Cardiovascular Journal of Africa: Vol 26 No 5 (September/October 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015 22 AFRICA
RHEUMATIC HEART DISEASE PATIENT SUPPORT
CLUBS: THE KENYAN EXPERIENCE
Matheka Duncan*, Murgor Mellany1, Musambayi Laura1,
Armstrong Kate2, Jowi Christine1
*Machakos Level 5 Hospital, Kenya;
1University of Nairobi, Kenya
2Caring and Living as Neighbours (CLAN), Australia
Background: Rheumatic heart disease (RHD) is the most
common heart disease among children in Kenya. It is a chronic
disease that primarily affects poor populations that cannot
afford healthcare services. These patients often despair and are
lost from follow up until advanced stages of the disease, usually
resulting in high mortality rates. There is therefore an urgent
need to promote holistic healthcare in Kenya to alleviate this
burden. We hereby share our experience adapting a person-
centred support club model that has been effectively used by
CLAN (Caring and Living as Neighbours, an Australian NGO)
to improve quality of life for children and adolescents living
with a range of chronic health conditions in low-income settings
in the Asia–Pacific region.
Methods: Planning for the Kenyan RHD family support club
utilised CLAN’s rights-based, community development frame-
work for action, and focused multi-sectoral, internationally
collaborative action on five key pillars: (1) affordable access to
medicine (monthly penicillin) and equipment (echocardiogra-
phy); (2) education (of children with RHD and their families,
healthcare professionals, policy makers and the national and
international community), research and advocacy; (3) optimal
medical management (through primary, secondary and tertiary
prevention); (4) establishment and development of Kenyan
RHD family support clubs; (5) reducing financial burdens on
and promoting financial independence of families living with
RHD.
Results: Successful engagement of a broad network of nation-
al and international multi-sectoral organisations around the
Kenyan RHD support club launch of 8 March 2014 established
the Kenyan RHD community as a visual hub for ongoing
person-centred healthcare in the country. Support clubs offer
material, moral and psychological support within a cost-effec-
tive, strategic, sustainable health system-strengthening, multi-
disciplinary approach.
Conclusion: Support clubs as modelled in the Asia–Pacific
region have potential for empowering families and communities
in Kenya to engage with a broad range of partners around a
united vision of improved quality of life for children who are
living with RHD in Kenya.
CHOICE OF ANTI-HYPERTENSIVES AMONG PHYSI-
CIANS AND ITS IMPACT ON BLOOD PRESSURE
CONTROL IN NIGERIANS WITH HYPERTENSION
Mijinyawa Muhammad Sani*, Muhammad Hamza1, Saidu
Hadiza1 , Sulaiman Balarabe2
*Department of Medicine, Bayero University, Kano; and
Aminu Kano Teaching Hospital, Kano, Nigeria; msanim2000@
1Department of Medicine, Bayero University, Kano,
Nigeria
2Department of Medicine, Aminu Kano Teaching Hospital,
Kano, Nigeria
Introduction: Hypertension, if untreated or uncontrolled, leads
to damage of vital organs such as the brain, heart and the
kidneys, among others. These complications have been shown
to be severer in black Africans. The benefit of treatment has
been repeatedly demonstrated by many studies. Therefore many
guidelines have been produced by relevant bodies in differ-
ent countries in order to assist physicians in making the right
choices for blood pressure (BP) control. Most of these bodies
produce the guidelines based on the peculiarities of hyperten-
sion in their respective population. Several reports have shown
how different hypertension is in black Africans, but there is no
published guideline for its treatment in this population.
Methods: This was a survey of known hypertensives who were
on follow-up visits. Their prescriptions were assessed for drug
name, class and number. Their blood pressures at that visit were
also recorded. The prevalence of single therapy and combina-
tion therapy were determined. The percentage of BP control as
well as the prescribed drugs in each group were also obtained.
Compliance with the AHA-recommended two-drug combina-
tion was determined.
Results: Those on a single agent were 13.11%, of whom 51.16%
were controlled; 86.89% were on various combinations of two
or more drugs, of whom 31.21% had controlled BP. BP control
in those on two drugs was better than in those with more than
two drugs (p = 0.0027).
ACEIs were the commonest used drug, either as a single
agent (55.81%) or as a two-drug combination, as seen in 54.83%
of the subjects on a two-drug combination. Fourteen different
two-drug combinations were identified, with the best control
seen in an ARB + diuretic, ACEI + diuretic and CCB + diuretic.
The least control was observed in the ACEI + CCB group.
Compliance with AHA recommendation was good but 7.7%
were still in the unacceptable group, while another 7.7% were
unclassified.
Conclusion: Although there is better control in diuretic-based
combinations, fewer diuretics are used as single agents. Despite
fair compliance with AHA recommendations on drug combi-
nations, overall BP control is still a problem, which calls for a
revisit of these recommendations in African populations.
GROUP A STREPTOCOCCAL CARRIAGE IN CHILDREN
RESIDING IN AFRICAN COUNTRIES
Moloi Annesinah*, Moloi AH, Abdullahi L, Barth DD, Engel
ME
University of Cape Town, Groote Schuur Hospital, Cape Town,
South Africa;
Background: Asymptomatic children can be a major reservoir
of pharyngeal Group A Streptococcus (GAS), with reported
figures ranging from < 10% to > 20% in developing countries.