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 Africa
The 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.

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