24/03/2025
Defining the Syndemic Approach: A Public Health Puzzle
In Kenya’s syndemic disease context, the grouping of conditions such as leprosy (bacterial) and asthma (a non-communicable lung disease) raises critical questions about disease classification. While tuberculosis (TB) and leprosy share a bacterial origin (Mycobacterium), linking malaria (a protozoan infection) with syphilis (a bacterial disease) is less straightforward. This brings into focus the challenge of defining clear boundaries for lung diseases, sexually transmitted infections (STIs), or syndemic conditions for effective coordination and programming.
The broad and interconnected nature of diseases complicates the task of delineating responsibilities within public health institutions. Many conditions, including some cancers and allergies, fall under lung diseases, further blurring classification lines. The challenge is similar to defining territorial waters—artificial boundaries must be established, negotiated, and agreed upon before meaningful intervention strategies can be developed.
From an epidemiological perspective, every disease has a syndemic component. This creates a dilemma for agencies like the National Syndemic Diseases Control Council (NSDCC) when attempting to define their scope and integrate their mandate into a coherent organizational strategy. The flexibility of syndemic definitions can either provide opportunities for innovation or create challenges in focus and execution—akin to navigating open seas without instruments.
A social-humanistic approach could provide clarity, particularly by focusing on key and vulnerable populations (KPs)—often overlooked in health programming. Each disease has its own set of key populations and risk factors:
COVID-19 affects the elderly and immunocompromised.
Malaria disproportionately impacts children and pregnant women.
HPV, TB, HIV, and leprosy have distinct at-risk groups.
A patient case from Sololo, Marsabit County, illustrates the complexity of syndemics. A 56-year-old man undergoing TB treatment was also HIV-positive, malnourished, and diabetic—a combination that poses significant public health challenges. In such a scenario, where does one disease end and another begin? Addressing syndemics requires a holistic, integrated approach that acknowledges these overlaps and tailors interventions to reflect the interconnected realities of disease, social conditions, and healthcare access.