In recent decades, the fight against HIV and communicable diseases in East Africa has acted as a veil to cover the subtle, but now seemingly alarming emergence of high blood pressure. In recent years, signs are showing that Kenya could be in the early phases of a hypertensive epidemic and could prove to be severely underprepared in terms of awareness, screening and prevention. At the moment, The African Population and Health Research Center (APHRC) have determined that one out of eight residents of the urban slums in Kenya have diagnosable hypertension according to current guidelines. This group has proven to be especially vulnerable to develop hypertension and is the fastest growing sector of Kenyan society. In terms of the continental context - more than 40 percent of adults in some areas have some stage of hypertension. The question is now how to address the main driving forces behind this emergence, and if the current western treatment guidelines can be efficiently applied to the East African mileu.
The main reason behind the “silent” emergency of hypertension among the low to middle income members of Kenya society can be explained through two factors. The first is the long term diversion of attention and resources to communicable (mostly sexually transmitted) diseases, the second is the low degree of awareness in the african continent about hypertension and the risks it poses. During this diversion of attention in recent decades, a largely unnoticed shift in society was occurring - one of urbanization. This has proven to be one of the main driving forces. The urban population in Kenya is 22.3% and is growth with a rate of 4.2% every year. Adding to this growth is the fact that 60% of residents in the capital city reside in low income area slums. Within this milieu, there is a key misunderstanding that hypertension is a disease that afflicts the high income demographic and is less pertinent to address than the more immediate dangers of sexually transmitted ailments. In previous decades the greatest causes of morbidity and mortality in the region were of a sexually transmitted, maternal & nutritional nature. Now, blood pressures on average are higher in the African continent in comparison to continental Europe and the United States.
In these slums, the more fat saturated, greasy foods become the easiest option and the market for these cholesterol packed meals is expanding. These unhealthier options replace the staple diets and are paired with a largely sedentary lifestyle which compounds the problem. The lifestyles of low income earners have become altered through the effects of urbanization and globalization - the indirect result being the increased incidence and prevalence of hypertension in these communities.
The struggles in the slums of Kenya that are publicised are those mostly concerning the safety of its residents and the supplying of clean drinking water. This distracts from the key health issues that are arising with this demographic and are bound to form a great challenge to the healthcare services in the near future. The challenge lies in providing quality health care on a long term basis, supplying residents with adequate information and spreading awareness on possible prevention methods. In accomplishing this high population density compounded with a low education level form a significant barrier.
The main obstacle will be to bridge the communication gap between the healthcare suppliers and the slum residents in terms of spreading awareness and providing effective screening services. Even if the screening services prove adequate for the high population density - treatment is still too costly for most slum residents. The solution to this is to provide cheaper and more accessible treatment options of a non-pharmaceutical nature. This can be defined as spreading awareness about healthy lifestyle choices and adjusting dietary standards. In terms of the medicamentous approach, an initiative called the “Health Heart Africa” programme was started in 2014 in the largest slum in the capital city - Kibera. Backed by the pharmaceutical provider AstraZeneca © - this initiative aims to bridge the economic hurdles that prevent the effective treatment of this emerging epidemic. The programme provides screening cost-free and provides affordable medication to low-income earners who have been diagnosed with hypertension. They do this in cooperation with the local forces and authorities. There are currently two operational clinics in Kibera providing the aforementioned services. This enables residents to get monthly dosages for a fraction of the market prices, and allows them to be educated on their condition - a key aspect of this initiative’s approach.
The main problem seen with western guidelines that are applied to african regions is that these guidelines focus mostly on clinical aspects, and largely disregard the the societal and economic climate in which the treatment is being provided. The clinics maintain the stated Western guidelines for the treatment of hypertensive patients with an African background, and provide a combinative therapy of a calcium antagonist, thiazide diuretic, and beta blocker. The important change here in the African context is that these clinics are centrally located and work in close communication with local forces such as Amref Health Africa to be actively involved in these communities and provide effective healthcare. In Africa, the difficulty level of treatment is higher due to these socio-economic barriers than need to be addressed.
This begs the question if these clinics should adjust current guidelines to suit their local patient population on a more context-specific basis. These alterations and critical adjustments are essential to halting this fast emerging epidemic in its tracks and avoid the burden it will prove to form for the Kenyan society and healthcare infrastructure. As Kenya is more economically developed than most sub-saharan African nations, it forms a key case study at the current moment to developing effective techniques to battle this emerging hypertension epidemic. Changing societal views on non-communicable diseases and the danger they pose is still a major hurdle in implementing effective treatment strategies and require local initiatives backed by foreign funding. With shifting lifestyle and dietary choices in low-income areas, the young population is a specifically important demographic to target and educate. As hypertension progresses, the cheaper treatment alternatives become replaced by the less-affordable pharmaceutical options that become largely financially unobtainable in these low income regions.
Early intervention is of crucial importance here and the situation needs to be addressed sooner than later - demanding a pooling of resourcing and efforts on a local as well as national basis. This starts with raising awareness of the impending epidemic and informing the public on the seriousness of hypertension as a public health problem. The economic consequences are farther reaching than in the immediate sense and over time untreated hypertension could result in large portions of the working class and productive population becoming chronically ill and exacerbate the poverty cycle in the already disadvantaged slum areas. To halt the emerging epidemic, current guidelines need to be readjusted and modified in a meaningful way to make them accessible and relevant to this urban African context.