Why taking early TB tests is good for you and entire economy

Late diagnosis, lack of reliable data and stigma are the major stumbling blocks to the fight against tuberculosis (TB), health officials have said.

Early and improved detection of TB is one of the global priorities in the control of the disease, they say.

The delay in diagnosis and treatment of tuberculosis has worse outcomes, according to the head of the National Leprosy and Tuberculosis Control Programme (NLTP) Joseph Sitienei.

According to Kenya Demographic and Health Survey 2014, 84 per cent of women and 87 per cent of men aged 15-49 who have heard of TB know that it is spread through the air by coughing.

Women and men in rural areas and those in Western region (as compared to those in other regions) are less likely than their counterparts elsewhere to know that TB is airborne.

Correct knowledge of TB transmission increases with more education and wealth.

For Sylvester Sulwe (right), it was difficult for him to tell whether he had TB or not. He assumed it was an ordinary cough.

“I am living with Multi-Drug Resistant TB (MDR) Tuberculosis (TB); it developed up to the advanced stages because I could not tell whether I had it or not,” says Mr Sulwe.

He says that another factor that made it tough for him to go for TB test was stigma attached to it.

He says it began like a flu; he would take drugs to control it but he was forced to go for a test after his regular customers complained of his persistent cough.

“I am a boda boda (motorbike public transport) cyclist. One day I was carrying a customer and I had to stop to clear a cough,” he says. “With all these I did not seek treatment because I thought it was not a serious thing. When I went for a test, I was diagnosed with TB and later with multi-drug-resistant tuberculosis after defaulting.”

Coughing is observed when the disease is presented late to the health system. The challenge of stigma comes on top of all others, he offers.

“It took me a while to tell my friends and family that I had TB. I felt that having TB was dirty, so I told them that I had pneumonia that had been treated. But because  of  the  side  effects  of  medication,  which  everyone  could  see,  I  eventually  owned up. I expected sympathy and perhaps help but when I communicated that I had been living with the disease, I was shocked that they wanted to know if I might have infected them,” he says.

He adds that the treatment he got later was not welcoming even from the wife.

“We slept in different bedrooms for fear that I might infect her,” he said, adding he was abandoned by close relatives “who didn’t want anything to do with me. They knew I would die the following day.”

The stigma associated with TB infection is a major impediment to rallying people to seek early diagnosis and treatment for the airborne disease.
After a long struggle, the 30-year-old father of one left his job and stayed at home.

He was weak and went for his second line treatment at a nearby dispensary. He was placed on injection for eight months and drugs for 22 months.

MDR is a more lethal, infectious, and expensive to treat TB strain caused by a germ that is exposed to medicine in some optimal level to an extent that it cannot be cured by medicines in the market.

20,000 undetected

The government estimates that about 100,000 cases of TB are reported annually in Kenya. However, it notes that another 20,000 remain undetected and untreated.

The last prevalence survey on the disease was conducted in 1959 and Kenya, today, doesn’t know the real extent of the TB burden in the country.

It is against this backdrop that the government is conducting a household prevalence survey of the disease to help fight the germ.

The survey process which is ends this month is regarded as a very intensive and expensive venture that will cost tax payers close to Sh1 billion.
The survey will help to effectively plan on how to manage TB cases in the country.

“We need to know whether all patients are on medications or not for those who are not on medications, we need to ask hard questions as to why they aren’t on medications. If they drop medicines the germs will start developing resistance,” Dr Sitienei said.

Dr Sitienei noted that the survey will help understand health-seeking behaviour among the people; for instance, at what time they go to the hospital.

“If people are not going to the hospitals: what are the reasons. Is it because the hospitals are far away from them or is it because of the cost or stigma issues,” he said.

Recent data on health-seeking behaviour shows that there is a delay of about eight weeks and by this time such patients are infecting other people.

WHO targets

While Kenya was the first country in 2008 to attain the WHO targets of detecting 70 per cent of TB cases and treating 85 per cent of those cases successfully, the Ministry of Health still estimates that there are about 20,000 people suffering from TB who have not been put on medication.

The Economic Survey 2016 ranks TB as the fifth largest killer of Kenyans as at the end of last year. Where the cause of death was detected, the survey shows that TB killed 10,000 people in 2014 compared to 11,000 people in 2015.

However, the data is not considered comprehensive because it is only for registered deaths.

According to statistics from WHO, there are 20 countries with the highest burden in terms of absolute cases.

Kenya is ranked 15th among the 22 high-burden countries that account for more than 80 per cent of the world’s tuberculosis cases.