How alcohol, work culture are fueling TB deaths among Kenyan men

Frustrated man standing near the window. [Courtesy, GettyImages] Alcohol consumption and prioritising work are contributing to the high prevalence of tuberculosis (TB) among men in Kenya. Data from the National Tuberculosis, Leprosy and Lung Disease Programme shows that at least 55 per cent of TB cases are men, compared to 33 per cent in women and 12 per cent in children. Every day in 2023, at least 350 people developed TB, and 70 died from the disease, with most of the deaths being among men. According to the data, six out of 10 TB cases were men, followed by women at six per cent and children at one per cent. The reasons behind the high number of TB infections and deaths among men were revealed in a study by Leaving No One Behind: Transforming Gendered Pathways to Health for TB (LIGHT). "Men who consume alcohol and other drugs, sometimes as a way to cope with stress, can miss clinic appointments, forget to take their TB medication, or even lose their medication," reads a section of the study. Similarly, men, especially those in casual, informal, or insecure employment, tend to prioritise income generation and providing for their families over their own health needs. Even those who test positive for TB are said to avoid taking time off work to seek treatment and attend hospital appointments. At least one in every five people with TB missed out on treatment and care. "Men have limited control over taking time off work, making it harder for them to seek and sustain healthcare during clinic hours. "Healthcare workers have fixed working hours, often from 8am to 5pm, and the lack of compensation for overtime prevents longer opening hours," adds the report. The research aimed to understand policy gaps from the perspective of healthcare workers handling TB cases. Edel Sakwa of the LIGHT Consortium added that adult men have one to seven times higher TB incidence rates than women. Salome Ndeto, a healthcare worker at Mukuru kwa Reuben Health Centre, said men rarely visit hospitals, and when they do, the disease is usually at an advanced stage with severe symptoms. "Men come to hospital very late, when it is too late and they can't go to work. At that point, they are usually very weak, so they are just forced to come to hospital," said Ndeto. Contrary to men's poor health-seeking behaviour, TB patients must adhere to medication, as failure to do so can lead to multidrug-resistant TB (MDR-TB), which is expensive to treat and takes longer to cure. Dr Lorraine Mugambi, an official from the Centre for Health Solutions (CHS), said that while TB infection rates are similar in boys and girls at early ages, men have double the prevalence of TB compared to women in adulthood. "It is important that as we think about strategies for preventing TB infections in men, we take this into account," said Mugambi. She added, "For us to end TB, we have to search for it, treat it, and prevent it. We must actively look for it because it exists in the community. If found, it should be treated effectively through early diagnosis. For those without TB, we must prevent them from acquiring it. Prevention is better than cure." In 2023, over 10 million people were diagnosed with TB globally, with 1.25 million dying from the disease. Kenya is among 30 high-burden countries for TB and TB/HIV, with TB being the fourth leading cause of death in the country, affecting men the most. The World Health Organisation (WHO) estimated that 32,000 Kenyans died from TB in 2021. Kenya aims to meet global targets of ending TB by 2030. "It is barely five years until 2030, and as a country, we are working towards ensuring we end TB. We must use both new and existing technologies, integrate them, and start thinking differently about TB elimination," said Mugambi. Mugambi added that a patient-centred approach and differentiated care are critical for TB treatment and prevention. She noted that a 2016 study by the Ministry of Health revealed undiagnosed TB cases within communities. "TB exists, and Kenya is one of the high-burden countries, contributing to 80 per cent of TB cases globally," she said. The study found that late TB diagnosis in children was linked to limited availability of chest X-rays, inadequate funding for scans, and lack of transport to referral sites. Additionally, diagnosing TB in children can be challenging, as their symptoms are unique, including sleepiness, headaches, and seizures related to TB meningitis. "Diagnostic tools for pulmonary TB in children, such as chest X-rays and stool testing using GeneXpert, are not widely available. Access to chest X-rays at selected health facilities has worsened following the discontinuation of previous funding for paediatric chest X-rays and transport to testing sites," explained Mugambi. In some cases, healthcare workers have been forced to pay out of pocket to transport patients to referral sites due to cuts in donor funding. "Insecurity in the community and limited funds for healthcare workers' airtime (mobile phone bundles) and transport hinder outreach efforts," adds the report. TB is an infectious disease caused by bacteria that primarily affects the lungs. It spreads through the air when infected individuals cough, sneeze, or spit. Even as the government works towards ending TB, Aiban Rono from the National Tuberculosis, Leprosy and Lung Disease Programme (NTLD-P) said that at least 28 per cent of TB patients miss out on treatment. Rono explained that patients might miss treatment due to failure to get diagnosed, misdiagnosis, or defaulting on their medication. "People miss treatment at different levels. For instance, a person may fail to report to a facility, a healthcare provider may not diagnose TB, or a diagnosed case may not be reported. Someone may also fail to get diagnosed due to gaps in the healthcare system," said Rono. As a solution, he said the Ministry of Health is creating awareness and promoting good health-seeking behaviours among men and the general population. Additionally, community outreach initiatives are ongoing, particularly in informal settlements, where mobile X-rays are used to test individuals presenting with TB symptoms.

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