TB overtakes malaria as leading cause of death

A man coughing.(Courtesy/iStockphoto)

Improving health in Kenya today is an important  objective, with an obvious direct impact on longevity and accelerating economic growth for millions of Kenyans

The distribution of diseases in the country has been examined, identifying frequently reported diseases by Kenyans. Knowledge of the disease prevalence is not only important for identifying the relative risk levels among the population but it is also key in enhancing formulation of effective intervention policies.

Presently, Kenyans are finding themselves in hospitals for diseases that were killing in the 1960s, including tuberculosis (TB), pneumonia, diarrhea, cholera, malaria and the neglected tropical diseases (NCDs) amid changing lifestyles and technology, which is an irony to say the least.

Additionally, the country is experiencing an increased burden of diseases that were in the past termed Western diseases such as cancer, diabetes, hypertension, stroke, heart disease and depression.

As per the 2023 Kenya Health Facility Census Report provided by the Ministry of Health, Kenya faces a triple burden where communicable diseases still contribute to high mortality rates, with infectious diseases and injuries contributing more than half of the deaths.

But an estimated 39 per cent die due to non-communicable diseases.

It is projected that in the coming years, the share of deaths from non-communicable diseases and injuries will continue to spike.

According to data from the 2024 Economic Survey, more Kenyans suffer from diseases of the respiratory system than any other, with at least 22 patients in every 100 reporting to have suffered from them. This is followed by malaria with a rate of 5 patients in every 100. This comes as an improvement from the 2018 Economic Survey where malaria led with at least 37 patients in every 100 reported to have suffered the disease.

This means that Kenya has made significant progress in the fight against malaria. The government places a high priority on malaria control and tailors its efforts according to malaria risk to achieve maximum impact.

Malaria risk in Kenya is heterogeneous, and its epidemiology is influenced by altitude, rainfall patterns, and temperature. Therefore, malaria prevalence varies considerably by season and across geographic regions.

Regions located in the western and coastal areas, including Kisumu, Homa Bay, Kakamega, Bungoma, Kilifi, Kwale and Lamu, experience higher transmission rates due to favourable climatic conditions for the breeding and survival of malaria-carrying mosquitoes; as well as environmental factors such as stagnant water which serves as breeding grounds.

Malaria control efforts in these areas include widespread use of insecticide-treated bed nets (ITNs), indoor residual spraying (IRS), prompt diagnosis and treatment, and public health education campaigns, to reduce the risk of infection.

The recommendation of the Kenya Malaria Strategy 2019–2023 is that all individuals with suspected malaria cases be tested and that those confirmed as having malaria receive the recommended antimalarial treatment.

According to the National Malaria Treatment Guidelines, caregivers of children under age 5 with fever should seek advice or treatment within 24 hours.

On the other front, diseases of respiratory system are illnesses that affect the air passages, including the nasal cavity, the bronchi and the lungs. They include acute as well as chronic respiratory diseases such as tuberculosis, asthma, chronic pulmounary disease and lung cancer.

Tuberculosis remains a major health concern in Kenya and is associated with more deaths. It is typically considered a chronic respiratory disease with about 130,000 people contracting it annually. 50,000 of them are said to be HIV-positive. The highly contagious disease is also responsible for about 4 per cent of all deaths.

Also on the high-hitting disease list is pneumonia, which  claims between 8,000 to 10,000 young lives annually in Kenya. This represents approximately one in five of all child deaths. This burden is attributed to inadequate access to healthcare and poor health-seeking behaviour.

According to the 2022 Ministry of Health data, Narok, Samburu, West Pokot, Marsabit and Mandera recorded high cases of pneumonia while Kisumu, Kericho, Laikipia, Samburu, Kitui, Nyeri, Uasin Gishu and Nairobi reported the highest neonatal deaths.

Then there is COVID-19. This was a pandemic in Kenya and across  the world. Its full scientific name is SARS-CoV-2.

The virus was confirmed to have reached Kenya on March 12, 2020, with the initial cases reported in Nairobi and in the coastal area of Mombasa.

But with 344,130 confirmed cases in the country and 5,689 deaths as of April 2024, the Coronavirus Tracker is no longer active due to the unfeasibility of providing statistically valid global totals.

However, there have been muted reports of new strains of the disease, with the ministry at some point confirming an emergence of an influenza. Many Kenyans, have lately been reporting choleric bouts of cold.

Besides the respiratory diseases and conditions, a huge population suffering from other diseases has emerged.

The survey indicates that diseases, including skin ulcers, diarrhea and urinary tract infections are significant, at 4.8, 3.9 and 3.2 per cent respectively.

There is a significant rise of patients reporting skin diseases from the last survey report. In 2018, two in 100 people had diseases of the skin, currently five in 100 report to suffer from the disease.

Similarly, there is an immense number of patients reported to suffer from Urinary Tract Infections (UTI), from 0.2 to 3.2 per cent. Urinary tract infection is an infection in any part of the urinary system. The urinary system includes the kidneys, ureters, bladder and urethra. The most common causes being bacteria and fungi.

Women have a higher prevalence rate of UTIs than men. Ages between 25 and 30 years are the worst hit, at 16.2 per cent and the lowest, 1.2 per cent in children under five years.

On the other hand, rheumatism and joint pain diseases are rated at 2.1 per cent whereas eye infections and conditions are rated at 1.7 per cent. Intestinal worms rank at one per cent of all the disease cases.

Apart from major killer diseases, Kenya has a serious problem with death in traffic accidents. The country has posted a high rate of traffic deaths, with 4,324 deaths in 2023 and 4,690 in 2022. This presents a difference of 366 fatalities, a decrease of 7.8 per cent, according to data from the 2024 Economic Survey.

All other diseases reported than the listed were rated at  52.3 per cent. They include cancer, HIV/AIDS and sexually transmitted infections .

Cancer is the third highest cause of death in Kenya.

In 2020, Kenya reported 42,000 new cancer cases and 27,000 cancer-related deaths. Cancer has been the leading killer among those aged 50-59, accounting for 12.7 per cent of the deaths.

Cervical and breast cancers take the lead, contributing to 23 per cent of cancer-related deaths, followed by esophageal cancer at 11.8 per cent, colorectal cancer at 10.1 per cent and prostate cancer at 7.1 per cent. According to the National Cancer Registry Data for 2021/2022, Nairobi, Nakuru and Kiambu counties lead in cancer cases.

From a study done by the British Journal of Healthcare and Medical Research, the reasons for high cases of cancer in Meru and Tharaka Nithi counties have partly been blamed on poor post-harvest handling of cereals, thus leading to brain and lung cancers. Cereals develop aflatoxin due to high moisture content because farmers who rely on irrigation rush to harvest their crops when the rains start. Aflatoxin can be passed to human from animals that have consumed affected feeds.

Leukemia is the leading childhood cancer, followed by brain tumor, lymphomas, kidney and nasopharynx.

In Kenya, communicable diseases accounted for half of all-cause mortality. The country is grappling with a high burden of both communicable and non-communicable diseases.

 A majority of Kenya’s population receive healthcare services from the public sector. The range of services include preventive, promotive, curative and rehabilitative.

However, with the recent long-drawn doctors’ strike that paralysed healthcare in public facilities, the survey may post slightly different results next year, on the medical provision front.

Preventive services include routine childhood immunisation and environmental activities to control mosquito breeding, which in turn reduces malaria transmission.

While the government has admitted to facing funding challenges that have seen a shortage of vaccines in the country, the reduced budgetary allocations in this year could have a bigger impact in immunisation.

Promotive services are mostly educational services provided to the general population on healthy lifestyles and available interventions. Curative and rehabilitative services include all treatment activities available at hospitals and other healthcare facilities.