Diagnosis holds the key to ending the TB epidemic

Late diagnosis and stigma are the major stumbling blocks to the fight against tuberculosis (TB), a Nakuru County health official has said.

County Coordinator for Tuberculosis Ms. Alice Tebes also indicated that one’s HIV status does not determine an individual’s risk of contracting TB as out of the 33,000 Kenyans who died of TB in 2019, only 20,000 were HIV negative.

Ms. Tebes said about four out of ten Kenyans suffering from tuberculosis (TB) are unknown and could be fueling the spread of the disease in the country, adding that most people with the disease do not seek care, for the assumption that their symptoms were not severe enough to require medical attention.

The coordinator noted that the devolved unit in collaboration with the National Ministry of Health has rolled out a programme to intensify TB case-finding at the grassroots, increase lab diagnosis and treatment of TB, particularly in children and special conditions, as well as improve the management of drug-susceptible and drug-resistant TB.

She spoke during the launch of a weeklong training programme for 30 Health Managers on Active Case Finding Strategies for Tuberculosis at the Nakuru Level 5 Teaching and Referral Hospital.

“The team that includes Sub County TB Coordinators, clinicians and Health records officers among other providers is expected to roll out the same training to 125 Health workers by the end of this month. The team will be tasked with encouraging more screening at the community and various service provision points because early detection and proper surveillance is one of the best remedies to mitigate the spread of TB,” stated Ms. Tebes.

She said the team would also carry out surveillance among county residents who did not exhibit symptoms of the disease as a significant proportion of Kenyans are carriers of Latent TB.

“We need to catch the condition early and treat it before it makes people sick. This will bring down the cases of active TB in the country. We will widen the scope of latent TB screening and treatment. We will begin with health workers and prisoners before moving to the wider population,” noted Ms. Tebes.

The exercise, according to the coordinator, would also involve risk populations for screening and treatment of the condition including people living with HIV and children below the age of five years that are in contact with individuals infected with TB.

“Due to their low immunity, they are likely to develop active TB if they are carriers of Latent TB. So, to prevent that from happening, we need to screen them and treat the condition. Generally, if your immunity is likely to be low for one reason or another, then it’s important you present yourself to be screened for Latent TB,” she said.

Other high risk groups that would be targeted for Latent TB screening and treatment include people receiving dialysis, those preparing for organ transplants as well as people with non-communicable diseases like cancer and diabetes as their immunity is usually low.

Ms. Tebes stated that health workers would work closely with community volunteers to trace missing people infected with the disease so that they could be screened and put them on treatment to prevent transmission.

“To win the war against tuberculosis, we need to suppress disease transmission through similar public health interventions that worked for Covid-19, detect and successfully treat all cases, have an effective contact tracing programme, and protect those amongst us who are vulnerable to infection,” she added.

To improve early detection, Ms. Tebes revealed that the county government and its key stakeholders in healthcare would continue to conduct and support health awareness promotion campaigns which employ easy-to-understand but high-impact information within social and mainstream media and similar methods.

According to the official, the devolved unit was collaborating with the private health care providers as such partnerships improved early TB diagnosis irrespective of where the patients first seek care, in the health system, and establish mechanisms that allow for efficient and high-quality diagnosis and treatment.

She noted that while most health interventions for TB control have largely been focused and implemented in public health facilities, the private sector has been shown to account for 48 per cent of health facilities with a significant proportion of people seeking care from these facilities.

“The TB patient pathway analysis of 2016 showed that 42 per cent of patients with TB symptoms access the private sector as the initial point of care. In addition, 27 per cent of the people with TB symptoms seek care from individual private providers who have inadequate engagement with the public system,” Ms. Tebes pointed out.

Kenya is classified as a high burden country for TB and TB/HIV (“WHO Global TB Report 2021”). TB is the fourth-leading cause of death in the country.

The 2016 National TB Prevalence Survey found that about half of the people with TB are missed by public health services. Yet research shows an infected person who is not on treatment could infect 10 to 15 people in close contact within a year, posing a big challenge in TB control.

According to the report, there are 21,000 new childhood TB cases in Kenya but only 7,648 (36 percent) are notified or confirmed. It is estimated that about a quarter of these infected children usually die, mainly as a result of not being diagnosed and started on treatment in good time.

Even among those that get treatment, adherence to the medicine, which lasts for six months, could be a challenge for many, leading to high non-completion rates and deaths.

Recent survey data from the Ministry of Health estimates tuberculosis to be prevalent in more than 420 people amongst every 100,000 Kenyans, and that the country fails to diagnose about 40 percent of these cases.

Further, only about 52 percent of Kenyans suffering from tuberculosis eventually receive complete and successful treatment. It also indicates that men have a higher risk of contracting TB and dying of the disease compared to women.

In Kenya, it is estimated that about 150,000 people are diagnosed with TB annually, with about 60 per cent of patients placed on treatment, according to the National Tuberculosis Program.

In 2020, Kenya recorded 72,943 TB cases, 5,663 cases (8 per cent) of which were paediatrics.

In 2019, there were about 147, 000 new cases of TB, out of which only 86, 385 were placed on treatment.

A survey carried out by the ministry in 2016 indicated that the country misses an estimate of 40 percent of TB cases, an issue that affects the fight against respiratory the disease.



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