TB: The preventable disease that still kills

Stephen Angura Shikoli, a Tuberculosis (TB) survivor and founder of Pamoja TB Group based at Kangemi Health Centre. The group educates the locals in Kangemi on TB. PHOTO BY NANJINIA WAMUSWA.

Nairobi, Kenya: Stephen Shikoli was diagnosed with Tuberculosis (TB) in 2009 after a friend advised him to go for TB screening following consistent long cough, chest pains and sweating at night.

"I had sought numerous treatments including use of traditional herbs believing it was witches without success," he recalls.

Angura, 23, went for screening at Westlands Health Centre and results showed TB positive. At this point, he didn't know TB: "All l wanted was get treated for l was going through hell. I was weak and weighed about 40kg."

On learning of his TB status, his mother chased him saying he'd brought home a curse. Fortunately, a friend accepted to host him while on TB drugs.

His mother accepted him back home after he started recovering. After full recovery, Angura steered the formation of Pamoja TB Group early 2010 based at Kangemi Health Centre which educates the community about TB and reduce stigma.

While Angura survived, today at least two people die every hour in Kenya due to TB.

Dr. Enos Masini, Head of the National Tuberculosis Program at the Ministry of Health says these are gains because numbers have gone down, although battle for TB is not yet won.

He explains, globally Kenya is feted for TB control, having achieved targets that were set by World Health Organization (WHO) of successful treating more than 85 per cent of the cases notified and also being able to detect more than 80 per cent of the cases that occur.

"Despite the gains, basically no one should be dying because TB is both treatable and preventable," he said.

Figures drawn from WHO 2015 Global TB Report released in November 2015, set in the context of the newly agreed Sustainable Development Goals which target the end of TB by 2030, show that in 2014, 17,500 people died of TB and 46% of these were also infected with HIV in Kenya. Same year, there was an estimated 110,000 cases of TB in Kenya.

At this time, Kenya ranked 15 out of 22 Countries with high TB burden among them China, India, Tanzania, Nigeria and South Africa.

Globally, more than 9 million people became ill with TB and 1.5 million died, making it the world's leading infectious killer.

It is for this reason that in same year (2014) the World Health Assembly unanimously approved the End TB Strategy.

Evaline Kibuchi, Chief National Coordinator, Stop TB Partnerships-Kenya says discloses individual countries were tasked to craft a way to end the TB by 2030.

Kenya launches 'Mulika TB, Maliza TB' slogan to end TB as the world marks World TB Day, 2016.

"This is to reach 90 per cent of all people with TB, reach at least (90%) of the vulnerable populations and achieve at least 90% Treatment success rate," she explained.

Symbolically, in Mulika TB, Maliza TB, 10 torches will be presented each to high TB burden Counties which include Homabay, Kisumu, Meru, Isiolo, Nakuru, Kiambu, Siaya, Turkana, Machakos and Nairobi.

In essence the slogan is to provide special focus to high burden counties and other key regions that are affected by the disease. It involves mobilizing and screening with emphasis that health workers are vulnerable and they too go for screening.

Dr. Masini discloses they are providing people living with HIV an Isoniazid drug to prevent them from developing TB. "It's a key intervention targeting people living with HIV," he said.

They using new technology GeneXpert that can test TB within hours give more accurate results and detect Drug resistant TB. He says Kenya already has 156 machines, within every County.

"We're also making sure all health facilities have drugs for TB, equipment are able to test TB, and health workers are adequately trained to suspect and test for TB in patients who present to them," he said.

This time, they target TB in other groups of people suffering from diabetes, cancer and malnutrition because it lowers their immunity.

He says they are involving local TB ambassadors.

He observes the fight of TB must be seen in the context. Before 1990 TB cases were about 10,000 in a year. The challenge came with the emergence of HIV because the number increased from about 10,000 to over 100,000 in the years of 2007 and 2008.

He states, "Today, we have made progress and controlled most TB cases associated with HIV."

Tuberculosis

Tuberculosis (TB) is an infectious disease spread through the air caused by a germ called Mycobacterium tuberculosis. It generally affects the lungs, and other parts of the body.

It is spread when infected person coughs and sneezes putting the germs in the air and another person inhales.

"Those bacteria remain inactive when the body is able to contain them using the immunity. In cases where immunity goes down, the disease progresses and germs multiply. Then it becomes TB disease," explains Dr. Masini.

The symptoms include cough, produce sputum sometimes with mucus or blood, chest pains, hotness of the body, loss body weight, night sweats and generally feeling unwell.

 

TB can be prevented by early tests and putting those infected on treatment immediately. Outside medical sphere, since it also affects the poor, it can be prevented by increasing the economic wellbeing of the people.

Other prevention involves using drugs Isoniazid which given to people with HIV and prevents people from developing TB. Treatment takes six months, and drugs taken consistently as advised healthcare provider.

If the patient fails or misses some of the doses they are likely to develop drug resistant tuberculosis," he explained.

Despite achievements TB stigma is higher than HIV because of lack of adequate information and most people fear talking it openly. Kibuchi says, "Many people still think that people with TB also has HIV."

She says the challenge is lack of awareness and government needs to invest in it.

There is also myths and misconceptions that TB is witchcraft. Such was Angura's fate. "My mother claimed no one in our family had suffered such a disease, and that must have been a curse from step-mother," He recalls.

There is also good number of defaulters. She warns it is dangerous to take alcohol while on TB medication.

The fund is also inadequate.

Sidebar/the TB Champions...

The use of local champions to end TB is an initiative by Stop TB Partnership-Kenya that joins the government to help fight TB.

"These are celebrities that many people look up to them, and have a larger audience," says Evaline Kibuchi, Chief National Coordinator, Stop TB Partnerships-Kenya

One of them is artiste Steve Otieno Otieno aka Tripple One. In 2014, he recorded a TB track titled 'TB ina Tiba' that urges people to go screening and get treated because TB has cure and offered free in public facilities.

"All my parents succumbed to TB. My father died when l was two and mother while nine years old, affecting my livelihood. I use music to educate the people about TB," says Otieno, an orphan and only child.

Otieno, 20, is optimistic the rap song in both English and Kiswahili that describes TB symptoms and warns of death if people don't seek treatment will help in fighting TB.

Hon Stephen Mule, a Member of Parliament for Matungulu Constituency in Machakos County, was elected into Parliament in 2013, and after joining Parliament's Health Committee discovered zero funding for TB in 2013/20 14 National budget.

"There was no money for TB yet it is one of the biggest killers. Having come from Bio-medical engineering l knew it was going to be hard for Kenyans to survive TB," he said.

Hon Mule later in interrogated the national budget and put up a supplementary budget for TB and passed getting around Sh 300million.

In Parliament, Hon Mule rallied and 130 fellow MPs signed the Barcelona Declaration as a demonstration of combined commitment to address TB in Kenya and in the Africa region.

Carlin Alusa is an International Fifa referee, soccer instructor and National Chairman Sportsmen/Women (SPOFA) Fighting HIV and TB. He would be championing TB information through sports.

"We want create TB awareness in stadiums and other sports areas where fans meet. We want to brand t-shirts/jerseys with TB messages. As an official, if l doesn't tell you about TB, will lose you as a fan," he explains.

The TB messages will be shown during matches and training for both players and referees. He says they want to work with all sports officials.

Another Champion is Stephen Angura Shikoli, who was infected by TB. After successful recovery, Angura and others founded Pamoja TB group based at Kangemi Health Centre. The group educates the community about TB and reduce stigma. It has TB clinic every Tuesday.

Champion is Mohammed Ali, the CEO Moha Grafix is another champion, who would use his artistic work to paint TB messages on matatus.

"He also motivates youths and will empower them about TB using any platform at his disposal," said Kibuchi.