Rapid urbanisation is contributing to an increase in the incidence of non-communicable diseases like diabetes and hypertension in sub-Saharan Africa.Mass migration from rural areas in search of better opportunities is not only increasing the risk of lifestyle diseases but is also fostering the growth of slums as exemplified by Nairobi where several hundred thousand urban poor now reside in slums. These people live under precarious economic and sanitary conditions with high unemployment, low wages and vulnerability to exploitation; predominance of the informal sector, and poor access to health care.Although some health facilities do exist in the slums, these are often of questionable quality, focussed on emergent care and are poorly utilised. As a result, diseases of all kinds prevail including diabetes and hypertension that are further fuelled by high levels of health-related risky behaviours such as alcohol consumption, tobacco use and poor diet. As a consequence of these socio economic determinants, outcome of care is very poor. The objective of the project is to improve access to diabetes care and management for slum dwellers in Nairobi.
The project is headed by the African Population & Health Research Center, which is an international NGO committed to conducting research on population and health issues facing sub-Saharan Africa. The African Population & Health Research Center will collaborate with the City Council of Nairobi, Kenya Diabetes Management and Information Centre and Provide International to ensure successful implementation of the project in three slums of Nairobi, namely Korogocho, Viwandani and Dandora.Together these areas have an estimated population of 260,000 people.By establishing and running an outreach clinic in each of the three slums the project aims to improve the management of diabetes, its co-morbidities and complications with an emphasis on promoting self-care, compliance to treatment and lifestyle changes. The clinics will be set up in existing primary health care facilities. Each clinic will be run on a fortnightly basis on weekends and manned voluntarily by 4 clinicians, 2 nurses, a counsellor and an assistant. Staff will be available to offer counselling and consultation outside the clinic's normal opening hours in more urgent situations. Health care personnel manning the service will be trained in the principles of diabetes care and management based on current guidelines and existing training materials developed by Kenya Diabetes Management and Information Centre under the WDF funded project "Diabetes Education Programme" (WDF04-085). A total of 30 clinicians, 60 nursing staff and 24 community health workers will be trained.Once a month, a specialist physician will visit the clinics to deal with complicated cases. The work carried out at the clinics will focus on promoting self-care, monitoring of blood glucose and blood pressure and management of complications. Once the patient's blood glucose and blood pressure are controlled health workers will conduct home visits to the patients to check that things are proceeding well.It is expected that 450 people with diabetes and 2,250 people with hypertension will benefit from the improved care available to them at the clinics.
• 3 clinics have been established in Korogocho, Dandora and Lunga Lunga. Furthermore, 14 other health facilities, whose staff received training in 2009, have received equipment for the diagnosis and screening of diabetes and hypertension. • 502 diabetes patients are registered in the 3 clinics. • 41 support groups sessions have been conducted. • Training: 27 clinicians and 54 nursing staff have been trained; 17 community health workers and 19 lay educators have been trained; 33 medical students have been trained in the clinics. • 11 health camps have been organised in the slums areas Dandora, Korogocho and Viwandani. More than 6,000 people have been screened and 600 detected with diabetes. • Awareness has been created through various channels: the community radio station in Korogocho; door to door campaigns in Viwandani; posters distributed at health facilities and a quarterly newsletter distributed at the centre as well as at the centre's website. • World Diabetes Day 2009 was celebrated with workshops and screenings at 15 health centres.