By MIKE MWANIKI
Poor people in Kenya suffer disproportionately from Non-Communicable Diseases and Injuries (NCDI) compared to their wealthier counterparts, new data shows.
Data—tabulated from Health and Demographic Surveillance Sites —reveals a higher proportion of deaths due to NCDs among the poorest compared to wealthiest quintiles.
The NCDI Poverty Commission—established in December 2016 by the Health Ministry to assess the causes and impacts of NCDs particularly on the poorest populations in the country—says NCDs are currently contributing 37 percent of the overall burden of disease and 35 percent of all deaths.
“Contrary to popular belief, NCDs occur at younger ages and affect those in the productive years of life, with over half of the NCD disease burden and almost three-quarters of injuries occurring before the age of 40.”
The Commission said NCD conditions are diverse, and although global targets in NCDs focus on four major diseases (cardiovascular diseases, type 2 diabetes, asthma and cancer), 67 percent of NCDs in Kenya are due to other NCD conditions.
These conditions contributing 67 percent have been identified as mental and substance abuse disorders (15 percent), musculoskeletal disorders (10 percent), neurological disorders (8 percent) and urogenital, blood and endocrine diseases (6 percent).
Others are digestive diseases (4 percent), cirrhosis and other chronic liver diseases (3 percent), and other NCDs (21 percent).
The 24 experts’ commission said NCDs account for 37 percent of the disease burden in disability –adjusted life years (DALYs).
“More than half (53 percent) of NCD DALYs and 72 percent of injury DALYs occur before the age of 40.”
Currently, 37 percent of total DALYs in Kenya are due to NCDs with communicable, maternal, neonatal and nutritional diseases contributing 63 percent followed by NCDs 30 percent and injuries 7 per cent.
“Of all DALYs from NCDs—67 per cent were related to conditions other than cardiovascular diseases, diabetes, neoplasms and chronic respiratory diseases,” the data shows.
This is notably higher than in high-income countries –where 53 percent of NCD DALYs are due to these conditions.
The report notes that in Kenya, mental health disorders, neurological diseases and chornic respiratory diseases account
NCD disease categories with the highest proportion of DALYs occurring under the age of 40 included mental health disorders (74 per cent) followed by neurological diseases (70 per cent) and chronic respiratory diseases (50 per cent).
The World Health Organisation (WHO) says NCDs kill 38 million people globally—with a majority of the deaths—80 per cent, occurring in developing countries whose fragile health systems are still grappling with a heavy burden of communicable diseases resulting in a duo burden of disease.
The WHO estimates that the NCDs will cause 73 percent of global deaths and 60 percent of the burden of disease by 2020.
In the report released in July 2018, the NCDI Poverty Commission said crude death rates among the poor were more than double for NCDs and triple for injuries than those among the wealthier populations.
“In modeling of risk factors for NCDIs, less than one-quarter of the risk factor profile can be attributed to individual behaviours, such as tobacco or alcohol, or metabolic risk factors—such as obesity or blood pressure.”
The report noted that the prevalence of particular risk factors such as alcohol, obesity and hypertension, may be lowest in the poorest wealth quintiles.
The Commission also found that services for basic NCDIs are lacking—particularly in poorer regions and in the public sector.
Despite strong inclusion of NCDIs in the Kenya Essential Package for Health (KEPH), the report notes, availability of key medications and readiness of NCD services remains limited and inversely related to the poverty level of regions.
“At the same time, Referral hospital level NCDI services remain sparse compared to the population of the country and concentrated in urban areas. Coverage of basic NCDIs—such as diagnosis and treatment of hypertension, diabetes or cancer screening, is low, and is inversely related to wealth.”
According to the report, NCDIs also have a significant economic impact on households.
Household surveys demonstrate NCDs cause a greater decrease in household income (28.6 per cent) and a higher rate of catastrophic expenditures than communicable diseases.
“Catastrophic expenditures for NCDs are greatest for the poor and rural households. Households affected by NCDs are 30 per cent more likely to be impoverished than households with communicable diseases. And, despite comprising a large burden of disease in Kenya, currently, NCD spending comprises only 6.5 per cent of total health expenditures.”
Based on the overall burden of disease, the Commission has selected 14 NCDI disease conditions on which to increase health sector interventions.
The conditions include asthma, chronic obstructive pulmonary disease (COPD); hypertensive heart disease and stroke; rheumatic heart disease; diabetes (type 1 and 2); cervical cancer and non-Hodgkin lymphoma.
Others are: Breast cancer; major depressive disorders; epilepsy; sickle cell disease; cirrhosis; motor vehicle road injuries and interpersonal violence/assault.
The experts also identified several interventions—which when implemented—it is estimated that over 9,000 premature deaths can be averted annually by 2030.
These interventions include out-patient, in-patient, surgical, mental health, rehabilitation and palliative care services along with facility-and central-level indirect costs, which would cost about 17 per cent of total health expenditure.