Prevalence of Non-Communicable Diseases and Social Interactions in Kenya: An Empirical Analysis

Despite a remarkable progress in the control and management of communicable diseases over the past century, the world is not better-off as the prevalence of Non-Communicable Diseases (NCD) is on the increase, both in developed and developing countries. The upsurge in NCD prevalence is attributable to risk factors both outside and within the control of individuals. . One risk factor that has received less attention than it deserves is the social interactions variable. Social interactions are the established relationships among individuals, e.g., among peers or persons in the same circumstances. Interactions of persons in the same circumstances affect behavior because of the necessity for the individual to conform to established group norms or values. It is believed that NCD prevalence in Kenya is high in sections of the populations where social interactions among certain groups is intense, but little evidence exists in support of this supposition. This paper examines this assumption taking into account the endogeneity of behavior in a group setting .In particular, we estimate a binary probit model of an individual contracting a non-communicable disease, conditional on engaging in certain consumption behaviors that are malleable by peer or group pressure. The key finding from the estimation exercise is that variables that capture social interactions such as the village level means of drinking alcohol, consuming vegetables and fruits, and smoking cigarettes are significantly associated with the likelihood of getting an NCD. The policy implication of this finding is that NCD prevalence in Kenya can be reduced by implementing programs to change health behaviors within social groups

NON-COMMUNICABLE DISEASES RISK FACTORS AND THEIR CONTRIBUTION TO NCD INCIDENCES IN KENYA

Although mortality from communicable diseases and poor nutrition have been declining, non-communicable diseases have been on the rise in developing countries. Consequently, this poses a serious challenge to health programming. There are predictions that NCDs will continue to rise in the coming years resulting to at least 9 million deaths every year. This death rate would occur among people who are below 60 years of age in sub-Saharan Africa. NCDs are associated with some underlying risk factors of which most of them can be tackled through clear policy intervention. Notably, many risk factors are also known to be country specific which requires country specific studies. The efforts towards the prevention of NCDs in Kenya are inadequate. This could be attributed to inadequate understanding of the contribution of suspected risk factors to NCDs. In addition, addressing the risk factors associated with these diseases may present a cheaper and long-term solution to the problem of rising cases of NCDs in Kenya. This paper uses household national survey data to estimate the influence of risk factors associated with NCD in Kenya. A probit binary model was used while controlling the econometric problem associated with endogeniety and heterogeneity assumptions. The key finding is that income, distance, peer, effects on area of residence, and education are key risk factors associated with the rising NCD in Kenya. Age and gender are non-policy variables that increased the likelihood of one getting a NCD. This study has pointed out that the health care system in Kenya needs to develop mechanisms for promoting preventive care for NCDs. Also, effective prevention methods that address the NCD risk factors are preferable for treatment. However, these prevention methods are not only expensive, but are also protracted

NON-COMMUNICABLE DISEASES RISK FACTORS AND THEIR CONTRIBUTION TO NCD INCIDENCES IN KENYA

Although mortality from communicable diseases and poor nutrition have been declining, non-communicable diseases have been on the rise in developing countries. Consequently, this poses a serious challenge to health programming. There are predictions that NCDs will continue to rise in the coming years resulting to at least 9 million deaths every year. This death rate would occur among people who are below 60 years of age in sub-Saharan Africa. NCDs are associated with some underlying risk factors of which most of them can be tackled through clear policy intervention. Notably, many risk factors are also known to be country specific which requires country specific studies. The efforts towards the prevention of NCDs in Kenya are inadequate. This could be attributed to inadequate understanding of the contribution of suspected risk factors to NCDs. In addition, addressing the risk factors associated with these diseases may present a cheaper and long-term solution to the problem of rising cases of NCDs in Kenya. This paper uses household national survey data to estimate the influence of risk factors associated with NCD in Kenya. A probit binary model was used while controlling the econometric problem associated with endogeniety and heterogeneity assumptions. The key finding is that income, distance, peer, effects on area of residence, and education are key risk factors associated with the rising NCD in Kenya. Age and gender are non-policy variables that increased the likelihood of one getting a NCD. This study has pointed out that the health care system in Kenya needs to develop mechanisms for promoting preventive care for NCDs. Also, effective prevention methods that address the NCD risk factors are preferable for treatment. However, these prevention methods are not only expensive, but are also protracted

Costs of streamlined HIV care delivery in rural Ugandan and Kenyan clinics in the SEARCH Studys.

OBJECTIVES/DESIGN:As antiretroviral therapy (ART) rapidly expands in sub-Saharan Africa using new efficient care models, data on costs of these approaches are lacking. We examined costs of a streamlined HIV care delivery model within a large HIV test-and-treat study in Uganda and Kenya. METHODS:We calculated observed per-person-per-year (ppy) costs of streamlined care in 17 health facilities in SEARCH Study intervention communities (NCT: 01864603) via micro-costing techniques, time-and-motion studies, staff interviews, and administrative records. Cost categories included salaries, ART, viral load testing, recurring goods/services, and fixed capital/facility costs. We then modeled costs under three increasingly efficient scale-up scenarios: lowest-cost ART, centralized viral load testing, and governmental healthcare worker salaries. We assessed the relationship between community-specific ART delivery costs, retention in care, and viral suppression. RESULTS:Estimated streamlined HIV care delivery costs were $291/ppy. ART ($117/ppy for TDF/3TC/EFV [40%]) and viral load testing ($110/ppy for 2 tests/year [39$51/ppy), recurring costs ($5/ppy), and fixed costs ($7/ppy). Optimized ART scale-up with lowest-cost ART ($100/ppy), annual viral load testing ($24/ppy), and governmental healthcare salaries ($27/ppy), lowered streamlined care cost to$163/ppy. We found clinic-to-clinic heterogeneity in retention and viral suppression levels versus streamlined care delivery costs, but no correlation between cost and either retention or viral suppression. CONCLUSIONS:In the SEARCH Study, streamlined HIV care delivery costs were similar to or lower than prior estimates despite including viral load testing; further optimizations could substantially reduce costs further. These data can inform global strategies for financing ART expansion to achieve UNAIDS 90-90-90 targets

Expectations about future health and longevity in Kenyan and Ugandan communities receiving a universal test-and-treat intervention in the SEARCH trial

Expectations about future health and longevity are important determinants of individuals’ decisions to invest in physical and human capital. Few population-level studies have measured subjective expectations and examined how they are affected by scale-up of antiretroviral therapy (ART). We assessed these expectations in communities receiving annual HIV testing and universal ART. Longitudinal data on expectations were collected at baseline and one year later in 16 intervention communities participating in the Sustainable East Africa Research in Community Health (SEARCH) trial of the test and treat strategy in Kenya and Uganda ({"type":"clinical-trial","attrs":{"text":"NCT01864603","term_id":"NCT01864603"}}NCT01864603). A random sample of households with and without an HIV-positive adult was selected after baseline HIV testing. Individuals’ expectations about survival to 50, 60, 70, and 80 years of age, as well as future health status and economic well-being, were measured using a Likert scale. Primary outcomes were binary variables indicating participants who reported being very likely or almost certain to survive to advanced ages. Logistic regression analyses were used to examine trends in expectations as well as associations with HIV status and viral load for HIV-positive individuals. Data were obtained from 3126 adults at baseline and 3977 adults in year 1, with 2926 adults participating in both waves. HIV-negative adults were more likely to have favorable expectations about survival to 60 years than HIV-positive adults with detectable viral load (adjusted odds ratio [AOR] 1.87, 95% CI 1.53–2.30), as were HIV-positive adults with undetectable viral load (AOR 1.41, 95% CI 1.13–1.77). Favorable expectations about survival to 60 years were more likely for all groups in year 1 compared to baseline (AOR 1.53, 95% CI 1.31–1.77). These findings are consistent with the hypothesis that universal ART leads to improved population-level expectations about future health and well-being. Future research from the SEARCH trial will help determine whether these changes are causally driven by the provision of universal ART

Effectiveness of artemether-lumefantrine provided by community health workers in under-five children with uncomplicated malaria in rural Tanzania: an open label prospective study

\ud Home-management of malaria (HMM) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT) within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL), presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs) and administered unsupervised by parents or guardians at home. An open label, single arm prospective study was conducted in two rural villages with high malaria transmission in Kibaha District, Tanzania. Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test (RDT) were provisionally enrolled and provided AL for unsupervised treatment at home. Patients with microscopy confirmed P. falciparum parasitaemia were definitely enrolled and reviewed weekly by the CHWs during 42 days. Primary outcome measure was PCR corrected parasitological cure rate by day 42, as estimated by Kaplan-Meier survival analysis. This trial is registered with ClinicalTrials.gov, number NCT00454961. A total of 244 febrile children were enrolled between March-August 2007. Two patients were lost to follow up on day 14, and one patient withdrew consent on day 21. Some 141/241 (58.5%) patients had recurrent infection during follow-up, of whom 14 had recrudescence. The PCR corrected cure rate by day 42 was 93.0% (95% CI 88.3%-95.9%). The median lumefantrine concentration was statistically significantly lower in patients with recrudescence (97 ng/mL [IQR 0-234]; n = 10) compared with reinfections (205 ng/mL [114-390]; n = 92), or no parasite reappearance (217 [121-374] ng/mL; n = 70; p ≤ 0.046). Provision of AL by CHWs for unsupervised malaria treatment at home was highly effective, which provides evidence base for scaling-up implementation of HMM with AL in Tanzania.\u

Serum immunoglobulin G and mucosal immunoglobulin A antibodies from prepandemic samples collected in Kilifi, Kenya, neutralize SARS-CoV-2 in vitro

Objectives: Many regions of Africa have experienced lower COVID-19 morbidity and mortality than Europe. Pre-existing humoral responses to endemic human coronaviruses (HCoV) may cross-protect against SARS-CoV-2. We investigated the neutralizing capacity of SARS-CoV-2 spike reactive and nonreactive immunoglobulin (Ig)G and IgA antibodies in prepandemic samples. Methods: To investigate the presence of pre-existing immunity, we performed enzyme-linked immunosorbent assay using spike antigens from reference SARS-CoV-2, HCoV HKU1, OC43, NL63, and 229E using prepandemic samples from Kilifi in coastal Kenya. In addition, we performed neutralization assays using pseudotyped reference SARS-CoV-2 to determine the functionality of the identified reactive antibodies. Results: We demonstrate the presence of HCoV serum IgG and mucosal IgA antibodies, which cross-react with the SARS-CoV-2 spike. We show pseudotyped reference SARS-CoV-2 neutralization by prepandemic serum, with a mean infective dose 50 of 1: 251, which is 10-fold less than that of the pooled convalescent sera from patients with COVID-19 but still within predicted protection levels. The prepandemic naso-oropharyngeal fluid neutralized pseudo-SARS-CoV-2 at a mean infective dose 50 of 1: 5.9 in the neutralization assay. Conclusion: Our data provide evidence for pre-existing functional humoral responses to SARS-CoV-2 in Kilifi, coastal Kenya and adds to data showing pre-existing immunity for COVID-19 from other regions

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