Browsing by Author "Kyobutungi, Catherine"
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Item Analysis of Non-Communicable Disease Prevention Policies in Five Sub-Saharan African Countries: Study Protocol(Archives of Public Health, 2016) Oti, Samuel; Juma, Pamela A.; Mohamed, Shukri F.; Wisdom, Jennifer; Kyobutungi, CatherineBackground: The burden of non-communicable diseases (NCDs) and their risk factors is increasing in sub-Saharan Africa, and there have been calls for adopting a multi-sectoral approach in developing policies and programs to address this burden. Evidence exists largely from high-income countries on the success (and lack thereof) of multi-sectoral approach in improving population level health outcomes. In sub-Saharan Africa, there is limited research on the application and success of multi-sectoral approach in the formulation and implementation of policies aimed at prevention of non-communicable diseases. Therefore, this protocol describes a study that aims to primarily generate evidence on the extent to which multi-sectoral approach has been applied in developing policies to prevent non-communicable disease in six countries in sub-Saharan Africa –Kenya, Malawi, Nigeria, Cameroon, Togo and South Africa. Methods/Design: The study applies a multiple case study design. Data will be collated mainly through document reviews and key informant interviews with the relevant decision makers in various sectors. In each country, a detailed case study analysis will be undertaken of any policy/policies developed, adopted and implemented, aimed at implementing the World Health Organization recommended “best buys” for non-communicable disease prevention. These case studies will be conducted by research teams in each country; each team includes a senior research fellow supported by a doctoral student, and research assistants. Discussion: Uptake of the evidence generated from the case studies will be ensured by systematic engagement with policy makers in each country throughout the research process. Ultimately, a forum of experts will be convened to generate actionable recommendations on the use of multi-sectoral approach in non-communicable disease prevention policies in the region.Item Facilitators and Barriers in the Formulation and Implementation of Tobacco Control Policies in Kenya: A Qualitative Study(BMC Public Health, 2018) Kyobutungi, Catherine; Mohamed, Shukri F.; Juma, Pamela A.; Asiki, GershimBackground: Tobacco use has serious public health implications for both smokers and non-smokers and significant economic implications on health care spending for governments. Tobacco-related deaths are preventable through well-formulated and implemented tobacco control policies. Using tobacco policy as a case study, we aim to describe the tobacco control policy formulation and implementation and the associated facilitators and barriers in Kenya. Method: We used a case-study methodology to integrate two sources of data: a document review of relevant policy documents, published articles and reports between 2004 and 2015 (N = 24 documents) and in-depth interviews (N = 39). Participants were from sectors relevant to tobacco control: research and academia, government, private industry, civil society and non-governmental organizations. Thematic analysis was used to analyze all data. Results: Kenya developed a comprehensive tobacco policy in 2007. The main facilitators to the policy formulation and implementation process were (1) political commitment and strong leadership, (2) the presence of a coordination mechanism, (3) stakeholder passion and commitment, (4) resources and (5) constitutional requirement for inclusion of stakeholders. The main barriers to policy formulation and implementation were (1) industry interference, (2) resources, (3) poor enforcement and (4) lack of clear roles. Conclusion: Although the process for formulating a tobacco control policy in Kenya was protracted, the current policy aligns well with current global efforts. The implementation is still weak and this can be enhanced by provision of necessary resources and continued engagement of all relevant stakeholders. There is a need for continued engagement with political leadership and continuous international information exchange on how policy-makers can address and counter industry interference in tobacco control efforts.Item Influence of The WHO Framework Convention on Tobacco Control on Tobacco Legislation and Policies in Sub-Saharan Africa(BMC Public Health, 2018-08) Kyobutungi, Catherine; Wisdom, Jennifer P.; Juma, Pamela A.; Mwagomba, Beatrice Matanje; Ndinda, Catherine; Mapa-Tassou, Clarisse; Assah, Felix; Nkhata, Misheck; Mohamed, Shukri F.; Oladimeji, Oladepo; Oladunni, Opeyemi; Oluwasanu, Mojisola; Sanni, Saliyou; Mbanya, Jean-ClaudeBackground The World Health Organization’s Framework Convention on Tobacco Control, enforced in 2005, was a watershed international treaty that stipulated requirements for signatories to govern the production, sale, distribution, advertisement, and taxation of tobacco to reduce its impact on health. This paper describes the timelines, context, key actors, and strategies in the development and implementation of the treaty and describes how six sub-Saharan countries responded to its call for action on tobacco control. Methods A multi-country policy review using case study design was conducted in Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo. All documents related to the WHO Framework Convention on Tobacco Control and individual country implementation of tobacco policies were reviewed, and key informant interviews related to the countries’ development and implementation of tobacco policies were conducted. Results Multiple stakeholders, including academics and activists, led a concerted effort for more than 10 years to push the WHO treaty forward despite counter-marketing from the tobacco industry. Once the treaty was enacted, Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo responded in unique ways to implement tobacco policies, with differences associated with the country’s socio-economic context, priorities of country leaders, industry presence, and choice of strategies. All the study countries except Malawi have acceded to and ratified the WHO tobacco treaty and implemented tobacco control policy. Conclusions The WHO Framework Convention on Tobacco Control provided an unprecedented opportunity for global action against the public health effects of tobacco including non-communicable diseases. Reviewing how six sub-Saharan countries responded to the treaty to mobilize resources and implement tobacco control policies has provided insight for how to utilise international regulations and commitments to accelerate policy impact on the prevention of non-communicable diseases.Item Multi-Sectoral Action in Non-Communicable Disease Prevention Policy Development in Five African Countries(BMC Public Health, 2018) Kyobutungi, Catherine; Juma, Pamela A.; Mapa-Tassou, Clarisse; Mohamed, Shukri F.; Mwagomba, Beatrice Matanje; Ndinda, Catherine; Oluwasanu, Mojisola; Mbanya, Jean-Claude; Nkhata, Misheck J.; Asiki, GershimBackground: The rise of non-communicable diseases (NCDs) in Africa requires a multi-sectoral action (MSA) in their prevention and control. This study aimed to generate evidence on the extent of MSA application in NCD prevention policy development in five sub-Saharan African countries (Kenya, South Africa, Cameroon, Nigeria and Malawi) focusing on policies around the major NCD risk factors. Methods: The broader study applied a multiple case study design to capture rich descriptions of policy contents, processes and actors as well as contextual factors related to the policies around the major NCD risk factors at single- and multi-country levels. Data were collected through document reviews and key informant interviews with decision-makers and implementers in various sectors. Further consultations were conducted with NCD experts on MSA application in NCD prevention policies in the region. For this paper, we report on how MSA was applied in the policy process. Results: The findings revealed some degree of application of MSA in NCD prevention policy development in these countries. However, the level of sector engagement varies across different NCD policies, from passive participation to active engagement, and by country. There was higher engagement of sectors in developing tobacco policies across the countries, followed by alcohol policies. Multi-sectoral action for tobacco and to some extent, alcohol, was enabled through established structures at national levels including inter-ministerial and parliamentary committees. More often coordination was enabled through expert or technical working groups driven by the health sectors. The main barriers to multi-sectoral action included lack of awareness by various sectors about their potential contribution, weak political will, coordination complexity and inadequate resources. Conclusion: MSA is possible in NCD prevention policy development in African countries. However, the findings illustrate various challenges in bringing sectors together to develop policies to address the increasing NCD burden in the region. Stronger coordination mechanisms with clear guidelines for sector engagement are required for effective MSA in NCD prevention. Such a mechanisms should include approaches for capacity building and resource generation to enable multi-sectoral action in NCD policy formulation, implementation and monitoring of outcomes.Item Opportunities and Challenges for Evidence-Informed HIV-Noncommunicable Disease Integrated Care Policies and Programs: Lessons from Malawi, South Africa, Swaziland and Kenya(Wolters Kluwer Health, 2018) Bermand, Josh; Mwagomba, Beatrice Matanje; Amehe, Soter; Bongoming, Pido; Juma, Pamela A.; MacKenzied, Rachel K.; Kyobutungi, Catherine; Lukhelei, Nomthandazo; Mwangi, Kibachio Joseph Muiruri; Amberbird, Alemayehu; Klipstein-Grobusch, Kerstin; Gomez-Olive, Francesc XavierIntroduction: Countries in sub-Saharan Africa (SSA) are recognizing the growing dual burden of HIV and noncommunicable diseases (NCDs). This article explores the availability, implementation processes, opportunities and challenges for policies and programs for HIV/NCD integration in four SSA countries: Malawi, Kenya, South Africa and Swaziland. Methods: We conducted a cross-sectional analysis of current policies and programs relating to HIV/NCD care integration from January to April 2017 using document review and expert opinions. The review focussed on availability and content of relevant policy documents and processes towards implementating national HIV/NCD integration policies. Results: All four case study countries had at least one policy document including aspects of HIV/NCD care integration. Apart from South Africa that had a phased nation-wide implementation of a comprehensive integrated chronic disease model, the three other countries – Malawi, Kenya and Swaziland, had either pilot implementations or nation-wide single-disease integration of NCDs and HIV. Opportunities for HIV/NCD integration policies included: presence of overarching health policy documents that recognize the need for integration, and coordinated action by policymakers, researchers and implementers. Evidence gaps for cost-effectiveness, effects of integration on key HIV and NCD outcomes and funding mechanisms for sustained implementation of integrated HIV/NCD care strategies, were among challenges identified. Conclusion: Policymakers in Malawi, Kenya, South Africa and Swaziland have considered integration of NCD and HIV care but a lack of robust evidence hampers large-scale implementation of HIV/NCD integration. It is crucial for SSA Ministries of Health and throughout low-and-middle-income countries to utilize existing opportunities and advocate for evidence-informed HIV/NCD integration strategies.Item Policy Environment For Prevention, Control and Management of Cardiovascular Diseases in Primary Health Care in Kenya(BMC Health Services Research, 2018) Asiki, Gershim; Shao, Shuai; Wainana, Carol; Khayeka–Wandabwa, Christopher; Haregu, Tilahun N.; Juma, Pamela A.; Mohamed, Shukri F.; Wambui, David; Gong, Enying; Yan, Lijing L.; Kyobutungi, CatherineBackground: In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya. Methods: A targeted document search in Google engine using keywords “Kenya national policy on cardiovascular diseases” and “Kenya national policy on non-communicable diseases (NCDs)” was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews. Results: A total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014–2030), The Kenya Health Sector Strategic and Investment Plan (2014–2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015–2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012–2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents. Conclusion: This review revealed important gaps in the policy environment for prevention, control and management of CVDs in PHC settings in Kenya. There is need to continuously engage the ministry of health and other sectors to prioritize inclusion of CVD services in PHC.Item Prevalence and Predictors of Physical Inactivity Levels Among Kenyan Adults (18–69 Years): An Analysis of STEPS Survey 2015(BMC Public Health, 2018) Ogola, Elijah; Gichu, Muthoni; Asiki, Gershim; Juma, Pamela A.; Kibachio, Joseph; Kyobutungi, CatherineBackground: Physical inactivity accounts for more than 3 million deaths worldwide, and is implicated in causing 6% of coronary heart diseases, 7% of diabetes, and 10% of colon or breast cancer. Globally, research has shown that modifying four commonly shared risky behaviours, including poor nutrition, tobacco use, harmful use of alcohol, and physical inactivity, can reduce occurrence of non-communicable diseases (NCDs). Risk factor surveillance through population-based periodic surveys, has been identified as an effective strategy to inform public health interventions in NCD control. The stepwise approach to surveillance (STEPS) survey is one such initiative, and Kenya carried out its first survey in 2015. This study sought to describe the physical inactivity risk factors from the findings of the Kenya STEPS survey. Methods: This study employed countrywide representative survey administered between April and June 2015. A three stage cluster sampling design was used to select clusters, households and eligible individuals. All adults between 18 and 69 years in selected households were eligible. Data on demographic, behavioural, and biochemical characteristics were collected. Prevalence of physical inactivity was computed. Logistic regression used to explore factors associated with physical inactivity. Results: A total of 4500 individuals consented to participate from eligible 6000 households. The mean age was 40.5 (39.9–41.1) years, with 51.3% of the respondents being female. Overall 346 (7.7%) of respondents were classified as physically inactive. Physical inactivity was associated with female gender, middle age (30–49 years), and increasing level of education, increasing wealth index and low levels of High Density Lipoproteins (HDL). Conclusion: A modest prevalence of physical inactivity slightly higher than in neighbouring countries was found in this study. Gender, age, education level and wealth index are evident areas that predict physical inactivity which can be focused on to develop programs that would work towards reducing physical inactivity among adults in Kenya.Item Prevalence, Awareness, Treatment And Control of Hypertension and Their Determinants: Results From a National Survey in Kenya(BMC Public Health, 2018) Ogola, Elijah; Mohamed, Shukri F.; Mutua, Martin K.; Wamai, Richard; Wekesah, Frederick; Haregu, Tilahun; Juma, Pamela A.; Nyanjau, Loise; Kyobutungi, CatherineBackground: Hypertension is the most important risk factor for cardiovascular diseases and the leading cause of death worldwide. Despite growing evidence that the prevalence of hypertension is rising in sub-Saharan Africa, national data on hypertension that can guide programming are missing for many countries. In this study, we estimated the prevalence of hypertension, awareness, treatment, and control. We further examined the factors associated with hypertension and awareness. Method: We used data from the 2015 Kenya STEPs survey, a national cross-sectional household survey targeting randomly selected people aged 18–69 years. Demographic and behavioral characteristics as well as physical measurements were collected using the World Health Organization’s STEPs Survey methodology. Descriptive statistics were used to estimate the prevalence, awareness, treatment and control of hypertension. Multiple logistic regression models were used to identify the determinants of hypertension and awareness. Results: The study surveyed 4485 participants. The overall age-standardized prevalence for hypertension was 24.5% (95% confidence interval (CI) 22.6% to 26.6%). Among individuals with hypertension, only 15.6% (95% CI 12.4% to 18.9%) were aware of their elevated blood pressure. Among those aware only 26.9%; (95% CI 17.1% to 36.4%) were on treatment and 51.7%; (95% CI 33.5% to 69.9%) among those on treatment had achieved blood pressure control. Factors associated with hypertension were older age (p < 0.001), higher body mass index (BMI) (p < 0.001) and harmful use of alcohol (p < 0.001). Similarly, factors associated with awareness were older age (p = 0.013) and being male (p < 0.001). Conclusion: This study provides the first nationally-representative estimates for hypertension in Kenya. Prevalence among adults is high, with unacceptably low levels of awareness, treatment and control. The results also reveal that men are less aware of their hypertension status hence special attention should focus on this group.Item The Evolution of Non-Communicable Diseases Policies in Post-Apartheid South Africa(BMC Public Health, 2018) Kyobutungi, Catherine; Ndinda, Catherine; Ndhlovu, Tidings P.; Juma, Pamela A.; Asiki, GershimBackground: Redressing structural inequality within the South African society in the post-apartheid era became the central focus of the democratic government. Policies on social and economic transformation were guided by the government’s blueprint, the Reconstruction and Development Programme. The purpose of this paper is to trace the evolution of non-communicable disease (NCD) policies in South Africa and the extent to which the multi-sectoral approach was utilised, while explicating the underlying rationale for “best buy” interventions adopted to reduce and control NCDs in South Africa. The paper critically engages with the political and ideological factors that influenced design of particular NCD policies. Methods: Through a case study design, policies targeting specific NCD risk factors (tobacco smoking, unhealthy diets, harmful use of alcohol and physical inactivity) were assessed. This involved reviewing documents and interviewing 44 key informants (2014–2016) from the health and non-health sectors. Thematic analysis was used to draw out the key themes that emerged from the key informant interviews and the documents reviewed. Results: South Africa had comprehensive policies covering all the major NCD risk factors starting from the early 1990’s, long before the global drive to tackle NCDs. The plethora of NCD policies is attributable to the political climate in post-apartheid South Africa that set a different trajectory for the state that was mandated to tackle entrenched inequalities. However, there has been an increase in prevalence of NCD risk factors within the general population. About 60% of women and 30% of men are overweight or obese. While a multi-sectoral approach is part of public policy discourse, its application in the implementation of NCD policies and programmes is a challenge. Conclusions: NCD prevalence remains high in South Africa. There is need to adopt the multi-sectoral approach in the implementation of NCD policies and programmes