Wellness & Fitness

Health system gaps fail Kenya TB patients

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Based on results of the 2016 Kenya Tuberculosis Prevalence Survey, close to 140,000 (138,105) people fall sick each year with TB. FILE PHOTO | NMG

Peter Otieno was diagnosed with drug-resistant tuberculosis (MDR-TB) in 2016, about five years after he developed symptoms associated with the disease.

“I visited very many private health centres in Migori County and they kept treating me for pneumonia and other diseases but my condition didn’t improve,” he told the Business Daily.

Mr Otieno eventually decided to seek an alternative opinion from a public health facility where he got the right diagnosis and was thus excited to begin treatment.

Unfortunately, he succumbed to the illness and died in 2017 before finishing his two-year treatment course comprising injections and drugs.

Based on results of the 2016 Kenya Tuberculosis Prevalence Survey, close to 140,000 (138,105) people fall sick each year with TB.

While it is not a guarantee that all patients receiving treatment for TB will survive or recover fully, health experts note that some of the associated deaths are needless as they are caused by TB management gaps in Kenya that if fixed, can forestall the unnecessary loss of lives.

Otieno’s journey with the disease, right from when he began feeling sickly to the time of his demise, offers insights into how health systems can at times fail patients despite their optimism to stay alive.

Dr Enock Masini, head of the tuberculosis programme at the World Health Organisation (Kenya) office, stated that late diagnosis — as was the case with Otieno — is a major contributor to TB deaths.
“If doctors get it right the first time, then the treatment is likely to be effective and the patient will suffer less.”

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A recent study conducted by the Kenya Medical Research Institute (Kemri) dubbed TWENDE (Tuberculosis: Working to Empower Nations Diagnostic Effort) found that many people tend to over-rely on easily accessible private health centres — including pharmacies or chemist and herbal clinics for medical care yet these facilities are not equipped to diagnose and manage TB.

“Many of these facilities will first test for other diseases like malaria and pneumonia before patients discover that they are suffering from TB. This leads to late diagnosis,” said Barbara Miheso, research officer at Kemri who was involved in the study.

Currently, centralised and quality TB care is mainly offered in public hospital, faith-based facilities and high-level private healthcare institutions.

“We need to change this strategy because it’s hard to change the health-seeking behaviours of patients. We can make a lot of noise about where people should go for treatment but in the end, they will just go where they prefer irrespective of what we say,” said Dr Masini who until mid-last year, was the head of the National Tuberculosis, Leprosy and Lung Disease programme.

He says the WHO is working with the Health ministry to identify appropriate ways of engaging players in the private sector as well as informal healthcare providers such as herbalists so as to enable them to identify suspected TB cases and help in referring patients to recommended facilities for proper screening and TB treatment.

“We’ve done the much we can do in the public health sector. So reaching out to these other facilities is the only way we are going to get the missed TB cases so as to ensure that each person with the disease in this country is identified and given appropriate care,” he says.

The Ministry of Health statistics shows that about four out of 10 (40 per cent) Kenyans suffering from TB are unknown and could thus be fuelling the spread of the disease.

The 2017 Kenya Economic Survey ranked the disease as the fifth leading cause of death in the country, claiming close to 5,000 (4,735) lives every year. This figure could actually be much higher due to the missed TB cases that are not usually captured by the survey.

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Dr Evans Amukoye, chest specialist and deputy director of research and development at Kemri, noted that even though healthcare providers in the informal sector can help with the diagnosis of TB, treatment drugs should only be administered by skilled healthcare providers trained on their use so as to curb misuse that can increase MDR-TB.

“We can’t just go ahead and trust the drugs with anyone that will be a disaster!”

Fred Orina, TB researcher at Kemri, called for enhanced training of healthcare professionals on the use and application of various TB diagnostic tools to further minimise missed TB cases.

There are three TB diagnostic tools — Gene Xpert, Culture and Line Probe Assay — in Kenya.

The TWENDE study by Kemri revealed that most healthcare facilities use the Gene Xpert machine more frequently than the other two tools which play a key role in identifying drug resistance TB cases.

“All these tools have a role they play in diagnosing TB. Therefore, none should be ignored,” says Dr Amukoye.

According to Ms Miheso, enhanced awareness is also required to tackle stigma associated with TB which usually discourages people exhibiting symptoms of the disease from seeking medical attention.

“Families and friends sometimes run away from their ailing members suffering from the disease thinking that they’ve probably been bewitched yet this isn’t the case. Their support would be really valuable to the patient."

READ: Survey shows TB prevalence in Kenya is underestimated

Agatha Mandu, TB expert at Path Kenya, says aside from treatment drugs, which are offered at no cost in government facilities, those suffering from TB (especially the drug resistance type) also require additional support to deal with certain “hidden” costs of the disease such as transport expenses they incur while travelling to health facilities for treatment as well as adequate food that enable the drugs to work effectively.

“Most people affected by TB come from low-income households. These people are usually already struggling to make ends meet and take care of their families. So when they get the disease, it takes a toll on their resources and makes their life difficult.”

She says the patients also need counselling and psychological support to help them cope with the stress of dealing with the disease so they do not give up along the way.

On paper, the government is supposed to offer financial assistance or stipends to meet some of these expenses. But the money is usually delayed and sometimes not given at all to some patients.

When the Business Daily visited Mr Otieno’s home before he died, he had been put on treatment for drug resistance TB for three months but was still struggling with food and transport expenses as he was yet to receive financial aid from the government. This could have contributed to his death.

Drugs for treating tuberculosis, especially those targeting resistant TB, are very strong. Without good nutrition, they can bring patients down and make them suffer from severe side effects that may be life-threatening.

To complement the resources coming from the Health ministry which are often scarce, Dr Masini noted that county governments could also chip in to offer a sustainable support system for patients.

But this may be a tall order since an assessment undertaken last year found that apart from Nairobi, no other county has set aside a budget line for TB management in those regions.

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