Why Kenya's effort to eradicate TB have failed

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Why Kenya’s efforts to eradicate TB have failed

By Mathangani

As African nations grapple with a tuberculosis emergency declared three weeks ago, Kenya is on the spot as one of the countries where the disease is rapidly on the rise.

British MPs, and , during a press conference after visiting TB and Aids programmes in Nyanza and Kibera slums. They said the TB situation in the country is shocking.

In the last 15 years, TB cases have increased fivefold, and the country now ranks tenth on the World Health Organisation’s list of countries badly hit by the pandemic.

Last year alone, 105,000 new cases were reported, but the number is feared to be three times higher.

A grim picture of unending suffering emerges in some of the worst hit areas like Nyanza Province, where the prevalence rate of 14 per cent is well above the national average of 6.7 per cent.

And because it is most contagious in crowded areas like slums, TB is labelled as a disease for the poor. With a recent indication by the UN that Kenyans are growing poorer, there is cause for alarm.

A group of British MPs who recently visited the country faulted the political commitment to combat the disease.

But Ministry of Health officials say the Government has done its best and blames the crisis on the patients’ ignorance, stigma, HIV/Aids and poverty.

"Many patients stop taking their prescription as soon as they start feeling better. They fall ill again and may become resistant to drugs,"says Health Assistant minister, Mohammed Abdi Kuti.

Ironically, Kenya is among few African countries that have fully adopted the Direct Observation Therapy (DOT) recommended by WHO.

Under this method, patients are put under constant observation by health workers or relatives to ensure that they adhere to instructions.

But the WHO acknowledges the impact on measures so far taken had not been significant.

During the health ministers’ meeting in Mozambique where the TB emergency was declared, WHO Africa Director, Gomes Sambo, called for "urgent and extraordinary actions" to deal with the scourge.

Kuti says with over 1.2 million people infected with HIV, the TB prevalence is bound to be aggravated. Indeed, WHO says TB is the leading killer of Aids patients.

The director of the Department for Health Promotion, Dr Muraguri, says Kenya’s priority is to fight ignorance, stigma and poverty. He said a key challenge is to incorporate TB treatment with that of HIV, so that everyone visiting a tuberculosis clinic undergoes HIV testing.

Further, he says the magnitude of stigma facing TB patients is nearly the same as that experienced by HIV/Aids patients: "Many people think if one is infected with TB, they have HIV. They fail to seek treatment in fear of being discriminated."

This stigma is fueled by the myth that TB is not curable. Muraguri said: "The rate of recovery between TB patients infected with HIV and those who don’t have the virus is similar."

He adds that tackling poverty, providing treatment to people living in slums, remote areas as well as women and children would be key to combating the disease.

The Maputo meeting of the 55th Regional Committee for Africa urged member states to improve detection of TB, accelerate the DOT method and improve the provision of anti-retroviral (ARV) drugs.

In Kenya, this is a tall order because only about 45,000 patients out of 200,000 patients who qualify get the ARVs.

The Government is also slow in utilising donor funds. For instance, only 44 per cent of Sh375 million from the Global Fund to fight TB has so far been spent.

Out of Sh750 million given by the fund for Malaria, only 60 per cent had been used, while 72 per cent of Sh2.8 billion meant for HIV/Aids had been utilised.

A ministry official, Dr Tom Mboya Okeyo, blamed the delay on stringent procurement regulations given by donor agencies: "The World Bank was instructed to release money for Malaria in December but only did so in March."

Health providers agree that many of the deaths from TB are actually avoidable, but only if measures are timely and well-coordinated.