Chronic Disease Prevention and Control in Rural Nigeria Using Virtual Management Strategies

Alison Rodriguez MPH, RN

Chronic health diseases such as diabetes mellitus (DM) and hypertension (HTN) affect over two billion individuals worldwide.1,2 HTN and DM contribute to the top ten leading causes of death globally.3 These problems are amplified in low income rural communities where access to health care is limited. In Nigeria, the prevalence of HTN and DM is estimated to be at 43% and 8.5% respectively.4 Individuals living in rural communities are at increased risk due to limited access to resources and interventions that can aid in the control of these chronic diseases. Without appropriate interventions to control and prevent DM and HTN, this population is at risk for health disparities, preventable disabilities, and deaths.

In 2013 the Clifford O. Imudia Memorial Foundation (COIMF) conducted its first medical mission trip to in the community of Oza-Nogogo. The prevalence of HTN was observed at an alarming level. Over a two-day period, just under 1,000 patients were triaged and treated. All patients seeking treatment during the mission trip had their blood pressure and blood glucose values screened. While the blood glucose levels proved to be below average for the country, the blood pressure rates were significantly higher. The prevalence was observed at 51.6% of the population screened with values consistent with stage one and two HTN. An additional 28% of the population screened were found to have pre-hypertensive values. This leaves a mere 20.4% of the population screened with normal blood pressure. This mission trip also revealed that 12.5% of the individuals found to have blood pressure readings in the pre-hypertensive or HTN range identified as having a history of HTN. Three percent of this population reported they were currently taking medication to treat their HTN. None of the patients who reported taking medication for HTN had a normal value and .75% were found to have a blood pressure value in the pre-hypertensive range. Although the rate of DM was lower than the national average, the rate of control was similar to what was observed with HTN. Two percent of those screened reported being previously told that they have DM. Of this population, three individuals reported actively taking medication to control their DM; all of which failed to have controlled blood glucose levels at screening.
One must ask why these rates are so much higher than national and global averages. Access to health care, cost of health care, and health awareness and education are three barriers this community faces. These barriers mirror what studies across Nigeria have found as barriers hindering the awareness, treatment, and control of HTN and DM.

Determining ways to improve awareness of HTN and DM is the first step to mitigating the risk of these chronic diseases within the population. COIMF currently works with the local community of Oza-Nogogo to promote the health of the community through biennial mission trips. While these trips prove to be beneficial, many members of this community lack the access to health care, screening, health education, and medications in-between mission trips. To expand the positive impact on health outcomes, Non-Government Organizations (NGOs) like COIMF must find a way to promote continuous intervention.

NGOs like COIMF can work with local communities to create sustainable programs that spread awareness, prevention, and treatment efforts. To promote sustainability of such programs, virtual management strategies can be integrated into program plans. Thus, broadening the scope of individuals a NGO can reach. Developing a program plan with integrated virtual oversight can allow a NGO based in the United States the ability to have a continuous and sustainable impact on a remote community. Such efforts are only possible with local partnerships and volunteers to facilitate the program. Limitations will be faced, like many rural communities Oza-Nogogo has limited access to electricity, internet, and basic technologies that are relied on heavily in the United States. Program planning must work around these limitations and design record keeping systems that can be used both on and offline.

Such a program could be used as a model to develop medical outreach programs in other remote locations globally. The intent of the program directly aligns with the essential public health services with a focus on assessing, policy development, and assurance. The use of virtual management strategies allows a NGO the ability to assist and be present in a community without always having a physical presence. Additionally, interventions such as these help enable a community to sustain these programs with the assistance and oversight of a NGO. Thus directly improving health care access and education while continually assessing the health of a community and evaluating the effectiveness of the intervention. The development of program plans such as this, are vital contributions to public health goals to minimize health disparities and deaths caused by chronic diseases.

REFERENCES

1. World Health Organization. Diabetes. http://www.who.int/mediacentre/factsheets/fs312/en/. Accessed November 20, 2016.

2. World Health Organization. Hypertension. http://www.who.int/topics/hypertension/en/. Accessed November 20, 2016.

3. World Health Organization. The top 10 causes of death. http://www.who.int/mediacentre/factsheets/fs310/en/. Accessed November 20, 2016.

4. World Health Organization. Non-communicable Diseases Country Profile 2011.
http://apps.who.int/iris/bitstream/10665/44704/1/9789241502283_eng.pdf. Accessed September 24, 2016.