E-DRUG: Kenya Mortality among treated NCD patients paper
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[There are other studies that indicate that women are better at adherence to medication than men. Another factor that might be worth consideration for impact on mortality is exercise. Women continue to care for family, food crops and animals, collecting water etc.. Further discussion and suggestions for people dispensing the medications would be good. BS Moderator]
Hi E-Druggers,
I am happy to share a spin off paper about mortality risk factors among NCD patients in Kenya. While not primarily about Essential Medicines, the paper arose out of the evaluation of the Novartis Access program in Kenya. (http://sites.bu.edu/evaluatingaccess-novartisaccess/)
To do this evaluation we identified individuals in eight counties of Kenya who had been diagnosed with and treated for an NCD. Half of these people lived in a county which received the Novartis Access intervention which was provision of 14 NCD medicines at reduced prices. Over the next four years, the patients were contacted regularly by phone and by two field surveys. As always happens in such cohort studies, there is loss to follow up and our partners in Kenya made a real effort to find out what had happened to the patients who were lost to follow up. Some had moved away and changed their phone number but quite a few had died. So we were able to ask the question "What were the risk factors for death among NCD patients in rural Kenya?"
So two very smart epidemiology students crunched the numbers and we were able to produce this paper with our Kenyan colleague and members of our BU evaluation team members. Some of the results are not surprising, the older patients were at higher risk. But some other results raised some questions. Although there were more women in our sample they were at lower risk of dying. I wonder if they were more adherent to taking their treatments?
Then education was protective at least when comparing patients with no education. The same was true for household income. So the question we could not answer was why did these differences exist? It may have been that poor people without education could not afford their medicines or that they were not adherent to their medicines.
The implications for people dispensing these NCD medicines are clear. Often dispensers do not make as much effort to educate or support NCD patients because the patients are often quite knowledgeable about their conditions but what this study shows is that there are differences in risk factors so paying extra attention to poorly educated men with low incomes is important.
While the intention of all of the field work was to evaluate the Novartis Access program which tuned out not to be very successful, such evaluations can generate other information that may be useful!
ASSOCIATION BETWEEN RISK FACTORS AND MORTALITY IN PATIENTS WITH NON-COMMUNICABLE DISEASES IN EIGHT KENYAN COUNTIES: AN OBSERVATIONAL COHORT STUDY
I. Chitre, A. Rede, J. Mboya, V. Wirtz, P. Rockers and R. Laing
ABSTRACT
Objectives: The risk-factors associated with deaths from Non-Communicable Diseases (NCDs) have not been studied in Kenya. The objective of this study was to identify risk factors for death among patients diagnosed and treated for hypertension, diabetes and asthma.
Design, Setting and Subjects: A total of 639 individuals diagnosed and prescribed treatment for hypertension, diabetes or asthma were identified in a representative sample in eight Kenyan counties in 2016. The individuals were followed via three-monthly phone calls until 2019. Risk factors for mortality were quantified.
Main Outcome Measure: Mortality
Results: Of the 639 individuals studied 445 had hypertension of whom 43 died (9.6%), 69 patients had diabetes of whom 11 died (15.9%) and 113 had asthma of whom 7 died (6.2%). Significant risk factors for death were older age [OR= 1.033 (1.016, 1.050) p=0.0001]. There was a reduced risk by being female [OR= 0.442 (0.260, 0.750) p= 0.0025], having primary or secondary education [OR= 0.611 (0.420, 0.887) p= 0.0097], and belonging to a higher wealth quintile [OR= 0.787 (0.649, 0.953) p= 0.0143]. Risk factors not associated with mortality for all cases included county of residence, marital status, number of NCD patients in the household or numbers of NCDs per patient.
Conclusion: The risk factors of older age, male sex, no education and low wealth have been shown to have significant associations with mortality. Clinicians managing patients with these conditions should recognize that older male patients with no education and from the poorer households have the highest risk of mortality.
Reference I. Chitre, A. Rede, J. Mboya, V. Wirtz, P. Rockers and R. Laing (2021) ASSOCIATION BETWEEN RISK FACTORS AND MORTALITY IN PATIENTS WITH NON-COMMUNICABLE DISEASES IN EIGHT KENYAN COUNTIES: AN OBSERVATIONAL COHORT STUDY East African Medical Journal Vol. 98 No. 1 January 2021 https://www.ajol.info/index.php/eamj/article/view/205315
Richard Laing
Richard Laing
Retired Professor, Department of Global Health
Boston University School of Public Health,
Tel 617 435 7860 (Mobile)
E mail richardl@bu.edu