On Saturday, October 1, just three days after the official launch of the child-friendly TB medicines in Kenya, Ivanna a 10-month-old child was fortunate to be among the first children in the country to be put on the improved medicines for the treatment of TB in children. Although she may be unwell, she still has a reason to smile. The improved medicines easily dissolve in water and are pleasantly flavoured thus Ivanna enjoys taking it. “She appears very willing to take the medicine, often licking her lips to the last drop,” says her mother who is equally excited.
Ivanna’s mother goes on to narrate how her daughter developed TB in a story that is common among a number of TB patients. At seven months of age, Ivanna experienced a blocked chest and weight loss. The once healthy baby was also sweating heavily at night that whenever her mother put her to sleep in her baby cot, she would often leave the sheets soaked. She was taken to a nearby health facility and put on antibiotics. However, she did not improve and was admitted for further examination. She was later diagnosed with severe pneumonia one month after being discharged from hospital and readmitted.
This bothered her mother forcing her to seek better treatment at Baraka Clinic in Mathare, Ruaraka sub-county. Here, she was examined by the paediatrician and referred to the facility’s TB clinic. After having an x-ray taken, she presented with pneumonia and rickets symptoms and was put on antibiotics and asked to go back to the facility after two weeks for re-examination. She did not improve and upon further examination, she was diagnosed with TB and immediately put on treatment.
Ivanna’s family hails from a less privileged background in one of Nairobi’s informal settlements. This is one of the contributing factors of developing TB especially among children as TB affects populations living in densely congregate settings. “Ivanna contracted TB from her environment as after taking the history, there was no one in her household who had been diagnosed with TB,” said TB Nurse Wendy Gatwiri.
She proceeds to explain how she often gives all her patients health education information about TB whenever they visit the clinic. “Here in the urban villages, TB is very common and therefore, we always ask all patients to keep their houses well ventilated and practice cough hygiene so as not to infect others.” Nutrition guidance is also very vital so as to achieve the desired treatment results more so among children.
Wendy narrates that with the improved medicines, there is renewed hope as the pill load is reduced and patients will have less confusion during the calculation of pills as they used to. The TB nurse says that the news about the child-friendly TB medicines is some of the best she has received in her four-year experience as a TB nurse. She adds that she once diagnosed a two-month old infant and taking her through the previous treatment regimen was very disturbing and sad. Without the fixed dose, it was hectic to approximate the dosage especially for children weighing below two kilograms.
Another major challenge was switching from the intensive to continuation phase of treatment, as some caregivers would not return the remaining pills in the intensive phase dose. Once introduced to the continuation phase, they could not differentiate between the two pill combinations. However, this has since been resolved as there is a better and quick understanding of the dosage. It is also going to be easier for health care workers to give health talks concerning the medicines. Further, in the absence of the TB Nurse, it will be easier for another health care worker to relieve them and give TB medicines correctly.
Pharmacists will also find it easier to order for medicines, as the formulation is in a fixed dose. It will also be easy for them to distribute, as they do not have to keep matching the combinations.
These Fixed Dose Combinations (FDCs) are not new, but are improved medicines that are simple for providers and parents to administer, and easy for children to take. They are made to dissolve in water in just a few seconds. This means children will take fewer pills that taste better, simplifying and improving the treatment journey.