Non-communicable Diseases in Kenya

Communicable diseases like HIV, tuberculosis, and malaria have for a long time significantly contributed to disease burden in Kenya (Gouda et al., 2019). A rapid epidemiological transformation, however, is currently affecting the country and features the dominance of non-communicable diseases (NCDs). NCDs in Kenya account for over 50 percent of all hospital admissions and more than 55 percent of deaths in hospitals (Wamai et al., 2018). The most prevalent NCDs include mental and substance use issues, cancers, cardiovascular illnesses, chronic kidney illness, severe respiratory illnesses, and diabetes. High mortality rates are likely to affect the country due to NCDs. It is necessary to determine the causes, risk factors, and prevention methods for NCDs in this region. 

The current paper examines the causes of NCDs in Kenya, the factors that continue to exacerbate NCDs, and formulate an action plan to address the issue. 

Causes of NCDs in Kenya 

Multiple factors that interact in complex ways cause NCDs (Haregu et al., 2018). A majority of these factors concern the way people live and can be changed. Most NCDs also share several causes, which emphasize the importance of examining all the involved causes. The factors can also be categorized into individual issues, community factors, cultural factors, family roles and structure issues, and environmental factors. 

Individual Causes 

Tobacco smoking is the main cause of NCDs in Kenya (Wamai et al., 2018). Nearly 13 percent of Kenyans use different forms of tobacco in which men account for about 23 percent of the users followed by 4.1 percent of women (Ministry of Health Kenya, 2015). Young people in the age range of 10-14 years also use tobacco. Young people account for 7 percent of tobacco users with boys accounting for 9.6 percent and girls 4 percent (Ministry of Health Kenya, 2015). 17.6 percent of adults at the workplace and 14.3 percent at home are exposed to tobacco smoke (Ministry of Health Kenya, 2015). Most tobacco users start using the product at the age of 21 years while about 80 percent of tobacco users are under 50 years. Most of them are in the age range of 28-29 years old (Wamai et al., 2018). People in the age range of 50 to 59 are three times more likely to engage in tobacco use daily compared to young people. Tobacco use causes cancers and cardiovascular illnesses and affects the respiratory and immunity systems. 

Additionally, physical inactivity is a risk factor for different NCDs. About 7 percent of Kenyans are physically inactive based on the WHO recommendations (Wekesah et al., 2018). NCDs associated with physical inactivity include colon and breast cancers, diabetes, and ischaemic heart illness. 14 percent of women and 10 percent of men are physically inactive. Physical inactivity is less in rural areas compared to urban places (Ministry of Health Kenya, 2015). Inadequate fruit intake also significantly contributes to the prevalence of NCDs in Kenya where over 90 percent of people fail to adhere to the recommended guidelines regarding daily fruit intake (Wamai et al., 2018). Most people also consume high dietary salt and engage in inadequate physical exercise (Tawa, Waggie & Frantz, 2011). The poorest individuals display less high salt intake and less physical activity compared to wealthy individuals. 

Community Causes 

Gender plays a vital role in NCD prevalence. Studies show that gender is a significant factor in risk behaviors such as alcohol intake and increased blood sugar levels (Tawa, Waggie & Frantz, 2011). Men are significantly associated with risky alcohol consumption and smoking (Siddharthan et al., 2015). About 19 percent of Kenyans engage in alcohol consumption where 13 percent of them engage in daily alcohol consumption (Wamai et al., 2018). 18-29-year-olds were found to be heavy episodic drinkers of alcohol at 35.5 percent (Wamai et al., 2018). Alcohol plays a role in different NCDs such as cancer, liver cirrhosis, and heart disease. 

Kenya also experiences an extra adverse effect of traditional drinking because producers of these beverages sometimes adulterate them with toxic substances that lead to fatalities and other complications such as loss of eyesight (Ministry of Health Kenya, 2015). Alcohol consumption has also been linked to additional issues such as public disorder, risky sexual behaviors, injuries, crimes and violence, road accidents, and issues at home and work (Ministry of Health Kenya, 2015). Women, on the other hand, are significantly related to overweight and hypertension (Tawa, Waggie & Frantz, 2011). 27 percent of Kenyans are either obese or overweight in which women account for about 40 percent of this population followed by nearly 18 percent of men. Urban dwellers account for 12 percent of obese Kenyans compared to 7 percent of rural residents (Wamai et al., 2018). People in poor urban settings experience higher rates of NCDs. Healthcare costs in low-resource environments drain household resources quickly. The high costs required to manage most NCDs and the lengthy treatment hinder millions of poor people from accessing appropriate health care. 

Family Roles and Structures 

Studies demonstrate that when three or more individuals share a household, they face less risk of engaging in unhealthy diets, tobacco smoking, and harmful alcohol consumption (Haregu et al., 2018). Married people are therefore less likely to engage in unhealthy behaviors such as alcohol consumption and smoking compared to single-family households (Haregu et al., 2018). Married women, however, have been found to face more NCD risk factors compared to married men. Studies have found that while the married or cohabiting couples engaged in heavy episodic drinking, the separated couples or a single couple engaged more in heavy episodic drinking (Wamai et al., 2018). 

Culture 

Cultural values and beliefs also significantly contribute to the burden of NCDs in Kenya. Most patients with NCDs, for instance, regularly seek treatment services from faith or traditional healers because of accessibility and reduced cost. These services, nevertheless, offer unrealistic treatment promises (Siddharthan et al., 2015). Cultural views that depict overweight women as having a high social status or attractive contribute to the emergence of NCDs in Kenya. 

Environmental issues 

Urbanization that is underway in Kenya has led to a rapid increase in cardiovascular risk factors such as high blood pressure (Siddharthan et al., 2015). Urbanization also leads to higher consumption of low quality and prepackaged foods (Siddharthan et al., 2015). Factors such as inadequate information, inappropriate built environment, and motorized transport hinder physical activity (Ministry of Health Kenya, 2015). Additionally, indiscriminate use of chemicals in farming and the release of toxic products from illegal chemical industries causes NCDs such as kidney disease and cancer 

Factors that Continue to Exacerbate NCDs in Kenya 

Individual Factors 

Unhealthy diets, alcohol consumption, and smoking exacerbate the effect of NCDs. Kenyans increasingly face NCDs related to poor diets, which is especially significant in urban areas. Unhealthy diets emerge from the consumption of diets high in salt, trans- and saturated fats, sugars, and calories but low in vegetables and fruits (Wekesah et al., 2018). Unhealthy diets combined with changing lifestyles have cause high levels of diabetes, cancers, and cardiovascular illnesses. 

Community Factors 

Workforce shortages continue to exacerbate NCDs in Kenyan. There is a gap of nearly 8 million health care workers (Wamai et al., 2018). These workers are needed to manage NCDs. Health care workers also leave the country in large numbers to search for high paying organizations elsewhere (Gouda et al., 2019). The immigration of healthcare workers continues to exacerbate the shortage of human resource. Besides, knowledge deficits concerning NCDs is also another major challenge that adversely affects NCD management (Siddharthan et al., 2015). The affordability and availability of NCD drugs is also another challenge where the availability of NCD drugs in most places is below 50 percent (Wekesah et al., 2018). Price variability both in the public and private sector concerning pricing for NCD drugs is also marked where the average monthly cost for patients with an NCD is nearly a third of their average monthly income (Wamai et al., 2018). The quality of the medication is another persistent issues even when drugs are affordable or accessible (Siddharthan et al., 2015). Many health care facilities in Kenya also lack clear protocols and equipment such as mammogram to detect NCDs. 

The various aspects of NCD screening available in most clinics are scanty and most clinics do not appropriately evaluate patients to examine their compliance level (Kazungu, 2017). Poverty also exacerbates the issues as tobacco use is high among the poorest people, particularly among men. Most uneducated individuals also consume tobacco more compared to educated people (Ministry of Health Kenya, 2015). Alcohol consumption, including both episodic and regular drinking, is high among the wealthy people (Ministry of Health Kenya, 2015). Wealthy men also consume alcohol more than poor men even though the poorest populations have significant cases of unrecorded alcohol consumption. 

Cultural Factors 

Cultural myths exacerbate NCDs. Most breast cancer patients, for example, consider the diagnosis of the disease to be a death sentence, which delays the need to seek health care (Kazungu, 2017). The belief that there is no cure for cancer inhibits patients from seeking the required care as they explore other culturally acceptable options based on how they define the disease according to their culture (Kazungu, 2017). Another factor that exacerbated NCDs is the failure of people to associate screening of some NCDs such as cancer with direct benefits (Kazungu, 2017). Since some NCDs such as cancer are not prevalent in certain regions, most residents who may likely be affected fail to participate in early screening programs. 

Cultural myths also impede early screening of NCDs such as cancer where the affected populations are afraid of openly discussing such illnesses (Kazungu, 2017). Patients mostly pray to determine why and who is causing the illness, which delays early screening and treatment of the conditions (Kazungu, 2017). Another cultural myth regarding NCDs such as cancer concerns the belief that the illness is a curse (Freiberg et al., 2016). Some people believe that cancer emerges as a curse after one disobeys his parents after their death. Other myths concern the belief that mimicking practices and values of the West such as Western vaccinations and diet cause some NCDs such as cancer (Freiberg et al., 2016). These myths exacerbate NCDs by acting as barriers to prevention and treatment. 

Environmental Factors 

Environmental conditions in urban slums such as stressful conditions, poor education, and air quality aggravate NCDs among inhabitants (Siddharthan et al., 2015). Another contributing factor that exacerbates NCDs is the dependence on biomass cooking fuels among the underprivileged in the country (Wekesah et al., 2018). Additionally, late diagnosis worsens the effect of NCDs in the Kenyan population as these often result in severe complications (Gouda et al., 2019). Exposure to occupational and environmental carcinogens such as ultraviolet and ionizing radiation, petroleum exhaust gases, and asbestos both in the working and living environments worsen the risk of cancer. 

Action Plan 

Education 

It is vital to change practice patterns by emphasizing NCD management in healthcare worker education and system delivery. Public health efforts will be instituted to raise awareness of the lasting effects of tobacco use and unhealthy nutritional intakes. Patient education will be launched to advice people regarding the symptoms of severe manifestations of NCDs and the appropriate time to seek healthcare. Educational programs will also be established with a focus on lifestyle factors and preventing measures that contribute to NCDs. 

Communication 

Communication interventions to decrease the preventable causes of NCDs such as tobacco use, exposure to smoking, harmful alcohol consumption, unhealthy diets, and physical inactivity will be developed. Mass media campaigns will be used to raise awareness regarding the health issues of unhealthy diets such as high salt consumption. 

Relief workers 

Qualified relief workers are needed to offer intensive training and avail information regarding the benefits of early screening to improve uptake of NCD screening. These workers will also educate the affected populations about how to identify body changes and assist them with the choices to make if they identify changes. Relief workers will also educate community health workers regarding the nutritional and other factors that cause NCDs. 

Technology 

Another vital action is to invest in enhanced NCD management to support better detection, screening, and treatment of NCDs and to provide access to palliative care for the needy. Primary health care approaches can be used to deliver high impact essential interventions, which will reinforce early detection and appropriate treatment. These investments are viable because early interventions will decrease the necessity for costly treatment. Voluntary testing programs need to be established for NCDs to develop an infrastructure for opportunistic screening of people. Mobile technology can also be used to enhance the effectiveness of compliance with medications and reduce integrated care costs for patients with NCDs. Care can also be decentralized both geographically and professionally to offer patient-centred and community-based NCD management. 

Innovations such as new medication and appointment reminders, community follow-up, home-based care, and counseling can also be used to improve adherence to treatment. 

References 

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Haregu, T. N., Wekesah, F. M., Mohamed, S. F., Mutua, M. K., Asiki, G., & Kyobutungi, C. (2018). Patterns of non-communicable disease and injury risk factors in Kenyan adult population: a cluster analysis.  BMC Public Health ,  18 (S3). https://doi.org/10.1186/s12889-018-6056-7 

Kazungu, H. K. (2017).  The Impact of Non-communicable Diseases on Development; a Case Study of Breast Cancer in Gede, Kilifi County  [MSc Thesis]. http://erepo.usiu.ac.ke/bitstream/handle/11732/3599/HARRIETTE%20KADZO%20KAZUNGU%20MAIR%202017.pdf?sequence=1&isAllowed=y 

Ministry of Health Kenya. (2015).  Kenya National Strategy for the Prevention and Control of Non-communicable Diseases . https://extranet.who.int/nutrition/gina/sites/default/files/KEN-2015-NCDs.pdf 

Siddharthan, T., Ramaiya, K., Yonga, G., Mutungi, G. N., Rabin, T. L., List, J. M., Kishore, S. P., & Schwartz, J. I. (2015). Noncommunicable Diseases in East Africa: Assessing The Gaps In Care And Identifying Opportunities For Improvement.  Health Affairs (Project Hope) ,  34 (9), 1506–1513. https://doi.org/10.1377/hlthaff.2015.0382 

Tawa, N., Waggie, F., & Frantz, J. M. (2011). Risk factors for chronic non communicable diseases in Mombasa, Kenya: Epidemiological study using WHO stepwise approach. 

Wamai, R. G., Kengne, A. P., & Levitt, N. (2018). Non-communicable diseases surveillance: overview of magnitude and determinants in Kenya from STEPwise approach survey of 2015.  BMC Public Health ,  18 (S3). https://doi.org/10.1186/s12889-018-6051-z 

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