Chapter 1: Manage common diseases and ailments

Common diseases and ailments form the bulk of health challenges encountered in community health practice across Kenya. Effective management of these conditions requires community health professionals to accurately identify disease types and conduct thorough patient assessments. This foundational knowledge enables early intervention, appropriate referrals, and health education crucial for improving community health outcomes and reducing disease burden.

1.1 Identification of Common diseases and ailments

Identifying a disease early is the first step in managing it. A community health professional is usually the first health worker a sick person meets, so the ability to recognise a disease from its signs, to know what can be done at community level and to know when to refer decides whether a patient is helped early or arrives late. In Kenya the disease profile includes communicable diseases, which remain a serious public health concern, and non-communicable diseases (NCDs), which are becoming more common as lifestyles change. This topic describes how each disease named in the unit is recognised, what the community health professional does and what is left to the health facility.

1.1.1 Non-communicable diseases

Non-communicable diseases are conditions that do not spread from person to person. They are usually long-term, develop slowly and need continuing care and changes in lifestyle. In Kenya the rising number of people with diabetes, hypertension and cancers reflects changes in town life, diet and physical activity.

Characteristics and prevalence of non-communicable diseases

NCDs often develop slowly and give few signs at first, so early detection is difficult. Cardiovascular diseases are a leading cause of death, linked to tobacco use, unhealthy diets and physical inactivity. Diabetes is becoming more common, especially in towns where diets have changed and people are less active. Cancers such as cervical and breast cancer are a significant burden, and screening is vital for early diagnosis. Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease are linked to environmental pollutants and tobacco smoking.

Risk factors contributing to non-communicable diseases in Kenya

Risk factors are of two kinds. Modifiable risks include tobacco use, excessive alcohol, diets high in salt and sugar, physical inactivity and obesity. Non-modifiable factors are age, genetic predisposition and gender. In rural areas where people are physically active but far from health facilities, hypertension often goes unnoticed until a complication such as stroke appears. Town life exposes more people to the modifiable risks, so health education and screening by community health professionals are targeted at them.

Diagnostic approaches for non-communicable diseases

Diagnosis combines the patient's history, a physical examination and the simple investigations available at community level. Repeated blood pressure measurements confirm hypertension. A glucometer measures blood glucose in suspected diabetes. Visual inspection with acetic acid (VIA) screens for cervical cancer, and breast awareness is taught for early detection of breast changes. Spirometry for respiratory disease is rarely available in the community, so symptoms guide the decision to refer.

Common non-communicable diseases managed in the community

Besides the diseases named below, community health professionals often meet people with hypertension, diabetes mellitus, chronic respiratory disease and mental health disorders.

• Hypertension: needs regular blood pressure checks and daily medicine without gaps. A person with a very severe headache, chest pain, sudden weakness of one side of the body or difficulty speaking is referred as an emergency.
• Diabetes mellitus: care combines blood glucose control, advice on diet and activity and foot care to prevent ulcers. Excessive thirst, passing urine often, tiredness and weight loss are signs that should prompt testing.
• Chronic respiratory disease: patients are taught how to use inhalers and to avoid triggers such as smoke.
• Mental health disorders: depression and anxiety are recognised as NCDs that need support in the community and referral for treatment.

1.1.1.1 Cancers

Cancer is a group of diseases in which cells grow without control, form a lump or spread into other tissues. In Kenya, cancers of the breast, cervix and prostate are among those that community health professionals meet often in their work. Many cancers can be treated successfully when found early, and the main danger is late presentation.

• Risk factors: tobacco use, harmful alcohol use, obesity and inactivity, older age and a family history of cancer. Infection also plays a part: persistent human papillomavirus (HPV) infection causes cervical cancer, and chronic hepatitis B infection raises the risk of liver cancer.
• Warning signs to recognise: a lump in the breast or elsewhere, unusual bleeding or discharge (for example bleeding after sex or between periods), a sore that does not heal, a cough or hoarse voice that does not go away, difficulty swallowing, a change in bowel habit and weight loss with no explanation.
• Screening and early detection: women are encouraged to attend cervical cancer screening such as VIA, and to know how their breasts normally look and feel. Men are advised to ask a health worker about symptoms such as difficulty passing urine.
• Prevention: avoiding tobacco, limiting alcohol, keeping a healthy weight, eating vegetables and fruit, and vaccinating girls against HPV and infants against hepatitis B.
• Community-level management: diagnosis and treatment are done at health facilities. The community health professional refers any person with warning signs without delay, follows up so that the referral is completed, and gives psychosocial support and basic comfort care at home to patients with advanced disease.

1.1.1.2 Auto-immune diseases

In an auto-immune disease the immune system, which normally defends the body against infection, attacks the body's own tissues. The causes are not fully understood, and several diseases of this kind are more common in women. Examples include rheumatoid arthritis, systemic lupus erythematosus, type 1 diabetes, psoriasis and some thyroid diseases.

• How they present: persistent tiredness, joint pain and swelling, skin rashes, recurring low fever and symptoms that come and go in episodes called flares. The pattern depends on the organs involved.
• Recognition at community level: these diseases cannot be diagnosed in the community. The community health professional notices a person whose symptoms last for weeks without a clear cause or return repeatedly, and refers the person to the facility for blood tests and specialist review.
• Long-term treatment: treatment aims to control the immune response and relieve symptoms. Some medicines lower the body's defences against infection, so patients are advised to keep up with recommended vaccinations, to report fever early and to avoid contact with people who have infectious illness.
• Adherence: long-term medicines such as steroid tablets must never be stopped suddenly without a health worker's advice, because stopping can make the disease worse or cause other harm.
• Support: auto-immune diseases are long-term and can affect work and relationships, so the community health professional helps the person and the family to understand the illness and to keep clinic appointments.

1.1.1.3 Arthritis/Asthma

Arthritis and asthma are long-term conditions that are common in communities and are managed mainly through education, avoidance of triggers and regular follow-up.

• Arthritis, what it is: inflammation of one or more joints, causing pain, stiffness, swelling and reduced movement. Osteoarthritis comes from wear of the joint and is linked to older age, obesity and past injury. Rheumatoid arthritis is auto-immune and usually affects the small joints of both hands or feet, with stiffness that is worst in the morning.
• Arthritis, community management: keep a healthy weight, move the joints gently every day, protect the joints during heavy work, use a walking stick where it helps and take pain relief only as advised by a health worker. A single hot, swollen and painful joint with fever, a joint that cannot move at all and joint pain that keeps getting worse are signs to refer, because they may be an infection or a serious disease.
• Asthma, what it is: a long-term condition in which the airways become inflamed and narrow. A person has episodes of wheezing, cough (often at night or in the early morning), chest tightness and shortness of breath.
• Asthma triggers: dust, smoke from cooking fires and tobacco, pollen, cold air, animal hair, strong smells, respiratory infections and exercise. Finding and avoiding the person's own triggers reduces attacks.
• Asthma, management: a reliever inhaler such as salbutamol opens the airways during an attack, and a controller medicine taken daily as prescribed reduces inflammation. The community health professional checks that the person knows how to use the inhaler, that a spacer is used when available and that medicines are taken even when the person feels well.
• Asthma, danger signs for urgent referral: being unable to speak in full sentences, blue or grey lips, very fast or laboured breathing, drawing in of the chest between the ribs and no relief after using the reliever inhaler.

Challenges in managing non-communicable diseases in Kenyan communities

Barriers include few diagnostic tools, low awareness among patients, cultural beliefs that affect health-seeking behaviour and the cost of medicines. Patients may stop hypertension treatment because of side effects or cost and then develop complications such as stroke. Community health professionals educate patients and link them to health facilities for continued care.

1.1.2 Communicable diseases

Communicable diseases remain a major cause of illness and death in Kenya, especially in rural and peri-urban areas. They are caused by infectious agents such as bacteria, viruses, parasites and fungi, and they pass directly from person to person or indirectly through vectors, water, food or objects.

Modes of transmission of communicable diseases

Knowing how a disease spreads shows how to prevent it. Direct contact diseases such as scabies spread from skin to skin, and airborne infections such as tuberculosis spread through respiratory droplets. Vector-borne diseases such as malaria need mosquito control. Waterborne diseases spread through contaminated water, which is why clean water and sanitation are central to control.

Clinical presentation and diagnosis of communicable diseases

Signs vary widely but often include fever, cough, diarrhoea, weight loss and skin lesions. Malaria typically causes fever and chills that come and go, while TB typically causes a long-lasting cough and weight loss. HIV may cause no signs at first and later weakens the defences of the body. Diagnosis relies on clinical suspicion and on tests: rapid diagnostic tests (RDTs) for malaria, sputum tests for TB and blood tests for HIV. Community health professionals recognise the signs and arrange testing and referral.

1.1.2.1 TB

Tuberculosis (TB) is an infection caused by the bacterium Mycobacterium tuberculosis. It usually affects the lungs. A person with lung TB releases the bacteria into the air by coughing, sneezing or speaking, and people who share an enclosed, poorly ventilated space with that person may breathe them in.

• Signs to recognise: a cough lasting two weeks or more, or any cough together with fever, night sweats, loss of appetite and weight loss. Some patients cough up blood or have chest pain. Children may show poor weight gain, persistent fever and tiredness instead of a clear cough.
• Who is at higher risk: household and close contacts of a person with TB, people living with HIV, people who are malnourished, people with diabetes and people who smoke or drink heavily.
• Diagnosis: done at the health facility by sputum testing and, where needed, a chest X-ray. Every person diagnosed with TB is also offered an HIV test.
• Community-level management: the community health professional finds people with suspected TB, refers them for testing, and supports those on treatment as a treatment supporter under directly observed therapy (DOTS). Drug-sensitive TB is cured by a course of several medicines taken for at least six months, and stopping early allows drug-resistant TB to develop.
• Prevention: BCG vaccination of newborns protects against the severe forms of TB in young children. Covering the mouth when coughing, good ventilation and early treatment of cases reduce spread. Contacts, especially young children and people living with HIV, are screened and may be offered preventive treatment.

1.1.2.2 Malaria

Malaria is caused by Plasmodium parasites, which are passed to people by the bite of an infected female Anopheles mosquito. It is common in the lake and coastal regions and in other parts of Kenya at certain seasons.

• Signs to recognise: fever, chills, sweating, headache, body aches, vomiting and tiredness. In young children fever may be the only sign.
• Danger signs of severe malaria: convulsions, drowsiness or loss of consciousness, inability to drink or breastfeed, repeated vomiting, difficulty breathing, severe paleness and dark urine. A child or adult with any of these is referred urgently.
• Diagnosis: a malaria rapid diagnostic test or microscopy confirms infection. Treatment is given after a positive test, not on suspicion alone, so that other causes of fever are not missed.
• Community-level management: a trained community health professional gives the first-line medicine for uncomplicated malaria according to national guidelines, which is a combination medicine, for example artemether-lumefantrine. The patient must finish the course, and should be seen again if fever persists.
• Prevention: sleeping under an insecticide-treated net every night, removing mosquito breeding places, indoor residual spraying where the health authority provides it, and intermittent preventive treatment in pregnancy given at antenatal visits.

1.1.2.3 HIV and AIDS

HIV is the human immunodeficiency virus, which attacks the immune system and gradually weakens the body's defence against other infections. AIDS is the advanced stage of HIV infection, when the body can no longer fight serious infections and certain cancers. With treatment, a person living with HIV can stay healthy for many years.

• How it spreads: unprotected sex with an infected person, contact with infected blood (for example shared needles or unscreened blood), and from mother to child during pregnancy, birth and breastfeeding. HIV is not spread by hugging, shaking hands, sharing food or plates, toilet seats or mosquito bites.
• Signs to recognise: many people have no signs for years. Later signs include weight loss, long-lasting fever, chronic diarrhoea, repeated infections, white patches in the mouth (thrush), skin problems and TB. Because signs alone cannot show who is infected, testing is essential.
• Testing: a rapid HIV test, offered with counselling before and after the test, and with the person's consent and confidentiality.
• Treatment: all people who test positive are offered antiretroviral therapy (ART), which is taken every day for life. A person on effective treatment who has an undetectable viral load does not pass HIV on through sex.
• Prevention: correct and consistent condom use, voluntary medical male circumcision, pre-exposure prophylaxis (PrEP) for people at high risk, post-exposure prophylaxis (PEP) started as soon as possible and within 72 hours after a possible exposure, safe blood, and treatment of pregnant women to prevent transmission to the baby.
• Community-level role: offering testing and counselling, linking people who test positive to a care and treatment facility, supporting adherence, tracing those who stop attending, and countering stigma.

1.1.2.4 Pneumonia

Pneumonia is an infection of the lungs caused by bacteria, viruses or, less often, fungi, in which the air spaces fill with fluid and breathing becomes difficult. It is a major cause of illness and death in children under five years and in older people.

• Signs to recognise in a child: cough with fast breathing or difficult breathing. Fast breathing is counted over a full minute while the child is calm: 60 breaths or more a minute in a baby under two months, 50 or more in a child of 2 to 11 months and 40 or more in a child of 12 months to under 5 years.
• Danger signs requiring urgent referral: drawing in of the lower chest wall when the child breathes in, inability to drink or breastfeed, convulsions, unusual sleepiness, blue lips and severe malnutrition.
• Signs in adults: cough, fever, chest pain and shortness of breath. Older people may be confused or unusually weak.
• Community-level management: a trained community health professional counts the breathing rate. A baby under two months with fast breathing, chest indrawing or any danger sign may have a serious bacterial infection and is referred urgently, not treated at home. A child aged 2 to 59 months with fast breathing and no danger signs is treated with an antibiotic as described in the national guidelines, the carer is advised to give fluids and continue feeding, and the child is referred if there is no improvement. Any child with a danger sign is referred at once.
• Prevention: childhood vaccines that include protection against the bacteria that cause pneumonia and against measles, exclusive breastfeeding for the first six months, good nutrition, handwashing and reducing smoke in the home.

1.1.2.5 Syphilis

Syphilis is a bacterial infection caused by Treponema pallidum. It is passed mainly through sexual contact and from an infected mother to her baby during pregnancy. It is curable, but untreated infection can cause serious harm years later.

• Primary stage: a painless sore (chancre) appears at the place where the bacteria entered, usually on the genitals, a few weeks after infection, and heals by itself even without treatment, which gives a false impression of recovery.
• Secondary stage: a rash that often includes the palms and soles, fever, swollen glands and sores in the mouth or on the genitals.
• Latent and late stages: the infection may cause no signs for years and then damage the heart, the brain and other organs.
• Congenital syphilis: an infected pregnant woman can pass the infection to her baby, causing miscarriage, stillbirth, early death or lifelong disability. This is why syphilis testing is part of antenatal care.
• Diagnosis and treatment: diagnosis is by blood tests, including a rapid syphilis test, and treatment is with penicillin injections given by trained health workers. Partners must be treated at the same time or the person can be infected again.
• Community-level role: encouraging early antenatal attendance and testing, promoting condoms, referring people with genital sores or a rash for testing, and helping people to inform their partners.

1.1.2.6 Gonorrhoea

Gonorrhoea is a bacterial sexually transmitted infection caused by Neisseria gonorrhoeae. It spreads through sexual contact and from mother to baby during birth, where it can infect the baby's eyes.

• Signs in men: pus-like discharge from the penis and pain on passing urine, usually within days of exposure.
• Signs in women: many women have no signs. Others have an unusual vaginal discharge, pain on passing urine or lower abdominal pain.
• Complications: pelvic inflammatory disease, ectopic pregnancy and infertility in women, and swelling and pain of the testicles in men. Untreated gonorrhoea also makes HIV infection easier to acquire.
• Management: gonorrhoea is treated with antibiotics given at the health facility according to national guidelines. Resistance of the bacteria to some antibiotics is a concern, so treatment must follow the current guideline and be completed.
• Prevention and community role: condoms, fewer partners and early treatment. The community health professional refers people with discharge or pain on passing urine, explains that sexual partners must also be treated and advises avoiding sex until treatment is finished.

1.1.2.7 STIs

Sexually transmitted infections (STIs) are infections passed mainly through sexual contact. Besides syphilis and gonorrhoea, they include chlamydia, trichomoniasis, genital herpes, human papillomavirus (HPV), hepatitis B and HIV. Many STIs cause no signs, especially in women, so a person can pass on an infection without knowing.

• Syndromic management: where laboratory testing is not available, health workers treat according to the group of signs, called a syndrome. The main syndromes are urethral discharge in men, vaginal discharge, genital ulcer, lower abdominal pain in women, swelling of the groin glands and scrotal swelling.
• Signs that should lead to referral: unusual discharge, genital sores or blisters, genital warts, pain on passing urine, pain during sex and lower abdominal pain.
• Genital herpes: a viral infection that causes painful blisters and sores that return from time to time. It has no cure, but medicines shorten attacks.
• HPV: some types cause genital warts and some types cause cervical cancer, which is why girls are vaccinated and women are screened.
• Partners and counselling: all sexual partners need to be told and treated, and every person with an STI is offered an HIV test because having an STI makes HIV infection easier.
• Prevention: condoms used correctly every time, limiting the number of partners, delaying the start of sex among young people and early treatment of infection.

1.1.2.8 Cholera

Cholera is an acute diarrhoeal disease caused by the bacterium Vibrio cholerae. It spreads when faeces from an infected person contaminate water or food, so outbreaks follow floods, poor sanitation and unsafe water.

• Signs to recognise: sudden, large amounts of watery stool that may look like rice water, often with vomiting and leg cramps. The person loses so much fluid that dehydration develops within hours: sunken eyes, dry mouth, very little urine, weakness and loss of skin elasticity.
• First response in the community: begin oral rehydration solution (ORS) at once and keep giving small, frequent sips, including on the way to the facility. A person with severe dehydration or who cannot drink needs intravenous fluids and is referred urgently.
• Reporting: a suspected case of cholera is reported to the sub-county health team immediately, because one case can signal an outbreak.
• Prevention: safe drinking water (boiled, chlorinated or filtered and stored covered), latrines, handwashing with soap, safe preparation of food and safe handling of the bodies of those who die of cholera. In outbreaks, an oral cholera vaccine may be used as an additional measure.
• Community role: teach families to treat water, to wash hands and to seek care early, and trace contacts in the household and neighbourhood.

1.1.2.9 Typhoid

Typhoid fever is caused by the bacterium Salmonella Typhi. It spreads by the faecal-oral route through food or water contaminated with the faeces or urine of an infected person or a carrier. Food handlers who carry the bacteria without symptoms can infect many people.

• Signs to recognise: a fever that rises step by step over several days, headache, tiredness, loss of appetite, abdominal pain and either constipation or diarrhoea. Without treatment, serious complications such as bleeding from the bowel or a hole in the bowel can occur later in the illness, often from the third week.
• Diagnosis: blood culture is the confirming test and is done at the health facility. The Widal test is widely used but can give misleading results.
• Management: typhoid is treated with antibiotics prescribed by a clinician according to national guidelines, together with fluids and rest. Patients with persistent high fever, severe abdominal pain or vomiting are referred.
• Prevention: safe water, handwashing, safe food preparation, latrine use and avoiding street foods that are handled with dirty hands. Typhoid vaccines are available, and their use follows national policy.
• Community role: educate families, check water and food hygiene in homes and markets, and identify food handlers with prolonged illness for referral.

1.1.2.10 Measles

Measles is a highly contagious viral disease that spreads through the air when an infected person coughs or sneezes. A person is infectious from about four days before the rash appears until about four days after.

• Signs to recognise: fever, cough, runny nose and red watery eyes, followed by a red rash that starts on the face and spreads down the body. Tiny white spots inside the cheeks (Koplik spots) may appear before the rash.
• Complications: pneumonia, diarrhoea, ear infection, blindness and brain infection. They are more common and more severe in malnourished children and in children lacking vitamin A.
• Management: there is no specific medicine for measles. Care is supportive: fluids and continued feeding, treatment of fever, vitamin A given according to the guideline and referral of any child with complications such as fast breathing, convulsions, eye problems or severe diarrhoea. The sick child is kept apart from other children.
• Reporting: any person with fever and a rash together with cough, runny nose or red eyes is a suspected case and is reported at once, since measles spreads fast.
• Prevention: measles-containing vaccine given on the national immunisation schedule, with follow-up of children who miss doses and support for vaccination campaigns. High coverage with two doses, about 95 per cent of children, is needed to stop the spread in a community.

1.1.2.11 Polio

Polio is a disease caused by poliovirus, which spreads mainly by the faecal-oral route and affects children under five years most often. Most infected people have no signs, but in a small share of infections the virus attacks the nerves and causes permanent paralysis.

• Signs to recognise: fever, tiredness, headache, vomiting and stiff neck, followed in some patients by sudden weakness or floppiness of a limb, most often a leg. This is called acute flaccid paralysis (AFP).
• Reporting: any child under 15 years with sudden floppy paralysis is reported immediately to the sub-county health team as a suspected polio case, and stool samples are collected for testing at the laboratory.
• Management: there is no cure. Care is supportive and includes rehabilitation, and children with paralysis are referred for assessment and physiotherapy.
• Prevention: polio vaccination, using oral polio vaccine and inactivated polio vaccine as set in the national schedule, and vaccination campaigns. Handwashing, safe water and sanitation reduce spread.
• Community role: tracing children who have missed vaccination, explaining to caregivers why every dose is needed even when no polio is seen in the area, and reporting any floppy paralysis in children without delay.

Prevention and control measures at community level

Immunisation campaigns, health education on hygiene and sanitation, insecticide-treated nets and promotion of safe sexual behaviour are the main preventive measures. Community health professionals take part by mobilising communities and watching disease trends. During a cholera outbreak, for example, prompt community education on treating water and on sanitation reduces spread.

Challenges in control of communicable diseases

Poverty, weak health infrastructure, stigma and cultural practices make control harder. In some communities, misunderstandings about diseases such as TB and HIV delay the search for treatment. Seasonal changes and climate change also affect vector populations and so malaria patterns.

Chapter Summary

This chapter provides a comprehensive overview of managing common diseases and ailments, beginning with the identification of both non-communicable diseases such as cancers, autoimmune disorders, arthritis, and asthma, as well as communicable diseases including tuberculosis, malaria, HIV/AIDS, pneumonia, and various sexually transmitted infections. It emphasizes the importance of thorough patient assessment to accurately diagnose these conditions. The chapter then explores the provision of appropriate medication tailored to individual patient needs to ensure effective treatment. It highlights the role of home visitation and follow-up in monitoring patient progress and supporting recovery. The process of patient referral is also discussed as a critical step for cases requiring specialized care. Furthermore, the chapter addresses psychosocial factors that influence patient management, recognizing how emotional and social support impact healing. Lastly, it considers cultural factors that affect how patients engage with healthcare services, underscoring the need for culturally sensitive approaches in disease management.