The last frontier for global Non-Communicable Disease action: the Emergency Department – a cross-sectional study from East Africa

Background Deaths due to non-communicable diseases (NCDs) have surpassed those due to communicable diseases globally and are projected to do so in Africa by 2030. Despite demonstrated effectiveness in high-income country (HIC) settings, the ED is a primary source of NCD care that has been under-prioritized in Africa. In this study, we assess the burden of leading NCDs and NCD risk factors in Kenyan Casualty Department patients, to inform interventions targeting patients with NCDs in emergency care settings. Methods Using the WHO STEPwise approach to surveillance (STEPS) tool and the Personal Health Questionnaire (PHQ-9), we conducted a survey of 923 adults aged 18 and over at Kenyatta National Hospital Emergency Department (KNH ED), the largest hospital in East Africa between May-October 2018. We used descriptive statistics and covariate-adjusted logistic analysis to analyze results. We included the following socio-demographic variables in our models: age, income, household size (t-test), sex, education, marital status, work status, and poverty status (chi-squared test or fisher’s exact test). Findings More than a third of respondents had hypertension (35.8%, n=225/628), one in five had raised blood sugar or diabetes (18.3%, n=61/333), and more than one in ten reported having cardiovascular disease (11.7%, n=90/769). Having lower levels of education was associated with tobacco use (OR 6.0, 95% CI 2.808– 12.618, p < 0.0001), while those with higher levels of education reported increased alcohol use (OR 0.620 (95% CI 0.386– 0.994, p = 0. 0472). While a predominant proportion of respondents had had some form of screening for either hypertension (80.3%, n=630/772), blood sugar (42.6%, n=334/767) or cholesterol (13.9%, n=109/766), the proportion of those on treatment was low, with the highest proportion being half of those diagnosed with hypertension reporting taking medication(51.6%, n=116/225). Determinants of disease burden were age, sex, and income. Interpretation Comprehension of the unique epidemiology and characteristics of patients presenting to the ED is key to guide care in African populations. Patient-driven interventions, and collaboration with community-based stakeholders such as patient navigators, are ideal considerations to sustainably address NCDs leveraging the ED in the resource-limited setting. Funding Hecht-Albert Global Health Pilot Innovation Award for Junior Faculty, Global Health Leadership Institute, Yale University.