Cardiovascular disease prevention in rural Nigeria in the context of a community based health insurance scheme: QUality Improvement Cardiovascular care Kwara-I (QUICK-I)
1 Dept of Global Health, Academic Medical Center, University of Amsterdam, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
2 Dept of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
3 Depts of Internal and Vascular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
4 Dept of Epidemiology and Community Health, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, postal code 240001, Nigeria
5 PharmAccess Foundation, 1c Raymond Njoku Street, S.W. Ikoyi, Lagos, Nigeria
6 Institute for Medical Technology Assessment, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, The Netherlands
7 Dept of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
8 PharmAccess Foundation, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
9 Dept of Cardiology, Lagoon Hospitals, 8 Marine Road, Apapa, Lagos, Nigeria
10 Hygeia Nigeria Ltd, 13B Idejo Street, Victoria Island, Lagos, Nigeria
11 Ogo Oluwa Hospital, 64/65 Ahmadu Bello Way, Bacita, Kwara State, Nigeria
12 Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, Ho Chi Min City, District 5, Vietnam
BMC Public Health 2011, 11:186 doi:10.1186/1471-2458-11-186Published: 25 March 2011
Cardiovascular diseases (CVD) are a leading contributor to the burden of disease in low- and middle-income countries. Guidelines for CVD prevention care in low resource settings have been developed but little information is available on strategies to implement this care. A community health insurance program might be used to improve patients' access to care. The operational research project "QUality Improvement Cardiovascular care Kwara - I (QUICK-I)" aims to assess the feasibility of CVD prevention care in rural Nigeria, according to international guidelines, in the context of a community based health insurance scheme.
Design: prospective observational hospital based cohort study.
Setting: a primary health care centre in rural Nigeria.
Study population: 300 patients at risk for development of CVD (patients with hypertension, diabetes, renal disease or established CVD) who are enrolled in the Hygeia Community Health Plan.
Measurements: demographic and socio- economic data, physical and laboratory examination, CVD risk profile including screening for target organ damage. Measurements will be done at 3 month intervals during 1 year. Direct and indirect costs of CVD prevention care will be estimated.
Outcomes: 1) The adjusted cardiovascular quality of care indicator scores based on the "United Kingdom National Health Services Quality and Outcome Framework". 2) The average costs of CVD prevention and treatment per patient per year for patients, the clinic and the insurance company. 3) The estimated net health care costs of standard CVD prevention care per quality-adjusted life year gained.
Analysis: The primary outcomes, the score on CVD quality indicators and cost data will be descriptive. The quality scores and cost data will be used to describe the feasibility of CVD prevention care according to international guidelines. A cost-effectiveness analysis will be done using a Markov model.
Results of QUICK-I can be used by policy makers and professionals who aim to implement CVD prevention programs in settings with limited resources. The context of the insurance program will provide insight in the opportunities community health insurance may offer to attain sustainable chronic disease management programs in low resource settings.
This protocol has been registered at ISRCTN, ID number: ISRCTN47894401.