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands eHygeia Nigeria Ltd, Lagos, Nigeria fOgo Oluwa Hospital, Bacita, Kwara State, Nigeria *Deceased.
Marleen E
ME
Hendriks
Oladimeji A
OA
Bolarinwa
Ferdinand W N W
FW
Wit
Lizzy M
LM
Brewster
Aina O
AO
Odusola
Nicole T A
NT
Rosendaal
Navin R
NR
Bindraban
Peju
P
Adenusi
Kayode
K
Agbede
Joep M A
JM
Lange
Tanimola M
TM
Akande
Constance
C
Schultsz
D017954:Africa South of the Sahara; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D015331:Cohort Studies; D003153:Community Health Services / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006293:Health Promotion; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000628:therapy; D007348:Insurance, Health; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011634:Public Health; D012307:Risk Factors; D012424:Rural Population