Telemedicine is an effective way to manage cardiovascular disease in rural Kenya and to achieve universal healthcare
Authors: Kamotho C.G , Bukachi F 
Published: November 2020

Abstract

Background
Africa faces a growing burden of communicable and non-communicable diseases (NCDs). Innovative health tech companies are on the rise in Africa, but to be truly effective they need to cover the patient journey and to involve key stakeholders in the health ecosystem.

Purpose
To prove that Digital Health could enable rural folk to consult a doctor conveniently, to control NCDs and to access affordable, quality drugs, all part of Universal Healthcare.

Methods
This was a longitudinal, interventional, comparative study based at a community hospital in Murang'a County. The centre lacks doctors but the local paramedics and nurses carried out initial assessments. Doctors and specialists in Kiambu County were consulted online using the Daktari Africa telemedicine platform, which has regulatory approval and received various awards. Blood pressure and sugar levels were recorded on individual patient profiles.

Results
121 consultations were made between January and October 2019: 81 were online (the “Cases”), and 40 were interviewed there who had been seen in the usual way by the local staff (the “Controls”). Of the 81 case consultations, 72 were unique patients, seven were seen twice online, and two were seen three times. Of the Cases 60 (83.3%) were female and 12 (16.6%) were male. The average age was 63 years. 44 (61.1%) were hypertensive and 8 (11.1%) were diabetic. Among the Controls, 27 (67.5%) were female and 13 (32.5%)male. Average age was 54 years. 15 (37.5%) were hypertensive and 10 (25%) diabetic. Between the Cases and the Controls, the p-values of the differences in gender and age were 0.125 and 0.054 respectively, meaning that they were essentially homogeneous. For hypertension, among the Cases the average initial BP was 145/85 mmHg, the average final BP (in a subsequent check) was 143/89 mmHg. The average drop in BP in the Case group was 15.17/8.83 mmHg. In the Control group the average initial BP was 150/91 mmHg, the average final was 147/92 mmHg. The average drop in BP was 3.4/-0.4 mmHg. The difference in drop in BP between the two groups of patients was significant for the systolic BP (p-value = 0.048), but not for the diastolic (p-value = 0.534). While all diabetic Cases were recommended to have HbA1c tests, only 2 (2.5%) managed to. None (0%) of the Controls had HbA1c. (The local laboratories are limited.) The consulting doctors held two live, educative webinars on diabetes for the local paramedics using the same telemedicine platform. And a partnership was entered into with a Kenyan drug manufacturer to ensure access to quality but affordable medication.

Conclusions
Telemedicine is acceptable in rural African populations. Daktari Africa was effective in improving systolic blood pressure control, and was able to organize educative sessions for the local staff. Quality, affordable medication was made available to patients. These are steps towards universal healthcare.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Pfizer Global Medical Grants