College of Social Sciences

By Anthony Muchai Manyara, School of Social and Political Sciences

According to the World Health Organization, diabetes is one of the top four noncommunicable diseases that causes about one and a half million deaths annually. Sub-Saharan Africa have high inequalities in access to diabetes healthcare and the International Diabetes Federation estimates that the region will have the largest increase in diabetes prevalence (people living with diabetes) by 2045. The main type of diabetes (type 2 diabetes) is preventable through lifestyle modification such as weight loss, consumption of healthy diets and increasing physical activity levels. Kenya is one of the countries in East Africa with a population of about 48 million. The Kenyan Ministry of Health has acknowledged an urgent need for diabetes prevention. However, current diabetes prevention policies and strategies are based on scant local evidence.

This study aimed at understanding the local contexts, experiences and factors influencing diabetes risk, as these are important in developing culturally coherent interventions that maximise engagement and potential effectiveness.

The study was conducted in Nairobi, Kenya’s largest city, as a national study found that diabetes prevalence was higher in urban compared to rural settings. The majority of residents in Nairobi live in low-income settings (mainly informal settlements), and studies have reported that they have poorer health outcomes than those living in middle- and high-income areas. Although diabetes prevalence is generally associated with a higher socioeconomic status, studies in low-income settings in Nairobi have reported that diabetes and diabetes risk factors such as excess weight are on the rise. Therefore, participants were recruited from one low-income community and one middle-income community. Data was collected via in-depth interviews which were audio recorded, translated (if conducted in Swahili), transcribed, and thematically analysed.

We found that participants from the low-income community had lower knowledge about diabetes and risk factors compared to participants from the middle-income community. Further, the low-income setting presented barriers to preventing diabetes. For example, unaffordability of healthy foods was mentioned as one of the barriers to consuming healthy diets. In addition, poor infrastructure (lack of sidewalks) and limited safety (due to risk of accidents for pedestrians and high crime rate during dark hours) were mentioned as barriers to increasing physical activity levels through walking in the low-income community.

The findings suggest that diabetes prevention strategies that only focus on increasing knowledge may not be sufficient, particularly in low-income settings. There is a need to ensure the environment supports diabetes preventive practices such as through increasing affordability of healthy foods and improving infrastructure and safety to increase physical activity levels. These and other findings have informed development of a theory of change for diabetes prevention in Nairobi that is sensitive to the realities of people living in low-income settings.

 

Why is this study important?

Previously diabetes was associated with a high socioeconomic status in sub-Saharan African countries like Kenya, but it is now on the rise in low-income settings. People living in low-income settings may have low knowledge about diabetes and diabetes risk factors due to lower education levels and limited contact with the health system. This may in turn translate to low engagement in preventive practices and increase inequalities in diabetes prevalence.  This study is therefore important as it increases our understanding of perceptions, contexts and factors that may increase diabetes risk for the development of interventions that would reduce health inequalities in Kenya.

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First published: 16 March 2022