Two in every five Kenyans have TB – but they don’t know it

Two in every five Kenyans are unaware that they have tuberculosis (TB). And they are spreading it, hour after hour, albeit unknowingly. Findings from the National TB Prevalence survey 2016 released Friday showed that 40 per cent of Kenyans infected with tuberculosis were undetected and thus untreated.

Head of the National Tuberculosis, Leprosy and Lung Disease programme Enos Masini said this pool of missed cases fuels the spread of the respiratory disease countrywide. “This is a dangerous trend considering that one undiagnosed and untreated individual can infect about 10 to 15 people,” said Dr Masini.

He noted the undiagnosed cases could be people who had symptoms of TB like a persistent cough that lasts more than two weeks, chest pain and fatigue but ignored the need to seek treatment. “There is a second possibility that the person could be infected with TB, but has no symptoms thus they see no need to see a doctor,” Dr Masini said.

The third reason for such cases, Dr Masini added, was failure of the health workers to test for TB even after the person presented with symptoms. Some testing kits also fail to catch the disease because they are not sensitive and specific enough to test positive for the TB-causing bacterium.

According to the survey, the national burden of TB was also found to be twice as high - at 558 per 100,000 people compared to the World Health Organisation’s estimate of Kenya’s burden at 233 per 100,000. Dr Masini said the survey findings corroborated with those from Ghana, Zimbabwe, Uganda and Zambia that show that their national TB prevalence cases were higher due to the undiagnosed and untreated cases. The survey released yesterday also found out that men have twice as high tuberculosis cases compared to their female counterparts.

“Based on these differences, we will move a step further and investigate whether the exposure is related to the kind of work they do, whether their health-seeking behaviour encourages them to seek treatment,’ Dr Masini said. He further said that the findings would also establish whether the social places men spent their leisure time were fertile TB transmission zones or were they also triggered by other environmental factors.

Men in the 25-34 age group were found to bear the highest burden of the disease whereas in women, those who were mostly affected were those aged over 65 years. The prevalence of the disease was higher in urban areas than rural areas; with 760 persons per every 100,000 compared to 453 persons per every 100,000.

“We will investigate whether this disparity is due to the number of urban poor living in informal settlements, do they have lack of access to affordable healthcare in urban areas?” Dr Masini said. The survey was conducted through community-level screening of 63,000 people in 45 counties between July 2015 and July 2016.

Dr Masini cited the national survey as a critical step to establish, which has remained unknown in the last five decades. He added that the data from the newly released survey would supplement the last TB prevalence survey that was conducted before independence in 1958-59.

“It provides a precise estimate of the burden of TB and assesses the associated health seeking behaviour of TB patients and those reporting TB symptoms. These findings will be used to inform country planning and policy formulation to end TB,” Dr Masini said in an interview with The Standard on Saturday.

The release of the survey coincided with the globally observed World Tuberculosis Day themed: Unite to end TB that called for concerted global efforts from individuals, governments, development partners, civil society and the private sector to eliminate the disease. The day is marked on March 24 to commemorate the day in 1882 when Dr Robert Koch announced he had discovered the TB bacillus that causes tuberculosis. TB is caused by bacteria (mycobacterium tuberculosis) that mostly affects the lungs. It is curable and preventable.

It is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected. The fight against TB has been complicated by resistance to drugs, thus patients are placed on more expensive drugs requiring strict adherence, Dr Masini said. Dr Masini believes that creating awareness would reduce the number of diagnosed persons who require stronger medicines to treat the more expensive forms of TB.

Resistance to anti-TB drugs occurs when these medications are misused or mismanaged, especially when patients do not complete their full course of treatment MDR TB is caused by an organism that is resistant to the two most potent TB drugs whereas XDR TB is a rare type that does not respond to both the first line and second line TB drug.

Dr Masini was optimistic that the data collected from the national survey would enable the relevant health authorities plan and implement policies that would end tuberculosis spread in Kenya. In May last year, the World Health Organisation shortened the TB treatment period to six months, a relief for patients who previously were on anti-TB drugs for at least a year.

Consultant Chest Specialist Joseph Aluoch said that reduced treatment time was as a result of years of evidence-based research and consultations to manage tuberculosis better globally. To diagnose and effectively treat more people, Dr Aluoch offered some solutions. “We need to improve our national health systems so that health workers can have a higher index of suspicion to test for tuberculosis and hence begin treatment immediately. The test kits used need to be more sensitive and specific.

Patients should also be educated on the importance of adhering to treatment,” said Dr Aluoch, who is also the patron Kenya Association for the Prevention of TB and Lung disease. Dr Aluoch noted that having public health promotion campaigns encouraged patients to complete their treatment as they drew support from partners, family, colleagues and the community.

The awareness campaigns reduce infection by more than 10 per cent, Dr Aluoch added.

Dr Masini reiterated the importance of expanding health education on TB, citing the need to involve children and teachers to spread the preventive message. “We need to expand health programmes to include TB and target children as change agents to reach young families,” Dr Masini said.

The writer is Health and Medicine Editor at The Conversation Africa (theconversation.com/africa)