Do cancer & kidney failure kill more Kenyans than malaria, TB & AIDS?

Do deaths from cancer and kidney failure really eclipse three of Africa’s leading killers in Kenya? The country’s deputy president recently claimed so but the available data show it is unlikely to be correct.

When Kenya’s ruling coalition gathered recently to form a single party, deputy president William Ruto used the opportunity to highlight the administration’s achievements.

At the launch of the Jubilee Party, Ruto said that “statistics show that cancer and matters to do with kidney failure kill more people in Kenya today than malaria, tuberculosis and AIDS combined”.

Therefore the Jubilee administration decided to buy medical equipment for diagnosing and treating cancer as well as dialysis equipment, he said.

Since then, Kenya has announced a US$5 million donation towards the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Could three of Africa’s leading killers really be eclipsed by cancer and kidney failure in Kenya?

Only about 45% of deaths in Kenya registered

Kenya's deputy president, William Ruto, gives a press conference in April 2016. Photo: AFP/TONY KARUMBA
Kenya’s deputy president, William Ruto, gives a press conference in April 2016. Photo: AFP/TONY KARUMBA

Ruto’s office would not divulge the source on which the claim was based despite persistent queries. His spokesman, David Mugonyi, said that the deputy president and the minister for health were both out of the country. (Note: We will update this report should Ruto’s office respond.)

Accurate data on causes of death are hard to find in Kenya. This is partly because of poor cause of death coding at health facilities and by government officials who register deaths at home, Samuel Cheburet, the head of the vital statistics unit at Kenya’s health ministry, told Africa Check.

Low coverage is also a significant challenge. Data from Kenya’s Civil Registration department shows that death registration declined from 45.8% of all deaths in 2014 to 45.2% in 2015. In some of Kenya’s 47 counties, only 5% of deaths were registered with authorities in 2015.

Due to these challenges, many organisations use the limited data available to statistically model how many people suffer from a specific disease.This the coordinator for mortality and health analysis at the WHO’s information, evidence and research department, Dr Colin Mathers, told Africa Check.

Many cancer cases unaccounted for

A community health worker screens an HIV+ patient in Ndiwa, Homa Bay county, in November 2015. Photo: AFP/SIMON MAINA
A community health worker screens an HIV+ patient in Ndiwa, Homa Bay county, in November 2015. Photo: AFP/SIMON MAINA

The problems with accurate death registration we described are clear when you consider cancer.

Civil registration data captured by the Kenya National Bureau of Statistics showed a provisional figure of 15,714 deaths from cancer in 2015, and 12,574 deaths in 2012.

But the first ever study of non-communicable diseases in Kenya carried out last year estimated 28,000 deaths in 2015. The study involved a nationally representative sample of 6,000 people aged 18-69.

The authors said that this estimate is “conservative and could be higher because many cases go unreported and unaccounted for”.

Kenya has only started setting up a national registry, which is considered the gold standard for cancer surveillance. Expected to be fully-fledged in 2019, the registry will be housed at the Kenya Medical Research Institute.

No national data on kidney deaths

Deaths from kidney disease are even harder to establish. The research coordinator of the Kenya Renal Association, George Odinya, told Africa Check that the country currently did not have national data on kidney deaths.

A national dialysis registry is currently being built and would tentatively be available within the next year, he said.

In its 2014 Global Health Estimates, the World Health Organisation (WHO) gives a number of 3,100 Kenyans who died of kidney diseases in 2012. This best guess was determined with “statistical modelling of data from available sources and countries”, the WHO’s Mathers told Africa Check.

‘Logistically impossible’ to investigate all HIV deaths

Figures for HIV-related deaths in Kenya vary. This is understandable, as it is “logistically impossible and ethically problematic” to investigate all deaths, UNAIDS states in explanatory notes for its data. The body added that modelled estimates with upper and lower bounds provide a scientifically acceptable way of discussing trends.

UNAIDS’ models estimate that there were 36,000 HIV-related deaths in Kenya in 2015, which could possibly be as high as 47,000 deaths.  

This figure contained the updated surveillance and antiretroviral coverage data that Kenya included in its most recent submission to UNAIDS in March 2016, the organisation told Africa Check.

Year Estimated deaths Lowest possible Highest possible
2012  38,000 28,000 49,000
2013  38,000 28,000 49,000
2014  38,000 28,000 50,000
2015  36,000 26,000 47,000

Source: UNAIDS

Malaria death figures highly erratic

In its Global Tuberculosis Report 2015, the WHO estimated that 9,400 Kenyans died of tuberculosis in 2014, a number that excludes those who had HIV/AIDS. (Note: When someone who is HIV+ dies of TB, their death is officially coded as HIV-related.)

Data on malaria deaths is highly erratic.

The WHO said in its World Malaria Report for 2015 that it was unable to collect data for six East African countries, including Kenya, between 2000 and 2014 because of “inconsistent reporting, or changes in health service accessibility or diagnostic testing”.

The WHO counted 472 reported deaths in Kenya from a reported 2,808,931 cases in 2013. However, as up to 11 million infections may have been missed, the organisation says the number is more likely between 2,500 and 12,000.

Kenya’s civil registration data, which has low coverage, provisionally shows 20,691 deaths in 2015 and 23,789 deaths in 2013.

Conclusion: The claim is most likely incorrect

Based on the data Africa Check could find, deputy president Ruto’s claim is unlikely to be correct. The estimated number of deaths in 2015 due to HIV alone (36,000) exceed the estimated cancer deaths (28,000) plus kidney failure deaths (3,100).

However, as more than half of deaths in Kenya go unregistered, the figures are highly unreliable. It is therefore impossible to say for a fact whether Ruto’s claim is correct or incorrect. But, as always, the burden of proof lies with the speaker and Ruto needs to show his hand.

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