Heart diseases in Kenya set to overtake Aids, malaria in ten years

Heart diseases are projected to overtake Aids, tuberculosis, and malaria (ATMs) by year 2025, experts have said.

“We call them ATM diseases because they can squeeze your pockets dry — that is an open secret,” said Prof Gerald Yonga, a consultant cardiologist and chair of the Non-Communicable Diseases Alliance.

Of greatest concern is the growing number of rheumatic heart diseases in Kenya. Every year, about 200,000 Kenyans, mostly children, are diagnosed with rheumatic heart disease.

Of the most affected are the poor who cook using firewood.

The smoky indoor cooking fires expose children and women to air pollutants that can damage their hearts and lungs.

Household air pollution from solid fuels and smoking by adults are among the top 15 risks for children in Kenya, according to a Lancet report.

“Eighty per cent of Kenyans live in rural areas and no whole-country epidemiological data exists, so the new rheumatic disease cases could even be more,” Prof Yonga said, adding that over five million Kenyans stare at death yearly due to lack of knowledge on their heart condition.

In Kenya, rheumatic heart disease is the biggest killer, followed by congenital then coronary, yet most vulnerable Kenyans are not aware of how the disease presents itself. The disease is caused by untreated streptococcal (strep) bacteria infection.

“The more occurrence of cold and sore throat the more likely one is to get rheumatic heart disease,” said Dr James Munene, a senior cardiologist at Kenyatta National Hospital (KNH).

It starts as a sore throat which comes with aching limbs, breathlessness and can easily be confused for malaria or normal fever and most Kenyan parents buy over-the-counter drugs for children.

Public education

Dr Mohamed Jeilan, the director, cardiac sciences programme at Aga Khan University Hospital, said the bacteria causing strep infection should be treated before the age of 21 with daily doses of penicillin which costs as low as Sh50, otherwise it progresses into rheumatic heart disease. If the disease progresses it may cost up to Sh1 million to treat.

The bacteria is also contagious and can be spread through coughs hence the need for public education and testing.

Hard economic times have pushed rheumatic heart diseases to record levels as a majority of Kenyans share sleeping rooms, increasing the spread of the bacteria that causes the disease, and cook using firewood or charcoal.

In most urban slums and rural areas, young children fan charcoal or firewood stoves every morning and evening, a daily chore that exposes them to the smoke at an early age that damages their heart and lungs.

Half of Kenyan households cook from the rooms where they sleep, with 56 per cent using firewood, increasing the risk of damaging their heart and lungs from indoor smoke pollution.

The Kenya Demographic and Health Survey (KDHS) 2014 shows that 77 per cent of households in urban areas cook inside their houses with a majority using charcoal or firewood compared to 30 per cent in rural areas. Only 0.4 per cent of Kenyans use electricity in cooking.

Connection to electricity remains low in the country with statistics from KDHS showing that 64 per cent of Kenyans are not connected to the national grid. The disease has hit the poor the hardest.

The decline of rheumatic fever in developed countries is believed to be a result of improved living conditions and availability of antibiotics for treatment of children with strep infection.

In Kenya, a rheumatic fever blood test costs about Sh300 in public and Sh1,000 in private hospitals. Penicillin costs Sh50 a dose but the cost is still unaffordable to many. And in most cases, those who go to clinics are given a wrong diagnosis.

Another problem, Dr Munene said, is that unscrupulous pharmacists dilute the penicillin to increase sales, making it ineffective in treating recurrent strep infections.

“A group of greedy Kenyans end up tampering with drugs like penicillin, diluting it so that they can sell more,” he said.

But as more adults and children are diagnosed with heart diseases, Kenya’s healthcare system is ill-prepared. There are only five cardiac catheterisation laboratories (cath-lab) in the country, all located in Nairobi. There is one at KNH and the others are in the four top private hospitals. Open heart surgeries are also restricted to Nairobi, forcing Kenyans from rural pockets of the country to spend over Sh1,000 to travel to hospital.

The high cost of surgery in private hospitals — which charge up to Sh1 million — has also forced Kenyans to flock to KNH which charges Sh175,000.

The high number of heart disease patients has burdened KNH. The cardiology unit has not been expanded since being opened at KNH in 1973 despite the swelling number of patients.

The hospital has only one cath-lab which was opened in 2014 with state-of-art machines. The bed capacity in most public health facilities has not risen despite the increase in the number of patients. For instance, the number of Intensive Care Unit beds countrywide has been 58 since 2013.

During the recent State of the Nation Address, President Uhuru Kenyatta pledged that the hospitals will have 113 beds in eight months.

The inadequate number of specialist doctors is also holding back the government’s dream of universal quality healthcare to every Kenyan.

KNH, for instance, has five paediatric cardiologists and eight adult cardiologists. Dr Munene faulted the few schools teaching medicine for the low number of specialists.

In the past, most Kenyans went to government schools and universities where there was almost a particular way of transitioning. It was almost automatic, he said.

“One would finish Standard Seven then go to Form One. After Form Five or Six, a student would leave school and he almost knew where he was going to work,” he said. Then the demand for school went up and the private sector saw a business opportunity, drawing investors to the education sector. “But that did not happen in health. Why? Because the cost of providing care is high.

‘‘As long as one has a room, he can erect a board and teach, but for health a similar room would require a bed, equipment, drugs, and many other things for teaching to happen,” he said.

The best bet for Kenyans lies in devolution. Dr Munene said that with devolution, Kenyans can demand for health reforms and counties can construct more heart centres.

“When every other person is being referred to KNH sometimes we get overwhelmed,” he said.

However, he said, not every county should set up a heart centre since it is very expensive and some will remain underutilised.

“Even countries like the US and the UK, with much bigger GDPs than ours, still do not have as many such facilities despite having top-notch hospitals because every investment has to make economical sense.”   

Cost of a heart centre

Setting up a heart facility requires a theatre, wards, a fully-equipped Intensive Care Unit and a cath-lab with machines that can help check arteries blockage, an investment that costs millions of shillings.

An ICU bed alone costs about Sh500,000. KNH has only five ICU beds at the cardiology department. For a hospital to have a theatre, it has to buy an operation table which costs about Sh5 million.

The anaestheric machine, also required in a theatre, costs Sh5 million while the heart and blood pressure monitoring devices would cost another Sh2 million each.

A bypass pump and a heater cooler also have to be installed at an approximate cost of Sh5 million and Sh4 million respectively.

“A ward should not be an expensive thing because there are many wards that can be used,” said Dr Munene.

A cath-lab facility, essential in conducting heart surgeries, costs about Sh600 million.

With these high costs, Dr Munene said, it makes little economic sense for every county to set up a heart centre and other specialised units.

What Kenya needs is at least four national referral units that deal with heart diseases, he said.

‘‘If we had cardiology units in level five hospitals in Kisumu, Mombasa, Eldoret and Northern Kenya, the working burden at KNH could be reduced and many lives saved.’’

He said counties should strike partnerships and pool resources. A higher budgetary allocation for non-communicable diseases such as diabetes and heart disease will also go a long way in taming deaths. For years, the Health ministry has focused on malaria and Aids.

Dr Munene said it costs Sh40 to treat a malaria patient and between Sh5 million and Sh10 million —considering the equipment and personnel required — to treat a heart patient.

‘‘Without the Sh40 treatment for malaria a patient may die and with the heart disease patient, there is no surety whether the disease will resurface after surgery or if a patient will make it through theatre.

‘‘So most budget makers would rather pay for a million patients with malaria at the expense of the one with heart disease,” said Dr Munene, adding that it is time to prioritise diabetes, heart diseases and kidney ailments as every life is important.

As most of these diseases are fuelled by unhealthy diets, over indulgence in alcohol in adults, smoking and physical inactivity, Prof Yonga said that stringent food policies should be put in place to ensure that people limit intake of foods with high in fats and sugars.

South Africa, for instance, is considering banning sugary and fizzy drinks as a food policy to reduce rising cases of diabetes.

“It is very ironic that healthy foods are the most expensive in Kenya simply because there are no guidelines to encourage their intake. Sugary drinks continue to flood our country but who is regulating this?” he asked. Dr Munene also said most heart disease patients live in slums and the congestion in these areas cannot allow physical activity.

Dr Joseph Kibachio, head of the Division of Non-Communicable Diseases at the Health ministry, told the Business Daily that the government was partnering with doctors in private hospitals doing ECG tests, stress tests, providing heart pacemakers and administering penicillin to patients in the bid to manage heart diseases.

He said that the ministry was offering monthly doses of penicillin, free of charge, to children across the country.

“We are offering free penicillin treatment to children across the country through health facilities as we enforce preventive measures rather than curative,” he said.

Aga Khan University Hospital, in collaboration with Cape Town University and other partners, also plans to train about 40 students on how to use electrocardiogram (ECG) machines to detect heart diseases at an early stage.

These students will be deployed to different parts of the country.

“We have done some preliminary training where random students were trained for two weeks on how to use ECG machines and in cases where heart diseases were not detected they (students) were 98 per cent correct and in cases where they detected rheumatic heart disease, for instance, they were 78 per cent right.

‘‘This evidence-based research shows that with more effort Kenya can combat heart diseases,” said Prof Yonga.