Tuberculosis in Kenya

A study aimed to assess the extent of pre-treatment loss to follow-up (PTLFU) among adults with pulmonary tuberculosis (PTB) in western Kenya and to identify associated patient factors. The research utilized a retrospective record review from January 2018 to December 2021, examining laboratory and treatment registers at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu. The population studied comprised adults (≥18 years) with bacteriologically confirmed PTB. This method proved suitable for determining PTLFU rates and associated factors, though it depended on the accuracy of recorded data and did not account for patient behaviors or external systemic influences.[1]

The study reviewed independent variables including demographics, contact information, residence, HIV status, TB history, diagnosis methods, and linkage to treatment. The primary dependent variable was the time from diagnosis to treatment initiation. The analysis found a PTLFU rate of 42.4% among the 476 participants studied. Significant risk factors included limited contact details, with those having only a physical address or a telephone number facing markedly higher odds of PTLFU compared to those with both types of contact information. Additionally, older adults (≥55 years) were more likely to experience PTLFU. Factors such as sex, HIV status, place of residence, and prior TB treatment did not significantly impact PTLFU after adjusting for confounders. The study concluded that a significant proportion of adults with PTB in western Kenya are lost to follow-up before treatment, with restricted contact details and older age being key risk factors.[1]

Another paper highlights that enhancing the screening of asymptomatic and latently infected individuals is crucial for decreasing infection transmission among susceptible populations. It posits that the most effective strategy for reducing tuberculosis (TB) transmission involves a combined approach of vaccination, screening, and treatment of all forms of the disease. Specifically, screening and treating all pulmonary tuberculosis forms is more beneficial than merely vaccinating and treating symptomatic individuals. The least effective method identified is treating only those who exhibit symptoms, which minimally curtails transmission.[2]

The study emphasizes the importance of focusing on latent infections and asymptomatic carriers. By screening and treating these groups, the development of pulmonary tuberculosis can be curtailed, significantly reducing transmission rates. Furthermore, managing the asymptomatic infectious population effectively decreases the spread of infections to susceptible individuals, further reducing transmission rates.[2]

Men face a disproportionately high burden of tuberculosis (TB) but often exhibit poor health-seeking behavior, leading to higher mortality and treatment failure. Structural barriers, such as the concentration of TB diagnostic facilities in urban areas and an overburdened healthcare system, further limit access, particularly for rural populations. Social stigma, cultural beliefs favoring traditional medicine, and weak governance also contribute to delayed treatment and poor outcomes. Additionally, TB policies in Kenya lack gender-specific interventions, and limited research funding prevents evidence-based policy improvements. Heavy reliance on donor funding further raises sustainability concerns for TB care programs.[3]

To address these challenges, targeted interventions should focus on gender-responsive TB strategies, decentralizing healthcare facilities, and implementing community-based anti-stigma initiatives. Strengthening collaboration between national and county governments, increasing domestic TB funding, and promoting evidence-informed decision-making are also crucial. Male-friendly outreach programs, such as screenings at social gathering places, can improve TB case detection and treatment adherence. By prioritizing these solutions, Kenya can enhance TB care outcomes and reduce disparities in treatment access.[3]

References:

1. Mulaku, M.N., Ochodo, E., Young, T. and Steingart, K.R., 2024. Pre-treatment loss to follow-up in adults with pulmonary TB in Kenya. Public Health Action, 14(1), pp.34-39.

2. Kirimi, E.M., Muthuri, G.G., Ngari, C.G. and Karanja, S., 2024. A Model for the Propagation and Control of Pulmonary Tuberculosis Disease in Kenya. Discrete Dynamics in Nature and Society, 2024(1), p.5883142.

3. Abdullahi, L.H., Oketch, S., Komen, H., Mbithi, I., Millington, K., Mulupi, S., Chakaya, J. and Zulu, E.M., 2024. Gendered gaps to tuberculosis prevention and care in Kenya: a political economy analysis study. BMJ open, 14(4), p.e077989.