Recent events in Nairobi have understandably focused the world on security challenges in Kenya. In that context it is important to recognize inspiring public health advances that represent innovative collaboration between CDC and our Kenyan partners to increase health security for Kenya and the global community. I made a two-day trip to visit our CDC-Kenya programs – a quick stop before commissioning the new CDC Global Disease Detection Center in Dhaka, Bangladesh. While I have previously worked as CDC Country Director in Ethiopia and had a general idea of what to expect, visiting Kenya reminded me that each of our CDC country offices has developed unique programs and solutions to address public health issues affecting local populations.
Understanding the burden of disease in a country is a critical first step to implementing policies and developing systems to tackle public health threats. In Kibera, a large informal settlement on the edge of Nairobi, an impressive laboratory and local clinic are integral parts of a population-based disease surveillance program set up by CDC in collaboration with the Kenya Medical Research Institute (KEMRI) and Carolina for Kibera, a non-governmental organization (NGO).
With regular house-to-house surveys involving more than 28,000 participants, the system documents the burden of infectious diseases in an area where there is no formal sewer system or safe water supply and limited access to clinical care. As an example of the value the surveillance system provides, the program found that typhoid was fifteen times more common in Kibera and had a higher level of drug resistance than in a rural site where CDC also works. These findings can inform policies for using typhoid vaccine in urban areas in sub-Saharan Africa.
In addition to understanding the burden of disease, addressing health threats requires evidence-based interventions. In western Kenya, CDC and KEMRI have built a health and demographic surveillance system which provides a platform for globally-relevant research activities in HIV, malaria, tuberculosis (TB), influenza and other diseases. This platform has been used by CDC and other organizations that fund research to evaluate new public health interventions, such as investigating new TB treatments, the use of insecticide-treated bed nets to reduce the risk of malaria infection, or the safety of providing antiretroviral treatment to mothers with HIV who are breastfeeding and its effectiveness in reducing the risk of transmission of HIV from mother to infant.
Evidence-based interventions must also be sustainable. In Nairobi, I met with staff at Kenyatta National Hospital where CDC has been working to investigate hospital-associated infections and how to reduce them. A simple but important intervention is ensuring hospital staff wash their hands or use alcohol-based hand gels. CDC is supporting sustainable solutions, like implementing production of hand gels in the hospital which provides significant cost savings. Hospital staff told me that producing the gel in-house cost seven times less than what it would cost to purchase the same product locally.
Of course, there are still challenges. At Siaya District Hospital, I met Jackton Omato, the Medical Superintendent, who gave me an overview of the health situation in western Kenya. While CDC programs have supported highly effective HIV prevention programs and helped to reduce malaria and tuberculosis infection and child mortality in this region, other health problems need additional intervention. Maternal mortality still remains high with approximately 488 maternal deaths per 100,000 live births. Two-thirds of pregnancy-related deaths are due to indirect causes, including HIV, tuberculosis and malaria. Another one third of deaths are due to postpartum bleeding and severe infection.
Additionally, although Kenya is still vulnerable to a wide range of infectious diseases, the burden of non-communicable diseases has increased due to changes in lifestyle and a population that is living longer. There is a need for us to create better synergies between the programs we have so that we can support countries like Kenya to address diseases and conditions such as high blood pressure, diabetes and high blood pressure.
Addressing these health concerns will be challenging but Kenya has a greatly improved capacity to respond to emerging health threats. CDC values the opportunity it has had to work hand-in-hand with Kenya’s scientists and health workforce to achieve sustainable, country-driven approaches to improving the health of Kenyans.