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September 23, 2018

Nyanza key to our future success in steeplechase

 Between Kenya and Ethiopia it is hard to pick which is the superior nation when it comes to athletics. In terms of medal count, Kenya has won 86 medals participating in the Olympics over the years. Out of this total, 56 medals have come from long distance running events.

Ethiopia in comparison has won a total of 45 medals, all in athletics. Each country has had great individual champions in every generation since they started participating on the world stage. Where does the success come from? Both countries are ranked as poor economically with each country having a GDP of about $42 billion. There are some differences in terms of population with Ethiopia having more than 80 million while Kenya has about 44 million but again the similarity is that both countries are multi-ethnic in composition. Also economically, Ethiopia is growing at between seven and eight per cent a year while Kenya is around five per cent. Of interest is that whereas Kenya has about 50 per cent of the population living below the poverty line, the corresponding figure for Ethiopia is about 30 per cent. Given the much smaller Kenyan population growing relatively slowly, these facts point to huge economic disparity in Kenya, which reflects in terms of health status too.

Consider the findings of the recent Kenya AIDS Indicator Survey. The survey found that in 2012, there were 1,192,000 persons with HIV infection. For adults aged 15 to 64 years, that is those who are supposed to be most economically productive, 5.6 per cent had HIV. While this may sound horrible, and it is, it represents a reduction from the 2007 figure of 7.2 per cent, remembering of course that in 2007, Kenya’s population was much less.

Much more interesting is that Nyanza region has a prevalence of 15.1 per cent, seven times that of the lowest region, North Eastern. Whatever the reason, it is a big shame that a country can allow such huge disparities in health status within its own borders, among its own citizens. Perhaps reviewing the terminology used in public health can give a better understanding of the magnitude of the problem.

In the early years of the HIV epidemic, the concern of public health scientists was the incidence of the disease. Incidence refers to the number of new cases that occur. The initial emphasis was on finding how many new cases occurred. This was partly because the disease was spreading rapidly and killing people just as quickly. Almost 30 years later and the HIV disease burden profile has changed. Because of more people being aware of their status, better nutrition, the advent of antiretroviral drugs, and a host of other interventions, more people with HIV now live longer.

Prevalence, the number of people with the condition, now becomes an important measure of the disease because it is now a chronic disease. A chronic disease like diabetes or high blood pressure has similar issues except in one crucial difference. When I have diabetes, I cannot transmit it directly to another person. The name of the virus Human Immunodeficiency Virus – HIV, says it all. The pool from where the virus is found is humans. The more human beings exist with the virus; conceptually the harder it is to get rid of it. Think about the effort to rid the world of polio virus; it involves immunising children so that the virus is no longer found in any human being. The problem with HIV is that not only is there no cure, there is no vaccine either. All the methods being used are aimed at controlling the virus and its effects, but do not in themselves cure. The true cure is really prevention.

Prevention is much more difficult to carry out than cure. When there is a need to vaccinate people, for example, it is possible to line up everyone and give them a shot of vaccine. Given enough diligence and persistence targets will be achieved. Prevention on the other hand requires that the population be first persuaded that changing their current behaviour has significant benefits in the long term. And here is where poverty kicks in. A community that is poor does not have the capacity to think long term, even when surrounded by potential wealth. Where poverty is rife, you meet your daily water needs, not discover an aquifer many metres beneath the ground.

A country that has two groups of people sitting side by side - one group dirt poor, the other world class - will not grow unless significant attention is paid to the poor. Counties where disease levels are high should be talking nothing else but improving health, otherwise even the superficial gains made will not take root. How else to explain Ethiopia meeting MDG 4 on child health, while Kenya watches. Next will be the 3,000 metres steeplechase.

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