Dagi Kimani
20 July 2009
Nairobi — Kenyan health experts have warned that the country is sitting on a tuberculosis time-bomb, and are suggesting that the disease be declared a national emergency like HIV/Aids.
Of most concern, the experts say, is the continued unchecked spread of multi-drug resistant TB (MDR-TB), which is harder and more expensive to treat than conventional tuberculosis.
Last week, the director of Kenyatta National Hospital revealed that the institution had diagnosed 330 cases of MDR-TB over the past year, the largest ever caseload.
In contrast, there were only 250 cases of multidrug-resistant MDR-TB nationally in 2007, according to the ministry of health.
The actual number now is thought to have risen substantially despite a high mortality rate from the new disease variant.
According to Dr Jotham Micheni, MDR-TB, which costs up to $20,000 to treat, is probably one of the gravest "new public health challenges" to emerge this decade for poor countries like Kenya that are still struggling to cope with normal TB.
Health experts blame the emergence of MDR-TB on the misuse of first-line medicines, leading to the tuberculosis bacteria acquiring resistance.
"MDR-TB is now a time bomb," said Ms Lucy Chesire, a prominent Kenyan tuberculosis activist last week. "People have been panicking about such scares as swine flu, but this is far worse."
The fear now is that MDR-TB could degenerate into the so-called XDR-TB, or extreme drug resistant TB, a form that cannot be managed by even second-generation medicines. Cases of XDR-TB have previously been reported in South Africa, and virtually all have led to death.
According to the World Health Organisation, Kenya is currently the 13th most TB-affected country in the world, and the fifth hardest hit in Africa.
According to the organisation's Global TB Control Report of 2008, the country had more than 140,000 new TB cases. New cases are reported at the rate of 153 infections per 100,000 population per year, one of the highest in the world.
Health experts say that the emergence of MDR-TB in the country has been facilitated by widespread co-infection with HIV/Aids. Kenya has about 1.3 million people infected with HIV. About 52 per cent of new TB patients are HIV-positive.
Critics of the manner in which the government has handled the emerging TB crisis say that not enough attention has been given to public awareness, as well as the establishment of specialist treatment facilities.
Since the conversion of the then so-called Mbagathi Infectious Diseases Hospital in Nairobi into a normal health facility five years ago, the critics say, the country has not had a specialist centre to manage the infection.
The lack of a specialist facility at Kenyatta, the critics add, has seen an inordinate number of health workers contract the disease.
Currently, the country also does not impose mandatory quarantines or at least basic travel restrictions on those infected with the MDR-TB as happens in some countries, raising the risks of transmission in such public places as restaurants and public transport.
Critics also say that with only one laboratory at KNH, Kenya's ability to conduct effective surveillance of MDR-TB is not commensurate to the disease burden.
Facilities are, however, being upgraded with the help of several agencies, including WHO, the Global Fund and USAid.
USAid's total support over the last six years has totalled about $15 million.
On their part, Kenyan authorities say the country has made progress in the fight against TB, especially in the areas of diagnosis and treatment.
The country's National Division of Leprosy, TB & Lung Disease (DLTLD) began to implement the WHO-recommended DOTS (directly observed treatment, short course) strategy in 1993, and reported 100 per cent DOTS coverage by 1996.
In 2006, at 82 per cent, the DOTS treatment success rate was considered to be one of the best on the continent, being close to the WHO target of 85 per cent. Treatment in is free.
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