Sustain the gains in the control and the tuberculosis burden in Kenya. e prevention of
By Ibrahim Abdi Mohamed-Phd(C)
Tuberculosis is a serious public health issue worldwide and one of the main causes of death among the infectious illnesses. It is ranked among the top 10 diseases surpassing HIV/AIDS. A significant proportion of the world’s population is either infected with tuberculosis or at danger of contracting the disease.
During the 78th United Nation General Assembly session held on September 2023, Member States reflected on the progress made in the fight to end tuberculosis with the focus on accelerating multi-sectoral actions to ensure equitable high-quality people-centered TB care and addressing TB determinants in the context of Universal Health Coverage.
Tuberculosis is a major public health concern in Kenya. Despite significant investment by the government and partners in tuberculosis care and prevention over the last two decades, the illness remains the fourth highest cause of death, with Kenya identified as one of the 30 high burden states by the World Health Organization.
Kenya as a country has de-escalated the focus in the recent time from the control of infectious diseases like TB to the emerging non-communicable diseases like Cancers and neglected tropical diseases. This shift might derail the gains made overtime in the control and prevention of TB as well as achieving the SDG and vision 2030 targets in the Country.
Tuberculosis diagnosis and treatment services in Kenya have evolved over a long period of time. It is currently among the top well managed program in the Country despite facing numerous hurdles. Thanks to the support from the bilateral donors, Government and other stakeholders.
In the early 80s and 90s, patient infected with Tuberculosis confronted huge challenges including stigma and discrimination from friends, family and the community members leading to neglect and abandonment. Access to TB services in the yester years especially diagnosis and treatment was non-existent leading to early death.
The roll out of the World Health Organization recommended Directly Observed Treatment Short Course (DOTS) strategy that was introduced in Kenya in 1993 that has accelerated TB treatment reaching 100% geographic coverage. This strategy combined with the creation of TB Manyatta units had an impact on the TB patient outcomes and improved quality of life especially in the areas classified as pastoralist counties. According to Kenya’s National Tuberculosis Program, tuberculosis is the leading infectious disease killer. The latest prevalence survey revealed that the burden of tuberculosis in Kenya is 426 cases per 100,000 people. This huge proportion is a wake-up call for the nation that necessitated enhanced attempts to discover where patients with TB were being neglected by the system and to deploy novel interventions. This approach has led to a rise of TB case notifications by more than 10% in the past five years.
The greatest obstacle to TB prevention and control is noncompliance to treatment, even if the disease may be effectively treated with the approved regimen. Targeting the several underlying causes linked to non-adherence is essential for improving adherence, and understanding these features in the local context requires a blended studies.
TB treatment adherence has been connected to a number of social and economic variables in Sub-Saharan Africa, including low income, lack of social support, lack of education, financial difficulties, and inability to purchase services.
Among the reported patient-related characteristics that influence adherence are older age, male sex, inadequate knowledge, ignorance on treatment compliance and stigma. Poor service provider attitudes, bad attitudes by tuberculosis patients towards the treatment center, drugs stock out, access to health services, and living near the treatment center have all been reported as contributing causes to default in the health care system. Therapy-related factors that influence TB treatment default include side effects, medications that are too strong, and feeling better, while HIV co-morbidity is a condition-related factor that has been reported.
Undocumented studies indicate that a large number of informal health practitioners (herbalists, traditional healers, and medicine men) compete with professional practitioners. As a result, some patients choose to take herbal medicine instead of the recommended TB medications.
While a positive patient-provider connection may promote adherence, there are other health-care system-related issues that have a detrimental impact. These include bad service provider attitudes, a negative attitude towards the treatment center by tuberculosis patients, drug shortages, and limited access to health services.
Tuberculosis control and prevention require a comprehensive, multi-faceted approach involving healthcare systems, public health initiatives, and community engagement. Here are strategies to improve the control and prevention of tuberculosis:
Early Detection and Diagnosis: Promote widespread access to TB testing, especially in high-risk populations. Implement and strengthen diagnostic facilities, including the use of rapid and accurate diagnostic tools.
Treatment Adherence: Ensure that patients receive complete and appropriate treatment. Implement directly observed therapy (DOT) programs to monitor and support treatment adherence.
Contact Tracing: Identify and screen individuals who have been in close contact with TB patients to detect and treat latent infections early.
Infection Control: Implement infection control measures in healthcare settings to prevent the transmission of TB. Promote proper ventilation and use of respiratory protection
Health Education and Public Awareness: Conduct awareness campaigns to educate the public about TB symptoms, prevention, and treatment. Address misconceptions and reduce stigma associated with TB.
Research and Innovation: Support research for the development of new drugs, diagnostics, and vaccines. Foster innovation in TB control strategies and technologies.
Community Engagement: Involve communities in TB control programs to ensure cultural sensitivity and community ownership. Mobilize communities to actively participate in prevention efforts.
The writer is a Clinician/Health systems expert, researcher (PHD Candidate) and former CEC Health Services -Wajir County.
