Urbanization, Poverty and NCDs in SSA

Transcription

1 Urbanization, Poverty and NCDs in SSA Catherine Kyobutungi 6 th INTEREST Workshop Mombasa 1 th May 212

2 Outline Urbanization and poverty in African cities Population trends: global, SSA, slum growth Health challenges in urban SSA Urban Environments and NCDs Challenges in NCD control 2

3 Urbanization, Poverty and Health in African Cities Key Points The world will remain increasingly urban All future population growth will be in urban areas in LDC Africa s population will double from 1 to 2 billion by 25 By 25, Africa will account for 22% of world population, up from 15% in 21 In Africa, natural increase accounts for about 75% of urban growth Majority of urban population in Africa live in slums: very poor livelihood and environmental sanitation conditions Poverty, obesogenic environments and weak health systems in urban Africa portend for a bleak future with NCD

4 Population Growth Rate by Region and Residence, ,66 SSA 3,65 4,53,46 2,37 2,53 LDC -,52,72,54 MD,35 2,22 1,98 World Source: UNPD 29; UNHabitat 26 Slum Urban Rural

5 Projected Growth of Total, Urban and Slum Populations in SSA (In Millions) Total Pop Urban Slum By 22, one in three SSA residents will live in a slum

6 The Urbanization of Poverty Trends in proportion of Kenyans living in absolute poverty 22 estimates: National: 56%, Rural: 57%, Urban: 53%

7 Urban Africa: Two Worlds Nairobi CBD A slum, less than 1 km from the CBD

8 Health Challenges in Urban SSA Huge burden of infectious diseases Non-communicable diseases (NCD) will outstrip CD in next few decades Increases in behavioural risk factors (diet, alcohol, tobacco use) Diet: lack of dietary diversity and high use of street and fast foods; high salt consumption Limited access to screening and other preventive services In Kenya, prevalence of overweight & obesity among women of reproductive age almost doubled over a 15- year period (13% to 25%) 1 Increase more marked in urban than rural areas In 28: obesity & overweight in urban women was 4% c.f. 2% of rural women in Kenya 1 ; 35% and 16% in Ghana 2

9 Health Challenges in Urban SSA High NCD Risk Environments Increasing traffic volumes Infrastructural development geared towards easing motorised transport not physical activity High stress levels Environmental factors (air, water and soil pollution) Crime and insecurity

10 The four main risk factors among Nairobi Current smoker N % Male Female 22.9 slum residents Current alcohol user (a) Frequent heavy drinker (% of a) N % % Male Female Insufficient physical activity from all sources* N % Male Female Insufficient fruit and vegetable intake High salt intake N % N % Male 1, ,1 4.4 Female 1,

11 CVD risk factors in 2 Nairobi slums (2) Categories Overweight Obesity N % N % Male Female Hypertension Diabetes N % N % Male Female ASP

12 Leakages in a CVD prevention (HPT control) continuum -5-75% ~% -x% ~ -5-75% ~ People diagnosed with low risk People informed about need for lifestyle change People change lifestyle ~ -6% ~ ~ -8% People in risk group People aware of risk People aware of risk on hypertension People aware of possibility of screening People aware of preventive services People coming to screening People adequately diagnosed with risk People diagnosed with medium/ high risk People using preventive services People aware and understanding of diagnosis People seeking treatment People getting right medicines / lifestyle advice People seeking treatment Current hypotheses for key causes of leakages People taking meds for 1st time / Adopt healthier lifesty People being long-term compliant Reduced risk on CVD / Controlled BP People being compliant long term Population screening Population intervention Patient intervention Source: CVD study, WDF study, APHRC expert opinion

13 Addressing the leakages: The SCALE-UP model Costs People Elements of model # of ppl enrolled Variable pp Variable Fixed Investments Subtotal Total population Screening age above 35 34,491 Awareness Access High risk Incentive Baraaza Religious Radio Door 2 Door campaign by CHW Patients with high risk Voucher for patient Incentive CHW Consultation + Meds Incentive Consultation Medication Consultation + Meds Consultation Medication Leakage 21% 85% 9% 21% 8% 1% 65% 1% % of people moving on to next step Awareness 7,414 6,32 5,672 1, ,42 4,979 11,639 Access to screening 2,756 Seeking treatment 3, Train trainer SMS Discount for compliance Compliance bonus CHW Long term compliance 4,454 4,35 1,98 1, ,66 2,756 3,279 8,759 12,574 65% compliant in year 1 Total costs yr 1 46,971 Average running costs yr 2 1 Prog mgmt Total yearly costs Total costs (1 yrs) Note: All costs are in USD 13,884 6,855 27,16 35,29

14 Summary Rapid Urbanization in SSA Urbanization gone wrong Urban environments high risk for NCD Weak health systems Challenges in risk reduction across the continuum of care Many lessons to learn from the management of HIV