The magnitude of diabetes and its association with obesity in the slums of Nairobi, Kenya: results from a cross-sectional survey.

OBJECTIVES: To assess the prevalence, awareness, treatment and control of diabetes and to examine the relationship of obesity with raised blood glucose in the slums of Nairobi, Kenya. METHODS: We used data from a cross-sectional population-based survey, conducted in 2008-2009, involving a random sample of 5190 (2794 men and 2396 women) adults aged ≥18 years living in two slums - Korogocho and Viwandani - in Nairobi. RESULTS: The prevalence (weighted by sampling and response rates) of diabetes was 4.8% (95%CI 4.0-5.7) in women and 4.0% (95%CI 3.3-4.7) in men. Less than a quarter of those found to have diabetes were aware of their condition among which just over half of men and three-quarters of women reported being on any treatment in the 12 months preceding the survey. Overall, fewer than 5% of all people with diabetes had their blood sugar under control. Obesity and overweight were significantly associated with increased odds (1.7, 95%CI 1.1-2.6) of raised blood glucose only among women while adjusting for important covariates. CONCLUSION: The prevalence of diabetes in this impoverished population is moderately high, while the levels of awareness, treatment and control are quite low. In this population, obesity is an important risk factor for raised blood glucose particularly among women. Prevention and control strategies that target modifiable risk factors for diabetes and increase access to treatment and control in such disadvantaged settings are urgently needed.

Prevalence, awareness, treatment and control of hypertension among slum dwellers in Nairobi, Kenya.

AIMS: This study aims to assess the prevalence, awareness, treatment, and control of hypertension in two major slums in Nairobi, Kenya. METHODS: We use data from a cross-sectional population-based survey, conducted in 2008-2009, involving a random sample of 5190 (2794 men and 2396 women) adults aged 18 years and older resident in both slums. RESULTS: Overall, the prevalence (weighted by sampling and response rates) of hypertension (SBP ≥140  mmHg and/or DBP ≥90  mmHg and/or antihypertensive medication) was 12.3% (12.7% in women and 12.0% in men). The overall level of awareness (having been previously informed of hypertensive status by a health professional) among hypertensives was 19.5% (30.7% in women and 10.8% in men). About 47% (44.9% in women and 50.9% in men) of those who were aware of being hypertensive reported being on antihypertensive treatment in the 1 year preceding the survey. Among those who reported being on treatment, only 21.5% (14.4% in women and 35.7% in men) had their hypertension controlled to levels below 140/90  mmHg. Hypertension control among all hypertensives was below 3%. CONCLUSION: Our findings suggest that hypertension is common in the slums, but the rates of awareness, treatment, and control are low. However, once people are aware of their hypertension, most seek treatment. This indicates that the best gains in treatment can be made when awareness is raised. Overall, there is urgent need to implement strategies that improve prevention, detection, and access to effective treatment in these neglected populations.

A community-based intervention for primary prevention of cardiovascular diseases in the slums of Nairobi: the SCALE UP study protocol for a prospective quasi-experimental community-based trial.

BACKGROUND: The burden of cardiovascular disease is rising in sub-Saharan Africa with hypertension being the main risk factor. However, context-specific evidence on effective interventions for primary prevention of cardiovascular diseases in resource-poor settings is limited. This study aims to evaluate the feasibility and cost-effectiveness of one such intervention--the "Sustainable model for cardiovascular health by adjusting lifestyle and treatment with economic perspective in settings of urban poverty". DESIGN: A prospective quasi-experimental community-based intervention study. SETTING: Two slum settlements (Korogocho and Viwandani) in Nairobi, Kenya. STUDY POPULATION: Adults aged 35 years and above in the two communities. INTERVENTION: The intervention community (Korogocho) will be exposed to an intervention package for primary prevention of cardiovascular disease that comprises awareness campaigns, household screening for cardiovascular diseases risk factors, and referral and treatment of people with high cardiovascular diseases risk at a primary health clinic. The control community (Viwandani) will continue accessing the usual standard of care for primary prevention of cardiovascular diseases in Kenya. DATA: Demographic and socioeconomic data; anthropometric and clinical measurements including blood pressure. Population-based data will be collected at the baseline and endline--12 months after implementing the intervention. These data will be collected from a random sample of 1,610 adults aged 35 years and above in the intervention and control sites at both baseline and endline. Additionally, operational (including cost) and clinic-based data will be collected on an ongoing basis. MAIN OUTCOMES: (1) A positive difference in the change in the proportion of the intervention versus control study populations that are at moderate or high risk of cardiovascular disease; (2) a difference in the change in mean systolic blood pressure in the intervention versus control study populations; (3) the net cost of the complete intervention package per disability-adjusted life year gained. ANALYSIS: Primary outcomes comparing pre- and post-, and operational data will be analyzed descriptively and "impact" of the intervention will be calculated using double-difference methods. We will also conduct a cost-effectiveness analysis of the intervention using World Health Organization guidelines. DISCUSSION: The outcomes of the study will be disseminated to local policy makers and health planners. TRIAL REGISTRATION: Current controlled trials ISRCTN84424579.