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MDR-TB an emerging threat in Kenya

December 2007

The prevalence of Tuberculosis (TB) is increasing in Kenya and the health officials are in the process of preparing a paper that will declare TB as a disaster in the country. This is according to Dr Shahnaaz Sharif , the Deputy Director of Medical Services and Head of Preventive and Promotive Health.

Currently the case detection rate of TB in the country is placed at about 50 per cent. This means that their are 50 per cent of people who might be having TB but are not receiving appropriate treatment. "When the case detection is poor and we are not putting all these patients on treatment, it also gives rise to the condition of Multi Drug Resistance Tuberculosis (MDR-TB)," he added.

According to the Ministry of Health, their latest figures as of early December 2007 of people who have MDR-TB in the country are about 250 cases. A number of these have since died and few others are still on treatment. Currently, the Ministry of Health does not have a programme to treat those who have MDR-TB, but their is hope that by the end of 2007 or early 2008 their will be a programme in place.

Dr Sharif acknowledged that the Center for Disease Control in Kenya has contributed motorcycles that will be used in the active case finding process so as to ensure more people are screened for TB. In this mode of active case finding, the health team involved will ensure that for the people whose sputum tests positive they will trace all their contact persons previously using the motorcycle and screen them for TB. This mode of active case finding is an urban strategy that will be used in those areas that are highly congested and their ventilation poor in Nairobi, Mombasa and Kisumu.

"We are also considering using Mass Miniature Radiography (MMR) in places such as prisons. As prisons are usually congested, the MMR which is a small x-ray will be used to screen the prisoners for TB," Dr Sharif explained.

Dr Joseph Odhiambo the Managing Director of Center for Disease Control (CDC) in Kenya says that even though MDR-TB is an emerging threat in the country it is still preventable. "MDR-TB is preventable by way of enforcing good laboratory and good clinical practice in the management of TB."

In the last financial year, CDC contributed Kshs 1.9 million towards improving the capacity for the laboratory network in Kenya so as to respond to the need for accurate surveillance of MDR TB in the country and also to contribute to the emerging partnership with the Global fund and the Kenyan Government in putting facilities in place for the treatment of MDR-TB.

Many healthy people are at risk of contracting TB because it is spread through coughing. So if you are living with someone who has TB, the chances are that if you are in close contact with them, you will get it. It is important that these people access TB treatment as it is free of charge in all public health centers in Kenya.

Multi Drug Resistance- A potential problem for the fight against TB in Kenya

March 2007

Tuberculosis (TB) treatment often requires a patient to take a dosage for a long time. According to Dave Muthama of the Kenya National Leprosy and Tuberculosis Programme, when one is diagnosed as having TB, they are required to take drugs for a period of eight months, which is referred to as the first line of treatment.

During the first two and a half months of treatment, the doctor puts the patient on an intensive drug taking phase. After this period the patient is then tested to see whether they have TB or not. The result even though it is negative does not mean that the patient stops taking drugs but instead more tablets are given to the patient for the remaining six months to ensure that the TB bacteria is totally treated.

Unfortunately, their is still a number of patients who do not complete their dosage. In public hospitals, district hospitals or health centers, the treatment of TB is free of charge but one has to keep going back to the health institution to take their drugs as the health staff are keen on ensuring that the patients take their drugs correctly and for evaluation and monitoring purposes.

When a patient transfers to another geographical region for instance based on transfer of jobs, they can not carry their drugs with them, instead the health institution the patient has been going to gives the patient a letter that states that they are on treatment and where they have reached in taking the drugs. This letter is supposed to be submitted to the health institution of the new area the patient is going to.

The ability of the patient to continue taking their drugs when they move to a new area is based on the availability of a nearby health center and the personal commitment of the patient to continue with their treatment. If they do not complete their dosage and later on develop TB and go for treatment again their is a possibility of the patient developing Multi- Drug Resistant TB (MDR-TB).

MDR-TB is a specific form of drug resistant TB which occurs when the TB bacteria in the patient is resistant to at isoniazid and rifampicin, the two most powerful anti-TB drugs. When a patient develops MDR TB it means that they will have to be treated with second line drugs which are more expensive and have more side effects. If the patient does not complete their second line treatment their is a greater risk of developing extensively drug resistant tuberculosis (XDR). This form of TB has very few treatment options.

Julius Tome of AMREF-Kenya says that when one has MDR-TB the costs of treatment in Kenya could even rise to Kshs 1.5 million as it requires six months of intensive treatment through injecting and 18 months of continual drug treatment as opposed to the first line of treatment that only takes six months if adhered to and is free of charge in Kenya public hospitals.

Currently, about 300 people die in Kenya from TB yet it is a treatable disease. Unfortunately, the sensitization of TB is taking a back seat as focus in the health sector focuses on other "seemingly" more threatening disease such as HIV/AIDS. The unholy alliance between HIV/AIDS and TB is an issue that is not receiving the attention it deserves.

According to Kenya's National Leprosy and Tuberculosis Programme, the success rate of TB treatment in the country is commendable. The statistics of those who are cured nation wide is 70% and those who have completed their drugs though have not gone for their last testing is 12%. This gives Kenya a cure rate of 82 % which is a great record as the World Health Organisation (WHO) recognizes the universal cure rate as 85%.

This does not mean that Kenya is not taking the threat of MDR-TB lightly even though statistics of it been present is at about 0.004% against the WHO rate of 7%. Dave Muthama of Kenya's National Leprosy and Tuberculosis Programme says that the Kenyatta National Hospital, through the support of the Global Fund is in the process of setting up an isolation ward and sourcing for drugs to deal specifically with MDR-TB.

Every one in three people in the world is infected with dormant TB bacteria (germs) and it's only when bacteria becomes active like when one's immunity is low such as when one has HIV, old age and other medical conditions that one becomes infected.

On the stigma surrounding TB patients as being perceived as having HIV/AIDS, Julius Tome of AMREF-Kenya says that that should not be the case. "When one has TB it is as a result of breathing the air that could have been infected with the TB bacteria." His main concern is that when one has MDR-TB they should not be put together with other patients in a general ward.

The road to a TB free environment can be achieved if the public is sensitized on the preventive measures, importance of taking drugs to completion and all stake holders work together to eradicating TB.

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