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Sunday, May 20, 2012

Tackling the Burden of Non-Communicable Diseases in Kenya

Africa is witnessing a monumental triumph in development. According to a World Bank report released early this month, child mortality has plummeted more rapidly than hitherto anticipated. The average decline in child mortality in Africa today is faster than it was in China in the early 1980s.

12 of the 20 African countries which have detailed demographic and household surveys since 2005 reported falls child mortality of over 4% per year; a rate of decline that is required to meet the millennium development goal of cutting child mortality by two-thirds by 2015.

Kenya's infant mortality rate has fallen by 7.6 percent per year, the fastest rate of decline among the 20 African countries. The World Bank report attributes half of the overall drop in Kenya’s child mortality to the huge increase in the use of insecticide-treated bednets in areas where malaria is endemic. Targeted public policy works!

But as Kenya reins in child mortality, the grim reaper has forged a new scythe for adults. According Prof. Anyang Nyongo, Kenya’s Minister for Medical Services, non-communicable diseases (NCDs) account for almost half of hospital deaths.

In September 2011, the United Nations declared that for the first time in history, NCDs such as diabetes, heart disease and cancer pose a greater health burden globally. Today nearly 80% of deaths from NCDs occur in developing countries. By some estimates, 9 out of 10 deaths from NCDs, before the age of 60, occur in developing countries.

NCDs deliver a triple whammy of morbidity, early mortality and poverty. Medical expenses are often covered through family resources, leading to catastrophic erosion of family assets.  At the national level NCDs cost millions of dollars in care and hospitalization.
Like in the developing world, the epidemic of NCDs in the developing world is attributed largely to four behavioral risk factors that are associated with increase in per capita GDP, rapid urbanization “modern” lifestyles: tobacco use, unhealthy diet, insufficient physical activity and excessive consumption of alcohol.

Three of the most important and prevalent NCDs; heart disease, diabetes and cancer are linked to increased intake of sugar. In his book, Pure, White and Deadly, British physiologist John Yudkin illustrates that sugar and not fat is a more probable cause of heart disease. Yudkin showed that heart disease is uncommon among pastoral communities, like the Maasai and the Samburu, who live on a high fat diet mostly meat and milk but no sugar.

Nature made sugar hard to obtain. Sugar as fruit was available to our ancestors for only seasonally, or as honey fiercely guarded by bees. Today sugar is ubiquitous, added to virtually every processed food.

In a paper published early this year in the journal Nature, pediatric endocrinologist Robert Lustig and colleagues at the University of California, San Francisco School of Medicine argue that sugar in all forms is harmful to public health and must be regulated like alcohol.

Here is what you need to know about sugar. Table sugar is made up of glucose, bonded to fructose – a fifty-fifty mixture of the two. Insulin is produced when sugar is ingested. The more sugar you ingest, the more insulin your pancreas will produce, and the higher your triglyceride levels are likely to be. Triglyceride is a mechanism for storing unused calories.

High levels of triglycerides in the bloodstream is linked to atherosclerosis and the risk of heart disease and stroke. Atherosclerosis is a condition in which an artery wall thickens due to accumulation of fatty materials such as cholesterol.

Sugar is a major contributing factor to adult – onset of diabetes, also known as type II diabetes. Type II diabetes is associated with the inability of cells to respond adequately to insulin and excess release of glucose into the blood by the liver, leading to high blood sugar.

Sugar can be abused. Like any drug, sugar acts on the brain to induce subsequent consumption. Specifically, sugar interferes with the suppression of the ghrelin, a hormone produced in the stomach that regulates food intake. Sugar also interferes with the hormone leptin, which regulates appetite by signaling to your brain that you are full.

The processing of fructose by the liver leads to accumulation of body fat. So over time the cumulative consumption of small amounts of fructose in soda and fruit juices adds up and adds pounds, leading to obesity.

National Health Policy apparatus must focus on NCDs. Last month Prime Minister Odinga announced that the government was reviewing the National Health Policy to address NCDs. The new policy should introduce taxes on processed foods and drinks (e.g. sodas, juices and cereals). The new policy should also regulate location processed food outlets and impose age restrictions on who can make purchases. A ban on television commercials and outdoor advertising for processed sugared food could further protect public health.

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