Tuberculosis epidemic, which way forward?

Tuberculosis continues to be a major killer in the world and remains one of the top ten causes of death in the world.

Statistics show that 8.8 million people worldwide are infected with tuberculosis. According to a report by the World Health Organization, 10.4 million people fell ill with TB in 2016 while 1.7 million succumbed to the disease, out of whom 0.4 million were suffering from HIV/Aids.

According to the same report, over 95 per cent of TB deaths occur in low and middle-income countries.

Tuberculosis or TB is a contagious disease caused by a group of bacteria called mycobacteriumcomplex that majorly infects the lungs but can affect any other part of the body apart from skin, teeth and hair.

Tuberculosis remains a major cause of morbidity and mortality in Kenya, affecting all age groups, but has its greatest toll in the most productive age group of 15 to 44 years.

At least 500 Kenyans with the Multi-Drug Resistant Tuberculosis (MDR-TB) are currently on the tedious 18�24-month treatment regime, which costs Sh.2 million per person to complete the whole treatment which can go for as long as two years.

It cost about half of this amount to treat those who are on normal TB treatment and have not developed resistance.

Although this treatment is free to patients, it costs the country and donors heavily to treat this scourge, not to mention the lost incomes for the patients and their families as they are incapacitated during the illness.

The Ministry of Health released a survey in March 2017 which shows that there are more TB cases in Kenya than previously estimated, with a prevalence rate of 558 per 100,000 people.

TB was found to be higher in men between the ages of 25 and 34 years, urban dwellers, and women over the age of 65.This could be linked to smoking, drinking alcohol and the nature of jobs that men do.

Keziah Maina who is a Clinical Officer at the Tuberculosis, Leprosy and Lung diseases Programme at Narok Referral Hospital, says that there’s been an increase in reported cases of TB in the county which increased from 380 cases in 2016 to 398 last year with the month of December 2017 recording the highest.

She attributes the increase in TB is due to poor living conditions and the rise in HIV/AIDS pandemic. A patient can have either Active or latent TB. Active TB means the germs multiply and can make you sick. Such a patient can spread the disease to other people.

Latent TB infection is a condition in which TB bacteria are alive but inactive in the body. This means the body immune system stops them from spreading.

People with latent TB have no symptoms, don’t feel sick and cannot spread it to others and usually have a negative skin test reaction when tested. They may develop TB if their immunity weakens, for example in HIV patients. 99 per cent of adult cases of active TB are from the reactivation of a latent TB infection.

Surprisingly, the medic says about one-quarter of the world population has latent TB, which means people have been infected by TB bacteria but are not yet ill with the disease and cannot transmit it.

There are two kinds of tests that are used to detect TB bacteria in the body: the skin test (TST) and TB blood tests. A positive TB skin test or TB blood test indicates that a person has been infected with TB bacteria.

However, it does not tell whether the person has latent TB infection (LTBI) or has progressed to TB disease. Other tests, such as a chest x-ray and a sample of sputum, are needed to see whether the person has the TB disease.

According to the National Tuberculosis, Leprosy and Lung Disease Programme (NTLD-P) report of 2017, the main factors responsible for the large number TB disease burden in the country include smoking and the concurrent HIV epidemic.

Other factors that have contribute to the many TB cases include poverty and social deprivation that has led to a mushrooming of peri-urban slums, congestion and limited access to general health care services

Maina also says that lifestyle contributes to increase of Tuberculosis. For example, smoking and excessive drinking is believed to contribute in acquiring TB as it reduces the body’s immunity in fighting the infection.

Elsewhere, large social gatherings or family living in poorly ventilated or congested rooms can also fuel the spread of TB.

Maina says HIV/Aids and TB are so closely connected that their relationship is often described as co-epidemic. They form lethal combination, each speeding the others progress. In 2016, about 0.4 million people in the world died of HIVassociated TB.

There is a connection between TB and Hiv /Aids mainly because of the subdued body immunity, she says.

People living with HIV/AIDs are 20 to 30 times more likely to develop active TB disease than people without HIV due to their low body immunity.

It is very important to be screened for TB if you are found to be HIV positive. You are immediately put under treatment to protect you from spreading the scourge. It is treatable and curable even if you are HIV positive.

Maina says there are different types of tuberculosis which are medically classified as Pulmonary TB which affects occurs in the lungs, usually producing a cough that lasts for three weeks or longer. She says most TB cases in the county and the country is of this type.

There is also extra-pulmonary TB which affects any part of the body other than the lungs such as the kidney, spine, brain or lymph nodes.

The medical practitioner says there was also a type of TB that is resistant to drugs, called Multi-Drug Resistant (MDR) tuberculosis in medical circles.

MDR is caused by bacteria which are resistant to one or more of the most important medicine used to treat the disease. It is common in people who do not take their medicine regularly or those who fail do not take all of their TB medicine as advised by the doctor.

MDR can be prevented by diagnosing cases, following treatment guidelines, monitoring patients’ response to treatment and making sure therapy is completed.

To this end, Maina advises that it’s important for the family or caregivers to work with the health workers in ensuring the patient takes the drugs regularly and completes the dosage which lasts about six months.

Sadly, it’s expensive to treat TB but it costs more than double to treat Multi-Drug Resistant (MDR) tuberculosis as medics have to use a combination of more expensive drugs and also use them in large dosage in order to cure the patient.

Tuberculosis 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. People infected with TB bacteria have a 5-15% lifetime risk of falling ill with TB.

However, persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill.

You’ll need to get a skin or blood test to find out if you are infected. But there are usually signs that come if you have active TB disease. They include a cough that lasts more than three weeks, chest pain, coughing up blood, feeling tired all the time, night sweats, chills, fever, loss of appetite and weight loss.

According to Dr. Maina, a healthy immune system fights the TB bacteria, but if a patient is HIV/Aids positive, has diabetes, severe kidney diseases, head and neck cancers, undergoing cancer treatments such as chemotherapy, low body weight and malnutrition and medication for organ transplants, you might not be able to fend off active disease. Babies and young children are also at a greater risk, because their immune systems are not fully developed.

Meet Michael Gathogo Waweru, a 56-year -old man from Nairegia Enkare in Narok East who has been battling tuberculosis for the past two months.

He says it all started with dry coughs which persisted for some time, followed by chest pains. So he decided to go for diagnosis which tested TB positive.

Wawerusays that his biggest challenge is the treatment period which goes for six months hence the burden of daily medication for long duration, although the tuberculosis treatment is free in government hospitals.

I might have contracted the TB from by work in as it involves working in a dusty environment, Gathogo said, adding that at first his family members were worried and concerned but they have now accepted his situation and are supportive to ensure he recovers.

According to a report from the Ministry of Health, the United States Agency for International Development (USAID) and the U.S Department of Health and Human Services Centers for Disease Control and Prevention (CDC) have provided technical and scientific support to the ministry of health in the design and funding in order to help curb the disease.

For new patients with drug sensitive TB the World Health Organization (WHO) recommends that they should have six months of TB drug treatment. This should consist of a two month intensive treatment phase followed by a four month continuation phase.

The centers of diseases control and prevention recommend that people who are at a higher risk of tuberculosis such as smokers should be diagnosed for latent TB infection.

The league of people who are generally recommended are HIV patients, drug or tobacco users, people who are indirectly in contact with infected individuals, health care workers who treat people with a high risk of TB.

Maina is advising that overall health education, immunization and screening can help in preventing tuberculosis cases, as people who are infected with TB will not always be visibly sick, but they might be in need of treatment to prevent it from developing further in, future.

The Clinical Officer is also advising people to live in a clean environment and avoid congested vehicles and rooms and those who smoking to quit as they are exposing themselves to the risk of cancer and TB too.

Source: Kenya News Agency