Wellness & Fitness

Preventive healthcare can cut hospital expenses

doctors

Doctors perform a pacemaker placement surgery at a medical camp in Nairobi. FILE PHOTO | NMG

Kenya is going through an epidemiological shift where there is a decline in morbidity and mortality from communicable diseases like HIV/tuberculosis and an increase in the burden of non-communicable diseases (NCDs) are increasingly straining the health system.

Non-Communicable Diseases such as diabetes, cancer, heart disease and chronic respiratory infections have emerged as conditions of great public health concern in Kenya accounting for 39 percent of deaths annually.

In addition to their health impact, NCDs have a significant economic impact on households, communities and countries given their chronic nature and cost of care.

The NCDs have been shown to decrease household income by 28.6 percent in Kenya thus subjecting families to catastrophic expenditure spiralling them into a vicious cycle of poverty. Risk factors for contracting NCDs include tobacco use, harmful use of alcohol, being overweight, unhealthy diets, physical inactivity, environmental pollutants.

The Kenyan National Health strategic plan aims to halt and reverse the rising burden of non-communicable conditions.

One of the objectives of this plan is to put into place health promotion interventions that will address risk factors to health. These interventions are aimed at the improvement of individual-level behaviours, the physical environment and the societal environment. Screening for and treating NCDs is the main focus of management.

Screening tests are done to detect potential health disorders or diseases in people who do not have any symptoms of the disease.

The goal is early detection and lifestyle changes or surveillance, to reduce the risk of disease, or to detect it early enough to treat it most effectively.

Screening tests are not considered diagnostic but are used to identify a subset of the population who should have additional testing to determine the presence or absence of disease. What makes a screening test valuable is its ability to detect potential problems while minimising unclear, ambiguous, or confusing results.

While screening tests are not 100 percent accurate in all cases, it is generally more valuable to have the screening tests at the appropriate times, as recommended by your healthcare provider, than to not have them at all.

It is estimated that cancer is the second leading cause of NCD-related deaths in Kenya after cardiovascular diseases and accounting for eight percent of overall national deaths.

Early detection ensures a favourable outcome and prognosis of most cancers. About 70 percent of reported cases in Kenya are detected at an advanced stage when very little can be achieved, and outcomes are very poor.

Common cancer screening tests are PSA for prostate cancer, mammogram for breast cancer, pap smear for cervical cancer, faecal occult blood and colonoscopy for colon cancer.

blood test

PSA is a blood test. The prostate-specific antigen levels can be elevated in the presence of prostate cancer.

However, it is important to understand that other benign prostate conditions may also elevate PSA, such as benign prostatic hyperplasia, which is noncancerous swelling of the prostate. The pros and cons of PSA screening should always be discussed with your healthcare provider before testing.

Mammography screening for breast cancer every two to three years after age 50. This test is done in conjunction with a clinical breast exam, and when needed ultrasound.

Pap smears are samples of cells taken from the cervix in women to look for cellular changes indicative of cervical cancer. The pap smear is an important screening test in sexually active women under the age of 65, to detect cancer at a stage when there are often no symptoms.

It is important to understand that a pap smear may be referred to as “abnormal,” but may not mean that a person has cervical cancer.

This will require further follow up either a repeat pap smear with human papillomavirus screening or sometimes colposcopy. This is a procedure of direct visualisation of the cervix with samples of the affected tissue taken for analysis.

Faecal occult blood is detected by microscopic analysis or by chemical tests for blood in the stool. People with blood in their stool may have a cancerous growth indicative of colorectal cancer.

It is important to understand that when blood is present in a stool sample, it can be due to other noncancerous factors, such as certain medications or foods, gastrointestinal bleeding, or haemorrhoids.

Testing is recommended starting at age 50 every year.

A screening colonoscopy may be requested in addition for people who have additional risk factors such as a strong family history of colon cancer.

Cardiovascular diseases (CVDs) are the leading cause of death in the world, with 80 percent of all CVD-related deaths occurring in low and middle-income countries. These include hypertension, chronic ischemic heart disease (heart attack), cerebrovascular disease (stroke).

Mortality due to cardiovascular disease in Kenya is 13.8 percent. Hypertension is an important risk factor for cardiac disease and remains the single biggest risk factor for stroke. The prevalence of hypertension has increased over the last decade. Cholesterol screening is performed by a blood test. People with high cholesterol measurements have a higher risk for cardiovascular disease.

Undiagnosed cases of diabetes are a public health concern with costly public health implications.

This can have additional cost implications for households and on already overburdened health systems, thus a need to increase screening efforts in Kenya to prevent the progression to diabetes.

This rise in diabetes is associated with demographic and social changes such as urbanisation, ageing population, and adoption of unhealthy lifestyles such as consumption of unhealthy diets and physical inactivity.

In 2015, it was reported that more than 88 percent of Kenyans have never had their blood sugar tested, leading to late diagnosis of diabetes that contributes to the high morbidity and mortality burden before the age of 60.

All adults should be screened for diabetes or starting at age 45 by way of fasting blood glucose tests. This is not an expensive test and can be done in healthcare centres and also in some pharmacies.

NCD prevention, treatment and care services should be available, accessible, and affordable at all levels of care from the community level.