Objectives
To assess the prevalence, awareness, treatment and control of diabetes and to examine the relationship of obesity with raised blood glucose in the slums of Nairobi, Kenya.
Methods
We used ...data from a cross‐sectional population‐based survey, conducted in 2008–2009, involving a random sample of 5190 (2794 men and 2396 women) adults aged ≥18 years living in two slums – Korogocho and Viwandani – in Nairobi.
Results
The prevalence (weighted by sampling and response rates) of diabetes was 4.8% (95%CI 4.0–5.7) in women and 4.0% (95%CI 3.3–4.7) in men. Less than a quarter of those found to have diabetes were aware of their condition among which just over half of men and three‐quarters of women reported being on any treatment in the 12 months preceding the survey. Overall, fewer than 5% of all people with diabetes had their blood sugar under control. Obesity and overweight were significantly associated with increased odds (1.7, 95%CI 1.1–2.6) of raised blood glucose only among women while adjusting for important covariates.
Conclusion
The prevalence of diabetes in this impoverished population is moderately high, while the levels of awareness, treatment and control are quite low. In this population, obesity is an important risk factor for raised blood glucose particularly among women. Prevention and control strategies that target modifiable risk factors for diabetes and increase access to treatment and control in such disadvantaged settings are urgently needed.
Objectifs
Détermine la prévalence, la sensibilisation, le traitement et le contrôle du diabète, et examiner la relation entre l'obésité et la glycémie élevée dans les bidonvilles de Nairobi, au Kenya.
Méthodes
Nous avons utilisé les données d'une enquête transversale auprès de la population, menée en 2008–2009, auprès d'un échantillon aléatoire de 5190 (2794 hommes et 2396 femmes) adultes âgés de ≥ 18 ans et vivant dans deux bidonvilles de Nairobi, Korogocho et Viwandani.
Résultats
La prévalence du diabète (pondérée par les taux d’échantillonnage et de réponse) était de 4.8% (IC 95%: 4.0 à 5.7) chez les femmes et de 4.0% (IC 95%: 3.3 à 4.7) chez les hommes. Moins d'un quart des personnes dépistées avec le diabète étaient au courant de leur statut. Parmi ces derniers, un peu plus de la moitié des hommes et trois quart des femmes ont déclaré avoir été sous un traitement durant les 12 mois précédant l'enquête. Dans l'ensemble, moins de 5% de toutes les personnes atteintes de diabète avaient leur glycémie sous contrôle. L'obésité et la surcharge pondérale sont significativement associées à une probabilité accrue (1.7; IC 95%: 1.1–2.6) de glycémie élevée chez les femmes, lorsque les variables importantes sont ajustées.
Conclusion
La prévalence du diabète dans cette population pauvre est modérément élevée, alors que les niveaux de sensibilisation, de traitement et de contrôle sont très faibles. Dans cette population, l'obésité est un facteur de risque important pour la glycémie élevée en particulier chez les femmes. Les stratégies de prévention et de contrôle qui ciblent les facteurs de risque modifiables pour le diabète et l'augmentation de l'accès au traitement et au contrôle dans les milieux défavorisés sont urgemment nécessaires.
Objetivos
Evaluar la prevalencia, los conocimientos, el tratamiento y el control de la diabetes, y examinar la relación entre la obesidad y niveles aumentados de glucosa en sangre, en las barriadas de Nairobi, Kenia.
Métodos
Hemos utilizado datos de un estudio croseccional basado en la población, realizado entre el 2008–2009, con una muestra aleatoria de 5190 (2794 hombres y 2396 mujeres) adultos con ≥18 años viviendo en dos barriadas –Korogocho y Viwandani – en Nairobi.
Resultados
La prevalencia (ponderada por el muestreo y la tasa de respuesta) de diabetes era un 4.8% (IC 95% 4.0–5.7) en mujeres y un 4.0% (IC 95% 3.3–4.7) en hombres. Menos de una cuarta parte de aquellos hallados con diabetes eran conscientes de su condición, entre los que un poco más de la mitad de los hombres y tres cuartas partes de las mujeres reportaron haber recibido tratamiento en los 12 meses anteriores a la encuesta. En total, menos del 5% de todas las personas con diabetes tenían la glucosa en sangre bajo control. La obesidad y el sobrepeso estaban significativamente asociados con una mayor probabilidad (1.7, IC 95% 1.1–2.6) de tener un nivel alto de glucosa en sangre solo entre las mujeres, cuando se ajustaba para covariables importantes.
Conclusión
La prevalencia de diabetes en esta población empobrecida es moderadamente alta, mientras que los niveles de conocimiento, tratamiento y control son bastante bajos. En esta población, la obesidad es un factor de riesgo importante para tener aumentado el nivel de glucosa en sangre, particularmente entre las mujeres. Se requiere urgentemente de estrategias de prevención y de control que se centren en factores de riesgo modificables de la diabetes y que aumentan el acceso al tratamiento y al control en emplazamientos desaventajados como estos.
This study aims to assess the prevalence, awareness, treatment, and control of hypertension in two major slums in Nairobi, Kenya.
We use data from a cross-sectional population-based survey, conducted ...in 2008-2009, involving a random sample of 5190 (2794 men and 2396 women) adults aged 18 years and older resident in both slums.
Overall, the prevalence (weighted by sampling and response rates) of hypertension (SBP ≥140 mmHg and/or DBP ≥90 mmHg and/or antihypertensive medication) was 12.3% (12.7% in women and 12.0% in men). The overall level of awareness (having been previously informed of hypertensive status by a health professional) among hypertensives was 19.5% (30.7% in women and 10.8% in men). About 47% (44.9% in women and 50.9% in men) of those who were aware of being hypertensive reported being on antihypertensive treatment in the 1 year preceding the survey. Among those who reported being on treatment, only 21.5% (14.4% in women and 35.7% in men) had their hypertension controlled to levels below 140/90 mmHg. Hypertension control among all hypertensives was below 3%.
Our findings suggest that hypertension is common in the slums, but the rates of awareness, treatment, and control are low. However, once people are aware of their hypertension, most seek treatment. This indicates that the best gains in treatment can be made when awareness is raised. Overall, there is urgent need to implement strategies that improve prevention, detection, and access to effective treatment in these neglected populations.
Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for ...bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in patients with tuberculosis, and screening and preventive therapy for latent tuberculosis infections in individuals with diabetes. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher risk of drug toxicity than tuberculosis patients without diabetes. Good glycaemic control, which reduces long-term diabetes complications and could also improve tuberculosis treatment outcomes, is hampered by chronic inflammation, drug-drug interactions, suboptimum adherence to drug treatments, and other factors. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. From a health systems point of view, delivery of optimum care and integration of services for tuberculosis and diabetes is a huge challenge in many countries. Experience from the combined tuberculosis and HIV/AIDS epidemic could serve as an example, but more studies are needed that include economic assessments of recommended screening and systems to manage concurrent tuberculosis and diabetes.
Tropical countries are experiencing a substantial rise in type 2 diabetes, which is often undiagnosed or poorly controlled. Since diabetes is a risk factor for many infectious diseases, this increase ...probably adds to the large infectious disease burden in tropical countries. We reviewed the literature to investigate the interface between diabetes and infections in tropical countries, including the WHO-defined neglected tropical diseases. Although solid data are sparse, patients with diabetes living in tropical countries most likely face increased risks of common and health-care-associated infections, as well as infected foot ulcers, which often lead to amputation. There is strong evidence that diabetes increases the severity of some endemic infections such as tuberculosis, melioidosis, and dengue virus infection. Some HIV and antiparasitic drugs might induce diabetes, whereas helminth infections appear to afford some protection against future diabetes. But there are no or very scarce data for most tropical infections and for possible biological mechanisms underlying associations with diabetes. The rise in diabetes and other non-communicable diseases puts a heavy toll on health systems in tropical countries. On the other hand, complications common to both diabetes and some tropical infections might provide an opportunity for shared services-for example, for eye health (trachoma and onchocerciasis), ulcer care (leprosy), or renal support (schistosomiasis). More research about the interaction of diabetes and infections in tropical countries is needed, and the infectious disease burden in these countries is another reason to step up global efforts to improve prevention and care for diabetes.
Air pollution is among the leading global risks for mortality and responsible for increasing risk for chronic diseases. Community perceptions on exposure are critical in determining people's response ...and acceptance of related policies. Therefore, understanding people' perception is critical in informing the design of appropriate intervention measures. The aim of this paper was to establish levels and associations between perceived pollution and health risk perception among slum residents. A cross-sectional study of 5,317 individuals aged 35+ years was conducted in two slums of Nairobi. Association of perceived score and individual characteristics was assessed using linear regression. Spatial variation in the perceived levels was determined through hot spot analysis using ArcGIS. The average perceived air pollution level was higher among residents in Viwandani compared to those in Korogocho. Perceived air pollution level was positively associated with perceived health risks. The majority of respondents were exposed to air pollution in their place of work with 66% exposed to at least two sources of air pollution. Less than 20% of the respondents in both areas mentioned sources related to indoor pollution. The perceived air pollution level and related health risks in the study community were low among the residents indicating the need for promoting awareness on air pollution sources and related health risks.
Hypertension has always been regarded as a disease of affluence but this has changed drastically in the last two decades with average blood pressures now higher in Africa than in Europe and USA and ...the prevalence increasing among poor sections of society. We have conducted a literature search on PubMed on a broad range of topics regarding hypertension in Africa, including data collection from related documents from World Health Organization and other relevant organizations that are available in this field. We have shared the initial results and drafts with international specialists in the context of hypertension in Africa and incorporated their feedback. Hypertension is the number one risk factor for CVD in Africa. Consequently, cardiovascular disease (CVD) has taken over as number one cause of death in Africa and the total numbers will further increase in the next decades reflecting on the growing urbanization and related lifestyle changes. The new epidemic of hypertension and CVD is not only an important public health problem, but it will also have a big economic impact as a significant proportion of the productive population becomes chronically ill or die, leaving their families in poverty. It is essential to develop and share best practices for affordable and effective community-based programs in screening and treatment of hypertension. In order to prevent and control hypertension in the population, Africa needs policies developed and implemented through a multi-sectoral approach involving the Ministries of Health and other sectors including education, agriculture, transport, finance among others.
Background. An increasing burden of cardiovascular disease (CVD) is occurring in low- and middle-income countries (LMICs) as a result of urbanisation and globalisation. Low rates of awareness and ...treatment of risk factors worsen the prognosis in these settings. Prevention of CVD is proven to be cost effective and should be the main intervention. Insight into prevention programmes in LMIC is important in addressing the rising levels of these diseases.
Objective. To evaluate the effectiveness of the community-based interventions for CVD prevention programmes in LMIC.
Design. A literature review with searches in the databases of PubMed, EMBASE, CINAHL, LILACS, African Index Medicus and Google Scholar between 1990 and May 2012.
Results. Twenty-six studies involving population-based and high-risk interventions have been included in this review. The content of the population intervention was mainly health promotion through media and health education, and the high-risk approach focused often on education of patients, training of health care providers and implementing treatment guidelines. A few studies had a single intervention on exercising or salt reduction. Most studies showed a significant reduction of cardiovascular risk ranging from lifestyle changes on diet, smoking and alcohol to biomedical outcomes like blood pressure, glucose levels or weight. Some studies showed improved management of risk factors like increased control of hypertension or adherence to medication.
Conclusion. There have been effective community-based programmes aimed at reducing cardiovascular risk factors in LMIC but these have generally been limited to the urban poor. Health education with a focus on diet and salt, training of health care providers and implementing treatment guidelines form key elements in successful programmes.
The burden of cardiovascular disease is rising in sub-Saharan Africa with hypertension being the main risk factor. However, context-specific evidence on effective interventions for primary prevention ...of cardiovascular diseases in resource-poor settings is limited. This study aims to evaluate the feasibility and cost-effectiveness of one such intervention--the "Sustainable model for cardiovascular health by adjusting lifestyle and treatment with economic perspective in settings of urban poverty".
A prospective quasi-experimental community-based intervention study.
Two slum settlements (Korogocho and Viwandani) in Nairobi, Kenya.
Adults aged 35 years and above in the two communities.
The intervention community (Korogocho) will be exposed to an intervention package for primary prevention of cardiovascular disease that comprises awareness campaigns, household screening for cardiovascular diseases risk factors, and referral and treatment of people with high cardiovascular diseases risk at a primary health clinic. The control community (Viwandani) will continue accessing the usual standard of care for primary prevention of cardiovascular diseases in Kenya.
Demographic and socioeconomic data; anthropometric and clinical measurements including blood pressure. Population-based data will be collected at the baseline and endline--12 months after implementing the intervention. These data will be collected from a random sample of 1,610 adults aged 35 years and above in the intervention and control sites at both baseline and endline. Additionally, operational (including cost) and clinic-based data will be collected on an ongoing basis.
(1) A positive difference in the change in the proportion of the intervention versus control study populations that are at moderate or high risk of cardiovascular disease; (2) a difference in the change in mean systolic blood pressure in the intervention versus control study populations; (3) the net cost of the complete intervention package per disability-adjusted life year gained.
Primary outcomes comparing pre- and post-, and operational data will be analyzed descriptively and "impact" of the intervention will be calculated using double-difference methods. We will also conduct a cost-effectiveness analysis of the intervention using World Health Organization guidelines.
The outcomes of the study will be disseminated to local policy makers and health planners.
Current controlled trials ISRCTN84424579.
Many low- and middle-income countries are undergoing a nutrition transition associated with rapid social and economic transitions. We explore the coexistence of over and under- nutrition at the ...neighborhood and household level, in an urban poor setting in Nairobi, Kenya.
Data were collected in 2010 on a cohort of children aged under five years born between 2006 and 2010. Anthropometric measurements of the children and their mothers were taken. Additionally, dietary intake, physical activity, and anthropometric measurements were collected from a stratified random sample of adults aged 18 years and older through a separate cross-sectional study conducted between 2008 and 2009 in the same setting. Proportions of stunting, underweight, wasting and overweight/obesity were dettermined in children, while proportions of underweight and overweight/obesity were determined in adults.
Of the 3335 children included in the analyses with a total of 6750 visits, 46% (51% boys, 40% girls) were stunted, 11% (13% boys, 9% girls) were underweight, 2.5% (3% boys, 2% girls) were wasted, while 9% of boys and girls were overweight/obese respectively. Among their mothers, 7.5% were underweight while 32% were overweight/obese. A large proportion (43% and 37%%) of overweight and obese mothers respectively had stunted children. Among the 5190 adults included in the analyses, 9% (6% female, 11% male) were underweight, and 22% (35% female, 13% male) were overweight/obese.
The findings confirm an existing double burden of malnutrition in this setting, characterized by a high prevalence of undernutrition particularly stunting early in life, with high levels of overweight/obesity in adulthood, particularly among women. In the context of a rapid increase in urban population, particularly in urban poor settings, this calls for urgent action. Multisectoral action may work best given the complex nature of prevailing circumstances in urban poor settings. Further research is needed to understand the pathways to this coexistence, and to test feasibility and effectiveness of context-specific interventions to curb associated health risks.
Challenges of health programmes in slums van de Vijver, Steven, MD; Oti, Samuel, MD; Oduor, Clement, BA ...
The Lancet (British edition),
11/2015, Volume:
386, Issue:
10008
Journal Article
Peer reviewed
The African Population and Health Research Center, in collaboration with international partners, has been working for the past decade in slum settings in Nairobi, Kenya, doing research and ...intervention projects. The aim of this Viewpoint is to share our experiences working in the centre and provide some insights into the complexities surrounding design and implementation of programmes aimed at improvement of health and wellbeing in such a dynamic setting.
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