Kenya Takes Steps To Tackle Non-Communicable Diseases

Faced with the growing challenge of lifestyle diseases – already the second biggest killers in Kenya after HIV/AIDS, with cardiovascular diseases leading in the category – the government recently launched guidelines for cardiovascular disease management.

A patient receiving drugs at a pharmacy at Busia County Hospital in Western Kenya. The government of Kenya is keen to see rural hospitals offer treatment and management of non-communicable diseases.

The national guidelines are set to offer guidance in prevention and screening as well as standardising treatment of cardiovascular diseases.

The state of affairs has rattled health authorities. According to the Ministry of Health, non-communicable diseases (NCDs) account for 50 percent of hospital admissions and 55 percent of hospital deaths in Kenya.

The data from the ministry shows some 25 percent of hospital admissions and 13 percent of deaths in Kenya are due to cardiovascular diseases (CVDs).

Hypertension is the most significant risk factor for CVD, according to Kenya’s National STEPwise Survey for NCDs 2015 [pdf] (STEPS is a World Health Organization-developed framework for countries to monitor main NCD risk factors through questionnaire assessment and physical and biochemical measurements). The survey showed that more than 56 percent of Kenya’s adult population has never had their blood pressure tested.

Still, data from the ministry shows one in four Kenyans is living with hypertension, and only a quarter of them are on medication. The survey indicated that over 90 per cent of people diagnosed with hypertension are not managing the disease.

During the launch that took place on 31 May this year in Nairobi and which coincided with World “No Tobacco Day,” Kenya’s health ministry reiterated the need for inclusion of the national guidelines for cardiovascular disease management in the school curriculum.

Stakeholders in the health sector said a significant part of the Kenyan population which includes children between the ages of 13-15 years have adopted lifestyles that have pre-exposed them to non-communicable diseases such as hypertension and cardiovascular diseases.

This happens at a time when the United Nations General Assembly is preparing to convene the third High-Level Meeting on the prevention and control of noncommunicable diseases on 27 September. The forum will review the global and national progress in putting measures in place that protect populations – especially the young – from high mortality due to various cancers and diabetes.

It is also taking place when the NCD Alliance is championing inclusion of NCD indicators in the United Nations Sustainable Development Goals (SDGs) to enhance resource mobilization to fight them. The NCD Alliance was founded by four international NGO federations representing four main NCDs: cardiovascular disease, diabetes, cancer, and chronic respiratory disease.

Loise Nyanjau, Focal Person for Cardiovascular Diseases at the Kenyan Ministry of Health, attributes the growing burden of CVD to rapidly changing lifestyle choices.

In an interview with Health Policy Watch, Nyanjau said blood pressure is the biggest risk factor for CVD.

The rationale for the guidelines (Kenya National Guidelines for Cardiovascular Disease Management) [pdf] is to ensure the Kenya health policy focus on halting and reversing rising burden of NCDs.

They focus on CVDs that are of greatest burden in the country such as hypertension, heart attack, heart failure, rheumatic heart disease, congenital heart diseases. Other issues are implementing an NCD strategy to strengthen health systems for NCDs, develop and disseminate clinical guidelines and address capacity gaps.

The guidelines have detailed instructions on prevention of cardiovascular disease, promoting healthy lifestyles and diet. They also highlight issues of weight reduction, physical activity, and tobacco and alcohol cessation.

Other issues covered by the guidelines are screening for risk factors and disease conditions, and managing existing or potential risk factors.

Moreover, they address issues of diagnosis and treatment of select CVDs such as heart diseases and stroke. And the guidelines offer detailed management of CVD among people suffering from diabetes, renal diseases, and HIV infection.

The guidelines also offer guidance on tackling CVDs among special populations, namely children, pregnant women, older persons, and athletes. At the same time, they highlight methods to be used to disseminate them to the public.

Not left behind is capacity building, which includes training health workers as well as monitoring and evaluation, data collection, reporting and setting up of a CVD registry.

Research is also given prominence in the guidelines. It includes aspects such as regional mapping of the burden of priority CVDs, determination of occurrence and severity and qualitative studies on quality of CVD care in the country.

The guidelines were prepared through the collaboration of partnership with WHO, Kenya Cardiac Society, AstraZeneca, Healthy Heart Africa, Amref Health Africa in Kenya, Christian Health Association of Kenya and the Kenya Society for Thrombosis and Haemostasis.

According to Sicily Kariuki, Kenya’s Health Cabinet Secretary, statistics about the rise of noncommunicable diseases paint an alarming picture. Kariuki’s speech was read on her behalf by Ephantus Maree, head of the NCDs Unit at the Kenya’s Health Ministry, during the launch of the guidelines.

She mentioned the 2015 STEPwise Survey on Risk Factors for Non-communicable Diseases that indicated that 13 percent of adults use tobacco products and one in every 5 Kenyans is exposed to second hand tobacco smoke at home.

Kariuki reiterated the importance of partnerships and stakeholder engagement in the fight against CVDs. She added that this year’s No Tobacco Day theme, “Tobacco and heart disease,” is timely because it reaffirms the need to increase awareness on the link between tobacco use and cardiovascular diseases.

She noted, however, that the country has not done enough considering that 25 percent of hospital admissions and 13 percent of deaths in Kenya are due to CVDs.

Signpost showing some of the services available at the county hospital.

According to Kariuki, the guidelines offer an innovative and evidence-based approach towards bridging gaps in the prevention and treatment of cardiovascular diseases.

The move, she noted, will enable Kenyans to be screened for risk factors for cardiovascular diseases and other NCDs whenever they seek healthcare services.

Nyanjau dispelled fear that the guidelines will suffer the fate of “rosy policy documents that gather dust” instead of being implemented. She told Health Policy Watch that the guidelines are mainly targeted for health workers both in training and practice, given their crucial role in implementing them.

Noting the guidelines utilisation goes beyond policymakers, trainers and program managers, she said “adherence to the guidelines will stem from users knowing of their existence to begin with and then sustained capacity building of the workforce so that demand to use the guidelines is generated.” To cultivate good practices, she added, sensitisation and “up skilling” will be done continuously.

Nyanjau observed that most of the conditions addressed had not been articulated in a clinical guideline prepared in Kenyan context. “The guideline also incorporates guidance on prevention as well as treatment for CVDs thereby broadening the utility of the document beyond hospital setup,” she elaborated.

Speaking during the launch of the guidelines, Isabella Karanja of the Tobacco Control Board said that Kenya continues to make strides in tobacco control, which is a leading cause of CVDs and related ailments. The strides made, she said, suffer setbacks from aggressive legal onslaughts waged by the tobacco industry.

Her views were echoed by Nyanjau, who said Kenyans are exposed to many risks especially pertaining to CVDs with many emanating from tobacco use.

Nyanjau outlined other causes as unhealthy diet, inadequate physical activity, and harmful alcohol use. “Untreated or poorly treated hypertension and diabetes will almost certainly lead to heart attack, stroke or kidney failure,” she said.

Dissemination Plan

To ensure Kenyans have a clear grasp of the guidelines, Nyanjau said her ministry has a dissemination plan. She said in the initial years they are engaged in mobilising resources to reach many users by distributing printed copies and using digital platforms.

Kenya’s health system suffers from inadequacies on different fronts. Nyanjau said lack of funds to run control programs are a key barrier in Kenya and elsewhere. “The economic burden of CVDs far outweighs the current resources availed to the health system,” she said, adding that others are staff shortages and population poverty.

In terms of bridging the human resources gap to manage NCDs, for instance cardiovascular ones, Nyanjau noted they are cascading their care to lower level health facilities.

She said the Ministry of Health has developed a training module on NCDs for community health workers and volunteers to strengthen prevention of cardiovascular diseases.

Nyanjau disclosed that her ministry has been working with the WHO towards management of non-communicable diseases. The collaboration is in the form of provision of technical expertise and financial support for many activities around control of NCDs.

 

Image Credits: Justus Wanzala.

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