Kenya faces rising burden of diabetes
“I didn't know I had diabetes until I became sick. I went into hospital and was told: ‘Your blood sugar level is way up.’”
In 1996, Evelyne Musera’s diagnosis of type 2 diabetes set her on a life-long path of medical treatment. The ongoing costs of managing her condition pose a serious financial burden on her family.
“I am on medication every day,” she said, in a recent interview with WHO at the Kenyatta National Hospital in Nairobi. “If you don't take it, you find that you are again admitted to the hospital. You must have a lot of money to buy the medication. We are no longer able to afford the things we used to do.”
Barriers to treatment
Type 2 diabetes is a chronic illness resulting largely from excess body weight and physical inactivity. Like Evelyne, most people living with diabetes in Kenya are diagnosed too late, when preventing complications of the disease is no longer possible.
“Across Kenya, community awareness around diabetes is low,” notes Dr Nancy Ngugi, Head of the Diabetes Clinic at Kenyatta National Hospital. People are often diagnosed through medical outreach camps or when patients arrive at the hospital with complications of diabetes like thirst, vision change, fatigue and constant hunger, she adds.
For many Kenyans, the cost of health care is a key obstacle to treatment. “Health care is not free in Kenya,” says Dr Ngugi. “In lower-income communities, we find that life is hard. People do not have money to buy drugs, to see the doctor, to get their tests done.”
Treatment involves lowering a patient’s blood sugar levels through a healthy diet, regular physical activity and medication when necessary. Reducing the levels of other known risk factors that can damage blood vessels, such as high blood pressure, is also important.
Burden of diabetes
Once seen as a disease of affluent societies, diabetes has become a growing problem in developing countries—an increase driven largely by a rise in obesity. Of the estimated 1.5 million global diabetes deaths in 2012, more than 80% occurred in low- and middle-income countries.
About 1% of deaths in Kenya were directly attributable to diabetes in 2012, according to WHO data.1 But this is likely an under-estimate, says Dr Gojka Roglic, who leads WHO’s global work on diabetes. “Most people with diabetes do not die of causes uniquely related to diabetes, but of associated cardiovascular complications, like a heart attack,” she notes.
There are two major forms of diabetes. Type 1 diabetes is characterized by a lack of insulin production; the cause is unknown and it cannot be prevented. Type 2 diabetes is far more common, accounting for about 90% of all diabetes worldwide. Often preventable, it results from the body's ineffective use of insulin.
Over time, diabetes can damage the heart, blood vessels, eyes, kidneys and nerves, causing chronic problems and early death.
Risk factors and prevention
Dr. William Maina leads the Directorate of Preventive and Promotive Health Services in Kenya’s Ministry of Health. He notes the growing strain that diabetes and other non-communicable diseases (NCDs)—such as heart disease, stroke and cancers—are placing on the national health care system.
"We are seeing the burden of NCDs escalate in this country. If you walk into any hospital, you will find more than half the occupancy of hospital beds is due to NCDs. Almost half of deaths reported by hospitals are due to NCDs,” he says.
The increased consumption of unhealthy food is a major risk factor for NCDs, notes Dr Maina. “Traditionally, 20 or 30 years ago, people depended more on health foods rich in grains and vegetables. Currently, people depend on processed foods that are available in markets all over the country,” he says.
At the same time, physical activity is declining as more people depend on motorized transport. And, as buildings replace playgrounds, children are left with few places to engage in sports, says Dr Maina. Tobacco and alcohol use are other important risk factors for NCDs, he adds.
Taking action in Kenya
In collaboration with the Ministry of Health, Kenyatta National Hospital is now providing medical students at the University of Nairobi with hands-on training on how to prevent, treat and care for people with diabetes.
“We need to educate medical personnel about the management of diabetes because we do not have many specialists in this country,” notes Dr Ngugi. “Most of our patients are being handled by people who really don’t know a lot about diabetes.”
The prevention and control of NCDs are identified as priority issues in the Kenyan Government’s National Medium Term Plan (2014-2018) and National Health Strategic Plan (2014-2018). “We are very keen to scale up our programmes to halt and reverse the rising trend of NCDs," says Dr Maina.
Sustained political commitment will be essential to combat the increasing burden of NCDs in Kenya, and globally, notes Dr Etienne Krug, WHO Director of Management of NCDs.
“Governments have a dual role in responding to the diabetes epidemic,” says Dr Krug. “They can prevent people from getting diabetes in the first place by improving access to healthier foods and physical activity. And to support people living with diabetes, governments should improve capacity at the primary health care level, and ensure access to treatment.”
WHO provides technical guidelines for diabetes prevention, develops standards for diabetes diagnosis and care, and builds awareness around the global epidemic of diabetes.
The WHO Global action plan for the prevention and control of NCDs (2013-2020), endorsed by the World Health Assembly in 2013, includes a road map for countries and their development partners to attain nine targets. Among the key goals identified in the action plan are:
- Halting the rise in obesity and diabetes.
- Achieving a 25% relative reduction in premature mortality from diabetes by the year 2025.
World Diabetes Day, observed annually on 14 November, serves to remind governments of their commitment to develop national policies for diabetes prevention, treatment and care— a pledge they made during the 2011 UN High Level Meeting on Non-communicable Diseases (NCDs).
1 Published in the Noncommunicable Diseases (NCD) Country Profiles, WHO, 2014.