Arthur Okwemba
8 September 2005
Nairobi — A super tuberculosis strain is circulating in Nairobi, Coast, Nyanza and North Eastern provinces, says researchers at the Kenya Medical Research Institute and confirmed by a World Health Organisation's reference laboratory in the UK.
To treat a single case of the Multidrug Resistance Tuberculosis (MDR TB) is estimated to cost over Sh1 million. Such patients will be put on drugs, which could be very toxic to the liver and kidneys. In cases where the strains have done much damage, part of the patients lungs will have to be removed.
In response to the new threat, the government is already planning a national referral and isolation unit for these patients at Kenyatta National Hospital.
The patients will be held in the unit for about three months to monitor their response to the drugs otherwise the full treatment is supposed to take two years.
According to Kemri scientists, Dr Willie Githui and Dr Helen Meme-Murerwa, who conducted the surveillance study, patients who participated in the research were resistance to two key and most powerful anti-TB drugs- Isoniazid and Rifampicin.
Nairobi, Coast, Nyanza, and North Eastern provinces have the majority of these patients. Siaya in Nyanza and Busia in Western Kenya, also registered cases with the strain.
MDR-TB is a man-made phenomenon resulting from poor management of the disease. This may come about when those taking the drugs fail to adhere to the treatment guidelines, use low quality drugs, or when there is improper diagnosis and prescription of drugs.
The two Kemri scientists have been following 1255 patients for the last two years during the study, which was commissioned by WHO and Centre for Disease Control of America.
Their findings have been subjected to a Supranational Reference Laboratory in East Dulwich, UK, which, in line with WHO guidelines, is supposed to test and establish if what Kemri scientists found reflects the true picture.
Dr Davy Koech, Kemri director, says it is only after the UK laboratory confirmed Kemri findings that they can now be released to the public. The results, he adds, are interesting because in 1995 when they did a surveillance study that was published by WHO, no MDR TB was recorded.
To be published before the end of the year in The International Journal of Tuberculosis and Lung Diseases, a senior Ministry of Health official says the findings have shocked and disappointed his colleagues, some of whom have all along argued that things were not that bad.
In a letter reference No DC/7/3/27, the Director of Medical Services, Dr James Nyikal, says whereas he is saddened by the emergence of MDR TB, he is pleased to report that the ministry is planning to start an isolation unit to cater for patients with this strain.
Last year, the MoH denied MDR TB existed in the country in significant numbers when following media reports of its existence indicating that of the 149 TB patients who were referred to Kemri by private and public hospitals in Nairobi, 11.4 per cent had multidrug TB resistant strains.
The ministry was categorical that the country's MDR TB magnitude was only 0.03 per cent, which, they argued, did not warrant an elaborate government management response to the problem.
It later emerged that the 0.03 per cent figure was the same one cited in a ten year review of TB drug resistance in Kenya published in the October 1993 East African Medical Journal, Vol 70, No 10.
With these new findings, Dr Koech says health personnel will have to be trained to master the techniques of picking-out somebody who is resistance to more than one TB drug.
Dr Githui and Dr Meme-Murerwa add that simple procedures and characteristics to diagnose a person with TB resistant strains will have to be used especially in resource poor settings.
Currently, testing of drug resistance TB costs about Sh3,500 at Kemri while it is free in public hospitals to test for normal TB strains.
These bad news comes at a time the government is preparing to present a report to the Millennium Development Goals meeting in New York next week on how it is managing HIV/Aids related opportunistic infections. TB is one of the major opportunistic infections assaulting HIV positive people.
It is also coming when some European countries are requiring that people wishing to travel thre be screened for TB before being issued with a visa.
But the biggest fear now is that those who were found to have MDR TB strains are freely mingling with other people, and spreading the strains. Majority of them are too poor to raise even 0.1 per cent of the one million shillings required to manage their condition.
Although the government was about four years ago alerted of the issue of MDR TB and how to help such poor patients access medication, much of its policies have not been translated into action.
In 2002, the then Director of Medical Services, Dr Richard Muga, instituted a 20-person task force to look into the matter, after 30 people reported to Kemri with the super TB strains.
"Sporadic cases of MDR-TB have been notified to the National Leprosy and Tuberculosis Programme in the last quarter. At least 30 patients are now confirmed to have MDR-TB on sputum and culture and sensitivity done at Kemri," said Dr Muga then in a letter.
According to the letter, the task force terms of reference were to prepare guidelines for registration and treatment of MDR-TB; its prevention; and surveillance.
As an immediate response, the team was required to prepare an application to the Global Fund and the Green Light WHO committee to enable Kenya access funds and cheaper drugs to help in the management of the strains.
Be the first to Write a Comment!
Copyright © 2005 African Woman and Child Feature Service. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com). To contact the copyright holder directly for corrections — or for permission to republish or make other authorized use of this material, click here.
AllAfrica aggregates and indexes content from over 125 African news organizations, plus more than 200 other sources, who are responsible for their own reporting and views. Articles and commentaries that identify allAfrica.com as the publisher are produced or commissioned by AllAfrica.
