Tuesday, June 30, 2009

Non-communicable diseases: a time bomb about to explode

By Ochieng’ Ogodo
In a long time, certain diseases have been thought of as only afflicting those wallowing in material comfort. But that is now misplaced given non-communicable diseases such as diabetes and Cardio Vascular Diseases (CVDs] like high blood pressure have become common among lowlifes in places like Korogocho and Kibera slums.
And without clear cut policies and funding for most common non-communicable diseases [NCDs], Kenya could be sitting on a time bomb. Jane Nyambura Hiuko is one such lowlife citizen whose life became miserably from diabetes which took her long to discover. “I did not know I was suffering from diabetes. I always thought it was malaria or typhoid but with unending body weaknesses and knee aches,” she recollected.
In mid 2000s she used to visit a dispensary in Nairobi ’s Kariobangi estate where diagnosis and treatment was mostly for malaria and typhoid with no respite. “It was an agony in which my body behaved like it was being pricked by needles from every side. This was accompanied with extreme heat in the night and I bathed about four times before sunrise.”
From 75 kilograms, the 52 year old mother of six rapidly lost weight at an average of three kilograms a week. “I though I was suffering from TB.” It was not until October 2008 when she attended a free outreach clinic run by Africa Population and Health Research Center [APHRC] in Korogocho that she discovered her diabetic status.
Her sugar level was 32.6 millimals per litre and the doctor instantly put her on treatment through injections. She was also put on diet and after two weeks it dropped to 5.9.
Harry Ndara Waruinge, also of Korogocho, is attending the same clinic that offers medical services for no penny because of being diabetic high blood pressure patient. In 1996 he discovered he was diabetic and last year his situation got compounded by another diagnosis that revealed he was also suffering from high blood pressure.
Emphasis has been on most common communicable diseases in Kenya and Africa at large, among others, malaria, Tuberculosis [TB], HIV/Aids, measles, acute lower respiratory tract infections, diarrhea diseases and dysentery.
They are frequent because most African countries’ tropical climate that supports infection-causing agents to thrive and the growth of vectors that carry some of these diseases such as the mosquito that transmits malaria.
Weak health systems that do not fully offer preventive services like high immunization coverage for measles that can be easily contained is also a factor.
Dr. Kyobutungi

Non-communicable diseases on the rise
“But CVDs are on the rise because of change in lifestyles and exposure to environmental factors,” according to Dr. Catherine Kyobutungi, Associate Research Scientist with APHRC.

Kyobutungi says there are very high levels of alcohol consumption, most of which is cheap liquor with high alcoholic content. Other than interfering with the functions of various body systems and organs that culminates in NCDs, alcohol may have a direct effect on the pancreas which is responsible for insulin secretion. Insulin is one of the hormones that regulate the metabolism of glucose in the body and so if its secretion is interfered with, one may easily get diabetes.
“There are high levels of tobacco consumption mostly through smoking. Prolonged exposure to products of tobacco smoke results in damage to blood vessels which can ultimately result in a cardiovascular disease”.
Besides, some products of tobacco smoke are carcinogenic [cancer-causing] and high tobacco consumption is associated with many types of cancer especially cancer of the lungs.
Because of resource deprivation in slum areas like lack of land for cultivation, majority depend on cheap food resources with high starch levels. Economic factors also dictate that healthy foods such as fruits, foods with high fiber content, “healthy” fats are not affordable.
The poor are more concerned with having a meal rather than the quality of it. CVDs among the poor are also associated with prolonged stress.
Environment pollution around slum areas by toxins like smoke from factories, heavy traffic as well as indoors cooking (indoor air pollution) may also damage blood vessels and parts of the respiratory system leading to chronic obstructive diseases of the respiratory system, cardiovascular diseases and even cancers.
“Stress,” says Kyobutungi “has been long associated with conditions like high blood pressure which in most cases is a precursor of NCD of the heart, kidney, brain and other organs. The poor, especially those in slum settlements are constantly stressed due to the constant struggle to earn a basic living, insecurity and lack of social networks.”
According to Beryl Akinyi of the Counseling and Advocacy for Kidney Disease [CAFKID] most people do not know about the kidney disease while the mortality rate is 6000 annually.
“Those suffering from diabetes and high blood pressure are most vulnerable to kidney disease yet many do not about these NCDs,” she stated
Experts say CVDs will double up from 1990 to 2020 because of factors like urbanization and modernization. Many people are migrating from rural to urban area, changing their eating habits and live in polluted neighborhoods, which are some of the risk factors for the anticipated rise.
Unhealthy diet a major cause
The World Health Organisation [WHO] says the most important causes of heart disease and stroke are unhealthy diet [low in fruits and vegetables, high in sugar, high in salt, high in fat], physical inactivity, tobacco use and alcohol consumption. These are called 'modifiable risk factors'.
Effects of unhealthy diet and physical inactivity may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity; referred to as 'intermediate risk factors'.
The major modifiable risk factors are responsible for about 80 percent of coronary heart disease manifesting as heart attacks and cerebrovascular disease known as stroke.
There are also a number of underlying determinants of chronic diseases. They reflect the major forces driving social, economic and cultural change–globalization, urbanization, and population ageing. Other determinants of CVDs are poverty and stress.
In 1998 alone, WHO puts it, non-communicable diseases killed 31.7 million people world wide. It is projected this will be 36.5 million by 2020 with middle and developing countries bearing the brunt. The burden in low-income countries will also increase greatly over the same period.
Kyobutungi says there is need for universal early diagnosis, especially the poor. “Early detection and management of intermediate risk factors will lead to fewer complications and less probability of dying from these diseases. Most of them suffer for a long time without knowing it and by the time they do, they have already developed complications which are more difficult to manage.”
Early diagnosis, she explained, can be easily done even at the lowest level of health care in the country. Widespread prevention programs that encourage healthy lifestyles such as proper eating habits, less consumption of alcohol and tobacco and more physical activity are also necessary. “We need affordable medical services that are accessible to the urban poor.”
Not taken seriously in AfricaThe problem, she states, has not been taken serious in Africa and the focus of many ministries of health in Sub-Saharan Africa [SSA] has been on communicable diseases like HIV/AIDS, TB and malaria.
“Many SSA governments have therefore not invested much in health services to tackle the non-communicable diseases,” said Kyobutungi.
In addition, popular perception is that CVD are diseases of the affluent who can afford the high cost of diagnosis and treatment. Most people are diagnosed when they present with symptoms and yet screening could be easily integrated in primary health care services.
The average cost of screening diabetes is Kshs. 200 in a local pharmacy. These diseases are not treatable but are manageable. The cost of buying 1 vial of insulin that will last for two weeks is about Kshs.1500 from a local chemist and Kshs 500 from government hospitals.
The average cost for drugs to control high blood pressure is about KSh.1000 per month based on the drug combination and type of drugs used. It could be much higher.
Policies for non-communicable diseases in most countries are very weak or non-existent. For instance the current Kenya National Health Sector Strategic Plan II 2006-2010 says very little about non-communicable diseases and is mentioned only twice in the whole document..
Kyobutungi hopes that the new HSSP coming into effect in 2011 will have more substantive focus on non-communicable diseases. But the government can increase access to screening and treatment services at public health facilities, it can formulate and enforce national policies that reduce exposure to tobacco products [directly or indirectly], programs that educate the public about the dangers of high alcohol consumption and also encourage healthy eating.
“The beginning of any good policy is good data, so government should also invest in generating data that shows the true magnitude of the problem at the population level rather than relying on hospital generated data when it is clear that most people do not use these hospitals when they are sick,” she pointed out.
Currently, according to Elizabeth Kahurani, APHRC’s communication officer, their organization and the City Council of Nairobi’s Department of Health are involved in intervention in slum areas with the main objective of generating research that informs policy formulation, decision making and other development efforts in addressing health and population challenges among the urban poor.
**Ochieng’ Ogodo is a Nairobi journalist whose works have been published in various parts of the world including Africa, the US and Europe. He is the English-speaking Africa and Middle East region winner for the 2008 Reuters-IUCN Media Awards for Excellence in Environmental Reporting. He can be reached at ochiengogodo@yahoo.com or ogodo16@hotmail.com.

Thursday, June 18, 2009

Africa: Low technology level and lack of information hindering climate change adaptation

By Ochieng’ Ogodo

As climate change intensifies through increased temperatures and precipitation, most smallholder [SH] farmers in Africa , majority living in rural areas, are not adapting to global warming.
Low levels of technology and scarcity of information on climate change are some of the major obstacles for the vast majority of African farmers in adapting to global warming.
Claudia Ringler, a senior research fellow at the International Food Policy Research Institute [FPRI], says global change, including increased population, urbanization, international trade and climate change will have significant effect on food and water security in the coming decades on Africa .
Speaking at How can African agriculture adapt to climate change? Results and Conclusions for Ethiopia and beyond meeting December 11-14, 2009 in Nazareth Ethiopia , Ringler said rural areas in developing countries, especially Africa , will be least able to adapt to these changes, in particular climate change, as incomes and employment in rural areas are largely dependent on agriculture.
“Ethiopians will find it particularly difficult to adapt because of high dependence on rainfed agriculture, very low incomes, widespread poverty and food insecurity, low levels of human and physical capital and poor infrastructure,” she cited.
No adaptation to changing circumstances.
Whereas most households have perceived increase in temperature and decline in rainfall according to a study tabled at the meeting, many have done nothing to adapt to changing circumstances.
The study conducted by IFPRI under Food and Water Security Under Global Change: Developing Adaptive Capacity with a Focus on Rural Africa, in the Nile Basin of Ethiopia and Limpopo Basin in South Africa is the first detailed one on factors affecting adaptation to climate change among house hold farmers.
Approximately 1000 Ethiopian cereal crop farmers in the survey identified shortage of land as the biggest single constraint to adapting to climate change. Next was lack of information and credit lines.
Done in collaboration with the Center for Environmental Economics and Policy in Africa, the Ethiopian Development Research Institute, the Ethiopian Economics Association and the University of Hamburg, Germany the study shows that about half the farmers surveyed did not adapt at all to changes in temperature and rainfall,
Ringler, who was the project leader, said African countries are particularly vulnerable because of limited ability to adapt to dependence on rainfed agriculture, the low level of human and physical capital, poor infrastructure, and already high temperatures.
Ethiopia’s vulnerability, the study states, is intertwined with poverty, although some regions of the country are more vulnerable than the others like Afar, Somali, Oromia and Tigray.
Mahmud Yesuf from Addis Ababa University , the study’s co-author, argued that weak institutional and informal networks, little access to technology and a shortage of information is hampering farmers' ability to adapt to global warming.
“The majority of farmers do not have information on what to do but even where they do, there are no resources required for technologies like building stone and sand bunds,'' said Yesuf.
He warned that some technologies being given as one fix-it-all will not work. “There has been failure to take cognizance of the fact that a technology appropriate for one region may absolutely be unsuitable for another.”
There is also the insecure land tenure, and coupled with undeveloped labour market in agriculture, the future looks bleak without immediate interventions.
Yesuf said 42 percent of household farmers in the region of study did not adapt to climate change despite apparent knowledge of its existence.
Information on climate change is vital
The study on cereal crop farmers suggests that information about climate change and better access to institutions strongly improves farming households’ ability to adapt to global warming.
It found that households with good access to formal agricultural extension assistance, credit and farmer-to-farmer networks were among those most likely to initiate climate change adaptation measures on their farms.
About half the farmers surveyed said they did not adapt at all to changes in temperature and rainfall, blaming the lack of information, followed by shortages of labour, land and money.
Households led by older and more experienced farmers, and households led by literate farmers, were more likely to adopt climate change adaption strategies. Large households were also more likely to respond to climate change, suggesting that the availability of labour is a key issue.
Apart from changing their planting and harvesting periods, the IFPRI report said, farmers also changed crop varieties, were conserving soil and water, intensified water harvesting and planting trees. Five percent of the farmers surveyed said they responded by migration or shifting from crops to livestock herding.
African farmers find it relatively easy to alter planting schedules or using different tillage methods but need to do much more, such as using seed varieties designed to survive climate change, warned Kidane Georgis of the Ethiopian Institute of Agriculture.
Georgis also said that national and regional climate change research institutions were guilty of poor linkages, which affected the speed and quality of information-sharing. Weak agriculture department extension systems hampered the farmers' uptake of new technologies.
Small holder farmers narrated how weather variability has brought great suffering and altered their lifestyles. “We have over the years seen great increase in temperatures and severe change in rainfall patterns,” Tukies Barusha, a small holder farmer from Adami Tuli district said
Rainy season used to run from January through to Septembers but these days it has become unpredictable. Maize has been a staple food crop here but planting time has shifted much with low yield from long dry spells.
Sometimes severe floods destroy crops in the field, devastates infrastructure and kills animals and human beings according to Barusha.
“When I was a boy we were not using fertilizers but today we have to use chemical fertilizers if we have to realise some little yield. Even the amount of maize we get from a hectare of land is down considerably,” Barusha, 47, a father to 15 said.
“We also keep cattle but the changes have been severe with prolonged dry spells and there is not enough grass and water for the animals. My father, at any given time, kept around 100 heads of cattle but today I am forced have only fifteen,” said Fitala Lemu, a middle aged man from Dagada district in Oromia region.
Diseases like Malaria and typhoid are on the increase in the region according to the two farmers. In an area where people have families averaging ten, the pressure on ecological resources like water and forests is enormous and sometimes resulting into tension among communities.
Rethinking water storage strategies
Sub-Saharan Africa [SSA] countries must rethink and adopt water storage strategies for mitigation and adaptation, said Fitsum Hagos, a social scientist with the International Water Management Institute [IWMI].
SSA, he said, is one of the places that will be hit harder by severe water shortage as the region is already under severe water stress.
Most countries here enjoy good rains which could be harvested but it turns into waste run-offs. Citing Kenya , Hagos said it is among SSA countries with poor water storage infrastructure and urgently needs improved management as a mitigation and adaptation measure.
“We need to rethink water storage for climate change adaptation in Kenya and the rest of Sub-Saharan Africa,” Hagos said against a population of 32 million people Kenya had water storage of only 4 cubic meters per person.
“That is very low and the country needs to do something substantial about its water storage infrastructure for both human use and agricultural production, especially in the face of climate change,” he said.
He blamed the low water storage infrastructure in Africa on the lack of political will, dwindling donor funding and trans-boundary issues that make certain usage of water bodies like river Nile shared by several countries difficult.
Ethiopia, he pointed out, had irrigation potential of 3.7 million hectares that could be developed but currently only 200,000 hectares are under irrigation. “The total run-off during the peak season especially June through to Septembers is huge with the rest of the year a long dry spell,” he said. “If we store water we could use it for irrigation and domestic consumption.
The issue of water is critical in SSA since majority, especially in rural settings housing majority of the national populations, depend on fragile rainfed agriculture economies but climate change is not factored in development plans despite extreme weather variability.
“Water stress will affect agriculture, people’s health, among many others. We need to understand priority storage areas from infield to large scale schemes,” he said.
Promotion of water storage system depending on local circumstances and potentials-from farm and communal levels to large scale projects like dams at the basin level for hydroelectric powers stations for local consummation and export-is urgent.
Hagos said for rivers like Nile that passes through several countries it is imperative upstream activities takes care of the needs of those downstream. “We must take into perspective what happens at all stages whenever we are developing projects like a dam. We need an integrated water resource management,’ he pointed out.
Concurring, Ringler called for private investment on on-farm irrigation as a short term priority and a large scale public investment in water storage as one the ways for long term answers to the water problem in SSA.
Clean Development Mechanism
The Clean Development Mechanism, Ringler argued, should be expanded to compensate technologies that replace wood fuel in Africa .
A large percentage of the people in Africa were using firewood and charcoal which should be considered dirty energy. “In Ethiopia for instance,” she said, “92 percent of the people were using wood fuel and the forest cover had declined over the years from 40 to 4 percent.” . Ethiopia has a population of 73 million people.
“Replacing firewood with other clean energy sources like solar power should be accommodated under CDM as one of the ways of fighting global warming and Sub-Saharan Africa could play a big role in this,” she said at a meeting. “If a project replaces firewood then CDM funds should be made available to it,” she added.
Araya Asfaw, Director, Horn of Africa-Regional Environment Center, said Africa must prepare and talk with one voice in Copenhagen next year when a new agreement replacing the Kyoto Protocol is expected to be concluded.
“Africa did not benefit from the Kyoto protocol because it made it difficult for her to access the CDM fund yet it needs funds to mitigate and adapt to global warming,” he said.
He said most technologies recommended for CDM currently like solar power are not accessible to Africa because of lack of funds. Even countries protecting forests should be compensated.
In the past, he said, Africa has not been effective in global negotiations and African Union and her member states should this time round come up with a strong voice to ensure it benefits from the next agreement since it’s more affected by climate change and has very little mechanism for coping up.

**Ochieng’ Ogodo is a Nairobi journalist whose works have been published in various parts of the world, including Africa, the US and Europe . He is the English-speaking Africa and Middle East region winner for the 2008 Reuters-IUCN Media Awards for Excellence in Environmental Reporting. He can be reached at ochiengogodo@yahoo.com or ogodo16@hotmail.com.

Climate change a major threat to health

By Ochieng' Ogodo

Climate change has mostly been associated with melting ice caps, rising sea levels that threatens coastal cities and nations, extreme weather changes that includes prolonged droughts and heavy flooding including unexpected flash floods.
But health experts are now saying there are pathogens that could spread to new regions as a result of climate change, with potential impacts to both human and wildlife health and the global economy according to a report The Deadly Dozen: Wildlife Diseases in the Age of Climate Change.
“There are a number of diseases that could spread fast into new regions as a result of climate change with prospective impacts on both human and wildlife health,” Dr. William Karesh, Vice President and Director of the Wildlife Conservation Society [WCS] Global Health Programmes says.
In East Africa , he points out malaria could escalate due to climate change causing more harm to health problems than now. They believe monitoring wildlife health holds key to knowing what is lurking around us and giving an opportunity to come up with measures for mitigation.
Africa will be hard hit
The report points out that Africa is one of the places that will be hit hard by deadly human-wildlife diseases that have become a major threat in the age of climate change according to the health experts.
WCS’s Assistant Director, Global Health Programme, Kristine Smith says the region was more vulnerable because majority of the people live in rural areas and interact with the wildlife that could carry some of these deadly pathogens.
She says there will be increase in diseases like diarrhoea, cholera, malaria and resurgence of others like sleeping sickness because of changes in temperatures and the environment.
“The rift valley fever, malaria and rinderpest are increasingly becoming both human and wildlife health problems in East Africa due to changes caused by global warming, and leading to extreme weather circumstances and great environmental changes,” she told the Sunday Express.
As new diseases attack wild animals, she says, it increases chances of an epidemic in surrounding communities. In areas where people mostly depend on bush meat, the chances are even higher as climate change negatively impacts on wildlife health.
Dr. Stevens E. Sanderson, President and the CEO of the WCS, speaking on their report says there are deadly diseases that threaten human and animals.
The deadly dozen include such diseases as avian influenza, ebola, cholera and tuberculosis but these are only illustrative of abroad range of infectious diseases. The experts said in addition to the health threats the diseases pose to human and wildlife population, the pathogens that originate or move through wildlife populations have destabilised trade and caused economic damage.
Several livestock disease that emerged in mid 1990s, avian influenza included, caused an estimated loss of US$100 billion to global economy.
“Emerging infectious diseases are a major threat to the health and economic stability of the world,” says Rosa DeLauro, a congresswoman and a champion for The Global Avian Influenza Network for Surveillance [GAIN] programme created in 1996.
According to the experts many wildlife pathogens have been the focus of monitoring but there is very little data on how these diseases will spread because of climate change. The dozen pathogens that may spread as a result of climate change, they stated, are avian influenza, babesiosis, cholera, Ebola, intestinal and external parasites, Lyme disease, plague, red tides, rift valley fever, sleeping sickness, tuberculosis and yellow fever.
Early warning systems
One of the ways for the region and the rest of the world to deal with these increased threats of disease crossing from wild animals to humans, which will be further fuelled by climate change, is the need for early warning systems
"Building warning systems and doing disease surveillance in places like the Congo basin would be cheaper than building expensive machines to control an outbreak," says Karesh.
According to the expert, early warning systems include monitoring disease patterns in wild animals, environmental changes and how they affect the wild animals and the pathogens behaviour because of the changing temperatures and precipitation caused by climate change.
Continuous testing of the wildlife for pathogens could also be an invaluable part of this monitoring system. “Wild animals are more susceptible to new diseases than domesticated animals and are good indicators of an impending outbreak,” he says.
These, he says, does not only offer fertile grounds for building early warning systems but also areas that could be researched on.
He states there are many wildlife pathogens, like Ebola in the Congo area that may be spread as a result of the changing temperatures and precipitation caused by climate change.
For Karesh African governments and the international community should, among others, train local people on how to detect signs of such diseases when they are about to occur by monitoring the behaviour of and wildlife and the seasonality changes.
Sanderson said the health of wild animals is tightly linked t the ecosystem in which they live and influenced by the environment surrounding them.
“Even minor disturbances can have reaching consequences on what diseases they might encounters and transmit as climate changes,” he says. Monitoring wildlife health can, therefore, enable people predict where the trouble spots will occur and set in motion measures to counter.
“The monitoring of wildlife health provides us with a sensitive and quantitative means of detecting changes in the environment. Wildlife monitoring provides a new lens to see what is changing around us and will help governments, agencies and communities detect and mitigate threats before they become disasters, says Karesh
“What we have learnt from the WCS and the GAINS programme is that monitoring of wildlife populations for potential health threats is essential in our preparedness and prevention strategy and expanding monitoring beyond bird flu to other deadly diseases must be our immediate next step,” states DeLauro
Indigenious knowledge
Michael Kocke, also a veterinarian of the WCS, calls for the tapping of indigenous knowledge to deal with these diseases. “Indigenous knowledge can reveal past occurrence of some of these diseases and how they were dealt with including herbs used then to treat them. Scientist can then do research using conventional scientific technology and methods on how to deal with them,” he says.
He says in Africa most people, especially in rural areas, have interacted closely with wildlife and there could be a wealth of information out there that needs researching on.
Indigenious knowledge, Kock says, is vital and should be combined with conventional research for results. Karesh concurred saying that indigenous knowledge can add context to what is going on in the laboratories
Smith believes that building warning systems will also help design adaptation measures like when people should eat what foods and what to avoid when. For instance, this will help people to know when some of the wildlife people consume their meat could be on the verge of infection and they should, therefore, be avoided. This will also help earmark the disease and what needs to be done.
According to Kock climate will complicate the problem of HIV/Aids as those suffering from virus related ailments have their immunity compromised and low nutrition levels may worsen with this. “Climate change is a big issue both the developing and the developed world. The vector range is expanding because of it and more people are getting exposed,” says Kock.
The best defence, according to the experts, is a good offence in the form of wildlife monitoring to detect how diseases are moving so health professionals can learn and prepare to mitigate their impact.

**Ochieng’ Ogodo is a Nairobi journalist whose works have been published in various parts of the world including Africa, the US and Europe. He is the English-speaking Africa and Middle East region winner for the 2008 Reuters-IUCN Media Awards for Excellence in Environmental Reporting. He can be reached at ochiengogodo@yahoo.com or ogodo16@hotmail.com.