On March 24, the Ministry of Health supported by various health partners officially disseminated findings of the recently concluded, first post-independence National TB Prevalence Survey. The first TB prevalence survey in Kenya was done in 1958-1959.
The dissemination of findings was done during the commemoration of World Tuberculosis (TB) Day, marked every year on March 24. The World TB day is designed to increase public awareness that TB remains an epidemic in much of the world and a major public health problem in Kenya mostly affecting the poor and socially disadvantaged. This year’s theme was ‘Mulika TB Maliza TB! Unite to End TB for a TB Free Generation.’
This survey commenced in July 2015 with the objective of assessing the associated health seeking behavior of TB patients and those reporting TB symptoms, as well as inform the country’s planning and policy formulation to end TB. The survey is the first globally to make use of a fully digital system for real-time data collection as well as the innovative GeneXpert technology for TB testing.
The survey was carried out in 45 out of the 47 counties in Kenya with 63,050 people being screened. All participants were engaged in a series of questions to ascertain if they experienced any TB symptoms, followed by a chest x-ray. Afterwards, they submitted sputum for laboratory analysis through microscopy, GeneXpert machine and culture.
The findings indicate that the burden of TB in Kenya is higher than previously thought. The prevalence survey revealed that there are 558 people with TB among 100,000 people compared to the World Health Organization (WHO) 2015 estimates, which showed that there were 233 people with TB among 100,000 people.
The findings of the survey will enable the country to obtain an accurate estimate of the TB burden and provide direction on the next steps for TB control. TB was found to be higher among young men aged between 25 and 34 years, urban dwellers, people without HIV and women over the age of 65. The findings highlight that close to 40% of the TB cases in Kenya go undetected and untreated. Considering that one undiagnosed and untreated individual can infect 10-15 people, this pool of missed people with TB continues to fuel the spread of the disease.
Speaking during the event, the Head of National TB Program Dr Enos Masini said, “This survey was specifically carried out in the community to provide us with the exact data on the burden of the disease in Kenya, but also to go further and find out which groups of people are affected by the disease and what would be the best strategies for us to reach them.”
The survey demonstrated that the use of cough of any duration or any of the TB related symptoms and chest x-ray for screening leads to a higher rate of TB detection. The Cabinet Secretary for Health, Dr Cleopha Mailu in a statement said, “In light of these results and in an effort to find the missing TB cases, the Government commits to: ensure that TB is part of the evolving universal health coverage/social protection schemes and make TB diagnostics accessible where patients seek care by expanding the use of Chest X-ray to screen all persons presumed to have TB and make GeneXpert the first diagnostic test for all presumed TB cases.”
The missing cases were said to be among people in the community with non-severe symptoms, and therefore not seeking care. Others include people at work, school, home or clinics who are presumed not to have TB and hence not screened, as well as individuals seeking care for TB symptoms, but who do not get diagnosed.
The Senior Researcher at Kenya Medical Research Institute (KEMRI) Dr Jane Ong’ang’o, who was also the survey coordinator, while addressing the challenge of missing cases said, “We need to invest in communication so that we can effectively inform the public about TB symptoms to enable us widen the scope of screening and reach out to the missing cases in the community.”
With these findings there is need for an increased TB budget. Addressing the funding, United States Agency for International Development (USAID) Tuberculosis Accelerated Response and Care (TB ARC) Activity Manager Dr Maurice Maina assured USAID commitment to TB control. “We shall ensure TB funding is enough and identify funding gaps to ensure that the missed cases are known and that the TB burden in Kenya is reduced,” he said.
USAID funded TB ARC Activity supported the prevalence survey logistics including fleet management for all the teams and provided communication technical assistance. TB ARC further supported the midterm review of the prevalence survey in collaboration with other partners and the end of data collection workshop.