7th Call - Professor Ama de-graft Aikins

Project Title: Developing Community-Based Cardiovascular Disease Care in Ghana: A Therapeutic Lifestyle Approach to Hypertension Management in Ga Mashie, Accra

Principal Investigator: Prof. Ama de-graft Aikins (Centre for Social Policy Studies)

Email Address: adaikins@ug.edu.gh/ amaikns@gmail.com

Award Amount: GHC 59,955.00

Project Status: On-going

Summary:

The proposed project aims to develop a model for sustainable secondary cardiovascular disease prevention in Ghana by piloting and evaluating a therapeutic lifestyle approach for hypertension management in two poor urban communities in Accra. In Ghana, chronic non-communicable diseases (NCDs) have become major causes of disability and death. Hypertension and cardiovascular diseases (CVDs) take a significant proportion of this NCD burden. Urban hypertension prevalence is 32.3%, while rural prevalence is 27% (Agyemang, 2006). In contrast HIV prevalence is 1.8%. Prevalence rates of major risk factors for NCDs – especially poor diets, overweight/obesity physical inactivity, and alcohol over-consumption - are high. Hypertension is the fifth commonest cause of outpatient morbidity nationally. In the Greater Accra Region, hypertension was the second cause of outpatient mortality in 2007. The Ghanaian NCD burden reflects the Sub-Saharan African situation. While infectious diseases still account for at least 69% of deaths, age specific mortality rates from chronic diseases as a whole are higher in sub-Saharan Africa than virtually all other regions of the world (Young et al, 2009). There is significant unmet need for the prevention, treatment and care of hypertension. Ghana’s healthcare system struggles to cope with a double burden of infectious and chronic diseases. As a result health professionals are poorly trained in NCD diagnosis and management and lack appropriate knowledge and skills (Amoah, 2001; de-Graft Aikins et al, 2010). Health facilities lack the appropriate equipment for diagnosis, monitoring and treatment. Medicines are either expensive or unavailable. Competitive traditional medicine and faith healing systems offer unregulated chronic disease care to both urban and rural communities (de-Graft Aikins, 2002; de-Graft Aikins et al, 2010). Lay and patient knowledge of NCDs is poor. Community-based prevalence surveys consistently show that up to 70% of individuals living with hypertension or diabetes do not know they have these conditions (Bosu, 2012). This leads to late presentations at medical facilities, healer -shopping (between biomedicine, ethnomedicine and faith healing) and poor self-care. This interplay of factors is implicated in high morbidity and mortality rates. At the Korle-Bu Teaching Hospital the proportionate mortality for hypertension and its associated complications such as stroke is around 15% and most of the CVD deaths occur in the productive age group between 40 and 60yrs (autopsy series, 1990 – 2000; Sanuade et al, In Press). At Komfo Anokye Teaching Hospital (KATH), in Kumasi, 43.2% of individuals admitted with stroke between 2006 and 2007 died within one month (Agyemang et al, 2012). Current global, regional and national recommendations place emphasis on primary prevention (preventing NCDs in lay healthy populations) and secondary prevention (preventing complications and premature death among individuals with NCDs). The challenge in Ghana and the sub-Saharan African Region is to develop prevention models that are practical, sustainable and cost-effective. This project aims to address the challenge of developing secondary prevention models for hypertension in two urban poor communities in Accra. The project team aims to build on their existing work on CVD in urban poor communities – a theoretically significant group – to develop a scientifically tested therapeutic lifestyle approach that can be evaluated and scaled up at national level. Three secondary objectives are: (1) to train community health workers to provide the intervention and to improve their overall CVD care skills in the community by applying a task-shifting model; (2) train 3 postgraduate students (1 PhD and 2 MA) in population health and health policy through their attachment to the project as research assistants and supervisees of the project investigators; and (3) engage actively with the health service and health policy communities by involving key NCD experts in the development, implementation and evaluation of the project.