title: Cardiovascular prevention model from Kenyan slums to migrants in the Netherlands.
abstract: Cardiovascular diseases (CVD) are the main cause of morbidity and mortality worldwide. As prevention and treatment of CVD often requires active screening and lifelong follow up it is a challenge for health systems both in high-income and low and middle-income countries to deliver adequate care to those in need, with efficient use of resources.We developed a health service model for primary prevention of CVD suitable for implementation in the Nairobi slums, based on best practices from public health and the private sectors. The model consists of four key intervention elements focusing on increasing awareness, incentives for promoting access to screening and treatment, and improvement of long-term adherence to prescribed medications. More than 5,000 slum dwellers aged ≥35 years and above have been screened in the study resulting in more than 1000 diagnosed with hypertension and referred to the clinic.Some marginalized groups in high-income countries like African migrants in the Netherlands also have low rates of awareness, treatment and control of hypertension as the slum population in Nairobi. The parallel between both groups is that they have a combination of risky lifestyle, are prone to chronic diseases such as hypertension, have limited knowledge about hypertension and its complications, and a tendency to stay away from clinics partly due to cultural beliefs in alternative forms of treatment, and lack of trust in health providers. Based on these similarities it was suggested by several policymakers that the model from Nairobi can be applied to other vulnerable populations such as African migrants in high-income countries. The model can be contextualized to the local situation by adapting the key steps of the model to the local settings.The involvement and support of African communities' infrastructures and health care staff is crucial, and the most important enabler for successful implementation of the model in migrant communities in high-income countries. Once these stakeholders have expressed their interest, the impact of the adapted intervention can be measured through an implementation research approach including collection of costs from health care providers' perspective and health effects in the target population, similar to the study design for Nairobi.
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya. svijver@aphrc.org.|Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands. svijver@aphrc.org.
authors.forename: Steven
authors.initials: S
authors.lastname: van de Vijver
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya. soti@aphrc.org.|Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands. soti@aphrc.org.
authors.forename: Samuel
authors.initials: S
authors.lastname: Oti
authors.affiliation: Department of Family Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. e.p.mollvancharante@amc.uva.nl.
authors.forename: Eric
authors.initials: E
authors.lastname: Moll van Charante
authors.affiliation: Department of Public Health, Deakin University, Melbourne, Australia. steven.allender@deakin.edu.au.
authors.forename: Steven
authors.initials: S
authors.lastname: Allender
authors.affiliation: Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom. Charlie.Foster@dph.ox.ac.uk.
authors.forename: Charlie
authors.initials: C
authors.lastname: Foster
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya. j.lange@aighd.org.
authors.forename: Joep
authors.initials: J
authors.lastname: Lange
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia. brian.oldenburg@monash.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Oldenburg
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya. ckyobutungi@aphrc.org.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kyobutungi
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. c.o.agyemang@amc.uva.nl.
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
mesh_terms: D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000517:prevention & control*; D006801:Humans; D007630:Kenya / Q000208:ethnology; D008962:Models, Theoretical; D009426:Netherlands; D011204:Poverty Areas; D014171:Transients and Migrants