Full Answer Section

1. Non-Communicable Diseases (NCDs) (Heart Disease and Stroke, Diabetes, Cancer topics): There’s an alarming epidemiological shift towards a higher burden of NCDs in Kisumu County, mirroring national trends in Kenya. Hypertension, other cardiovascular diseases, and cancer are leading causes of death. Access to quality-assured medicines for NCDs is a major bottleneck.
2. Maternal and Child Health (Pregnancy and Childbirth, Child and Adolescent Development topics): Despite increased facility-based deliveries, maternal and newborn mortality remains a pressing concern in Kisumu County. Challenges include lack of skilled personnel in rural areas, geographical barriers to access, and issues with the quality of care provided. Child malnutrition levels (stunting, wasting, underweight) also indicate significant concerns.

Of these, the most crucial and concerning health problem to me is Non-Communicable Diseases (NCDs), with a particular focus on Hypertension and Cardiovascular Diseases.

My Selected Health Problem: Hypertension and Cardiovascular Diseases (NCDs) in Kisumu County

Description: Hypertension, often referred to as high blood pressure, is a chronic medical condition where the blood pressure in the arteries is persistently elevated. If left uncontrolled, it can lead to severe complications such as heart disease (e.g., heart attack, heart failure), stroke, kidney disease, and other serious health problems. In Kisumu County, like much of Kenya, there’s a rising burden of NCDs, with cardiovascular diseases (CVDs), primarily driven by hypertension, accounting for a significant portion of morbidity and mortality. Data indicates that hypertension contributes to 50% of hospital admissions and over 40% of deaths in Kenya. The challenge is exacerbated by inadequate screening, limited access to essential medicines, and insufficient awareness about risk factors and management.

Why is this topic important? This topic is critically important for several reasons:

1. High Burden and Increasing Trend: While infectious diseases like HIV/AIDS have seen notable declines, NCDs, particularly hypertension and CVDs, are rapidly becoming the leading causes of illness and death, placing a “double burden” on the healthcare system in Kisumu County. This epidemiological transition demands urgent attention.
2. Silent Killer: Hypertension often has no symptoms, earning it the moniker “silent killer.” Many individuals in Kisumu may be living with undiagnosed or poorly managed hypertension, unknowingly progressing towards severe complications. This makes early detection and continuous management paramount.
3. Preventability and Manageability: Hypertension is largely preventable through lifestyle modifications (diet, exercise, stress management) and highly manageable with medication. Effective control can significantly reduce the risk of debilitating and fatal complications.
4. Socioeconomic Impact: The complications of hypertension (stroke, heart attack, kidney failure) lead to long-term disability, loss of productivity, and catastrophic healthcare expenditures for families, perpetuating poverty. This affects not just individual health but also the community’s economic stability.
5. Strain on Healthcare System: The increasing prevalence and complexity of NCDs are overwhelming a healthcare system still grappling with infectious diseases, often lacking the infrastructure, trained personnel, and consistent supply of medicines needed for chronic care.

Will this problem lead to secondary conditions or complications? Absolutely. Uncontrolled hypertension is a primary risk factor for a cascade of severe and often irreversible secondary conditions and complications, including:

• Stroke: Caused by a sudden interruption of blood flow to the brain, often due to a clot or burst blood vessel weakened by high pressure.
• Heart Attack (Myocardial Infarction): Occurs when blood flow to a part of the heart is blocked, usually by a blood clot, often forming in arteries damaged by high blood pressure.
• Heart Failure: The heart muscle weakens and becomes unable to pump enough blood to meet the body’s needs.
• Kidney Disease/Failure: High blood pressure damages the small blood vessels in the kidneys, impairing their ability to filter waste.
• Aortic Aneurysm/Dissection: Weakening and bulging (aneurysm) or tearing (dissection) of the aorta, the body’s main artery.
• Peripheral Artery Disease (PAD): Narrowing of blood vessels outside of the heart and brain, commonly in the legs.
• Retinopathy: Damage to the blood vessels in the retina, potentially leading to vision loss or blindness.

What criteria are used to understand the risk of developing such conditions or complications? Understanding the risk of developing complications from hypertension involves a multi-factorial assessment using various criteria:

1. Blood Pressure Readings: The most fundamental criterion. Persistently high readings (e.g., systolic $\ge 140$ mmHg or diastolic $\ge 90$ mmHg, or even lower depending on guidelines and comorbidities) indicate increased risk. The duration of uncontrolled hypertension also plays a crucial role.
2. Presence of Other Risk Factors (Comorbidities):
   • Diabetes Mellitus: Co-existence significantly amplifies the risk of cardiovascular and kidney complications.
   • Dyslipidemia (High Cholesterol): High levels of LDL (“bad”) cholesterol increase plaque buildup in arteries.
   • Obesity/Overweight: Contributes to hypertension and other metabolic risk factors.
   • Smoking: Damages blood vessels and increases blood pressure.
   • Physical Inactivity: Contributes to obesity and cardiovascular risk.