Youth, elderly and urban dwellers worst affected by tuberculosis
The current prevalence of tuberculosis (TB) in Kenya to be higher than previously thought.
The Kenya Tuberculosis Prevalence Survey 2015-2016 report has found out that the burden of TB is higher in young men between the ages of 25 and 34 years, urban dwellers, HIV negative people and women over the age of 65.
The findings highlight that close to 40 percent of TB cases in Kenya go undetected and untreated yet one undiagnosed and untreated individual can infect between 10-15 people. This pool of missed out people with TB continues to fuel the spread of the disease hence the high burden of prevalence.
The survey was conducted across 45 counties in Kenya by a highly competent multi-disciplinary team with support of international experts and in line with the World Health Organization (WHO) among other partners.
According to Kenya’s Ministry of Health, a total of 63,050 people were screened at the community level where they asked questions on TB symptoms, chest x-rays taken and those with symptoms and abnormal chest x-rays were asked to submit sputum samples for laboratory analysis through the use of microscopy, GeneXpert and culture.
Enos Masini, Head of National Tuberculosis, Leprosy and Lung Disease said the survey demonstrated that the use of cough of any duration or any of the TB related symptoms and chest x-ray for screening identified more people with TB.
In addition, Masini stated, the GeneXpert detected 78 percent of the TB cases making it a more reliable and efficient test. Unfortunately, majority of people found to have TB, many of whom were men, had not sought healthcare for their symptoms.
However when they eventually sought medical care in public and private health facilities including pharmacies, results showed symptoms of TB hence they were booked for treatment.
Masini disclosed this is the first national TB prevalence survey in post-independent Kenya that commenced in July 2015. It provides a true estimate of the burden of TB and assesses the associated health seeking behaviour of TB patients and those reporting TB symptoms.
“The survey is also the first globally to make use of a fully digital system for real-time data collection as well as the innovative GeneXpert technology for TB testing,” Masini noted.
Cleopa Mailu, Cabinet Secretary for Health said: “In light of these results and in an effort to find the missing TB cases, the Government commits to ensure that TB is part of the evolving universal health coverage/social protections schemes and make TB diagnostics accessible where patients seek care by expanding the use of chest X-ray to screen all persons presumed to have TB and make GeneXpert the first diagnostic test for all presumed TB cases.”
The World TB Day is marked on March 24 and it seeks to raise awareness that TB remains a major public health concern. Kenya’s theme for this year’s World TB Day was dubbed, ‘Mulika TB! Maliza TB!’ (Unite to end TB for a TB free generation).
“In July 2015, Kenya officially began the journey towards a key milestone in the nation’s response to the fight against TB. In the spirit of true partnership, the nationwide TB prevalence survey was successfully conducted in accordance with WHO guidelines,” Mailu, said.
The survey had two objectives. One to obtain a better estimate of the TB prevalence among Kenya’s adult population and two, to describe the health seeking behaviour of identified TB cases towards informing the design of targeted interventions.
The survey involved community sensitization and mobilization as well as door-to-to-door listing and enrolment of participants in randomly selected clusters nationwide using a digital system that allowed for real-time data collection.
“With a participation rate of 83 percent, the survey participants underwent symptom and chest X-ray scree7ning and submitted sputum for laboratory examination,” said Mailu. He added: “The survey found prevalence of 558 per 100,000 contrary to the 2015 WHO estimate of 233 per 100,000.”
From the survey, he pointed out several important observations emerged for instance; the highest burden of TB was in young men between the ages of 25 and 34. It was also observed that TB rates were higher among men and women in urban areas compared to those in rural areas.
The elderly over the age of 65 not previously targeted for TB case finding were identified as a key target population at risk of infection.
The survey findings re-confirmed smear microscopy as a poor diagnostic test reporting with a low sensitivity of less than 50 percent. The chest X-ray emerged a good screening test for TB compared to symptom screening alone.
Over 50 percent of the confirmed TB showed no typical TB symptoms but had an abnormal chest X-ray. This shows a high number of missing cases should not be allowed to prevail.
Mailu said Kenya is committed to the very ambitious 2035 End TB targets incidence by 90 percent and TB deaths by 95 percent relative to the rates in 2015.
“If we are to achieve these targets, we must adopt new ways to bolster the response to TB care and prevention. This is by understanding who the missing cases are, where they are and how they can be reached,” he commented.
Mailu observed that enhancing the speed with which TB cases are identified and placed on treatment to reduce transmission and also enhancing social support systems to ensure higher treatment completion rates.
All these priorities need to be addressed consultatively with an understanding of the implications of the survey findings to develop robust responses to the evidenced huge burden of TB in Kenya.