Scaling up Non-Communicable Disease Control: Lessons to be learnt from the Infectious Disease Paradigm in Kenya

Non-communicable diseases (NCD) are emerging as the leading cause of morbidity and mortality globally; with the greatest rise in incidence of cardiovascular disease cases observed in Sub-Saharan Africa. This is in addition to the heavy burden of infectious diseases already present in this setting.Describing the cross-cutting epidemiology of NCDs and infectious diseases with focus on the interaction between tuberculosis and diabetes mellitus; HIV and cardiovascular disease; HIV and cervical cancer as well as assessing the disparities in funding and service delivery systems between NCDs and infectious diseases; we review this rising double burden of infectious and non-infectious diseases and propose four lessons that can be learnt from the HIV response and adapted to inform the scale up of NCD control in Kenya which are also applicable in other African countries

Control of skin infection in HIV positive individuals and AIDS patients

HIV prevalence is still increasing in many parts of the world. Poverty and inequity still prevail; and drugs are inaccessible to the majority of people living with HIV. Opportunistc infections constitute the major problem which makes their lives uncomfortable. At a Catholic Community Health Care giving health services to about 500;000 people living in the slums of Nairobi city; it has been observed that the main health problems facing HIV/ADS patients are: recurrent skin infection due to exfoliative staphylococcus aureus which presents as itchy rashes and pseudomycosis; development of cellulities or black pigmentation of skin; recurrent herpes zoster infection; chest infection and diarrhoea. This staph aureus is resistant to affordable topical antibiotics. Applying 2 percent chlorohexidine/cetrimide (savlon) once daily is useful when itching and rashes start; before they become septic. When the rashes are gone; savlon is applied once or twice in a week to keep the load of Staph aureus within normal range. If the patient develops superficial or deep cellulitis he is treated with neomycin/cetrimide ointment (oral erythromycin is added if the patient is having boils). Once the skin is back to normal the patient is also maintained as above. This management has proved quite effective in reducing recurrent skin infection. There is less use of topical antibiotics; antifungal drugs and hydrocortisone due to pseudomycosis compared with the previous period before the above managment was started