Kenya’s disease burden

The top five health challenges for Kenya are HIV, diarrhoea, lower respiratory infection, neonatal encephalopathy, and neonatal pre-term birth. On the other hand, back pain, iron-deficiency anaemia, and hearing loss are the top causes of disability in old age.

The scourges of HIV, diarrhoea and lower respiratory infections are Kenya’s worst health challenges, forming “triad of troubles” that is preventing millions from living long, healthy lives, a new study shows.

Whereas the study, by US-based Institute for Health Metrics and Evaluation (IHME), notes that life expectancy in Kenya is growing, it indicates that the country continues to struggle with communicable diseases like HIV and diarrhoea, as well as neonatal ailments that kill hundreds of thousands of infants.

To understand the gravity of the situation, we need to put things into perspective. Every day 3,400 children are born in Kenya, but only half of these will live to the current life expectancy age of 65.

The Global Burden of Disease Report, released last week, indicates that a Kenyan man born in 2016 can expect to live for 65 years, reflecting an increase in life expectancy of eight years over the past decade. On the other hand, a woman has a greater chance of living for four more years to the age of 69, an additional nine years from 2006.

Globally, life expectancy increased from about 62 years to nearly 72 from 1980 to 2015, thanks to improvements in sanitation, immunisation, indoor air quality, and nutrition in poor countries. Several nations in sub-Saharan Africa have also rebounded from high death rates due to HIV/Aids, says a 2016 Lancet report.

Conditions that kill are, however, not typically those that make people sick. In 2015, for instance, the top three non-fatal causes of “health loss” were iron-deficiency anaemia, neglected tropical diseases, and depression.

Life expectancy in Kenya, therefore, is growing, and should give citizens a reason to smile. But experts are divided on the growing contradiction of our expectation of more years versus the prospect of dying due to disease.

While these figures are a genuine cause for celebration, illness and injury are the silent but sinister factors that dampen the happiness in the added years.

A Kenyan male born in 2016 will live approximately 57 years in good health while a female only expects wellness for 60 years before disease or disability kick in.

The top five causes of premature death in Kenya are HIV, diarrhoea, lower respiratory infection, neonatal encephalopathy, and neonatal pre-term birth.

Back pain, iron-deficiency anaemia, and hearing loss are the top causes of disability in old age.

TOO MANY CHILD DEATHS

Researchers cast a bleak picture for Kenyan children, with health-related infant mortality being the biggest threat to their survival.

“Deaths of children under five are a persistent health challenge. For every 1,000 live births, 43 Kenyan children under the age of five die,” warns the Global Burdern of Disease report.

That exceeds the global figure of 38 but is lower than the averages of other East African countries like Tanzania and Uganda.

Babies born prematurely are at risk of dying before their time as well, especially if born in the remote areas of the country where access to resuscitation and life saving equipment is poor.

Gynaecologist and fertility specialist Jane Machira says the country’s total fertility rate of 3.9 is suitable for its workforce replenishing prospects, and that a lower rate would not be sustainable if we are to have enough young people to work in decades to come.

“We need to sustain the current rate if our country is to have enough youthful individuals to work and run our industries, social services and other vital sectors,” says Dr Machira.

“A lower fertility rate coupled with an aging population as the major population segment would prove challenging for our economy since the majority would be ailing and in need of specialised treatment and care, meaning that a shortage of youths would impact negatively on the society’s ability to work and produce enough offspring for the next generation.”

More, therefore, needs to be done in the healthcare sector for expectant mothers and newborns in order to stem the tide of infant mortality.

Dr Machira also points to the success of initiatives to reduce neonatal mortality, including the training of maternity staff on emergency obstetric and neonatal care, as some of the gains made in ensuring the survival of newborns countrywide.

She identifies three major contributors to neonatal and maternal deaths as decision making on where the mother will deliver her baby, access to health facilities, and access to and availability of health workers in those facilities.

“The first step, which is the decision on where she will deliver, plays a great role in ensuring the survival of the mother and her baby. A lot has been done in ensuring that mothers get to make this decision although the traditional birth attendants are still assisting a number of mothers. Training of TBAs to avoid cases of mothers and babies catching infections during childbirth has also helped a great deal to make home deliveries safer,” she says.

Premature babies are also in danger of dying before their time. In humans the usual definition of pre-term birth is one before a gestational age of 37 complete weeks.

ABOUT 1.5 MILLION KENYANS HAVE HIV

The National Aids and STI Control Programme (Nascop) says Kenya’s HIV prevalence rate of 5.6 per cent is driven by sub-groups within the general population that engage in high-risk sexual and drug-related HIV-risk behaviour.

Nascop says the groups include sex workers and their clients, men who have sex with men, prisoners, and injecting drug users.

“People who inject drugs, men who have sex with men, and those who give or receive money or favours for sex are at highest risk of HIV infection,” found a 2012 survey by the agency. About 1.2 million people between the ages of 15 and 64 were living with HIV in the country at the time.

But nearly half of all new infections in 2008 were transmitted through heterosexual sex in the context of steady relationships, and 20 per cent during casual heterosexual sex. Altogether, these groups are estimated to have contributed a third of all new HIV infections in Kenya in 2008, according to National Aids Control Council (NACC)

Other groups considered to be most at risk of HIV infection in Kenya include truck drivers and cross-border mobile populations.

Also,the United Nations Office for the Coordination of Human Affairs report warns against the negative effects of drought in arid and semi-arid lands (ASALs), saying it is magnifying the ravages of the HIV-Aids pandemic.

“Some 290,000 people living with HIV are at risk of the impact of the drought across the 23 counties, 60,000 of whom are in the 11 priority counties,” says the OCHA report.

OCHA says HIV patients’ ability to adhere to treatment regimes has been adversely affected by lack of food, leading to poor health and subsequent malnutrition.

“The ability to continue HIV treatment has been compromised by food insecurity, leading to deteriorating health, coupled with the effects of malnutrition. The risk of treatment disruption and malnutrition is high, leading to negative health outcomes and a reversal of the gains in controlling the HIV epidemic in the ASAL counties,” the report states.

OCHA singles out Turkana as an area of concern, saying its low numbers of patients on treatment coupled with severe drought could spell a humanitarian crisis.

“Of particular concern is the situation in Turkana, which has been severely affected by the current drought and also has a high HIV burden with an estimated 22,523 people living with HIV and a very low adult treatment coverage of 34 per cent,” says the UN agency.
More than 18 million people are on life-long HIV treatment worldwide, but an almost equal number do not have access to treatment yet. In Kenya, approximately 1.5 million people are living with HIV, and just over one million are currently on ARVs. Kenya records about 100,000 new HIV infections each year.

Adherence to HIV treatment regimens could also be a threat to the survival of infected Kenyans. Strict adherence to antiretroviral therapy (ART) has been identified by the US Department of Health and Human Services as a key component in management of the pandemic.

The US agency names poor adherence as “the major cause of therapeutic failure”, saying achieving adherence to ART is a critical determinant of long-term outcome in HIV infected patients.

This is not the case for many chronic diseases, such as diabetes or hypertension in which drug regimens remain effective even after treatment is resumed following a period of interruption.

In the case of HIV infection, emergence of drug resistance and loss of future treatment options may occur as a consequence of non-adherence to ARThe.

“Many patients initiating ART or already on therapy are able to maintain consistent levels of adherence with resultant viral suppression and improved clinical outcomes. Others, however, have poor adherence from the outset of ART and may experience periodic lapses in adherence over the lifelong course of treatment.

“Identifying those with adherence-related challenges that require attention and implementing appropriate strategies to enhance adherence are essential roles for all members of the treatment team,” the agency says.

RESPIRATORY INFECTIONS THE BIGGEST KILLERS

Kenya’s tuberculosis burden is higher than initially thought, with close to 40 per cent of the country’s cases going undetected. The National TB Prevalence Survey, released on March 24 this year, shows that Kenya diagnosed and treated 82,000 people for TB in 2015, but found that the number of people who contract the disease every year is actually 138,105.

“In the same year, the World Health Organisation had estimated that Kenya’s prevalence rate was 233 cases per 100,000. The new survey, however, estimates Kenya’s prevalence rate at 558 cases per 100,000. Considering that one undiagnosed and untreated individual can infect 10 to 15 people, this pool of missed TB cases continues to fuel the spread of the disease,” the Ministry of Health says.

Three out of every four people with TB symptoms who seek health care do not get diagnosed, while a further one out of four among those diagnosed with the disease do not report any symptoms.

According to the survey, the prevalence of TB in men is twice as high as that of women, with the overall highest burden reported among the 25- to 34-year bracket.

Interestingly, 83 per cent of TB cases are HIV-negative, suggesting that interventions to control TB among people living with HIV have been successful, and that a large burden of TB now exists among people not infected with HIV.

Another major burden is asthma, the commonest chronic lung disease in the world. It is estimated that over 300 million people suffer from this disease globally, four million of them in Kenya.

The Kenya Association for the Prevention of Tuberculosis and Lung Disease estimates that there are 600,000 people living with the disease in Nairobi alone.

Although asthma cannot be cured, effective treatment is able to fully control it, enabling affected individuals to live normal, productive lives.

Proper control of asthma is dependent on clinical service providers rapidly diagnosing the disease and subsequently placing patients on effective treatment regimens.

The other major respiratory infection burden for Kenya is pneumonia. According to the 2016 Economic Survey by the Kenya National Bureau of Statistics, pneumonia killed more Kenyans than malaria last year.

The acute respiratory infection killed 22,473 Kenyans, a deadly surge from 21,640 in 2013, with the most victims found among children under five years. The elderly and people with compromised immunity are also vulnerable to the disease.

In the survey report, these deaths were higher than those from malaria (20,691), HIV (11,311), tuberculosis (10,183) and anaemia (8,472).

People who smoke indoors or use kerosene, animal waste, charcoal and wood fuel for lighting and cooking — especially in rural Kenya — are likely to die from pneumonia, which is caused by viruses, bacteria or fungi entering the lungs.

DIARRHOEA REMAINS SCOURGE OF THE POOR

The World Health Organisation defines diarrhoea as loose watery stool that occurs more frequently than usual, meaning more frequent trips to the toilet and a greater volume of stool.

Doctors Fred Mwenje, Taratisio Ndwiga, Andrew Wanyonyi and Masta Omwono, in a research paper titled Factors Influencing the Occurrence of Diarrhoea in Children Under Five Years in West Pokot County, say that most diarrhoeal infections in children are caused by viral infections, including rotavirus, which is responsible for more than 40 per cent of all diarrhoea-related hospital admissions of children.

The medics identify immunisation and safe drinking water as a vital weapon in the fight against the ailment.

“Immunisation against childhood illnesses is one of the most effective methods of preventing diarrhoeal diseases (and) provision of safe drinking water is instrumental in prevention,” says the report.

Many bacteria can also cause diarrhoea, especially in conditions of lowered immunity. The most common bacteria are salmonella, shigella, staphylococcus aureus, escherichia coli and vibrio cholerae, which causes cholera in humans.

These ailments, unfortunately, affect the poor more than the rich, meaning deaths are skewed against those who cannot afford medication.

The United Nations Chidrens Fund (Unicef) says low- and lower-middle-income countries are home to 62 per cent of the world’s under five population, but account for more than 90 per cent of global pneumonia and diarrhoea deaths.

“The very poorest countries carry a disproportionate share of the burden of death. More than 30 per cent of all pneumonia and diarrhoea deaths are concentrated in low-income countries, yet these countries are home to only 15 per cent of the world’s under five population,” says Unicef.

FYI

In 2016, for the first time in modern history, fewer than five million children under age five died in one year globally, as compared to 1990 when 11 million died. Researchers attribute this global health landmark to improvements in increased educational levels of mothers, rising per capita incomes, declining levels of fertility, increased vaccination programmes, mass distribution of insecticide-treated bed nets, improved water access and sanitation, and a wide array of other health programmes funded by development partners.

LIFE EXPECTANCY

A Kenyan man born last year will live, on average, for 65 years, reflecting an increase in life expectancy of eight years over the past decade. On the other hand, a woman has a greater chance of living for four more years to the age of 69, an additional nine years from 2006. Globally, life expectancy increased from about 62 years to nearly 72 from 1980 to 2015, thanks to improvements in sanitation, immunisation, indoor air quality, and nutrition in poor countries.