Figure 1
Disability-adjusted life years due to major disease groups, by age (GBD 2016).
Figure 2
DALYs from NCDs in Kenya due to the four NCDs included and not included in the Global Action Plan (GBD 2016).
Figure 3a
Proportion of cause of death by wealth quintile in KEMRI/CDC HDSS in Siaya County 2003–2016 (source: KEMRI/CDC HDSS 2017).
Figure 3b
Crude death rates due to NCDs and injuries by wealth quintile in Nairobi Urban HDSS, 2010–2015 (Source: APHRC 2017).
Figure 4
Proportion of disability-adjusted life years in Kenya due to risk factor groups in each NCDI disease category (GBD 2016).
Figure 5
Mean availability of essential medications for NCDs compared to HIV, TB, and malaria (Service Availability and Readiness Assessment, 2013).
Figure 6a
NCD medication availability in all facilities by urban or rural categorization (Service Availability and Readiness Assessment, 2013).
Figure 6b
Percent of facilities in each county with the mean number of tracer medications available for NCDs by the percent of the county’s population living in the global poorest billion (Sources: Service Availability and Readiness Assessment 2013 and Oxford Poverty & Human Development Initiative).
Figure 7
Access to diagnosis for hypertension and diabetes and treatment for hypertension, by wealth quintile (STEPS 2013).
Table 1
Selected priority NCDIs for service expansion.
| DISEASE CATEGORY | PRIORITIZED DISEASE/CONDITION |
|---|---|
| Respiratory | Asthma |
| Chronic obstructive pulmonary disease | |
| Cardiovascular – behavioral & metabolic etiologies | Hypertension, Hypertensive heart disease, Ischemic heart disease, hemorrhagic stroke, ischemic stroke |
| Cardiovascular – other etiologies | Rheumatic heart disease |
| Endocrine | Diabetes mellitus (type 1 and 2) |
| Cancers | Cervical cancer |
| Burkitt lymphoma (non-Hodgkin lymphoma) | |
| Breast cancer | |
| Mental Health | Major depressive disorder |
| Neurologic | Epilepsy |
| Congenital | Sickle cell disorders |
| Liver | “Cirrhosis” – etiologies include hepatitis B, hepatitis C, alcohol, other causes |
| Surgical & Injuries | Motor vehicle road injuries |
| Assault |
Table 2
Selected priority interventions for NCDIs with cost-effectiveness rating, financial risk protection rating, equity rating, total cost for estimated population in need, estimated baseline coverage, assigned target coverage, and calculated incremental cost.
| CONDITION | INTERVENTION | COST EFFECTIVENESS RATING | FINANCIAL RISK PROTECTION RATING | EQUITY RATING | TOTAL COST | BASELINE COVERAGE 2018 | TARGET COVERAGE 2030 | INCREMENTAL COST | HEALTH SYSTEM LEVEL |
|---|---|---|---|---|---|---|---|---|---|
| Cirrhosis | Screening and brief intervention for alcohol use disorder | 3 | 2 | 1 | |||||
| Respiratory | Low-dose inhaled corticosteroids and broncho-dilators for asthma and for selected patients with COPD | 1 | 3 | 1 | 262,690,039 | 0.16 | 0.5 | 89,314,613 | Health Center |
| Respiratory | Management of acute exacerbations of asthma and COPD using systemic steroids, inhaled beta-agonists, and, if indicated, oral antibiotics and oxygen therapy | 1 | 4 | 1 | 165,654,576 | 0.16 | 0.5 | 56,322,556 | First-Level Hospital |
| Respiratory | Mass media for awareness on handwashing and household air pollution health effects | 0 | 1 | 1 | 1,768,986 | 0.1 | 0.8 | 1,238,290 | Population |
| Respiratory | Tobacco cessation counseling and use of nicotine replacement therapy in certain circumstances | 4 | 2 | 1 | 46,322,061 | 0.07 | 0.6 | 24,550,692 | Health Center |
| Respiratory | Mass media messages concerning use of tobacco and alcohol | 4 | 1 | 1 | 1,768,986 | 0.61 | 0.8 | 336,107 | Population |
| Breast Cancer | Treat early stage breast cancer with appropriate multimodal approaches, including generic chemotherapy, with curative intent, for cases that are referred from health centers and first-level hospitals following detection using clinical examination | 4 | 4 | 1 | 1,496,070 | 0.1 | 0.8 | 1,047,249 | Referral Hospital |
| Cervical Cancer | Opportunistic screening for cervical cancer using visual inspection or HPV DNA testing and treatment of precancerous lesions with cryotherapy | 3 | 3 | 1 | 8,295,680 | 0.14 | 0.6 | 3,816,013 | Health Center |
| Cervical Cancer | School-based HPV vaccination for girls | 3 | 3 | 1 | 10,835,837 | 0.02 | 0.8 | 8,451,953 | Community |
| Cervical Cancer | Early detection and treatment of early-stage cervical cancer | 0 | 4 | 1 | 380,650 | 0.6 | 0.8 | 114,195 | First-Level Hospital |
| Cancer-Lymphoma/ leukemia | Treatment of early-stage childhood cancers (such as Burkitt and Hodgkin lymphoma, acute lymphoblastic leukemia, retinoblastoma, and Wilms tumor) with curative intent in pediatric cancer units or hospitals | 3 | 5 | 1 | 205,957 | 0.1 | 0.5 | 82,383 | Referral Hospital |
| Cardiovascular | Long term management of ischemic heart disease, stroke, and peripheral vascular disease with aspirin, beta blockers, ACEi, and statins (as indicated) to reduce risk of further events | 2 | 2 | 1 | 109,888,784 | 0.8 | 1.0 | 32,966,635 | Health Center |
| Cardiovascular | Mass media messages concerning healthy eating or physical activity | 4 | 1 | 1 | 1,768,986 | 0.23 | 0.8 | 1,008,322 | Population |
| Cardiovascular | Opportunistic screening for hypertension for all adults and initiation of treatment among individuals with severe hypertension and/or multiple risk factors | 1 | 1 | 1 | 20,334,580 | 0.442 | 0.8 | 7,279,780 | Health Center |
| Cardiovascular | Screening and management of hypertensive disorders in pregnancy | 1 | 3 | 3 | 452,107 | 0.6 | 0.8 | 180,843 | Health Center |
| Cardiovascular | Provision of aspirin for all cases of suspected acute myocardial infarction | 4 | 2 | 1 | 4,330 | 0.1 | 0.5 | 1,732 | Health Center |