Diseases have taken to outsmarting each other

By GATONYE GATHURA

Diseases have also taken to the catwalk in a contest to determine which kills the largest number of Kenyans, with the winner seeking more local and foreign funding.

Contestants range from jiggers, malaria, HIV, diabetes, cancer, pneumonia and even violence. From government documents to official pronouncements and well-choreographed campaigns by health lobbyists, it is a season where health spending is determined by who shouts the loudest. The supremacy over who is top killer is not anything new, but this year it has been quite interesting, with official claims that perennial top killer – HIV, and has been beaten by pneumonia.

The Economic Survey 2013 released by Cabinet Secretary for Devolution and Planning Ann Waiguru in May says pneumonia is top dog having killed 19,011 people last year followed by malaria 18,746 then cancer and Aids coming third and fourth having claimed 11,863 and 9,436 lives respectively.

If these figures are to be believed then more resources should be targeted at pneumonia. But compared to HIV or malaria, pneumonia lacks the strong health activism that has seen the two diseases become top spenders.

It is estimated the country spends Sh40 billion annually on HIV, which is more than the Sh34 billion budgeted for by the Ministry of Health at the national level.

Much of this money comes from donors.

Indicator Survey

But HIV is not taking the overthrow lying down, the Joint United Nations Programme on HIV and Aids, or UNAIDS on data provided by Kenya estimates that the disease killed between 51,000 and 65,000 people last year.

In the previous years the Kenya Aids Epidemic Update 2011, prepared largely by the National Aids Control Council (Nacc) says so far the disease has killed 1.7 million people with 49,126 having died in 2011. Surprisingly, Kenya Aids Indicator Survey 2012 (KAIS), which was hurriedly released in August by Cabinet Secretary for Health James Macharia conspicuously failed to indicate how many people the disease is killing.

At a press conference after the release of KAIS, the then head of National Aids and STDs Control Programme Dr William Maina said Aids remains the main killer because most deaths reported as otherwise have HIV as the underlying cause.

It was not clear why the ministry opted for an early release of the KAIS report even before the data had been analysed to tell why for example in the last few years HIV prevalence has almost halved at the Coast, Nairobi and some parts of the Rift Valley. Nacc which is head hunting for a director, a post held by Prof Alloys Orago for a long time is on a charm offensive to convince country goverments that HIV is the biggest health problem in the respective areas. Nacc is pushing for creation of an autonomous body to run HIV programmes and to be fully funded by the Exchequer.

However, sources within Global Fund indicate that the government may consider a body that will incorporate both HIV and cancer treatment and prevention.

Highest prevalence

A resent presentation by Head of Nairobi Cancer Registry at the Kenya Medical Research Institute Anne Korir says cancer is the third biggest killer in the country after infectious diseases and heart disease. The registry goes on to say that last year 26,941 people died from cancer, a much higher figure than indicated for pneumonia, which according to Ms Waiguru, is top killer.

But according to the Kenya Cancer Association, there are up to 82,000 new cases being diagnosed annually with the highest prevalence recorded in women. The confusion does not end there, the national health policy document which is under review between the Ministry of Health and stakeholders in the sector, does not capture cancer as anywhere near the top 10 killer diseases in the country.

Ms Korir defends their data as stringently collated and presented to GLOBOCAN, a World Health Organisation affiliate to do national and global estimates. So cancer prevalence in Kenya remains just that – estimates.

According to the Kenya Health Information Systems of the Ministry of Health, 27,000 Kenyans died last year from malaria. This, again, disapproves the economic survey, which ranks pneumonia as the number one killer.

Malaria, which has the second highest donor support after HIV, does not lack its controversies. If in doubt, ask Dr Andrew Githeko of the Kenya Medical Research Institute, who has developed a simple tool to forecast malaria outbreaks as related to climate change.

Several studies in Kenya and other African countries have recorded a drop in mosquito populations, a phenomenon thought to be linked to climate change.  Jiggers are also not left out supported by one of the best media lobbyists at the Ahadi Kenya Trust led by Stanley Kamau.  The trust says jiggers have infested over 2.6 million Kenyans, translating to six per cent of the total population compared to a HIV prevalence rate of 5.6. The jiggers, however, do not appear anywhere in the radar of the Ministry of Health, with Ahadi calling on a national survey to determine extent of the problem and possible interventions just like is happening with other diseases.

But the best and most boggling statistic of killers in Kenya is yet to come.

In August, the acting Director General of Health Dr Francis Kimani released a national survey, which indicated that some 465,000 women procured unsafe abortion in the country last year. For those who believe life begins at conception then abortionists would be guilty of committing genocide in Kenya and it may require huge resources to arrest the problem.

It is not possible to explain whether this puffing of data is deliberate, local statisticians are inept or there is no way of standardising information meant to guide national as well as regional planning.