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Kenya has reported its first case of the killer extreme-drug-resistant tuberculosis, in a horror story of spreading infection that has seen ordinary TB cases triple since the early 1990’s, mostly among HIV-negative Kenyans, placing the country fifth in Africa and 13th in the world in a list of 22 high-burdened TB countries world-wide: as a result of late diagnosis, and erratic treatment, despite the drugs being available for free.
In Kenya, while AIDS is a part of the reason for the rise in cases, the majority of the cases are striking HIV-negative Kenyans, who are infected by others who have not realised they have TB, with the problem then spreading, and deepening into multiple-drug resistant TB, through poor observance of the free medicine regimes.
As a result, where in 1991, there were 54 TB cases per 100,000 people, according to the Ministry of Public Health, in 2009, the World Health Organisation (WHO) TB report showed Kenya had 132,000 new infections, with its infection rate having risen to 142 new TB infections per 100,000 people.
Of these, HIV accounts for 48 percent of new TB infections in Kenya, according to USAID. The rest are striking HIV-negative citizens. Re-infection is also a factor when ordinary TB patients fail to stick to and complete the medication given. It is this combination of factors that has put Kenya into the top league of TB-infected countries.
TB Action Kenya a local TB advocacy group has practical measures to reduce the chances of infection and spread. “When a TB case, is detected in a household, the rest of the members should be tested and put under medical observation” said Lucy Chesire of TB Action Kenya and a Clinical Nutritionist. Early diagnosis also helps, “anyone with a consistent cough for 3 weeks should also get tested” she added.
Kenya currently has 2000 TB treatment facilities and 900 TB diagnosis facilities. These facilities plus government hospitals are furnished with free drugs for the ordinary TB strain sufferers. “We are pushing for the 900 diagnosis facilities to become treatment facilities,” said Chesire. But these facilities only cater for ordinary TB.
However, even for those getting free treatment in Kenya, poverty is hampering the fight against the spread of the disease, as many are not isolated while they are infected, and cannot afford to be.
Moreover, when the treatment regimen of the ordinary TB is defaulted before the 6 month completion period elapses, an ordinary TB sufferer contracts Multi Drug Resistant Strain-TB. Currently there are 400 MDR sufferers in Kenya, 80 of which are on treatment. In 2007, as per WHO figures there were 2000.
With MDR having doubled in the country in just two years, it’s consequences are severe, due to the high cost of treatment. For MDR-TB cases, the drugs are not available for free in any government facilities due to high costs. “It costs Sh1.5 million to treat MDR-TB for a two year period” said Chesire. At present, it is the Global Fund that is currently paying for treatment of 40 MDR-TB cases in Kenya.
However, the most stubborn strain of TB is the Extreme Drug Resistance TB (XDR TB). This strain is spread like other TB strain in the air or coughs. Those susceptible to it are those who fail to take their MDR-TB medicine, or who are in a place where it’s prevalent or have interacted with someone having it. “Kenya has 1 reported case of XDR-TB in Eldoret,” said Chesire, where the patient is isolated at Moi Referral Hospital.
South Africa has now had 536 cases of XDR-TB, according to USAID. For the one XDR-TB patient reported in Kenya, the cost of treatment for over two years will be Sh3.5 million. It’s the most expensive TB strain to treat, and brings the patient’s life to a standstill until cured.
TB according to a Public Health Ministry report affects primarily 25 to 34 year olds. Private hospitals in Nairobi, including Aga Khan, Nairobi, MP Shah, Mater, and Equator Nursing Home sell their 6 month ordinary TB treatment kit for between Sh4700 to Sh5400. International funding also helps in the fight against TB, with USAID providing $2.9 million in 2008 to fight it.
However, a healthy diet is also vital to fighting TB; medical doctors at Central Middlesex in London in 2008 discovered many patients with TB had Vitamin D deficiency. Vitamin D, which comes from sunlight, was found to produce the cathelicidin molecule, which kills the TB bacteria according to research by Harvard School of Public Health.
Vitamin C supplements have also been reported as critical to boosting the body’s immunity while fighting the TB bacteria. And Vitamin A and beta carotene is also recommended as it strengthens the mucus membrane which gets weaker due to constant coughing. Vitamin B6 is also recommended by medics to be taken along with the medicine to replenish it in the blood for patients with resistant TB strains.
Over the years, medical studies have been inconclusive on the efficacy of the TB BCG vaccine. The UK’s medical research council survey in the 1940s showed that it brought an 80 percent infection reduction when first introduced. But today other factors such as HIV in the population have come into play when assessing the protective effect of the TB vaccine. Most studies point to 0 to 80 percent efficacy.
Tests for ordinary TB at Kenyatta National Hospital cost from Sh150 to Sh700. Charges are higher in private hospitals, running up to Sh3200. The primary drugs for treating the ordinary TB strain are Rifampicin and Isoniazid.
Written By James Karuga for African Laughter
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