What is killing Kenyans? Well, pneumonia tops!

Life expectancy in Kenya is gradually increasing. In 1960, it stood at 43, which means one was likely to die at that age, but it has shot up to over 67.

For many, reaching 67 is not easy. Disease, epidemics and unexpected events are a reminder that ever-longer lives are not guaranteed. In Kenya, many are still dying too young and from preventable causes.

Nation.Africa looked at the potentially devastating health conditions and the top killer diseases in Kenya, going by national government data, and how to avoid dying.

Death in Kenya can be tied to many different factors, including a person's gender, race or ethnicity, personal habits and region where one lives.

The 2020 Kenya Vital Statistics Report, released in August 2021, shows that 184,185 deaths were registered, compared with 191,495 in 2019, with more than half (53.4 per cent) of them occurring in health facilities.

In 2020, males accounted for 56.6 per cent of total deaths, with sex ratio recorded at 130 males to 100 females.

The World Health Organisation groups the causes of death into three categories: communicable (infectious and parasitic diseases and maternal, perinatal and nutritional conditions), non-communicable (chronic) and injuries. 

More Kenyans died from non-communicable diseases. These are not passed from person to person and typically progress slowly.

Lung diseases such as pneumonia (chest infection) were the top killers of Kenyans, with pneumonia responsible for two in 10 deaths last year.

The top four leading causes of mortality for men and women last year were pneumonia, cancer, sudden death and malaria, with more males than females dying from these diseases.

According to the 2021 Economic Survey 2021 by the Kenya National Bureau of Statistics, more deaths occurred as a result of pneumonia and cancer at home than in health facilities.

In neonatal, infant and children under-five, the major causes of deaths were premature birth and birth asphyxia, respiratory infections and pneumonia.

Birth-related complications are also a challenge and cause many deaths in women and babies. Kenya is still struggling with birth-related complications.

Last year, almost four out of 10 deaths of children were caused by these complications, followed by respiratory infections (13 per cent), pneumonia (nine per cent), cardiopulmonary and respiratory diseases (eight per cent) and neonatal conditions (eight per cent).

For teenagers, malaria topped the deaths followed by pneumonia and anaemia. Malaria is still not under control in low-income countries despite the leaps made in treatment and prevention.

HIV/Aids deaths have dropped dramatically and it is no longer among the top 10 killers but tuberculosis is still a leading cause of death.

Sudden deaths round up the list of top killers and more men are dying of sudden death than women.

Mortality in females of reproductive age and men aged 15-49 years was mainly caused by pneumonia, cancer, sudden death, cardiorespiratory failure and tuberculosis. 

The two leading causes of death for the population aged 50-59 and over 60 years were cancer and pneumonia, followed by sudden death and diseases associated with the heart.

By regions, Nairobi recorded the highest number of deaths (67 per cent).

Pneumonia

Pneumonia remained the leading cause of deaths nationally in the past five years, accounting for 11percent of all deaths in 2020.

Government data revealed that more men succumbed to the diseases. One in 10 deaths in males was caused by pneumonia while 12 per cent occurred in females.

Most of the people who succumbed to pneumonia were aged 15-49 years.

Although it was not the leading killer for neonates (infants less than a month) pneumonia accounted for 8.8 per cent of the deaths, coming third killer among infants.

However, pneumonia remains a great threat for children under the age of five, with only 33 percent getting the appropriate antibiotics, despite numerous interventions.

Pneumonia has recorded a total of 900 neonatal deaths a month, according to data from November.

The US Centers for Diseases Control and Prevention (CDC) says viruses, bacteria and fungi can all cause pneumonia. Common causes of viral pneumonia are influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes Covid-19).

Ministry of Health data shows that Narok, Samburu, West Pokot, Marsabit and Mandera recorded high cases of pneumonia in the past 12 months, while Kericho, Kisumu, West Pokot, Laikipia, Samburu, Kitui, Nyeri, Nairobi and Uasin Gishu registered the highest neonatal pneumonia deaths

This emerged during the commemoration of this year's child health days (World Pneumonia and World Prematurity days) by the ministry on Thursday.

"To ensure improvement of under-five outcome, uptake of oral rehydration salts (ORS) and zinc for management of diarrhoea in children under five, improved exclusive breastfeeding, introduction of new childhood vaccines like pneumococcal and rotavirus, advocacy to ensure availability of essential medicines in the facilities and strengthening community inventions to ensure early health seeking behaviour," advised Dr Andrew Mulwa, the director of medical services, preventive and promotive health at the ministry.

Cancer

Cancer is the second leading cause of death from non-communicable disease and the number of cases is rising rapidly. In 2020, 8.3 per cent of the total deaths were from cancer and just like pneumonia more men died from the disease than women.

Cancer has also been the leading killer disease among those aged 50-59, accounting for 12.7 per cent of the deaths. Cancer led to more deaths in females than males at 9.3 per cent and 7.6 per cent respectively.

The disease affects Kenyans of all ages and socio-economic backgrounds but has a disproportionate impact on the most vulnerable groups.

Cervical cancer makes up the largest portion of cancer cases (nearly 12 percent) followed by breast cancer, Kaposi’s sarcoma, and oesophageal and prostate cancer.  

In many low and middle-income countries including Kenya, most cancer cases are diagnosed at an advanced stage, when treatment options are limited and families make huge sacrifices, often with poor results.

“Diagnosis of cancer can be devastating but when diagnosed early, it can be managed and a lot prevented,” said Catherine Naliaka Nyongesa Watta, a Kenyan physician and radiation oncologist.

“It is always advisable to seek medical attention immediately you start feeling unwell.”

Sudden Death

Sudden death accounted for seven per cent of all deaths in 2020 and is the third killer disease in the country. There wasn’t a significant difference in the number of sudden deaths in both males (seven per cent) and females (six per cent).

According to WHO, sudden death is a non-violent death and not otherwise explained, occurring less than 24 hours from the onset of symptoms.

These are deaths that can either be as a result of suicide, road accidents, drowning, undiagnosed advanced terminal illness, war, murder, heart attack and even Covid-19.

It occurs in all age groups and the risk factors for sudden death include older age, low and high body mass index, arterial hypertension, diabetes mellitus, smoking, a sedentary lifestyle, unhealthy diet and stress.

Malaria

Malaria continues to be among the top four killer diseases in Kenya, accounting for six per cent of the deaths recorded. It is the fourth cause of death in both genders (female and male) and killed relatively more females (6.5 per cent) than males (5.4 per cent).

The disease was a leading cause of death for children aged between 5-14, accounting for 16.8 per cent.

Malaria remains a primary cause of childhood illness and death in sub-Saharan Africa. More than 260,000 African children under the age of five die from malaria annually.

In Kenya, nearly 70 percent of the country’s 46 million people are at grave risk. This presents challenges to the health system.

Every year, the country reports nearly 3.5 million new clinical cases and 10,700 deaths.

With the introduction of the vaccine called RTS,S, developed by the pharmaceutical giant GSK and proven effective six years ago, malaria cases fell nationally from a prevalence of eight percent in 2015 to 5.6 percent in 2020.

Kenya, alongside Ghana and Malawi, were the only countries globally that the WHO selected to participate in the malaria vaccine pilot.

In the lake regions, the prevalence has dropped from 27 per cent in 2015 to 19 percent in 2020, and from eight percent to 4.5 percent now on the Coast, an almost 50 percent reduction, according to the Malaria Indicator Survey 2020.

Cardiac Arrest

According to Johns Hopkins Medicine, cardiac arrest, also known as sudden cardiac arrest, occurs when the heart stops beating suddenly. The lack of blood flow to the brain and other organs can cause a person to lose consciousness, become disabled or die if not treated.

“In-hospital cardiac arrest (IHCA) is defined as a cardiac arrest that occurs in a hospital and for which resuscitation is attempted. Despite the increased morbidity and mortality, IHCA incidence and outcomes remain largely unknown especially in sub-Saharan Africa,” said Dr Benjamin Wachira, with Aga Khan University Hospital’s accident and emergency department.

According to the latest data from the WHO published in 2018 and other available data, cardiac arrest deaths in Kenya reached 7,522, with the country ranked 169th in the world.

Hypertension

People who succumbed to hypertension accounted for 5.1 per cent of all the deaths in 2020. Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure.

Blood is carried from the heart to all parts of the body in the vessels. Each time the heart beats, it pumps blood into the vessels. 

High blood pressure is one of the risk factors of non-communicable diseases. It affects about a third of the global population and causes an estimated 7.6 million premature deaths. 

In Kenya, a quarter of the population aged 18–69 is estimated to be hypertensive and a half pre-hypertensive.

The prevalence of hypertension in Kenya is 25 per cent. That means out of 10 people, three are hypertensive. An estimated 46 per cent of adults with hypertension are unaware that they have the condition.

Though it is a manageable condition and antihypertensive therapy is available, control rates remain low, largely due to lack of awareness.

A recent meta-analysis of African studies showed awareness, treatment and control rates of hypertension were 27 percent, 18 per cent and seven per cent respectively.

The WHO says hypertension is a serious medical condition and can increase the risk of heart, brain, kidney and other diseases. It is a major cause of premature death worldwide, with upwards of one in four men and one in five women – over a billion people – having the condition. 

Respiratory Infection

Respiratory infection caused 5,310 deaths (3,396 males and 2, 914 females).

Going by sex, respiratory infection is the number seven killer in females and number eight in males.

These are infections of parts of the body involved in breathing, such as the sinuses, throat, airways and lungs.

Respiratory diseases may be caused by infection, smoking tobacco, or breathing in second-hand tobacco smoke and air pollution. 

The symptoms of upper respiratory tract infections include nasal congestions, running nose and sore throat.

Tuberculosis

Tuberculosis (TB) is a serious public health issue in Kenya. About 120,000 people a year develop TB (48,000 of them being HIV-positive) and 18,600 people die from it. It is responsible for about 3.2 per cent of all deaths in 2020, killing 20,000 Kenyans.

The disease is curable and preventable, but many patients tend to get medical attention when it is in the advanced stage and hence they develop acute tuberculosis.

The curable disease mostly affects adults in their most productive years. However, all age groups are at risk, more so when around a sick person.

The disease is spread through the air from one person to another. The TB bacteria are put into the air when a person with TB disease of the lungs or throat coughs, speaks or sings. People nearby may breathe in these bacteria and become infected.

It is one of the leading infectious disease killers in the world, claiming 1.5 million lives each year.

Kenya is one of the 30 countries with the majority (at least 80 per cent) of cases. Last year, around 140,000 people in Kenya were estimated to have TB, among them 17,000 children, according to the Ministry of Health.

Of that number, 67,354 (17 per cent) were missing people with TB and of that 11,394 were children.
Among maternal, neonatal and nutritional diseases, TB is the fourth killer.

According to WHO, people who are infected with HIV are 18 times more likely to develop active TB. The risk of active TB is also greater in persons suffering from other conditions that impair the immune system.
Undernourished people are three times more at risk.

“Vaccination against tuberculosis works best. However, the best strategy is to seek treatment promptly should you begin to get unusual night sweats, a persistent cough or unexpected weight loss,” said Dr Mukuhi Ng’ang’a, a surgeon.

“TB of other organs presents differently (intestines: abdominal pain; brain: headaches, psychosis and seizures; backbone: back pain and even weakness of the legs). Remember, TB has a cure.” 

Anaemia

Anaemia deaths accounted for 3.1 per cent of all deaths.

This was only registered in females, recording 2,887 deaths. It is usually treatable if caught early, although some types are chronic, which means they need continuing treatment.

Anaemia is a serious global public health problem that particularly affects young children and pregnant women.

WHO estimates that 42 per cent of children less than five years of age and 40 percent of pregnant women worldwide are anaemic. 

Severe anaemia is one of the leading killers of children below five years old.

“If a child gets severe anaemia and they are not transfused, the likelihood of the child dying is high. In this region, I attend to many children with severe anaemia of hemoglobin of 0.8 grams which is much lower than the normal 15.6 grams per deciliter,” Dr Walter Otieno, a leading paediatrician, told Healthy Nation.

Anaemia is a condition in which the number of red blood cells or the haemoglobin concentration in them is lower than normal.

Haemoglobin is needed to carry oxygen and if a person has too few or abnormal red blood cells, or not enough haemoglobin, there will be a decreased capacity of the blood to carry oxygen to the body’s tissues. Symptoms include fatigue, weakness, dizziness and shortness of breath.

The most common causes of anaemia include nutritional deficiencies, particularly iron deficiency, though deficiencies in folate, vitamins B12 and A are also important causes; haemoglobinopathies; and infectious diseases such as malaria, tuberculosis, HIV and parasitic infections. 

Diabetes

Diabetes closes the list of the 10 killer diseases in Kenya, accounting for 3.1 per cent of all the deaths. It killed over 3,000 Kenyans last year.

Diabetes can occur at any age (from infants to the elderly). In children, it is due to lack of a special chemical in the body known as insulin. Insulin is vital in breaking down sugar in the body.

Most of the food we eat is broken down into sugar (also called glucose) and released into the bloodstream. When one’s blood sugar goes up, it signals the pancreas to release insulin. Insulin acts like a key to let the blood sugar into the body’s cells for use as energy.

In adults, diabetes occurs when the body does not respond to insulin and the disease may run in families. Diabetes can destroy kidneys, vision, sexual function, digestive function and put the sufferer at risk of getting a stroke and a heart attack. It is also one of the leading causes of limb amputation in adults.

According to the CDC, about 80,000 deaths occur each year due to diabetes. The number of fatalities related to diabetes may be underreported.

The WHO estimates that the prevalence of diabetes in Kenya is 3.3 per cent and predicts a rise to 4.5 per cent by 2025.

Unfortunately, Type 1 diabetes, which affects children, cannot be prevented. However, diabetes that develops in adulthood (Type 2) may be avoided. Doctors have also seen children with Type 2 diabetes, which is fuelled by poor feeding habits and a sedentary lifestyle.

Usually, there is a pre-diabetes phase, which acts as a warning that one is going to develop diabetes. A check-up by your doctor can help assess this. 

Those in a pre-diabetic phase can prevent the development of full-blown diabetes by changing their lifestyles, such as reducing one’s weight, exercising and changing their diet. If a person is already diabetic, they can keep the disease under control and live to a ripe old age.

If a person has diabetes, the body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in the bloodstream.

Over time, that can cause serious health problems, such as heart disease, vision loss and kidney disease.