Pensar global- actuar local: una polemica ProCOR

" Pensar global- actuar local"

Discusión sobre las guías - globales- de tratamiento y la realidad local, el ejemplode Nigeria, el país más poblado de Africa.

Carta en ProCOR:

Dear Colleagues,
I was strangely disquieted by the recent report from Nigeria
and wonder if anyone more closely connected to global
efforts to reduce hypertension could help me. My complaint
is not with Nigeria or any effort to reduce the burden
of hypertension but with issues that surround "guidelines."
My questions are as follows:
1. That creators of "guidelines" are now almost universally
"stakeholders" seems odd especially given the buden of
poverty in a country like Nigeria. The Oxford English Dictionary
defines a stakeholder as "one who has a stake in something,
especially a business." The examples listed come from banking
and business. Is there not a better word for those committed to
reducing the sequelae of hypertension?
What are the implications of "pharmaceutical sponsorship"
of guidelines?
2. What are the costs of new guidelines?
Is there added benefit to having individual rather than WHO
guidelines?
3. How do new guidelines differ from old?
4. How good was the adherence to old guidelines?
When the JNC7 Report came out in the USA (JAMA 2003;
289: 2560-2572), I was struck that in 1999-2000 treatment
of hypertension was 59% and control 34%. Are new guidelines
expected to improve these important measures?
5. Do new guidelines better address the importance of lifestyle
modification including diet, physical activity, and tobacco cessation?
Are new efforts implemented to make these goals a reality?
6. Do new guidelines address cultural/economic barriors
to diagnosis and treatment of hypertension?
7. Are there other solutions (other than "local manufacture")
to the need for affordable drugs within the country?

Evidence-based guidelines are clearly important but the how
and why and who and outcomes of guidelines also requires
close examination. Mine is now a steep learning curve in this
arena, and I welcome your insights.
Susanna E. Bedell, MD

Hass, Laura J. wrote:

>Case for Prevention: National hypertension guidelines in Nigeria
>
>Though guidelines for the management of hypertension are periodically published
>by the World Health Organization (WHO) and the International Society of
>Hypertension (ISH), most countries in sub-Saharan Africa, do not have their own
>localized guidelines. In Nigeria, however, hypertension guidelines were
>published in 1997 that address the country's unique socio-economic and cultural
>environment--a "triple-burden" of diseases, which include high levels of
>communicable diseases, a growing epidemic of non-communicable diseases, and the
>burden of poverty.
>
>Nigeria has a 20% prevalence of hypertension in a population of about 130
>million. The 1997 hypertension guidelines in Nigeria were developed through a
>nine-month series of consensus meetings of all stakeholders on hypertension
>under the initiative of Nigeria Heart Foundation. The stakeholders included
>Nigerian Hypertension Society, Federal Ministry of Health, Nigerian Institute of
>Medical Research, Guild of Medical Directors and the Association of General
>Medical Practitioners. Sponsorship for the guidelines was provided by
>pharmaceutical companies interested in cardiovascular research and development
>in Nigeria.
>
>The 1997 guidelines are being updated and revised, under the leadership of the
>Nigerian Hypertension Society, and are expected to be published later in 2005.
>The revision of the guidelines has provided an opportunity for stakeholders at
>primary, secondary and tertiary levels of healthcare to focus on prevention and
>control of hypertension; and for health policy makers to acknowledge that
>hypertension has assumed a significance that deserves attention. The revised
>guidelines will include data from the latest local studies.
>
>The availability of the guidelines has helped define the prevalence of
>hypertension in Nigeria, with emphasis on current management, risk factor
>identification, and the need for lifestyle changes. Almost all the
>anti-hypertensive drugs are manufactured outside Nigeria, resulting in a high
>cost for patients. Local manufacturing of anti-hypertensive drugs in Nigeria
>would provide affordable, inexpensive drugs within the country and also
>contribute to capacity building in research and development for the
>pharmaceutical industry.
>
>The process of publication of the guidelines has emphasized the importance of
>coalition building and role of relevant stakeholders in research, policy,
>training and health promotion in control and management of hypertension.
>
>
>For more information:
>Kingsley K. Akinroye MD
>Vice - President (Research Coordinator)
>Nigerian Heart Foundation
>[e-mail]
>
>
>-------------
>
>[ProCOR's "Case for Prevention" profiles community-based interventions and other
>prevention initiatives around the globe to address cardiovascular risk factors.
>These case studies summarize local and national examples of cost-effective,
>successful strategies promoting heart health. "Case for Prevention" is part of
>ProCOR's promotion of World Hypertension Day (Sunday, May 14) in collaboration
>with the World Hypertension League ()].
>Members of the ProCOR network are encouraged to share their CVD prevention
>activities-email your summary to [e-mail].]
>
_____________________________________________________________________

Contribute to ProCOR's Global Dialogue by replying to this message or
sending an email to .

ProCOR (www.procor.org) is a program of the Lown Cardiovascular
Research Foundation. ProCOR's email discussion is hosted by SATELLIFE
(www.healthnet.org), The Global Health Information Network.