Double burden of disease in the slums of Kenya

The goal of this thesis was to provide evidence of a double burden of disease in the slums of Nairobi and to make a case for an integrated health systems approach to tackling this situation. A double burden of disease refers to the coexistence of a high burden of communicable and non-communicable diseases in the same population. An integrated health system is one that is responsive to the burden of disease in any setting whether communicable or non-communicable. So why focus on slums? Because slums populations have experienced rapid growth over the last two decades and can therefore no longer be ignored. The thesis found that although mortality due to important communicable diseases like HIV/AIDS appears to be on a downward trend in Nairobi’s slums possibly due to scale up of public health interventions such as antiretroviral therapy, they still account for the majority of premature deaths. At the same time, certain risk factors for non-communicable diseases like hypertension, diabetes and obesity are relatively common in the slums while awareness, treatment and control of these risk factors remain dismally low. This thesis also demonstrated that it is possible to implement interventions for some non-communicable diseases risk factors at reasonable costs even in such a low-resource and marginalized setting. Overall, this thesis recommends that an integrated health systems approach including addressing key social determinants of health in slum populations such as poverty and lack of education will be critical to tackling the double burden of disease in the slums of Kenya.