Understanding the aetiology and people’s lived experiences of type 2 diabetes and diabetes risk in Kenya

Non-communicable diseases (NCDs) are the leading cause of adult death and disability in SubSaharan Africa (SSA). Type 2 diabetes exerts an increasing public health burden in the region: the age-standardised death rate from diabetes is approximately 5x higher than in the UK, and prevalence of diabetes-related complications is higher in SSA than in high-income countries Type 2 diabetes onsets at lower BMIs in SSA populations than in white Europeans. This is likely due to multiple factors, including: suboptimal early (including pre-natal) nutrition; suboptimal muscle mass and strength; and exposure to infectious disease.

The development and experience of NCDs is specific to time and place. Kenya is in a state of social and cultural transition: in 2017, 26.5% of the population lived in urban areas, and this figure was growing by 4.15% each year. This move from rural to city-dwelling is associated with a lifestyle transition where calorie-dense foods/drinks become easily accessible, and physical activity is reduced, leading to increasing prevalence of diabetes (currently 4.1% among women and 6.5% among men ≥35 years in urban areas of Kenya; c.f. 1.8% and 2.9%, respectively, in rural areas). A situated understanding of people’s lived experiences of diabetes and diabetes-risk, as well as information on the phenotype of Kenyans with/at high risk of diabetes, is essential to inform the design of effective, culturally-compelling diabetes prevention interventions.

Overall aim: To define and understand the causal factors of diabetes among urban-dwelling Kenyans in order to inform future diabetes prevention initiatives.

Research objectives: Three associated objectives are guided by Steps 1-3 of the 6SQuID model of intervention development:
Obj1. To understand the aetiology of diabetes in Kenyans
Obj2. To explore lived experiences of diabetes and diabetes-risk in the context of sociocultural transition from rural to urban dwelling
Obj3. To develop theory(ies) of change for diabetes prevention in urban Kenya.

Methods: A mixed-methods project combining survey, narrative ethnography and participatory action research to explore the causal factors of diabetes in people living in the Kenyan capital, Nairobi, and the extent to which these are amenable to change. There are three phases:

Phase 1: Field survey to describe the physical and metabolic phenotype, risk factor profile and health history of Kenyans with/at high risk for, diabetes (Obj1). The findings will inform the Phase 2 research design.

Phase 2: Interviews/focus groups to explore the context, values, perspectives, attitudes and behaviours of Kenyans with/at high risk for diabetes towards diabetes and its risk factors (Obj2).

Phase 3: Synthesis of Phase 1 and 2 findings to develop a causal-pathways model, and theory(ies) of change (Obj3) for diabetes prevention in urban Kenya. that are likely to be feasible, acceptable and effective both in urban Kenya and elsewhere in SSA.