African countries made huge gains in life expectancy. Now that could be erased

NAIROBI, Kenya — Hannah Wanjiru was plagued by dizzy spells and headaches for years. After a half-dozen costly trips to the doctor, she was finally diagnosed with high blood pressure. It took two more years — and some fainting spells — before she started to take medication. By then, her husband, David Kimani, had been shuttling between doctors himself and ended up with a diagnosis of diabetes, another condition the couple knew nothing about.

They might have wished for different diseases. Not far from their small apartment in the Kenyan capital, there is a public hospital where treatments for HIV and tuberculosis are provided for free. Posters for free HIV prevention services paper the streets in their low-income neighborhood.

There is no such program for high blood pressure or diabetes, or for cancer or chronic respiratory conditions. The health systems in Kenya and much of sub-Saharan Africa — and the international donations that support them — are heavily weighted to the treatment of communicable diseases such as HIV and malaria.

“Sometimes I go to have my sugars tested and I wait all day and I am almost fainting right there in the lineup,” Kimani said.

Success in fighting HIV, tuberculosis and other deadly infectious diseases, plus an expansion of essential services, have helped countries in sub-Saharan Africa achieve extraordinary gains in healthy life expectancy over the past two decades — 10 additional years, the largest improvement in the world, the World Health Organization reported recently.

“But this was offset by the dramatic rise in hypertension, diabetes and other noncommunicable diseases and the lack of health services targeting these diseases,” the agency said, launching a report on health care in Africa. It warned that the rise in life expectancy could be erased before the next decade is out.

Noncommunicable diseases now account for half of hospital bed occupancy in Kenya and more than one-third of deaths. The rates are similar across the rest of sub-Saharan Africa, and people in this region are being affected at younger ages than those in other parts of the world.

“Vaccination programs are running very well, HIV programs are running very well — but these same people will die of noncommunicable diseases while they are young,” said Dr. Gershim Asiki, a research scientist focused on management and prevention of these conditions at the African Population and Health Research Center, an independent organization in Nairobi.

The medications and supplies Wanjiru, 44, and Kimani, 49, need to control their conditions cost $60 each month, a huge portion of the income from their small convenience store, Wanjiru said over tea in their sitting room. Both skip their medication during months when school fees are due for their four children.

“I get headaches and I feel weak, and then I feel stressed knowing I need to buy medication instead of food for my family,” Kimani said.

Routine screening for conditions such as high blood pressure is rare here, diagnosis rates are low and care is often available only at specialized centers in urban areas. The public is not aware of the ailments — everyone can recognize malaria, but few connect blurry vision or exhaustion with high blood pressure — and primary care health workers often don’t know what to check for either.

When Asiki’s organization set up random screenings in a low-income community in Nairobi a couple of years ago, researchers found that one-quarter of adults had high blood pressure. But 80% of them did not know they had it. Of those who did, fewer than 3% were controlling their blood pressure with medication.

Unlike HIV medication and care, which is usually free and subsidized by international donors, treatment for diabetes or blood pressure is usually an out-of-pocket expense for families, and often cripplingly expensive, said Dr. Jean-Marie Dangou, who coordinates the noncommunicable disease program of the WHO’s Africa regional office.

In Congo, “hypertension treatment is two-thirds of the typical household income each month,” he said. “That’s absurd, for that family. But it is not unusual.”

The share of deaths caused by noncommunicable disease is increasing across the region, most rapidly in the continent’s most populous states, Dangou said. In Ethiopia, for example, mortality caused by these conditions climbed to 43% of deaths last year from 30% in 2015, and made a similar jump in Congo.

It is clear that rapid urbanization and an increase in sedentary lifestyles are driving some of the increase in these conditions. So are growing use of tobacco and alcohol, and consumption of processed foods.

Kenya’s government has been slow to update policies to discourage these. And all three industries have powerful lobbying organizations that are focused on stalling legislation such as a tax on sugar-sweetened beverages. Kenya is a major producer of tobacco, and the industry reminds the government of the jobs it creates, Asiki said.

Dr. Andrew Mulwa, who directs preventive and health promotion programs for the Kenyan Ministry of Health, said that the government was concerned about the soaring rates of noncommunicable conditions but that it was slow work rolling out diagnostics and treatment to the primary care level in rural areas.

“When I worked as a clinician in a rural area 10 years ago, you would see 50 patients a day with these conditions, and now it is 500 to 1,000 at the same facility,” he said.

Poor nutrition is influencing the rise of noncommunicable diseases in multiple ways — what Asiki calls “a double burden of undernutrition.” This region is home to both the largest number of stunted children in the world and the fastest-rising rate of obesity.

It is common in low-income households to find both malnourished children, who lack the protein and nutrients essential for growth, and adults who are obese, because they are reliant on cheap, fatty and energy-dense street foods — often a more affordable option than paying for vegetables and cooking gas to make food at home.

“You can have enough of the bad food but scarcity of the needed foods,” Asiki said. “The body stores excess energy as fat — but at the end it’s still scarcity.”

He speculated that the government had been slow to roll out screening programs because there was no way it could respond to the extent of the problem.

“That’s when you suddenly realize, I don’t have enough medications for hypertension, I don’t have enough medications to treat people with cancer,” Asiki said. “If you screen, you will pick cases that are treatable. But do we have the resources to treat them?”