“We are having a tsunami, and our tsunami now is non-communicable diseases…because we have changed our diet from the traditional African food to a Western-type of food, the fast foods.”Dr Geoffrey Mutuma – Kenya Medical Research Institute
What is Diabetes and Why is there a Cause for Concern in Kenya?
Diabetes is a Non-Communicable Disease (NCD) that is devastating the lives of people around the world. It is a disease largely associated with an unhealthy lifestyle and has often been called a rich-country problem. As a result, one of the most effective ways of preventing diabetes is by eating a healthy diet and exercising. Furthermore, if it is diagnosed early and managed properly diabetics can live a long and good quality life. However, this is not being achieved in all parts of the world, Kenya included.
Alarmingly, from 1980-2017 the number of patients being diagnosed has risen from 108 million to 425 million. This shows a huge surge in diabetes and contrary to popular opinion, low income countries are reported to carry the heaviest burden with 80% of diabetes related deaths originating there. Here, the reality is expected to get much worse with low income countries seeing a 92% increase in diabetes related mortality by 2040.
At present, research in Kenya found 56.3% of people studied to be suffering with undiagnosed diabetes. Moreover, only 7% of those who were aware of their condition had it under control. This identifies an insufficient health system, struggling to provide adequate care to diabetic people. An unfortunate reality, that explains why the unrelenting hands of diabetes takes so many Kenyan lives. Considering the projected increases, the future of Kenyan diabetics is of grave concern.
The response to this has seen diabetes switch from a disease of the rich to a disease of the poor. In addition, international bodies such as World Health Organisation (WHO), International Diabetes Federation (IDF) and United Nations (UN) have been calling for governments to recognise the crisis and work towards preventing it.
In Kenya, the situation cries out for an urgent multilevel approach to curb diabetes and prevent its harrowing effects on people’s lives. However, in order to do this effectively there must be an understanding of why Kenya has seen such an increase over the last few decades. Moreover, it is important to investigate the reasons why Kenya is struggling to cope with the diabetes epidemic. Finally, it does bring some relief to explore the steps Kenya, with the help of international bodies, has started to take in order to overcome this issue.
Causes and Risk Factors
As previously mentioned, diabetes is largely associated with the lifestyle people lead. Therefore, it is primarily concerned with the diet and activity level of individuals. As a result, the worrying increase in Kenya is often linked to the ‘Nutrition Transition (NT)’. This term has received a lot of interest in the academic world, see Popkin 2015, Walls, et al, 2018 and Ronto, et al, 2018. Not only this, a shift in diet and its relationship to diabetes has been picked up by multiple news stations in Kenya, see KBCNewsHour and Daily Nation.
Hence, the NT is characterised by a shift from traditional diets made up of grains and pulses to an energy dense diet consisting of fat, sugar, and meat.
The above images are an example of the NT from the traditional diet (left) to more increasingly, the new diet made up of fried food and sugary soda (right). This change in dietary behaviour across the world is understood to be a bi-product of both globalisation and urbanisation.
This is in regards to the globalisation of the food industry and the impact this has on consumer choice and imported goods. These developments in the food supply chain are making products that are high in fat and sugars and low in nutrients widely accessible to Kenyans.
Urbanisation is characterised by the migration of rural dwellers towards cities in search of work and a different lifestyle. This migration then exposes Kenyans to a different way of life surrounded by fast food, supermarkets and street food. To make things worse this is often coupled with less time to prepare traditional meals and a reliance on public transport. As a result, urban dwellers develop unhealthier lifestyles and this has landed urban spaces with the title of ‘obesogenic environments‘.
What does this mean for diabetes in Kenya?
The processes of urbanisation and globalisation have played a big role in encouraging the NT. This in turn has promoted an unhealthy life style that has significantly contributed to the increase of diabetes in Kenya.
Research has shown that urban populations are more likely to have high calorie diets and participate in less physical activity. This link is strengthened by a Kenyan study that found 21% of rural non-migrants to be classified as overweight or obese compared to 46% of rural-urban migrants. Interestingly, the figures for rural-urban migrants were also higher than urban non-migrants. This supports the link between urbanisation and the NT. Furthermore, the same study also found rural-urban migrants to eat less staple foods and more fatty and sugary foods compared to rural non-migrants.
Therefore, the relationship between urbanisation and the diabetes epidemic is a great cause for concern. This is especially true when taking into account the growing rates of urbanisation. According to the World Bank, Kenya is urbanising at a rate of 4.3% a year and 50% of the population will be living in cities by 2050. Consequently, a multilevel approach needs to be adopted in order to inhibit the increase of diabetes in correlation to rising urbanisation.
However, this does not mean that susceptibility to the NT is exclusive to rural-urban migrants. One study found that globalisation has brought better manufacturing technology to Kenya and has meant that small packets of butter have found their way to informal shops. This has made fat more accessible and provokes dietary shifts in rural Kenyans as well.
To add load to Kenya’s already heavy burden, it is important to consider what WHO calls the double burden of malnutrition. This is related to issues of food security and identifies a strong link between child malnutrition and a predisposition to diabetes. A study conducted by the Kenyan Government from 2015-2016 found that 29.9% of children under the age of 5 were moderately stunted due to lack of food and malnutrition. This identifies a huge proportion of young Kenyan’s at risk of developing diabetes, as a result of food insecurity in early life. Moreover, it adds to the complexity of Kenya’s problem and the need for a comprehensive approach to reduce this risk.
What is being done to reduce diabetes in Kenya?
All of this has unveiled the harsh reality of diabetes in Kenya and its negative association to the NT, urbanisation and globalisation. Fortunately, this crisis has not been kept silent and a global response has brought Kenyan diabetes to the forefront of international and national politics. Some of these policies are detailed below:
- Kenya National Diabetes Strategy – 2010-2015:
- To improve the quality of and access to diabetic care services and diagnosis
- Schools to include ‘healthy diets’ in curriculum and provide healthy meals
- Provides incentives for manufacturers to produce healthier alternatives
- Kenya National Strategy for the Prevention and Control of Non-Communicable Diseases – 2015-2020:
- Promoting healthy lifestyles and diets to prevent the onset of NCDs
- Strengthening health systems to cope with NCDs
- WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases – 2013-2020:
- Aims to reduce diabetes mortality rates by 25%
- Provides Kenya with a menu of policies to aid in achieving this
- Changing Diabetes in Children – 2009-2014:
- Established 8 health clinics providing medication and education to diabetic children
- Talks in school to raise awareness and tackle taboos
- Trained 187 teachers on the management of diabetes
- Kenya Diabetes Management and Information Centre (DMI) – Founded in 1999:
- Provides free community medical camps
- Trains medical professionals and teachers to manage diabetes
- Promotes awareness and support across the country
- Organises a yearly walk to raise vital funds for children with diabetes
This demonstrates a common consensus on the need to act fast to tackle diabetes in Kenya! By promoting healthy lifestyles it is hoped that the development of diabetes will be hindered. Furthermore, by increasing awareness and education it is hoped that if an unfortunate diagnosis is made, Kenyans will be able to manage the disease better. However, one thing we must keep in mind is the complexity of the ‘double burden of malnutrition‘. Given the impact this has on the development of diabetes later in life, it is crucial to target childhood malnutrition as a preventative measure.