While studying and working as a physician in Nigeria, Azuka Adeke, a Field Epidemiology and Laboratory Training Program (FELTP) fellow, heard countless stories of patients having strokes, needing multiple vascular stents, and experiencing other high-risk cardiovascular events. In witnessing these incidents firsthand and hearing about them anecdotally, he was often left wondering whether communities had the access to cardiovascular disease (CVD) care that was needed to prevent these issues before they occured.
During his formal medical training, Adeke focused much of his research and study on health care at the primary care level, believing that it was the best point for preventing the development of noncommunicable diseases (NCDs), including CVD. In 2016, when his father was diagnosed with an NCD, Adeke became even more passionate about the topic, determined to better understand issues around access and affordability of CVD care. When the call for applicants for the 2019-2020 TEPHINET CVD Small Grants was published, he saw an opportunity to pursue his research interests.
Adeke says that he felt confident in his ability to apply for and receive a TEPHINET small grant because the opportunity so closely matched the work he had been doing during his medical residency, particularly in the area of primary healthcare. His project, “Evaluation of essential medicines and technology in primary healthcare facilities in selected Local Government Areas (LGAs) of Ebonyi State, Nigeria,” aimed to assess the availability and affordability of care for hypertension at the community level. From January to July 2020, Adeke worked to assess 45 primary health care facilities in three of Ebonyi State’s Local Government Areas and interviewed 145 patients with hypertension.
His findings showed that fewer than half of the facilities had access to the antihypertensive drugs that were assessed, and a number of facilities lacked the equipment needed to screen for hypertension and other NCDs. The community health extension workers (CHEWs) that provided the majority of care at these facilities also expressed a lack of capacity to manage NCDs, citing a need for improved training that went beyond checking patient blood pressure. Of the hypertension patients he interviewed, Adeke found that none of them could afford their medications and often went for periods of time without taking them if they did not have financial support.
The COVID-19 pandemic and subsequent movement restrictions posed challenges for Adeke to conduct some of his work. Although he was granted access to his target health facilities, moving around became more expensive. Thanks to the TEPHINET small grant, however, he was able to address some of these limitations and carry out the project within its initial timeline.
Adeke’s work was recently published in PLOS One, providing him with a larger outlet for disseminating his findings. Although this is his fourth published manuscript as a primary author, it’s his first on NCDs, making it particularly meaningful. Among his recommendations, Adeke suggested a deeper review of current policies and guidelines around the role of CHEWs in the management of hypertension, as well as implementation of task-shifting to provide training and more efficient care. Adeke is adamant that there is an urgent need to expand health coverage to rural communities to alleviate the burden of out-of-pocket costs for CVD care, and hopes the country’s efforts to implement Universal Health Coverage through the Basic Health Care Provision Fund will address this.
To date, Adeke has shared his findings with the Ebonyi state health agencies linked to primary healthcare, and plans to follow-up on any actions they have taken to improve the primary care system.
The TEPHINET CVD small grant was the first research grant Adeke had ever received.
“They call it a small grant, but I value it as one of my biggest grants, irrespective of the sum,” he shared. “It gave me the confidence to do so much more. It boosted my confidence in research, my confidence in applying for grants.”
Since then, Adeke has been awarded another small grant from the Royal Society for Tropical Medicine and Hygiene (RSTMH) and National Institute for Health Research (NIHR), and is participating in an ongoing Emerging Authors Program* where he has developed a manuscript for submission to the Journal of Human Hypertension, and TEPHINET’s CVD-focused journal supplement for World Field Epidemiology Day 2022.
*The Emerging Authors Program is a joint effort of the Lancet Commission on Hypertension Group, Resolve to Save Lives, the U.S. Centers for Disease Control and Prevention (CDC), and the World Hypertension League to provide public health trainees and practitioners with scientific writing and publication mentorship from global cardiovascular disease experts.