Tuberculosis still a threat to Coast residents
Harrison Kivisu
No doubt the coronavirus pandemic has directed focus away from the fight against the deadly Tuberculosis (TB).
Ranked fourth among the leading infectious diseases in the country, TB kills an average of 52 people daily in the country.
Along the Kenyan Coast, a dark shadow hangs over people infected with TB.
In Kakoneni Village in Lungalunga, Kwale county, a couple walks into Kikoneni Health Centre, located in Lungalunga for review and collection of their medication.
The duo has visited the hospital more than 10 times since February 2020. Their situation is slowly normalising, but the challenge is how their health has been compromised by lack of proper diet required by people with TB.
Alice Mwikali, 42, and her husband Pius Mbuvi, 56, are both infected with tuberculosis, albeit two different strains.
Alice has Multi Drug Resistance (MDR) TB and is under medication, while Pius has normal TB, but a reinfection.
“Our health has continued to be compromised due to lack of good nutrition, making it hard to fight the disease.
We feed on githeri, cassava and this is not the best nutrition for the disease. Accessing health services has been a challenge because we fear contracting Covid-19,” says Alice.
Pius is on the Drug Sensitive (DS) TB medication and is taking his daily dosage.
His life took a different twist in 2019 when he was first infected with TB. The duo say what started as a normal cough has now grounded their operations.
Despite being the sole breadwinner, Pius was forced to quit farming in the village.
The situation worsened in September 2020 when his wife was also infected with TB.
“I can no longer go to the farm because the doctor discouraged me from doing so.
My body has continued to weaken because of the daily drugs I take. Sometimes, I feel like absconding and then again, I remember I have a family to take care of,” Pius says.
Contact tracing
According to Lungalunga sub county TB Leprosy coordinator Peter Jilani, the facility, through the community health volunteers, is scheduled to undertake contact tracing including screening the couple’s children to effectively manage the disease.
The couple has further been advised to minimise their engagements to reduce chances of infecting others.
Jilani notes that it is possible the couple could have infected each other with the bacteria mutating in Alice to give her the MDR TB or she could have contracted it from some else with a similar strain.
TB is a bacterial infection caused by a germ called Mycobacterium tuberculosis, which usually attack the lungs, but they can also damage other parts of the body.
It spreads through the air when a person with TB of the lungs or throat coughs, sneezes or talks.
If you think you have been exposed, you should go to your doctor for tests as soon as possible. You are more likely to get TB if you have a weak immune system.
Jilani adds that it is possible to get re-infected just like in the case of Pius, thus precautionary measures are critical.
A few kilometers away, Zuwa Nyawa, 36, a resident of Vigurungani has been on medication for MDR TB since 2020.
Nyawa says what started as a normal coughing while working as a butcher at his workstation in Ukunda developed into full blown TB.
He got concerned when he coughed up blood several times, prompting him to quit his job and seek medication.
To worsen the situation, his family had to be separated from him after his diagnosis. The doctor prescribed 12 tablets per day for 18 months, a period for the recommended treatment.
For months now, the father of three had gotten a reprieve from the Sh6,000 stipend offered by Amref Health Africa every month for his nutritional support, money he is forced to share with his wife and children since he is still not working.
“I have been on medication for the last 10 months, my life really changed as all my family members have been separated from me to avoid infecting them.
Again considering I am jobless, my health was compromised as my diet is not as recommended by the doctor,” Nyawa said.
Drug adherence
According to Margret Dama, 52, a trained MDR TB champion tasked with peer education of patients in Kwale Sub-County Hospital says most of them, among them Nyawa, have been negatively impacted by the Covid-19 period. Many of them have their health compromised by the poor diets.
“In Kinagini, Ndavaya and Vigurugani villages when I make follow ups on TB patients, I ensure they adhere to the dosage, but what appears to be the biggest challenge is that most of the patients are economically challenged,” says Dama.
Data from Kwale county Tuberculosis and Leprosy officer Lawrence Tanui shows transmission of TB disease is on the rise, with recent 2020 statistics indicating 16 cases of MDR TB up from six in 2019.
The data also shows the county recorded six MDR TB cases in 2016, two in in 2017 and seven in 2018.
Kwale county records 1,200 cases per year, with Ukunda, Msambweni sub-county, Matunga and Lungalunga as the hotspots. Men aged between 25-50 years are the most affected.
“Patients also minimised visits to healthcare facilities to reduce the risk of acquiring coronavirus.
This may adversely affect TB diagnosis, adherence to treatment, management of side effects and treatment outcomes.
For instance, a person with persistent cough, which could be because of TB, may feel hesitant to go for health services due to fear and stigma associated with Covid-19,” he explains.
In Mombasa county, at the heart of Maweni village, Millicent Anna, 30, is struggling with TB.
In May 2020, the hairdresser began coughing and was soon diagnosed with TB. She has been adhering to drugs thanks to Kenya AIDS NGOs Consortium (KANCO) trained community health worker Caroline Kilavire, who has kept daily follow up on TB patients in Mombasa.
“I used to make Sh300 per day, but since I was diagnosed, the doctor discouraged me from going to the salon to avoid transmitting TB to my customers.
I have been on medication for the last four months now. And I have a three-year-old child. My child and I are forced to be on under medication,” narrates Anna.
Mombasa county TB case management advocacy champion, Norman Otieno, says some factors fuelling spread of the disease are ignorance, lack of adherence to treatment, delayed treatment, stigma, poor access to services, low levels of TB awareness and TB-HIV co-infection.
According to KANCO TB Campaign manager Rahab Mwaniki, children below age of 14 years are vulnerable, especially because it is hard to diagnose TB infection in them.
At least 39 per cent of all TB patients in the country are HIV-positive while the disease is most prevalent among the young and most productive, between 15 and 55 years.
She says the support from the Global Fund, beginning May this year has ensured the fight against the disesase during this pandemic continued.
She acknowledges that the fight against TB had been derailed by Covid-19, but through extensive interventions, stakeholders were keen to see the country achieve its health development goals towards ensuring a healthy nation.
“Fifty per cent of people living with TB are facing challenges in accessing health facilities, treatment and care; therefore we have interventions towards tracing them and ensuring they get good nutrition. This was facilitated through Amref Health Africa,” says Mwaniki.
