By Justus Wanzala
NAIROBI (ACP-IDN) – In Kenya, a high burden tuberculosis (TB) country, infants and young children are at very high risk of developing severe and often fatal strains of the disease, and are estimated to comprise 10-11 percent of all TB cases.
In order to combat the disease, primarily among children but also the population in general, the country is putting mechanisms in place, including better equipment for TB testing, and in 2016 became the first country in the world to roll out child-friendly TB medicines.
Overseen by TB Alliance, an international non-governmental organisation that supports the development of affordable tuberculosis drugs, the medicines are easier for caregivers to give and for children to take and are expected to help improve treatment and child survival.
Enos Masini, head of the National Tuberculosis Leprosy and Lung Disease Programme (NTDL-P), explained that in the next five years the country will also phase out microscopy TB diagnosis and embrace GeneXpert, a new molecular test for TB which diagnoses the disease by detecting the presence of TB bacteria.
He added that his organisation is focusing on a multisectoral approach in the fight against TB involving the use of medical, nutritional and educational methods. “There is a need to expand health education on TB by involving children and teachers to spread the preventive message because children are agents of change,” he said.
Kiambu County, which neighbours the capital Nairobi, is one of the local governments making strides in the battle against TB, particularly among children but, as head clinician Elizabeth Mungai at the county’s Level 4 hospital‘s chest clinic notes, tackling TB in children is tricky because the symptoms are difficult to observe.
“TB symptoms can mimic asthma, so any persistent coughing in children should be referred to a doctor … and any person in the house who is coughing should adhere to coughing etiquette to avoid transmission,” she said, adding that success in fighting TB in children is dependent on efforts of their communities.
According to Mungai, the introduction of sweet TB treatment tablets has enhanced treatment among children. “Children used to find the former generation of tablets unpalatable and could vomit, but nowadays they swallow them easily.”
Sarah Wamaitha, whose two-and-a-half-year-old son is receiving treatment at the clinic, where both diagnosis and treatment are provided free of charge, said that the baby had a swelling on his neck and was also suffering from fever, leading to a false diagnosis when she initially sought treatment at a health facility near their home.
A diagnosis performed at the clinic late last year indicated that he was suffering from TB and “when I was notified of his condition, I was devastated because I thought it was incurable.”
She kept the matter to herself and a few close relatives because “in my community people associate TB with AIDS so disclosing that my son was infected would be tantamount to declaring that I am HIV positive,” she said.
Speaking during an event on March 20 in Kiambu County to raise public awareness of childhood TB and encourage testing and early diagnosis and treatment, Masini of the NTDL-P noted that TB is a major killer of children, with the World Health Organisation (WHO) indicating that at least one million children suffer from TB each year.
He added that 140,000 children die of the curable and preventable disease and in 2015, “Kenya reported nearly 7,000 cases of TB in infants and children aged 14 and below, with children under the age of five facing a greater risk of death.”
Masini also said that caregivers previously had to cut or crush multiple, bitter-tasting pills to achieve the right doses for children, making the six-month treatment programme difficult for children and their families, contributing to treatment failure and death from the disease. “These new medicines are improved formulations that come in the correct doses, require fewer pills, are flavoured and dissolve in water,” noted Masini.
Meanwhile, in order to curb infection among adults, much still needs to be done. Speaking during the forum on March 24 in Nairobi to launch Kenya’s National TB Prevalence Survey 2015-2016 Report, survey coordinator Jane Ong'ang'o said that TB infection was found to be higher in young men between the ages of 25 and 34, urban dwellers, people without HIV and women over the age of 65.
"TB prevalence has increased and is now at 558 per 100,000 people compared with the World Health Organisation estimate of 230 out of 100,000", she said, adding that over 138,100 people fall sick with TB every year in Kenya.
According to WHO, Kenya ranks 15th out of 22 high burden TB countries in the world and in Africa ranks fourth behind South Africa, Nigeria and Ethiopia.
in a speech read on his behalf by Izaq Odongo, head of the Department of Curative and Rehabilitative Services, Kenya’s Health Cabinet Secretary Cleopa Mailu said that the National TB Prevalence Survey had shown that Kenya’s TB disease burden is higher than initially thought, with close to 40 percent of the country’s cases going undetected hence untreated.
Mailu said that in order to boost response to TB care and prevention, the government will focus on detecting where the missing cases are and how they can be reached as well as enhancing the speed with which TB cases are identified and treated to reduce transmission.
Mailu also observed that TB is a social disease accelerated by poverty, poor living and working conditions as well as food insecurity. He concurred with Masini that fighting TB requires actions beyond the health sector to address underlying social determinants and engage sectors such as education, labour, social welfare, housing and agriculture.
The National TB Prevalence Survey was conducted with support from WHO, the Global Fund and United States Agency for International Development (USAID) and other partners. WHO Country Representative to Kenya Rudolf Eggers said that the organisation would support Kenya in deriving strategies to end TB based on the study.
He noted that in an effort to find the missing TB cases, the government will screen all persons with respiratory symptoms seeking care at health facilities for TB. It will also carry out targeted screening and active case finding among high risk. Moreover, he said, the government will engage the private sector in TB screening, diagnosis and treatment and invest in the health system to strengthen the fight against the disease.
John Ochero, Portfolio Manager at the Global Fund, said that while Africa accounts for 13 percent of the world’s population, it contributes 26 percent of the global TB burden and he urged African countries to raise their domestic funding in order to win the war against TB.
Randolph Augustin, head of USAID’s Health, Population and Nutrition Office, praised Kenya’s efforts in conducting the TB survey saying reliable data is required for effective interventions. “As long as we breathe we are vulnerable to TB. Let us continue working together to rid Kenya off the misery that accompanies this disease,” he said. [IDN-InDepthNews – 12 April 2017]
Photo: Enos Masini, (in a grey suit and a tie) head of Kenya’s National Tuberculosis Leprosy and Lung Disease Programme, speaking during an event to mark the 2017 World TB Day in Kiambu Town, Central Kenya. Credit: Justus Wanzala.
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