Lack of data on rock pythons was the terminal heartbreaker

The heart of the African Rock Python enlarges when it swallows an animal, like a whole gazelle, but later contracts to the normal size, and the gazelle lives to swallow another day. That is unlike human beings for who an enlarged heart means death.

Prof Matilu Mwau planned to study the human cardiovascular system using the African Rock Python. He wrote a research proposal whose funding was even approved in 2018. But the research was later dropped due to lack of data,  including lack of statistics on the number of African Rock Pythons in Kenya besides prior preliminary research on the reptiles.

“We were interested in studying the human heart,” recalls Prof Mwau, the Deputy Director at Kenya Medical Research Institute (Kemri), “but we were unable to come up with a hypothesis, so we gave up.” The researcher laments that data collection is hardly part of Kenyan culture and hence its scarcity in peer-reviewed manual scripts, journals or reports.  

Then there is Grace Ngari, a master’s degree in Public Health student at Torrens University in South Australia. Her research project on ‘culture and health-seeking behaviour in Kenya’ hit a snag due to lack of data.

Specifically, she was studying the effect of domestic violence on healthcare-but available data was so outdated she resorted to focusing on Aboriginal Australian Policy and the Western Australian Women Health Strategy whose data ran up to 2016.

Besides the scarcity of data, Kenya did not have clear policy guidelines to address culture and other social determinants in health, forcing Ngari to use policies from Nigeria, South Africa and Ghana.

Dropped project

“I could not use the findings of 1998, because there are a lot of changes in health. I listed lack of data as a limitation in my research,” said Ngari who graduated in June 2021.

Violet Maina, a data analytic student pursuing a skilled certificate course sponsored by Google, also dropped her project due to the migraine induced searching for supporting data.

Maina was researching on resource distribution in mental health and substance use and teenage pregnancies.

“I did not find any data on budgetary allocation on mental health, nor teenage pregnancies,” she laments. I wanted to see which part is more affected by teenage pregnancies, substance use, and mental health, and how the government can direct resources.”

Scarcity of data does not end there. According to the recently released Kenya Economic Survey Report 2022, the top 10 diseases are intestinal worms (minyo) and Urinary Tract Infections-but without reasons for increased prevalence-which is worsened by lack of research data on intestinal worms.

It’s the same case with other medical conditions: Though reproductive health is a major health concern among teenagers, available data on abortions dates back to 2012.

The Economic Survey Report also noted that dentistry has the fewest medical graduates, and is it any wonder that the last and only Kenya Oral Health Survey in Kenya was done in 2015?

Data on malaria, cancer, TB and HIV is, however, is updated within two-year periods while at the height of the pandemic, data on Covid-19 was updated daily, countrywide. Why such health data disparities?

Health PS Susan Mochache acknowledges that health data is the foundation of understanding, planning and hinging health care delivery on informed decisions as well creating alternative approaches.

But aggregating health and medical data, says Mochache, faces several headwinds, including inaccurate data, errors, incomplete data and poor reporting rates though that has increased over the years and presently more than 96 per cent of health facilities are reporting, said Mochache.

Scanty data

She acknowledged that data on some diseases remains scanty, but the District Health Information Software 2 (DHIS 2) has data on all diseases-from Leve 1 to Level 6 hospitals since 2010. 

But funding seems to be a major factor if the speed with which data on Covid-19 was collected, analyzed, tabulated and positivity rates updated.

Mochache explains that Covid-19 had the backing of the government and other stakeholders which made it possible to develop health information systems (digital), which could collect data and transmit the same real-time to allow real-time planning, resource distribution and research.

George Obudho, the Director-General, Kenya National Bureau of Statistics (KNBS), explains that data collection happens in three ways, namely household, institutional and administrative-with funding as the biggest issue.

Obudho says that while generating clinical data is done constantly, like family planning records from DHS, data involving research for undertakings like the Kenya Demographic and Health Survey (KDHS) takes about five years because of budgetary considerations.   

“We have to look for funds, to have KDHS study undertaken, and in the process, there can be a delay,” says Obudho, adding that some data like maternal and infant mortality rates, might appear outdated as they depend on the National Census which KNBS conducts every 10 years.

He adds: “What remains consistent is institutional data (found in the Kenya Economic Survey Report), but for survey and research, it can be tricky because of finances.”

Comprehensive health

Former Pharmaceutical Society of Kenya CEO Dr Daniella Munene offers that unlike other non-communicable diseases with outdated data, statistics on HIV, TB and malaria are mostly current as 99.9 per cent of positive patients collect their ARVs from a comprehensive health centre at no cost.

The HIV programme is donor-funded and it is well-coordinated, with healthcare providers trained and integrated with the supply from Kemsa.

“Collection of ARVs at a central place has made it easier to know the number of patients, and medication they have been put on, information that is computerised,” says Dr Munene.

PS Mochache concurs that communicable diseases, malaria, TB and HIV have current data as they are partner-supported programmes of national and global importance.

The programme has developed its own health information systems that are disease-specific and responds to the requirements of the partners.

On average, however, outdated health data has myriad hazards: Besides leading to inaccurate decisions, it also poses a challenge to policymakers and professional researchers.

Prof Mwau reckons that health data should be current as “research is about data collection, findings and interpretation. Without data, it is hard to have evidence.”

Lack credibility

He also argues that lack of data hinders budgetary allocation and financing research; for instance, in genotyping, data on sequencers is key, but data from clinical trials has not been documented in Kenya.

Prof Mwau explains that researchers are forced to call friends to link them with experts carrying out trials in the field and such “data collection strategies lack credibility”.

Mochache counters that old and updated data are useful in informed decision making

“Old data analyses progress in the fight against various diseases, while current data helps in developing trends and understanding evolving disease epidemiology,” she added.

Mochache also clarifies that not all information needed is found in collected data as some of the information is collected in routine health surveys like the KDHS, HIV prevalence surveys and household surveys. Institutions such as universities and Kemri also conduct research with information holding policy ramifications.