Challenges the Kenyan Government Is Facing in regard to Diabetes Disease - Research Proposal Example

Number: Due: Introduction and Background The cases of diabetic disease have been on the rise especially in the sub-Saharan countries. According to Azevedo, Mario, and Sridevi most of the people tend to think that the issue of unhealthy conditions play a major part in the rise of the disease, the health doctors in Kenya believe that there might be a genetic component to the disease, more so among the Kenyan population . Therefore, the role played by the genetic immunological factors in the diabetes process is considered vital in its rise in the Sub Saharan countries especially Kenya. The Kenyan country has a high population living in poverty that further implies that the diverse environments that is the habitat of the largest population could contribute to the understanding of the genetic and environmental mediators of both the type 1 and type 2 form of diabetes. Is it that sugarless sweeteners are not available in Kenya that has made these patients inject themselves with insulin? Or what would be the real issue behind the rise of the disease in Kenya? (102) Review of the Literature In many other world states there is quite a range of sugarless products such as jams, juices, breads, cakes that would be found in Kenya however at much higher prices than the citizens can afford. This has created a great demand of the sugarless products that has made the prices of these commodities to shoot up. Therefore the rise of the pandemic disease has been in due to the association of other factors such as the cultural changes of the population, the high rate of aging among the Kenyan population. Moreover, according to Azevedo, Mario, and Sridevi the rise of diabetes in Kenya has been due to an increase in the number of people living in urban areas that do not observe the traditional lifestyle, the dietary lifestyle change brought about by the ignorance of the traditional lifestyle and adoption of the modern style of living, and the behavioral patterns without prevention and preparedness for the occurrence of the disease. Moreover, other factors such as the low standards of living of the Kenyan people, lack of knowledge and understanding about the disease and lack of access to health facilities have too played a major role in the rise of diabetes cases in the Country (118). According to research, facts indicate that over two million people in the Country are infected with the disease, while the people living in urban areas are more prone to suffer from the disease due than their counterparts in the rural areas due to the ignorance of the traditional living methods and eating habits. This research further claims that the diabetic problem is down to lack of physical exercises and the increased use of junk foods by the urban dwellers. The Public Health minister in Kenya, claimed recently that there was a prevalence of diabetes between 2.7 and 14 per cent in the rural and urban areas respectively (Hossain, Kawar & Nahas 213). Generally, in Africa, quite a high population of women are more vulnerable to the disease as compared to men. Both the poor and the rich are at high risk of the disease according to the World Health Organization (WHO). Definition of Terms Diabetes Diabetes also called the diabetes mellitus can be defined as the metabolic disorder in the body of a human being that is brought about by a number of factors that are characterized by a high level of blood sugar that affects the metabolism of carbohydrate foods, fats, and protein that results from problems in insulin production, insulin functioning, or both. This in turn results in elevated blood sugar a condition called hyperglycemia which if not treated in earlier stages might lead to multiple organ damage (Azevedo, Mario & Sridevi 109). The most associated problems of diabetes include: The problems of the eye, heart and blood vessel complication, affects the kidneys, effect to the nervous system, and other foot complications that bring a condition called amputations. However, these are just minor problems associated with the disease. Some of the critical complications include: Diabetes ketoacidosis, and diabetes non-ketotic coma that is most often referred to as hyperosmolar. There are three types of diabetes disease: Type 1 diabetes, type 2 diabetes, and gestation diabetes. Type 1 Diabetes This type of diabetes disease is independent on the insulin amount in the body of a human being. It is sometimes called immune-mediated, or juvenile-onset diabetes. This type of insulin arises when the body’s defense mechanism attacks those cells that produce insulin. This implies that the amount of insulin in the body would be less since the cells producing the insulin have been affected. Hence people with this type of diabetes produce no insulin that is responsible for the amount of sugar regulation in the body. This disease is more common among people of young age and therefore they need more injections of insulin to balance the amount of glucose in the body. Type 2 Diabetes This type of diabetes does not depend on the amount of insulin in the body. It is therefore more often called non-insulin dependent diabetes or adult-onset diabetes. This type of diabetes is more critical as it contributes to a greater percentage of all cases of diabetes. This disease might be detected at later stages in life and therefore one can live with the disease without their knowledge. Type e diabetes can be diagnosed from other related diseases in the body or through blood or glucose test in the body. At some incidences one with the disease might be suffering from other complications such as obesity, that in most cases cause insulin resistance in the body. Gestation Diabetes This disease is characterized by a high amount of blood glucose levels during pregnancy, it is more so associated with other complication before or after birth. This disease disappears after birth but however it can be inherited and therefore offsprings are at high risk of contracting type 2 diabetes (Sobngwi & Mbanya 769). Cases of type 1 and type 2 diabetes are more common in Kenya as compared to other developed countries. Another type of diabetes disease called tropical diabetes exists, but however this disease is not more common in Africa and is related to malnutrition. The estimation of plasma glucose levels is the most common criterion that is used to diagnose the disease in patients. However, diagnosis and the treatment of the disease in Kenya is strictly under the guidelines of the World Health Organization. This problem would become worse if more attention is not given to the diabetes disease as it is the case with other diseases such as malaria, or HIV/Aids (Swai, Lutale & McLarty 1103). Mortality This can be used to refer to the number of people who die in a given country at a given time. According to a world survey the rate of mortality in 2005 was greatly high as compared to other infectious diseases raising more questions about the disease. Morbidity This is the condition of an individual being unwell, or a body disorder those results from a given disease. Throughout this paper, the term morbidity is used to refer to a body disorder in this case diabetes while mortality is used to refer to the death rate caused by diabetes disorder. Purpose of the Study This paper addresses the challenges that the Kenyan government is facing in regard to diabetes disease. In detail, awareness about the disease, how it is diagnosed and its treatment is discussed. In addition, the understanding and knowledge about the disease among the health professionals and the general public is dealt in depth and its treatment. Then finally the conclusion on the topic. Research Methods The research was conducted by taking a portion of a population in the capital center of Kenya. A sample of 100 people was given questions and asked to answer concerning the diabetes disease in Kenya. The population was divided into three groups; the health worker, people who were born in Nairobi and the other group those borne in the rural areas. It was realized that out of the questions answered people were not aware about some of the diabetes conditions, nor their causes and the health workers had no knowledge about the care and treatment of some complications involving diabetes disease. In the general 40per cent of the questions were answered correctly. Situation Analysis Most of the Kenyan population does not go for medical check up and therefore there are a lot of undiagnosed cases in the country. The rise of diabetes cases in Kenya has brought a big economic pressure in the country, including the individual, the families, the community, and the health care centers. Since Kenya is amongst the poorest countries, there is often limited or no resources put aside to cater for the diabetes patients unlike in the developed states where the mortality rate of diabetes is lower and the disease is not a big concern to them (Wilks & Balkauan 111). If it so happens that there are resources the problem of lack of training and knowledge about the disease often comes into question. This results in poor management of the disease and misdiagnosis due to lack of training that lead to the patients developing a lot of complications. In addition, the health facilities in place do not often detect the diabetes disease in the early stages that is a requirement for screening of the disease that is not often therefore done. The public too have little knowledge about most of the chronic diseases more especially diabetes. This has been due to lack of Primary Health Care (PHC) systems that are aimed at tackling the chronic diseases (Mufunda 522). In addition, there are reliable data that can be used to know the exact number of people suffering from the disease as no comprehensive research exists that can be used to inform the public and health practitioners on the best practices to control the disease. There is no attention given to most of the communicable diseases or if it exists it is so little. Most of the attention has been given to infectious diseases such as malaria, tuberculosis, and HIV/AIDS. It is clear that diseases such as diabetes, cardiovascular, and cancer and their causative factors such as high blood pressure, high cholesterol, and excessive body weight are on the increase in Kenya (Azevedo, Mario & Sridevi 150). The health sector in the country is burdened by also the communicable diseases and hence the problem should be addressed in order to be able to deal with the double burden from both communicable and non-communicable diseases and their challenges. Having a well functioning health system results in activities such as prevention, care and treatment, and research that is a concern for the disease. Assumptions of the Study Some of the assumptions included: All the people involved in answering the questions would read properly and they were not medically unfit to prevent them from understanding the questions. Challenges in Diabetes Treatment in Kenya The complications that are experienced during the treatment of the disease, the awareness of the population, and care are the main challenges that are facing the country’s ministry of Health. Most of the deaths in diabetes are caused by Cardiovascular disease (CVD). People that have been diagnosed with the disease have higher chances of suffering from the Cardiovascular disease that is brought about by factors such as hypertension, high lipids in the blood, and lack of exercises by the patient. Most of the adult blindness is caused by diabetic retinopathy whose patients have a higher risk of suffering from cataracts and other infections of the open-angle glaucoma in comparison to the entire population. Other forms of diabetes such as diabetic neuropathy might be present in the human body without any kind of symptoms. Studies in the country have indicated that the biggest hospital “Kenyatta National Hospital” experienced major problems in the treatment of the foot ulcer complication that is brought about by: Poor glycemic control, diastolic hypertension, infection, dyslipidemia, and lack of proper care. All these factors are easy to manage by oneself and this is a show that proper management of the body contributes to the prevention of some of the diabetes complications. The challenge of treatment of some of these complications of the diabetes disease is a major problem (Azevedo, Mario & Sridevi 130). A Kenyan research at the Kenyatta National Hospital indicated that the diabetic ketoacidosis was more common among patients in the hospital. Diabetic ketoacidosis (DKA) arises due to the lack of insulin and the high amount of glucose that results in high amounts of glucose in the body. This disease causes a lot of deaths in the hospital as the treatment is not available. Other research in the various hospitals in the country indicates that most of the patients who required an insulin injection were suffering from diabetic ketoacidosis. Therefore in Kenya, the most common cause of death has been due to the complications of diabetes that pose a great challenge to the doctors unlike in the western countries where these complications are just considered normal cases (Levilt 1377). These complications of diabetes that are giving doctors in Kenya and other sub-Saharan Africa countries a hard time is a show that more resources should be devoted and the issue of diabetes should be addressed. Most of the disease such as HIV/AIDS, malaria, and tuberculosis have seen to be of concern than diabetes it is high time that the people need to know that the diabetes complications are an emerging concern in the developing countries. The shortage of medicine and the high cost of the medicine if they are available is an indication of the poor economy in the country. The poor economy in Kenya has seen the patients who use the ambulatory care not reaching the desired glycaemic level of control due to their inaccessibility to insulin and its high cost of purchase (Azevedo, Mario & Sridevi 131) Cultural changes in Kenya have been the major reason behind the underutilization of insulin for normal blood sugar patients. Moreover, the chronic shortages, that affects the younger population mostly who need the insulin for treatment. Moreover, incompetence among the health workers, poor infrastructure and the diagnostic tools that lead to poor diagnosis of the disease is a major concern in Kenya. The World Diabetes Foundation (WDF), developed the Rapid Assessment Protocol for Insulin Access (RAPIA), that was aimed at eliminating the diabetes disease in the developing countries. This method determines the incidence and the most prone areas that the disease might be common in a certain population. However, studies show that the diabetes patients in Kenya do not often go for results after the method has been used to collect information on the Kenyan population and it reported that the major concern is lack of patient care. But contrary to the requirements of the doctors that the diagnosis of the disease be done at an early age, most of the patients do it a later stage implying that the disease has become complicated (Dagogo 415). Understanding and Knowledge about the Disease There is often poor knowledge about the diabetes disease in the developing countries more so Kenya. Most of the population and the health workers might have inappropriate knowledge concerning the disease and especially to the general public who might be influenced by traditional theories involving witchcraft. The International Diabetes Foundation (IDF), which is the body of knowledge of diabetes patients, is working on informing of the populations of the developing countries about the disease. It is clear that most of these developing countries are spending a lot of funds on such infections as malaria, tuberculosis, or HIV/AIDS meaning that their economy is low and thus there might be no funds for proper information to the public concerning the issue and purchase of medicine and diagnostic tools (Azevedo, Mario & Sridevi 115). Most of these patients rely on the traditional medicine as a cure for diabetes complications. This means that the traditional healers do not in most cases refer patients of the diabetes disease to the health facilities, a clear indication that they have little knowledge concerning diabetes even though they are unable to treat the disease following the symptoms they might see that include frequent urination and excessive thirst. This practice is more common in the developing countries (Knowler, Barrett & Fowler 394). From the beginning of the window period of the disease to the time when one needs to be diagnosed with the disease calls for a lot of education programs. The education awareness in Kenya concerning the diabetes disease is rapidly growing thanks to the good work that has been done by the International Diabetes Foundation that has been working all over the country in trying to inform the population about the disease. Moreover, the ministry of Health, and the Kenya Diabetes Management and Information Centre have not been left behind in diabetes education programs. A recent poll in the country that involved only 20 percent of the respondents, it had 70 per cent questions answered correctly a clear indication of the increase in informed education concerning the pandemic disease that the government is trying to implement (Anderson & Funnel 109). However, having well informed medical staff ensure that patients are able to regularly come for check ups and caring for them through advice. In the country, the physicians, diabetes educators, nutritionists, and physiologists are well informed about the disease and have been involved in the control of the rapidly increasing diabetes disease (Seley & Weinger 617). The Diabetes Declaration and Strategy for Africa that was formed by the International Diabetes Foundation Africa Region brought several organs together such as the IDF, WHO Africa Region, and the Africa Union that agreed to use the health care professionals in diabetes education programs so that the diabetes disease can be prevented, improve the quality of life of the people, and reduce morbidity and premature mortality caused by diabetes. This strategy was therefore aimed providing a clear mission, vision, and motivation that would be to prevent the disease and having a well informed member (Azevedo, Mario & Sridevi 103). The table below illustrates the challenges in Kenya with regard to diabetes. Table Information about Diabetes KNH MP Shah Thika General lack of resources X X X Recognition of diabetes as a public health problem X X X Other NGOs working in the fields of diabetes X X X Lack of enough funds for chronic diseases/diabetes X X X Distance between the doctors and diabetes patients X X X Distribution of medicines to hospital works well at the national level X X X This table clearly shows that diabetes is a major concern in Kenya and there is lack of resources set aside for the treatment of the disease. Moreover, there is limited knowledge concerning the chronic diseases. Access to Treatment Kenya is one of the poorest countries in the word. A country that has ignored the rural sector and most of her population resides in urban areas. The diabetic patients have problems of accessing the health care centers because they are either very far from those living in the rural areas or the roads are poor and hence no means of transport sine most of the clinics for diabetes are located in urban centers. Furthermore, most of the physicians are found in the urban centers that implies that the people in rural areas rely on local medicine and traditional healers that are more often incompetent (Mensing & Boucher 97). Discussion Diabetic diseases have now been a major concern to most of the world states. According to a World Bank report, most of the deaths that occur as a result of diabetes is mostly in the low-income countries Kenya is one of them. Unfortunately, these countries are also faced with other problems that include dealing with infections such as malaria, tuberculosis, and HIV/AIDS, that put a lot of pressure in their economies (Eddy, Schlessinger, and Kuhn 255). This disease should therefore be of public concern like the other diseases mentioned above. According to a research, deaths caused by the diabetes disease can be prevented especially for individuals in the age bracket of 35 years to 64 years since these people are economically productive and are able to sustain themselves and their families (Azevedo, Mario & Sridevi 126). According to Azevedo, Mario, and Sridevi at least every day quite a number of people die because of diabetic related infection and conversely, there have not been any resources put aside in order to curb the pandemic disease. The resources put aside are either too little or none at all that are able to prevent is a rapid spread in the developing countries. Therefore the Kenyan government should increase her efforts to ensure that the patients that have been diagnosed with diabetes related infection are treated and this would be of great help in reducing and preventing the rise of the disease. The causes of diabetes disease and other related infections that include the economic status of an individual, cultural changes, aging population, dietary lifestyles, increased urbanization and genetic patterns should therefore be looked into in a more serious manner and given the same weight as other infections (119). They continue to assert that the experts in the health profession have stressed on the importance of strategic planning, action, and implementation as the right approach to prevent the diabetes disease. Moreover, accurate data collection using the right diagnostic tools and analysis is recommended in the Kenyan scenario. The screening test might be discouraged but however, if a patient has been detected with the symptoms of the disease they need to be screened (124). Moreover, they assert that this is so because there is a low number of patients in Kenya that turn out to the patient care clinics for either screening and most of them turn out during critical stages. Several leaders in Kenya that through the Kenya Diabetes Association gets involved in various campaigns for example the most notable is the recent “World Diabetes Day” in 2006, when the chairman of the association came up with the slogan “Diabetes Care for Everyone” whose objectives included having all Kenyans to be aware of the disease, raising funds for non-governmental organizations to curb the non-communicable diseases, and promoting the vision and vision for diabetes prevention (125). The ever increasing number of diabetic patients however has a negative impact on the Kenyan government since it is unable to treat the diabetes complications. Therefore alternative sources of cure would be more appropriate as the government is pressured with the poor economy. Alternative sources such as the plant extracts can help as a way to treat the patients while taking care of the poor economy of Kenya. With this rate of diabetes patients reporting in hospitals, the scenario is expected to rise especially in Kenya and other developing countries and it might mostly affect the working age. Most of the population does not have access to diabetes care and the people diagnosed are few (Azevedo, Mario & Sridevi 109). The table below shows a comparison on the availability of various diagnostic tools in the Kenyan hospitals: Kenyatta National hospital, MP Shah, and Thika District Hospital. Hospital No. of Interventions Presence of urine glucose strips Presence of ketone strips Presence of glucometer Presence of Spectrophotometer or blood analysis equipment KNH 30 54% 13% 43% 23% MP Shah 37 18% 8% 21% 8% Thika 49 61% 49% 54% 10% The table indicates the lack of tools for diabetes treatment. This further illustrates on the importance of assigning of resources to fight diabetes. Conclusion According to the Impact of Chronic Disease in Africa journal, training of health professionals on how to handle the diabetes disease is often what the Kenyan government lacks. Studies show that lack of proper training of the health care professionals often have impacted negatively on the campaigns to prevent the rise of diabetes (Vukovljak 558). Incompetent professionals often lead into a poor analysis of the data that is a show of the prevalent areas of diabetes and poor diagnosis of the patients. Conversely, lack of proper guidelines from the government, the high rate of poverty in Kenya, and ignorance with regard to the diabetes disease result in leg complications that are realized later on result in most of the deaths. Studies in Kenya show that about 60 percent of patients die while they are receiving treatment and it is clear that in most of the developing countries foot complications make the patients with diabetes stay longer in hospitals (Carey, Courtenay & James 1635). In estimation most of the diabetes patients in Kenya die shortly and their life expectancy is not such long. The main objective of the World Diabetes Foundation was to make the price of insulin more affordable to the citizens of the developing countries (Okoro, Adejumoano & Oyejola 160). In collaboration with WHO and WDF, the World Diabetes Foundations’ aim in the developing countries was to: Create national health strategies, to build national care capacity, promote the best prices for insulin and provide funding for these nations to buy diabetes drugs through other several charity organizations (Azevedo, Mario & Sridevi 101). Suggestions for future Research Advocacy In the future the government should implement the policy that everybody should be concerned about the diabetes disease. Advocacy, involves all the individuals, the community, social, corporate, and the responsibility of the government. This should be the case because the disease affects the economy and hence it should be everyone’s concern and responsibility to ensure that it is prevented (Mills & Rogo 2). Empowerment This concept involves encouraging all individuals in society to engage themselves in taking the care and concern for health and being aware of the importance of being healthy as a society. This will help in preventing and in proper management of the disease as a unit. Therefore the need for prevention and care of the disease should be integrated into the health care program. Resource Mobilization and Prioritization In the country there are less resources that are prioritized to the control of diabetes this is because there are no evidence of the effectiveness of the resources if they are directed to the fight of the disease. Therefore having clear guidelines on the resources to be allocated to fight against diabetes would be of great help in the future. Moreover, the government in the future should ensure that making use of the scarce resources in order to achieve greatly in the fight against diabetes should be given a thought. All stakeholders should be involved in assessing the importance of controlling the disease against the available resources (Unwin & Marlin 41). Capacity Building The government should have to train the health workers on how to handle the disease and care for the patients. Moreover, improving the infrastructure, setting aside more funds to purchase medical equipments, and improve and encourage early diagnosis of the disease would be beneficial (Kaushik 32). Works Cited Anderson R.M, Funnell M. “The art and science of diabetes education: A culture out of balance”. 2008;34: pp. 109–17.  Azevedo, Mario, and Sridevi Alla. "Diabetes In Sub-Saharan Africa: Kenya, Mali, Mozambique, Nigeria, South Africa And Zambia." International Journal Of Diabetes In Developing Countries 28.4 (2008): pp101-199. EDS Foundation Index. Web. 22 Mar. 2012. Carey N., Courtenay M., James J. “An evaluation of a diabetes specialist nurse prescriber on the system of delivering medicines to patients with diabetes”. Pp 17:1635–44.  Dagogo-Jack S. “Primary prevention of type-2 diabetes in developing countries.2006;98:pp. 415–9.  Eddy M., Schlessinger L., Kahn R. 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