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Rising H.Pylori burden reflects safe water woes

Nairobi residents scrambling for water. FILE PHOTO | NMG
Nairobi residents scrambling for water. FILE PHOTO | NMG 

It has been 12 years now since the award-winning Nobel Prize for Physiology and Medicine works of Dr. Marshall and Dr Warren brought to the fore the association between the ubiquitous bacterium Helicobacter Pylori and gastritis or inflammation of the gut lining.

The evolution of the disease has gone full cycle, wreaking havoc across many populations. Its occurrence though isn’t felt anywhere more than in societies where water, sanitation and hygiene are lacking. Kenya is now smack in the middle of such a situation.

Like other diseases, the real impact isn’t just limited to the debilitating effects on the body, the economic costs too count given high recurrence rates and chronicity.

As medical conditions caused by poor WASH systems become major components of medical bills despite being avoidable, health system funders and payers need to wake up.

Medical insurance companies, in particular, must start seeing the rising investigations and treatment costs associated with gastrointestinal infections as a pointer of broken down sanitation systems and poor hygiene.

For biostatisticians, one question is whether this rise in H. Pylori cases is due to improved diagnosis or increased incidents.

What is without doubt though is that higher public awareness about the bacterium is prompting more requests by patients and medics for its diagnostic tests. This has been helped by newer and cheaper versions of diagnostic kits.

What previously cost Sh2,000 can now be screened for Sh300 and those suspicious guided for further tests.

Ironically, unlike the case with malaria where a reduction in cost and ease of diagnostic tests saw a decrease in the number of those testing positive and thus treated for malaria, the inverse is the case for H.Pylori.

As the cost of diagnostic tests has reduced so has the positive incidents of H.Pylori and its medication.

Whereas many patients used to self-medicate with over-the-counter antacids for heartburn and reflux, many now get tested. Those testing positive for the bacterium have a cocktail of antibiotics prescribed.

Including the diagnostic tests, consultation fees and medicines, the cost of managing one case using gold standard guidelines is upwards of Sh20,000.

No local data are available from insurers on individualised medical conditions, but it would be interesting to know how much the industry paid out last year to H.Pylori-related claims.

The economic costs of high recurrence reflects why focusing on the treatment as opposed to tackling the root of the infection is not solving the problem.

Similarly, bringing down the current treatment costs from Sh4,000 to below Sh1,000 is important. Otherwise, the cost would be too high, locking out the bottom of the pyramid.

Insurers and pharmaceuticals should join medical personnel in the fight for better sanitation, hygiene and lower costs of its treatment.

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