Lifestyle choices linked to high blood pressure in Kenya’s urban slums

Urban slums have through the years acquired the chilling reputation of being some of the roughest places to live in, and this is the uncomfortable reality that the 60 per cent of Nairobi residents who live in urban informal settlements know only too well.

Besides the more highly publicised struggles such as insecurity and water shortage that slum-dwellers have to routinely contend with, health challenges also abound, in part due to unaffordability of quality health care, lack of adequate information on prevention and treatment of common diseases, and a high population density.

There are currently more than 700 beneficiaries of the treatment plan in Kibera alone.

The population factor has been particularly to blame for the spread of communicable diseases such as HIV/Aids. Tellingly, HIV prevalence in Nairobi slums stands at 12 per cent, compared with five per cent among non-slum urban residents, and six per cent in rural areas, according to the 2008/2009 Kenya Demographic and Health Survey.

Fortunately, the response towards these communicable disease challenges has been resolute. Such interventions as the issuance of free antiretroviral drugs have become a standard practice in all urban slums.

But, with most of the focus and resources being directed towards communicable diseases, non-communicable ailments have been largely neglected. One of these, which has silently set root in Kenya’s urban slums recent years, is hypertension, also known as high blood pressure.

One out of eight adults living in Nairobi’s slums have high blood pressure, according to a study by The African Population and Health Research Center (APHRC). In a nutshell, therefore, hypertension is the new silent killer in the slums.

Dr Lilian Mbau, a project manager for the Healthy Heart Africa programme — run by Amref Health Africa — says the common reaction she gets from people when she speaks about the rising cases of hypertension in the slums is one of disbelief.

The disbelief arises from the fact that non-communicable lifestyle diseases such as hypertension have historically been the preserve of the rich. But this is changing, primarily due to urbanisation, which has affected the lifestyles of low income earners.

Fatty, greasy and sugary foods have become more affordable in the slums, sometimes even more affordable than the staple diet of ugali and sukuma wiki.  Hawkers selling potato chips, sausages and samosas via white metallic trolleys for as little as Sh20 have become a defining feature in slums.

Similarly, young men meet up frequently to watch football over alcohol and cigarettes, and many do not exercise. All these are documented risk factors for hypertension, explaining why prevalence in urban slums has spiked and now rivals some communicable diseases.

“Some of the major factors contributing to hypertension include the fact that we consume unhealthier diets such as fast and sugary foods and less fruits and vegetables. Other drivers include alcohol intake, smoking and physical inactivity,” said Dr Mbau.

Dr Mbau is, however, optimistic that with awareness, hypertension and other non-communicable diseases can be curbed. “Seventy-five per cent of these diseases can be prevented by addressing the risk factors through inexpensive interventions such as heightened physical activities, switching to natural foods, reduced alcohol intake, and encouraging smokers to quit,” she said.

Creating this awareness in the slums, however, is easier said than done. The first obstacle is the popular prejudice that hypertension is a rich man’s disease, which leads to an indifferent attitude towards intervention efforts in the slums.

SYMPTOMS NOT ALWAYS OBVIOUS

Moreover, hypertension does not always present obvious symptoms that compel the sufferer to seek medical attention. People seek attention when it is too late instead of going for screening when there is time, as is the recommended practice. Even when screening is done early enough and the disease is detected, treatment is often too expensive, at least for low income earners in the slums.

It is against the backdrop of these challenges that the Healthy Heart Africa programme in Kibera was introduced. The programme, which was launched across the whole of Africa by pharmaceutical firm AstraZeneca in 2014, is aimed at tackling rising cases of hypertension by providing free screening and affordable medicine at selected hypertension clinics in collaboration with Amref Health Africa and local authorities. In Kibera, there are currently two hypertension clinics run by Amref Health Africa.

Whereas a cumulative monthly dose of plendil and zestoretic — the common drugs used in hypertension treatment — would cost up to Sh8,000 over the counter at a chemist, the same monthly dose goes for Sh100 at the two hypertension clinics. These cost savings have enabled many who could not afford out-of-pocket purchases or health insurance to get proper treatment. There are currently more than 700 beneficiaries of the treatment plan in Kibera alone.