Epidemic in slow motion: Experts sound alarm over rise in NCDs deaths

A nurse checks a patient's blood pressure. [Courtesy] A silent epidemic is sweeping across Kenya. Non-communicable diseases (NCDs) are claiming more lives than ever before. The 2024 Vital Statistics Report by the Kenya National Bureau of Statistics (KNBS) reveals that non-communicable diseases were responsible for 61.7 per cent of all hospital deaths in 2024-a sharp rise from 52.4 per cent in 2023. Research data from the African Population and Health Research Center (APHRC) provides compelling evidence of this alarming trend. Dr Gershim Asiki, Research Scientist at APHRC, leading the non-communicable diseases (NCDs) research programme under the Health and Systems for Health Research Unit, has been tracking NCD deaths through demographic surveillance systems in two Nairobi slums since 2002, following nearly 100,000 people. "We have been able to track deaths and causes of death through verbal autopsy," Dr Asiki explains. His research reveals a five-fold increase in NCD deaths - from just five per cent in 2003 to 20 per cent by 2012 in urban slum settings. By 2018, his data showed that 43 per cent of all deaths were attributed to NCDs. Similar studies in rural Kisumu found that 37 per cent of deaths between 2003 and 2010 were attributable to NCDs, while national data from the Kenya Demographic Health Survey shows NCDs increased from 35 per cent of total deaths in 2003 to 45 per cent in 2010. "You can see most of these figures are overlapping," Dr Asiki notes. "One common feature that we see is all these data sets are showing an increase in NCD deaths." Currently, NCDs rank as the second leading cause of death in Kenya based on population studies, but the trajectory suggests this could change. "When you look at the trends, NCDs are rising while other causes of death are coming down," Dr Asiki explains. "What is likely to happen is that NCDs might surpass the other causes of death, just like what is globally known." According to David Makumi, CEO of Faraja Cancer Support Trust, the trend represents what he calls "an epidemic in slow motion". "Cases of non-communicable diseases have been on an upward trend over the years, and it's getting worse," Makumi explains. "Non-communicable diseases are multifaceted. We are talking about diseases that are not infectious, but many of them share the same risk factors." Cancer has surged from the fifth leading cause of death in 2021 to second in 2024, killing 8,954 people-a rise from 7,699 in 2023. Cardiovascular diseases, including heart attacks and strokes, ranked third in 2024, with 7,478 deaths. These conditions, often exacerbated by poor diet, stress, and untreated hypertension, are now claiming almost as many lives as cancer. The expert points to a troubling correlation between Kenya's socioeconomic development and the rise in lifestyle-related diseases. "Our lifestyles have continued to change as we develop socioeconomically," Makumi notes. Serious complications The changing lifestyle patterns revolve around dietary habits and physical inactivity. Makumi highlights how increased disposable income has led to spending on unhealthy food and alcohol consumption, while sedentary lifestyles have become the norm. These factors, combined with inadequate screening measures and inconsistent public education, have created fertile ground for NCDs to establish themselves. Perhaps most concerning is that the majority of deaths from these diseases are entirely preventable. Patients typically present to hospitals not for routine screening, but with serious complications from undiagnosed conditions. "A lot of people live with non-communicable diseases that they don't even know they have," Makumi explains. "They may have diabetes, but until they have a complication or show up in a coma, they don't know." Makumi further explains the pattern is similar for hypertension and cancer. Patients arrive at emergency rooms with strokes, kidney failure, or advanced cancers that could have been managed effectively if caught early. By the time they seek medical attention, treatment becomes more complex and expensive, and their quality of life is already compromised. Hypertension, once considered a minor health issue, is now among the top five causes of death, killing 5,035 people in 2024. Dr Asiki identifies three broad categories of factors driving this increase: demographic, behavioural, and environmental. Demographic factors include Kenya's aging population and genetic predisposition - both non-modifiable risk factors. However, behavioural factors account for more than 80 per cent of NCD cases. "Diet is the number one risk factor for NCDs," Dr Asiki emphasises. "There's evidence that when you combine all the other three behavioural risk factors, they don't even add up to the risk caused by diet." The 2015 Kenya Steps Survey revealed alarming statistics: 99.8 per cent of adults don't consume enough fruits and vegetables, while 89 per cent consume foods high in salt. The consumption of sugary drinks has doubled between 2008 and 2019, with sales becoming more affordable as costs dropped by 50 per cent. Meanwhile, 25.5 per cent of adults aged 20-89 engage in heavy episodic drinking, with 88 per cent of these being men. Environmental factors, including air pollution from vehicles and industries in urban areas, and household smoke from cooking fuels in rural areas, further compound the problem. "There are a lot of monitors in Nairobi that monitor particulate matter. If you looked at those measurements, you'd be shocked to see how much pollution is in Nairobi," Dr Asiki notes. The healthcare system's failures compound the problem. Makumi identifies several critical gaps: inadequate community education, poor referral systems, insufficient diagnostic capacity, and lack of resources at primary healthcare levels. "We haven't educated our communities enough sustainably and continuously," he says. "It shouldn't be a one-off opportunistic kind of education." Financial barriers also prevent many Kenyans from accessing timely care. Even when diagnostic equipment and skilled personnel are available, patients may not be able to afford medications or may face interruptions in treatment due to insurance limitations. The expert reserves particular criticism for preventable deaths from conditions like cervical cancer and hypertension. "To allow our women to die of cervical cancer the way they are is criminal," he states. "It just should not have a place in a country that is almost a middle-income country." APHRC is working directly with the Ministry of Health to address this crisis through evidence-based policy development. "We generate evidence that NCD is a problem in the country. For instance, there is clear evidence that 1 in 4 adult Kenyans have hypertension," Dr Asiki explains. The organisation is currently supporting the Ministry to conduct another Kenya Steps survey. The last one was done in 2015. Rather than relying solely on health promotion messages, APHRC is advocating for regulatory and fiscal policies. "Evidence worldwide has shown that you cannot change behaviours by just telling people eat well, don't drink, don't smoke. Systematic reviews have shown that all health promotion messages have failed," Dr Asiki notes. "The way to change it is to restrict choice through regulation and fiscal policies." Since 2019, APHRC has been working with the Ministry of Health on four key policies: restricting marketing of unhealthy foods, implementing simplified front-of-pack labelling with octagon warning symbols, promoting healthy food procurement in public institutions, and developing fiscal policies that tax unhealthy foods while reducing taxes on vegetables and fruits. Nutrient model Kenya already has strong tobacco control policies enacted in 2017 and the Alcoholic Drinks Act of 2010, but lacks comprehensive policies addressing unhealthy diets - the leading NCD risk factor. The Ministry has developed the Kenya Nutrient Profile Model, a document that guides identification of foods high in salt, sugar, and fat for regulatory purposes. "When you restrict marketing, increase taxes on unhealthy foods and label foods, consumers will start going for healthier ones," Dr Asiki explains. The solution, according to both experts, requires a multi-faceted approach: sustained community education, improved referral systems, better-equipped healthcare facilities, affordable medications, and addressing commercial determinants of disease through policy measures. "We need to accelerate efforts and progress," Makumi says. "NCDs are an epidemic in slow motion, and we need to wake up to this reality before more preventable deaths occur."

Epidemic in slow motion: Experts sound alarm over rise in NCDs deaths

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