Tuberculosis

Kenya continues to step up the fight against major communicable diseases that are of public health concern including Tuberculosis and HIV. In 2020, the country updated its Latent TB Infection (LTBI) management guidelines to be in line with the most recent WHO guidelines Incorporating an expanded population and shorter treatment regimens.
Most counties continued to implement strategies to find missing cases including active
case finding and Public-Private Mix (PPM).

TB Annual Report (2020)

The year 2020 was the most challenging in the recent history as far as public health is concerned. COVID-19 which was first reported in the country in March 2020 resulted in unprecedented response to contain and minimise the effects of the pandemic in the country.

In 2020, there was a 15% estimated reduction in TB case finding, largely attributable to the pandemic and subsequent responses. Lab diagnosis for TB also went down, negatively affecting case finding. 75 TB patients were reported to have been diagnosed with COVID-19 in the year.

TB notification decrease between 2016 and 2020
15.7% decline in drug-susceptible TB
Approximately 140,000 people fell ill with TB in 2020
Only 72,943 people were diagnosed & treated

Case Notification Rate

Map of Kenya showing TB case notification rates across 47 counties in 2020.

DR TB Case Finding Trends

The trend of drug-resistant TB cases in Kenya, 2006 – 2020.

  • Cases Reported

Age distribution

Age groups 20 – 44 reporting more cases.

  • Male
  • Female

In 2020, 66% of DS TB cases notified were men, who were mostly within the 20-44 year age-group.

Paediatric Tuberculosis

Childhood TB continues to be a recognized global public health problem. Children are infected either directly from an index adult case or from reactivation of latent TB. The predisposing factors include: under-developed immunity, congested living conditions, malnutrition, congenital heart diseases, chronic deprivation and HIV disease among others.

Case Finding – 8%
HIV testing – 96.1%
Treatment success rate – 88.6
Co-infection rate – 14.4%

TB HIV Comorbidity

HIV testing among the notified TB patients was 98%, with 9 counties recording 100% testing rate. These counties are as follows: Elgeyo Marakwet, Homa Bay, Kakamega, Kisii, Kitui, Laikipia, Mandera, Nyamira and Trans Nzoia. HIV testing was similar among males and females but higher among adults at 98.6% as compared to children at 96.1%, there is need to scale up HIV testing among children

Kenya HIV Co-infection Rates (25.2%)

The TB-HIV co-infection rate was 25.2%, a drop from 26% in 2019, however the positivity rate among the females was higher at 32% as compared to the males which was at 21%.

In addition, the HIV positivity was 26% among the adults and at 14% among the children. ART uptake among the co-infected patients was at 97% with Homa Bay county reporting 100% ART uptake.

Latent Tuberculosis Infection (LTBI)

The management of latent TB through the use of TB preventive therapy (TPT) among the at-risk populations is a key strategy to ending TB by 2035. In 2020, the Ministry of Health launched the LTBI policy and thereafter developed the guidelines on management of Latent TB infections to be used by health care workers.

The number of under-five child contacts initiated on TB preventive therapy was 8803 (61%) against a target of 14,445 (A-third of the bacteriologically-confirmed pulmonary TB cases notified). The improvement compared to the uptake in 2019 of 49% is attributed to sensitisations among health care workers on the need to screen contacts and initiate those eligible on TPT. There is need, however, to scale up this intervention to ensure that all children exposed to bacteriologically-confirmed cases are screened for TB and subsequently initiated on TPT when found to be negative.

  • Proportion of children contacts initiated on TPT (%)

Treatment Outcomes for Isoniazid Preventive Therapy

Among the under five children initiated on TPT in 2019, those who completed therapy successfully were 6467 (76.4%). This was a drop compared to 2018 where the treatment completion was 81%. One of the challenges experienced in the year was stock out of commodities.

  • Treatment completed - 81%
  • Died - 0.1%
  • Discontinued - 1.1%
  • Lost to follow up - 1.9%
  • Not Evaluated - 16%

Isoniazid preventive therapy outcomes (2018 cohort) for under 5yrs

Distribution of Diagnostic Services in Kenya

The country uses AFB microscopy, GeneXpert and culture in the diagnostic algorithm to be able to diagnose and do surveillance to support TB control. Below are maps showing the placement of all these diagnostic tools in the country.

Nutrition

In 2017, the NTLD-P conducted a TB Patient Cost survey that indicated that between 27.1% and 53.7% of TB affected households experienced food insecurity. Additionally, the high cost drivers among the DR-TB patients were largely attributed to nutritional supplement while among DS-TB patients, the main cost drivers in order of cost were hours lost, nutritional supplements and direct medical costs.

In 2020, 45.4% of the notified 72,943 cases of TB and 53.9% (521/961) of drug resistant TB cases were undernourished at the time of diagnosis. Key limitations in nutrition management of TB patients with malnutrition include:

  • Knowledge gap among HCWs on importance of nutrition assessment and management
  • Unsteady supply chain management leading to untimely procurement of nutritional supplements which affected provision of nutritional support to TB patients in 2020.

 

Current Risk

Why did we make Tuberculosis a focus area as an organization?

Notification rates of cases of tuberculosis (TB) in Kenya have increased six-fold in the past 15 years, largely as a result of the impact of the human immunodeficiency virus (HIV) on the disease, presenting substantial challenges to control of the disease. During this time, the coverage and quality of the national TB control programme (NTP) greatly improved, also contributing to the increased case notification rates.

TB Symptoms

The symptoms could be a combination or all of the following. Please seek medical attention should you experience these symptoms. Note that the symptoms are only used as a guide and test need to be done by a medical prationeer to ascertain whether or not a patient is suffering from TB.

Cough

A bad cough for about 3 weeks or longer

Fever

this is the short description

Weight loss

this is the short description

Chest pains

this is the short description

Drenching night sweats

this is the short description

Haemoptysis

Coughing blood stained sputum

Failure to thrive (In Children)

this is the short description

Lethargy (In Children)

Meaning a pathological state of sleepiness or deep unresponsiveness and inactivity

TB FAQs

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Is TB treatment free in Kenya?
Who is most at risk of getting tuberculosis?
How do TB symptoms start?
What are the TB symptoms?
Does Tuberculosis stay in your system forever?
Can you get TB if you are vaccinated?
Can you get TB twice?
Can TB be cured a second time?
Can I conceive after taking TB treatment?
What happens if my child has TB?
Is TB treatment free in Kenya?

TB treatment is fully subsidized by the MoH and is therefore free of charge for all persons seeking treatment in public health facilities countrywide.

Who is most at risk of getting tuberculosis?

In Kenya, the very young (<5years) and the elderly (>65years) are most at risk. However, the most affected age group is the reproductive age group (15 – 44years) where men are more affected than women. Additionally, key populations have been identified who include miners, people who inject drugs and those in congregate settings.

How do TB symptoms start?

The commonest initial symptoms of TB include fever and cough. These are usually low grade and most times are perceived as not serious. This is the reason that most TB cases are diagnosed after a prolonged period of illness.

What are the TB symptoms?
  1. Cough
  2. Fever
  3. Weight loss
  4. Drenching night sweats
  5. Chest pains
  6. Haemoptysis (Coughing blood stained sputum)

Additional symptoms/ signs in children.

  1. Failure to thrive
  2. Lethargy
Does Tuberculosis stay in your system forever?

No. Tuberculosis is a bacterial infection. Most people who are infected with tuberculosis do not exhibit any symptoms and can remain in a state of latent infection with TB. For those who progress to develop symptoms, the TB disease can resolve without any treatment in ~30%. Once treated though, Tuberculosis is completely curable and treatment clears all bacteria from the system.

Can you get TB if you are vaccinated?

Yes. One can contract TB even after vaccination. The vaccine for tuberculosis (BCG) protects children against severe forms of the disease (CNS and TB pericarditis)

Can you get TB twice?

Yes. TB is an airborne infection spread by droplets from an infected person to a susceptible host through speech, coughing, singing and sneezing. Due to this mechanism of spread, it is possible to be infected again after successful treatment. This is the reason why all contacts of confirmed TB cases are routinely screened and tested for TB to prevent re-infecting those who are treated.

Can TB be cured a second time?

Yes. TB can be cured as many times as one is infected. However, for those who have been previously treated, it is mandatory to exclude resistance to any of the anti-TB medicines.

Can I conceive after taking TB treatment?

Yes. In most instances, tuberculosis does not affect fertility. TB treatment does not affect fertility and it is important to inform your health worker if you are on hormonal contraception. The TB medicines could affect the function of these contraceptives leading to unplanned pregnancy.

What happens if my child has TB?

Any child with TB can be treated at any public health facility for free. Kenya has introduced baby-friendly formulations of first line anti-TB medicines. This has ensured that it is possible and easy to treat all children with TB. Children tolerate medicines much better than adults.

TB Myths Vs Facts

MYTHS FACTS
If I have TB, do I also have HIV NO. HIV increases one’s chance of getting TB. However, one can have TB without HIV
Can TB be inherited? NO, it is not inherited. TB can only be spread through to close members of the same family living together, when the person coughs, laughs, sneezes, sings or spits. TB may occur in close family members because of close proximity but not because of inheritance.
Is TB a result of witchcraft? NO, it is not. It is caused by a germ (bacteria)
Is TB a curse? NO, it is not. It is a disease caused by a bacteria and is treatable and curable
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