Kenya: Drug-resistant tuberculosis strains healthcare system

[Guest guest]

Drug-resistant tuberculosis strains healthcare system

By line Sundayand Stella Cherono (email the author)

Posted Monday, February 20 2012 at 18:53

Every morning, Rodgers Owino, a plumber in Kisumu County, wakes up at cockcrow

to prepare for work. His morning routine is like that of every other average

Kenyan—he showers, gets dressed and eats breakfast.

But before leaving the house, Mr Owino has to wait for Ms Dorcas Omollo, his

State-appointed nurse, who promptly passes by every day at exactly 7:30 am to

ensure he takes the 17 tablets that have become part of his morning routine.

Rodgers is one of hundreds of patients in Kenya diagnosed with multi-drug

resistant TB— MDR-TB— and has been living with the disease for the last one

year.

Multi-drug resistant TB develops when patients become resistant to antibiotics

during or after treatment of regular tuberculosis.

The resistance develops when patients fail to complete their antibiotic course,

drug supplies run out or patients keep on forgetting to take their medication.

MDR-TB is transmitted from an infected person to a healthy one as readily as

drug-sensitive TB but is much deadlier, with a mortality rate of 80 per cent.

" I developed a cough and when it became persistent I went to the hospital where

they ran some tests on me and I was found to have developed TB in my left lung, "

recalls Mr Owino.

Thus followed an intense eight- month treatment period which patiently

endured in the hope that he would be cured and life would become normal again

..But this was not to be.

Three months after completing his treatment, he was back in hospital with the

same symptoms. That was when doctors realised something was wrong.

After several months, tests and observations, Mr Owino was diagnosed with MDR-TB

and soon after placed on medication.

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His story strikes a chord with most TB, MDR-TB patients and clinicians in the

country who have learnt to live with a disease that is seldom talked about

despite the huge financial and social burden on the individual, community and

the country at large.

Data from the World Health Organisation (WHO) shows that Kenya is 13th in the

world, among the top 22 countries which bear the heaviest brunt of TB. The

report further states that the country is fifth in Africa in prevalence of TB.

In addition, Kenya's TB burden is higher than that of Liberia, Zimbabwe and

Uganda; countries with lesser GDPs and less sophisticated health systems than

ours.

This is a strong indictment to the country's ailing public health sector which

is grappling with financial constraints that have affected staffing, equipment

and supplies in its health facilities.

The situation is made worse by the specialised and expensive treatment process

that MDR-TB patients, many of them low income earners, have to undergo.

MDR-TB treatment takes two long years with patients being subjected to highly

toxic drugs and injections while being carefully monitored to ensure compliance

with treatment.

Treating one MDR-TB patient costs bout Sh1.3 million and some physicians will

insist that these patients remain isolated at least for the first six months to

avoid infecting healthy people.

Dr Esther Onyango is the lead specialist at the New Nyanza referral hospital

where she works directly with TB and MDR-TB patients in Nyanza Province and

western Kenya.

She explained the challenges of dealing with MDR-TB: " Managing an MDR-TB is not

a normal treatment programme you'd give an every-day patient but takes a team of

no less than seven people over a period of two years, " she says.

" There is the dietician, clinician, nurse, public health personnel, lab

technician, pharmacist and a social worker. "

" Even before the patient is started on treatment, these people have to chart a

treatment programme that they are all going to stick to over the two -year

course of treatment. "

The fact that the disease is associated with low income earners presents more

hurdles to health workers and the Government because the process becomes more

difficult.

" Most patients who develop MDR-TB are low income earners and in the initial

stages of treatment are too weak to even go to work, " says Dr Onyango. " Some are

even laid off and cannot get money for food yet they cannot take their

medication without a proper diet. "

The fight against TB is fought alongside the war against HIV and AIDS owing to

widespread co-infection with HIV. About 45 per cent of new TB cases in Kenya

result from HIV infection and pathologists attribute this to the low immunity

that patients develop when the body is attacked by the virus.

The Government has had to rely on donor funding to fight the disease and

although the inflows have been steady, the treatment budget keeps growing while

the funding gap widens even further.

Kenya's National Treatment Programme, (NTP) for the management of TB developed a

strategy in 2006 in line with global plan targets but whose budget requirement

remains a burden to the Government.

As at 2008, the NTP budget stood at Sh3.3 billion with a gaping deficit of over

40 per cent. Most of the budget is funded by global health partners like the

Global Fund with the Kenyan government providing only six per cent of the money.

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Not all is lost, however, and the Government has registered partial victory

against TB in the country. The Ministry of Health is up-beat that now, more than

ever before, the war against TB is close to being won.

Dr Sitienei is the head of the country's National Division of Leprosy, TB &

Lung Disease (DLTLD) under the Ministry of Health and is charged with the

responsibility of leading the drive towards kicking TB out of Kenya.

" Kenya has implemented all the six elements of the Stop TB global initiative and

we have gone further and are dealing with 15 key elements " , he says. " Because of

these measures the number of TB cases stagnated two years ago. "

Dr Sitienei, however, cautions that much more needs to be done to ensure that

the gains made against the disease are maintained.

" Yes, we have seen a decline for the first time since we started the programme

but if we do not sustain these efforts then the decline will not be sustained

and the disease will come back in a different and mutated form. "

ast year, three cases of extreme drug resistant XDR-TB were diagnosed in the

country. XDR-TB develops from mismanagement of MDR-TB and is virtually

untreatable. Two of the three patients have since died.

Dr Sitienei says the country needs modern diagnostic and treatment technologies

to eradicate the disease.

" TB is an evolving ailment and the old methods that were being used to fight it

may no longer be viable now and that is why we need to decentralise them.

Now there are new diagnostics methods in the market and Kenya is lucky to have

some of these facilities and clinical officers should make use of them. "

Last month the Government officially commissioned the first TB culture testing

centre outside Nairobi at the Kemri/CDC research centre in Kisumu County.

The lab manager, Albert Okumu. said decentralising TB testing centres would

improve the diagnosis and surveillance of the disease by cutting the turnaround

time.

" Medical workers in Nyanza Province will not have to send their samples to

Nairobi but will instead bring them to us.

Since we are nearer, they shall be able to run the tests and send the results

back to the patients and those that need treatment can be started on their

regimen immediately, " Dr Okumu said.

The opening of the facility at the Kisian Kemri branch came as a godsend to

health workers in the region who say early diagnosis and surveillance is key on

the agenda for the management of TB and MDR-TB.

" Initially, we had to send the samples to Nairobi for testing and this presented

a logistical nightmare for both the medical officers and patients, " says Dr

Onyango.

Share This Story

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" Sometimes it used to take months to get back results because the lab in Nairobi

handled samples from all over the country. "

This means patients had to wait longer to know their status and consequently

much longer before they were started on treatment.

http://www.businessdailyafrica.com/Opinion+++Analysis/Drug+resistant+tuberculosi\

s+strains+healthcare+system+/-/539548/1331536/-/item/2/-/2kjqi5/-/index.html

[Guest guest]

Drug-resistant tuberculosis strains healthcare system

By line Sundayand Stella Cherono (email the author)

Posted Monday, February 20 2012 at 18:53

Every morning, Rodgers Owino, a plumber in Kisumu County, wakes up at cockcrow

to prepare for work. His morning routine is like that of every other average

Kenyan—he showers, gets dressed and eats breakfast.

But before leaving the house, Mr Owino has to wait for Ms Dorcas Omollo, his

State-appointed nurse, who promptly passes by every day at exactly 7:30 am to

ensure he takes the 17 tablets that have become part of his morning routine.

Rodgers is one of hundreds of patients in Kenya diagnosed with multi-drug

resistant TB— MDR-TB— and has been living with the disease for the last one

year.

Multi-drug resistant TB develops when patients become resistant to antibiotics

during or after treatment of regular tuberculosis.

The resistance develops when patients fail to complete their antibiotic course,

drug supplies run out or patients keep on forgetting to take their medication.

MDR-TB is transmitted from an infected person to a healthy one as readily as

drug-sensitive TB but is much deadlier, with a mortality rate of 80 per cent.

" I developed a cough and when it became persistent I went to the hospital where

they ran some tests on me and I was found to have developed TB in my left lung, "

recalls Mr Owino.

Thus followed an intense eight- month treatment period which patiently

endured in the hope that he would be cured and life would become normal again

..But this was not to be.

Three months after completing his treatment, he was back in hospital with the

same symptoms. That was when doctors realised something was wrong.

After several months, tests and observations, Mr Owino was diagnosed with MDR-TB

and soon after placed on medication.

Share This Story

Share

His story strikes a chord with most TB, MDR-TB patients and clinicians in the

country who have learnt to live with a disease that is seldom talked about

despite the huge financial and social burden on the individual, community and

the country at large.

Data from the World Health Organisation (WHO) shows that Kenya is 13th in the

world, among the top 22 countries which bear the heaviest brunt of TB. The

report further states that the country is fifth in Africa in prevalence of TB.

In addition, Kenya's TB burden is higher than that of Liberia, Zimbabwe and

Uganda; countries with lesser GDPs and less sophisticated health systems than

ours.

This is a strong indictment to the country's ailing public health sector which

is grappling with financial constraints that have affected staffing, equipment

and supplies in its health facilities.

The situation is made worse by the specialised and expensive treatment process

that MDR-TB patients, many of them low income earners, have to undergo.

MDR-TB treatment takes two long years with patients being subjected to highly

toxic drugs and injections while being carefully monitored to ensure compliance

with treatment.

Treating one MDR-TB patient costs bout Sh1.3 million and some physicians will

insist that these patients remain isolated at least for the first six months to

avoid infecting healthy people.

Dr Esther Onyango is the lead specialist at the New Nyanza referral hospital

where she works directly with TB and MDR-TB patients in Nyanza Province and

western Kenya.

She explained the challenges of dealing with MDR-TB: " Managing an MDR-TB is not

a normal treatment programme you'd give an every-day patient but takes a team of

no less than seven people over a period of two years, " she says.

" There is the dietician, clinician, nurse, public health personnel, lab

technician, pharmacist and a social worker. "

" Even before the patient is started on treatment, these people have to chart a

treatment programme that they are all going to stick to over the two -year

course of treatment. "

The fact that the disease is associated with low income earners presents more

hurdles to health workers and the Government because the process becomes more

difficult.

" Most patients who develop MDR-TB are low income earners and in the initial

stages of treatment are too weak to even go to work, " says Dr Onyango. " Some are

even laid off and cannot get money for food yet they cannot take their

medication without a proper diet. "

The fight against TB is fought alongside the war against HIV and AIDS owing to

widespread co-infection with HIV. About 45 per cent of new TB cases in Kenya

result from HIV infection and pathologists attribute this to the low immunity

that patients develop when the body is attacked by the virus.

The Government has had to rely on donor funding to fight the disease and

although the inflows have been steady, the treatment budget keeps growing while

the funding gap widens even further.

Kenya's National Treatment Programme, (NTP) for the management of TB developed a

strategy in 2006 in line with global plan targets but whose budget requirement

remains a burden to the Government.

As at 2008, the NTP budget stood at Sh3.3 billion with a gaping deficit of over

40 per cent. Most of the budget is funded by global health partners like the

Global Fund with the Kenyan government providing only six per cent of the money.

Share This Story

Share

Not all is lost, however, and the Government has registered partial victory

against TB in the country. The Ministry of Health is up-beat that now, more than

ever before, the war against TB is close to being won.

Dr Sitienei is the head of the country's National Division of Leprosy, TB &

Lung Disease (DLTLD) under the Ministry of Health and is charged with the

responsibility of leading the drive towards kicking TB out of Kenya.

" Kenya has implemented all the six elements of the Stop TB global initiative and

we have gone further and are dealing with 15 key elements " , he says. " Because of

these measures the number of TB cases stagnated two years ago. "

Dr Sitienei, however, cautions that much more needs to be done to ensure that

the gains made against the disease are maintained.

" Yes, we have seen a decline for the first time since we started the programme

but if we do not sustain these efforts then the decline will not be sustained

and the disease will come back in a different and mutated form. "

ast year, three cases of extreme drug resistant XDR-TB were diagnosed in the

country. XDR-TB develops from mismanagement of MDR-TB and is virtually

untreatable. Two of the three patients have since died.

Dr Sitienei says the country needs modern diagnostic and treatment technologies

to eradicate the disease.

" TB is an evolving ailment and the old methods that were being used to fight it

may no longer be viable now and that is why we need to decentralise them.

Now there are new diagnostics methods in the market and Kenya is lucky to have

some of these facilities and clinical officers should make use of them. "

Last month the Government officially commissioned the first TB culture testing

centre outside Nairobi at the Kemri/CDC research centre in Kisumu County.

The lab manager, Albert Okumu. said decentralising TB testing centres would

improve the diagnosis and surveillance of the disease by cutting the turnaround

time.

" Medical workers in Nyanza Province will not have to send their samples to

Nairobi but will instead bring them to us.

Since we are nearer, they shall be able to run the tests and send the results

back to the patients and those that need treatment can be started on their

regimen immediately, " Dr Okumu said.

The opening of the facility at the Kisian Kemri branch came as a godsend to

health workers in the region who say early diagnosis and surveillance is key on

the agenda for the management of TB and MDR-TB.

" Initially, we had to send the samples to Nairobi for testing and this presented

a logistical nightmare for both the medical officers and patients, " says Dr

Onyango.

Share This Story

Share

" Sometimes it used to take months to get back results because the lab in Nairobi

handled samples from all over the country. "

This means patients had to wait longer to know their status and consequently

much longer before they were started on treatment.

http://www.businessdailyafrica.com/Opinion+++Analysis/Drug+resistant+tuberculosi\

s+strains+healthcare+system+/-/539548/1331536/-/item/2/-/2kjqi5/-/index.html