Tuberculosis in Kenya

Essay 2012 5 Pages

Medicine - Epidemiology


The Republic of Kenya is a third world country located in East Africa and has a number of issues (health and otherwise). Kenya is poor in terms of its economics; it is a low income developing country where agriculture sustains 80% of the people; relying on maize as its chief food crop and coffee and tea as the main cash crops (Kenya 2008). Kenya’s multiparty democracy and strong central government allows healthcare officials and researchers to communicate with them. However, Kenya has trouble providing adequate healthcare for its population. One of the health issues that Kenya must concern itself with is Tuberculosis and this can present itself with other medical conditions as well, such as HIV.

Tuberculosis infected 9.4 million patients in 2009 and nearly 14 million people are living with the disease worldwide. Kenya is one of the 22 World Health Organization defined high burden countries where 80% of the world’s burden for TB exists; it is 13th amongst the 22 high burden Tb countries (Billingsley et al. 2008). Tb is underreported; furthermore, Tb-related morbidity, mortality and drug resistance are expected to increase (Ayisi, Hoo, Agaya, Mchombre, Nyamthimba, Muhenje and Marstonn 2011 ). The Estimated number of new Tb cases in Kenya is around 130,000 (Infectious Diseases, Kenya, 2009). Estimated Tb prevalence in Kenya is around 300/100,000 (Infectious Diseases, Kenya, 2009). From 2006 to 2009, the total number of newly registered Tuberculosis patients reported each year decreased 5% from 115,234 to 110,015. Kenya has experienced an increase in TB detection rates from 51 to 320 per 100,000 between 1987 and 2004 (Billingsley et al. 2008). The Tb case detection rate is the number of incident TB cases in a given year (Mansoer, Schecle, Floyd, Dye, Sitiene, and Williams 2009).

Tuberculosis is caused by the bacterium Mycobacterium Tuberculosis (Basic TB Facts 2012). Mycobacterium Tuberculosis usually attacks the lungs, but it can also attack the kidneys, spine and brain. Tb is spread via air contact/droplets; person with Tb can spread it by coughing, sneezing or speaking; it is not spread by touch (Basic TB Facts 2012).

In order to formulate a plan to deal with Tuberculosis in Kenya, I followed what was done in the past. The plan would be to learn as much about the disease process and the disease in Kenya first and then figuring out what resources are needed (partially by contacting organizations) and partly by looking at previous research. Then it would be necessary to diagnose the disease, educate the public and actually treat cases of the disease, paying attention to any health, social and political repercussions.

The first step would be gathering information and knowledge of the disease in certain regions of Kenya. It would be important to know what information can be gathered and which cannot and how to go about gathering that knowledge . Electronic databases can be used to gather this information.

The next step would be figuring out what resources (monetary and otherwise) would be necessary to treat and prevent Tuberculosis. There are multiple sources of care available for Tuberculosis and there are also problems with access and affordability (Ayisi et al. 2011). There are private facilities that charge fees for service, but they were not selected; the focus here is on the public sector (Mauch et al. 2011). Issues to be considered with having public facilities active and available are costs for diagnostic tests and costs for treatment, administrative charges (personnelle need to be hired), medicines taken for TB symptoms, transport to and from health facilities, food and supplements and accommodation costs (Mauch et al. 2011).

After that it would be necessary to educate the public. One of the issues related to Tb is that patients are unsure about the causes of Tb; some examples of what Kenyans thought caused Tb are alcohol, certain drinking water, sharing utensils and physical labor (Ayisi et al. 2011). Education is necessary to dispel myths and spread knowledge about Tb, but it should be noted that popular and folk beliefs of the patients are mixed in as well and there are “therapeutic narratives” where people assign person and social meaning to illnesses; the health beliefs may come from the professional health sector, popular sector or social sector (family and friends) (Ayisi et al. 2011).

The public should be diagnosed and we should understand the disease ramifications. It is difficult to measure the incident of TB disease directly. Significant progress has been made in TB control over the last 10 years and again it is often studied with concurrent infections; almost all patients are also tested for HIV (Mansoer et al. 2009).

There is a social stigma associated with Tb even though patients in Kenya have reported that those around them did not treat them differently. Defaulting from treatment is also a problem because there is a lack of knowledge/misconception about the duration of Tb treatment; patients have stopped taking the treatments because they felt the treatments lasted too long (Ayisi et al. 2011).

After that, the next step would be to test and treat the public. A patient should get tested for Tb if they are or have been 1) exposed to Tb patients, 2) Immunocompromised, 3) show signs and symptoms of Tb or 4) use illegal drugs. A full diagnosis of Tb is made via a) Medical History, b) Physical Exam, c) Tb injection test, d) Chest radiograph and e) Lab tests . 2 kinds of tests are used: TB skin test (TST) and TB blood tests (Testing for TB Infection 2011). A positive test indicates that a person has been infected; it does not indicate whether the person has latent TB infection or has progressed to TB disease. The TB skin test is the Mantoux skin test in which a small amount of fluid (called Tuberculin) is injected into the skin into the larger part of the arm (Testing for TB Infection 2011). Tb blood tests measure how the immune system reacts to the bacteria that cause Tb.



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Title: Tuberculosis in Kenya