Reframing Non-Communicable Diseases and Injuries for Equity in the Era of Universal Health Coverage: Findings and Recommendations from the Kenya NCDI Poverty Commission.

Background: Kenya has implemented a robust response to non-communicable diseases and injuries (NCDIs); however, key gaps in health services for NCDIs still exist in the attainment of Universal Health Coverage (UHC). The Kenya Non-Communicable Diseases and Injury (NCDI) Poverty Commission was established to estimate the burden of NCDIs, determine the availability and coverage of health services, prioritize an expanded set of NCDI conditions, and propose cost-effective and equity-promoting interventions to avert the health and economic consequences of NCDIs in Kenya. Methods: Burden of NCDIs in Kenya was determined using desk review of published literature, estimates from the Global Burden of Disease Study, and secondary analysis of local health surveillance data. Secondary analysis of nationally representative surveys was conducted to estimate current availability and coverage of services by socioeconomic status. The Commission then conducted a structured priority setting process to determine priority NCDI conditions and health sector interventions based on published evidence. Findings: There is a large and diverse burden of NCDIs in Kenya, with the majority of disability-adjusted life-years occurring before age of 40. The poorest wealth quintiles experience a substantially higher deaths rate from NCDIs, lower coverage of diagnosis and treatment for NCDIs, and lower availability of NCDI-related health services. The Commission prioritized 14 NCDIs and selected 34 accompanying interventions for recommendation to achieve UHC. These interventions were estimated to cost $11.76 USD per capita annually, which represents 15% of current total health expenditure. This investment could potentially avert 9,322 premature deaths per year by 2030. Conclusions and Recommendations: An expanded set of priority NCDI conditions and health sector interventions are required in Kenya to achieve UHC, particularly for disadvantaged socioeconomic groups. We provided recommendations for integration of services within existing health services platforms and financing mechanisms and coordination of whole-of-government approaches for the prevention and treatment of NCDIs

Dietary risk factors for non-communicable diseases in Kenya: findings of the STEPS survey, 2015

Abstract Background Burden of non-communicable diseases (NCD) is increasing worldwide. Risk factor surveillance informs public health interventions in NCD control. This study describes the dietary risk factors for NCD found in the Kenya STEPS survey, 2015. Methods We performed secondary analysis of the STEPS dataset to determine prevalence of dietary NCD risk factors and their determinants. New variables were created; high dietary salt, defined as addition of salt while eating or intake of processed foods high in salt and high dietary sugar, defined as intake of processed foods or drinks high in sugar in most meals or addition of sugar to beverages already with sugar, on a daily basis. We used the World Health Organization definition of minimum required intake of fruits and vegetables as consumption of less than five servings of fruits and vegetables per day. Perceptions of respondents on diet and health were also assessed. Accounting for complex survey sampling, we calculated prevalence of the various dietary modifiable determinants and adjusted odds ratios (AOR) to identify factors independently associated with dietary NCD risk factors. Results Of the 4484 individuals surveyed; mean age was 40.5 years (39.9–41.1 years), 60% were female. Prevalence of high reported dietary salt intake was 18.3% (95% CI 17.2%, 19.5%) and sugar 13.7% (95% CI 11.7–15.8%). Awareness of health risk from dietary salt was 88% and 91% for dietary sugar. Approximately 56% of the respondents were implementing strategies to reduce dietary salt and 54% were doing the same for dietary sugar. Only 6.0% (95% CI 4.3–7.6%) of the respondents reported intake of a minimum of five servings of both fruits and vegetables daily. Unhealthy diet was associated with being male (AOR 1.33, 95% CI 1.04, 1.70,), age below 46 years (AOR 1.78, 95% CI 1.42, 2.12) and being a student (AOR 15.6, 95% CI 2.44, 99.39). Conclusion Dietary risk communication should be targeted to males and people under 45 years of age, especially students. Further research is necessary to understand the knowledge: practice mismatch on unhealthy diets

Prevalence, awareness, treatment and control of hypertension and their determinants: results from a national survey in Kenya

Abstract Background Hypertension is the most important risk factor for cardiovascular diseases and the leading cause of death worldwide. Despite growing evidence that the prevalence of hypertension is rising in sub-Saharan Africa, national data on hypertension that can guide programming are missing for many countries. In this study, we estimated the prevalence of hypertension, awareness, treatment, and control. We further examined the factors associated with hypertension and awareness. Method We used data from the 2015 Kenya STEPs survey, a national cross-sectional household survey targeting randomly selected people aged 18–69 years. Demographic and behavioral characteristics as well as physical measurements were collected using the World Health Organization’s STEPs Survey methodology. Descriptive statistics were used to estimate the prevalence, awareness, treatment and control of hypertension. Multiple logistic regression models were used to identify the determinants of hypertension and awareness. Results The study surveyed 4485 participants. The overall age-standardized prevalence for hypertension was 24.5% (95% confidence interval (CI) 22.6% to 26.6%). Among individuals with hypertension, only 15.6% (95% CI 12.4% to 18.9%) were aware of their elevated blood pressure. Among those aware only 26.9%; (95% CI 17.1% to 36.4%) were on treatment and 51.7%; (95% CI 33.5% to 69.9%) among those on treatment had achieved blood pressure control. Factors associated with hypertension were older age (p < 0.001), higher body mass index (BMI) (p < 0.001) and harmful use of alcohol (p < 0.001). Similarly, factors associated with awareness were older age (p = 0.013) and being male (p < 0.001). Conclusion This study provides the first nationally-representative estimates for hypertension in Kenya. Prevalence among adults is high, with unacceptably low levels of awareness, treatment and control. The results also reveal that men are less aware of their hypertension status hence special attention should focus on this group

Individual and household level factors associated with presence of multiple non-communicable disease risk factors in Kenyan adults

Non-communicable diseases (NCDs), are increasing globally, causing about 60% of disability-adjusted life years and 39.8 million deaths in 2015. Risk factors often cluster and interact multiplicatively in an individual and this is strongly associated with the development and severity of NCDs. We assessed the sociodemographic factors associated with the presence of multiple NCD risk factors among individuals aged 18 years and older in the Kenyan population

High impact health service interventions for attainment of UHC in Africa: A systematic review.

African countries have prioritized the attainment of targets relating to Universal Health Coverage (UHC), Health Security (HSE) and Coverage of Health Determinants (CHD)to attain their health goals. Given resource constraints, it is important to prioritize implementation of health service interventions with the highest impact. This is important to be identified across age cohorts and public health functions of health promotion, disease prevention, diagnostics, curative, rehabilitative and palliative interventions. We therefore explored the published evidence on the effectiveness of existing health service interventions addressing the diseases and conditions of concern in the Africa Region, for each age cohort and the public health functions. Six public health and economic evaluation databases, reports and grey literature were searched. A total of 151 studies and 357 interventions were identified across different health program areas, public health functions and age cohorts. Of the studies, most were carried out in the African region (43.5%), on communicable diseases (50.6%), and non-communicable diseases (36.4%). Majority of interventions are domiciled in the health promotion, disease prevention and curative functions, covering all age cohorts though the elderly cohort was least represented. Neonatal and communicable conditions dominated disease burden in the early years of life and non-communicable conditions in the later years. A menu of health interventions that are most effective at averting disease and conditions of concern across life course in the African region is therefore consolidated. These represent a comprehensive evidence-based set of interventions for prioritization by decision makers to attain desired health goals. At a country level, we also identify principles for identifying priority interventions, being the targeting of higher implementation coverage of existing interventions, combining interventions across all the public health functions-not focusing on a few functions, provision of subsidies or free interventions and prioritizing early identification of high-risk populations and communities represent these principles

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist.

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Burden of diseases for leading conditions by age cohort.

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Leading conditions in 25–59 age cohort in the Africa region, global and African region DALYs contribution, 2019.

Leading conditions in 25–59 age cohort in the Africa region, global and African region DALYs contribution, 2019.</p

Leading conditions in neonate age cohort in the Africa region, global and African region DALYs contribution, 2019.

Leading conditions in neonate age cohort in the Africa region, global and African region DALYs contribution, 2019.</p

Leading conditions in 5–9 age cohort in the Africa region, global and African region DALYs contribution, 2019.

Leading conditions in 5–9 age cohort in the Africa region, global and African region DALYs contribution, 2019.</p