A combination of unsafe water, poor sanitation and lack of handwashing is the leading factor in early deaths and ill health in Kenya, according to the broadest global study ever done on the subjects.
Unsafe sex is the second leading contributor followed by child and maternal malnutrition, according to the 26-year longitudinal study on the global burden of diseases, injuries, and risk factors.
Other factors include air pollution, high blood pressure, poor diet, tobacco use, occupational risks, high glucose which can lead to diabetes, and alcohol use. These risks have changed little from 1990.
As the world marks World Health Day today, the study published in The Lancet recommends that public heath interventions to eliminate the risks should continue throughout Kenya.
Six counties gained more than 10 years in life expectancy from 2006-2016. Siaya recorded an increase of 18 years from 47 years in 2006 to 65 years in 2016
The good news is that Kenya made considerable progress in tackling the various health challenges during the more than quarter century under review, although death rates remain relatively high and uneven across counties.
The prevalence of diarrhoea, lower respiratory infections, malaria, HIV and vaccine-preventable illnesses has declined, leading to lower death rates and a rise in life expectancy in the past decade, reveals the study.
A different story
However, Nairobi had a whole different set of leading contributors to early death, disability and disease. High blood pressure and alcohol and drug use were the second and third leading risks while unsafe water, sanitation and handwashing and air pollution had less important roles than in other counties.
Alcohol and drug use, and unsafe sex were, however, much lower risk factors in Garissa County, whereas tobacco was a much higher risk compared with other counties.
Communicable diseases reduced from 2006 to 2016 but still predominate the total disease burden and contribute to most deaths.
Experts credit the turnaround to many health interventions that were introduced in the early 2000s and then scaled up, including expansion of HIV and AIDS treatment, malaria control, childhood immunisation, free maternity programmes and slight improvements in access to safe water and sanitation.But the gains are partly being offset by a growing burden of non-communicable diseases (NCDs). In three counties (Nyeri, Kiambu and Nairobi), early deaths attributable to NCDs were higher than those attributable to child maternal, neonatal and nutritional causes.
In 2015, a resident of Taita-Taveta or Homa Bay was more likely to die from an NCD than someone living in another county.
Illnesses, disability and early death linked to non-communicable diseases increased in all counties.
The study finds Kenyans living longer, adding eight years from 59 years in 2006 and reaching 67 years in 2016, thus reversing a decline of two years between 1990 and 2006.
In the counties, a gap of 15 years was recorded between the county with the highest life expectancy, Laikipia (72 years), and that with the lowest, Homa Bay (57 years).
Although the impressive progress is mirrored in many counties, there are significant disparities across counties. For instance, Nyandarua and Nyamira each had life expectancy drop between 1990 and 2016 whereas Baringo, West Pokot, Siaya and Isiolo each recorded an increase of more than 10 years.
The figures were higher than 71 years in Laikipia (72 years), Uasin Gishu and Bomet, with 71 years each in 2016.
Simultaneously, Migori (59 years) and Homa Bay (57 years) stayed under 60 years.
Six counties gained more than 10 years in life expectancy from 2006-2016. Siaya recorded an increase of 18 years from 47 years in 2006 to 65 years in 201Six counties gained more than 10 years in life expectancy from 2006-2016. Siaya recorded an increase of 18 years from 47 years in 2006 to 65 years in 2016
Under five deaths
In the 26 years under review, the under-five death ratio fell by half from 95 deaths per 1,000 live births to 43 deaths per 1,000 live births.
The decline was steeper between 2006 and 2016, with an annual change of five percent compared with 1990 to 2006, with a yearly improvement of two percent.
Performance varied in counties during both periods, with such deaths reducing by over five percent yearly in some while remaining largely stable in others. The fastest changes in the under-five death rate were in West Pokot, with a decline of seven percent from 1990 to 2006, and Siaya, with eight percent between 2006 and 2016.
The slowest change was in Nyandarua, where it increased by two percent from 1990-2006 and in Meru, where it barely changed (-0.2 percent) from 2006-2016.
Deaths among pregnant and new mothers has recorded striking declines over time with greater decreases being observed after 2006 compared with the previous decade.
Nationally, the maternal death rate declined by a quarter from 342 deaths per 100,000 live births in 2006 to 258 deaths per 100,000 in 2016. That was a reversal of the previous 15 years, when the maternal death rate rose eight percentage points from 316 deaths per 100,000 live births in 1990.
However, figures from the study indicate that there is mixed progress in the counties and gaps to be addressed.
In the decade to 2016 the highest improvement in maternal mortality was in Siaya, with an eight percent annual decline. It slightly increased in Bungoma, Kakamega, Nandi, Taita-Taveta and Vihiga counties.
In the period 2006 to 2016, the national overall death rate dropped by more than a third (36 percent) to 579 deaths per 100,000. This was a reversal from 1990-2006, when the death rate increased six percentage points from 850 deaths per 100,000 people to 903 per 100,000.
In the same period, mortality declined across all age groups, although at a slower pace among males and females aged 15–19 years and 20–24 years. The fastest decline was among females aged 35–39 years, with an annual decrease of 11 percent.
Siaya had the fastest decline in the death rate of seven percent between 2006 and 2016 while Mandera had the slowest of about two percent.
The sharp decline in the death rate in Siaya was as a result of the gains made in reducing HIV-related deaths. Between 1990 and 2006, HIV-related death rates increased among most age groups (with the exception of males aged 20-24 and 25-29) and in all counties. However, between 2006 and 2016, such deaths declined among all age groups, with the fastest change registered in Siaya and the slowest in Wajir.
In 2016, Siaya reported the highest rate of years of life lived with disability for diarrhoea (365 per 100,000) but the county had one of the lowest rates of early deaths due to diarrhoea. At the same time, the county also had the lowest rate of years lived with disability for respiratory infections of seven per 100,000
The highest rate of years lived with disability attributable to lower respiratory infection in 2016 was reported in Taita-Taveta (9.6 per 100,000) but this county also reported the second-lowest years lived with disability attributable to diarrhoea, at 200 per 100,000.
The share of early deaths, ill health and disabilities attributed to malaria decreased steadily in Kenya over the 26 years. However, one is likely to get sick with malaria and die near Lake Victoria compared with other parts of Kenya.
Public health experts say dealing with risk factors such as obesity, smoking and high blood pressure offer the most effective way of fighting some of the top NCDs.
Lifestyle changes such as healthier diets and physical activities are also needed.
According to The Lancet study, health interventions alone do not dictate health outcomes. For instance, infrastructure development to improve quality and sanitation and regulations to mitigate air pollution and improve workplace safety can have direct effects on the health of Kenyans without strict health interventions.
Focusing on important risk factors associated with health loss – including water, sanitation, hygiene, unsafe sex and malnutrition – can enable policymakers to intervene effectively and realise better returns on investment.
The study, based at the Institute of Health Metrics and Evaluation at the University of Washington, compiles data from every country in the world and makes informed estimates where there are gap.