Photo Credit I MESHA
By Joyce Chimbi I j.chimbi@gmail.com
His grandmother’s house in the village was by the roadside. People would pass by on their way to a nearby health center and his grandmother would comment that they not only had tuberculosis (TB), but were also HIV positive.
Years later, Walter left home in the lakeside Nyanza region of Kenya in search of greener pastures in the capital Nairobi. The big break did not come fast enough and he found himself at the heart of Kibra, an informal settlement, where he shared tiny room with two other men.
“I fell ill in 2015 and it was clear that something serious was eating my body. A community health worker told me I most likely had TB and needed to go for testing. A friend told me I must have been bewitched and introduced me to a herbalist. I only got worse,” he said during a media science cafe attended by TB care champions, scientists, activists, and Media for Environment, Science, Health and Agriculture (MESHA) journalists.
“I did not want to go to hospital because I remembered what my grandmother said about people with TB; that they also had HIV. When my situation worsened, I went to hospital and tested positive for TB. I was however HIV negative. I was treated and two months later, I recovered,” says Walter.
TB is preventable and curable, but remains a deadly infectious disease and a serious public health crisis in Kenya. It affects at least 120,000 people annually in the country.
The disease was the leading cause of mortality from a single infectious agent long before COVID-19. It is among the top five leading causes of death in Kenya. It accounted for 3.2 per cent of all deaths in 2020. The Ministry of Health estimates that the burden of TB is 426 cases per 100,000 people.
To subdue TB as a health crisis, experts such as Prof Jeremiah Chakaya, the Respiratory Society of Kenya (RSK) CEO, says there is dire need for a gendered approach.
“TB is higher in men than women. This trend however varies across ages. From 0 to 14 years, there is a near match between men and women. The point of divergence occurs at puberty where more men begin to present with TB and this continues until age 65, where the convergence that we had between 0 to 14 years, recurs,” he says.
The RSK is part of LIGHT Consortium, which aims to leave no one affected by TB behind in the sub-Saharan Africa. With a programme themed leaving-no-one behind, the six-year cross-disciplinary global health research programme funded by UKAaid, and led by LSTM in collaboration with partners in Kenya, Malawi, Nigeria, Uganda, and the UK, LIGHT will support policy and practice in transforming gendered pathways to health for people with TB in urban settings.
According to the consortium, gender plays a significant role in determining health outcomes, “including equitable access to quality TB prevention and care”.
It says “people of different genders face different challenges, thus require tailored solutions to access the care they need”.
Statistics presented at the science café showed men constituting over half (56.5 per cent) of the people with TB globally in 2021, compared to 32.5 per cent adult women and 11 percent children. It showed two out of every three cases of TB that went undiagnosed or not notified were in men.”
The LIGHT consortium therefore aims to “contribute to real-world change through generating new evidence to inform policies that are gender-responsive and effectively actioned to improve male access to quality TB care; reduce the number of people with TB-related ill health and deaths; reduce transmission to the wider community, including to women and girls; and reduce devastating associated costs for those with TB and their families.”
Photo Credit I MESHA
Addressing TB in men is therefore critical, especially due to their habit of not seeking health related help until it is too late sometimes. As a result, two-thirds of all TB transmissions are from men to others. Men also drop out of treatment at a much higher rate, making them a risk to their families,” he adds.
Research shows children in the care of TB-infected persons are at particularly high risk of infection and developing severe and often fatal forms, including TB meningitis and miliary TB since babies and young children have weak immune system.
TB is caused by bacteria and is spread from person to person through air when an infected person coughs, sneezes, speaks, or sings. The World Health Organisation (WHO) ranks Kenya among the 30 high TB burdened countries that together account for more than 86 per cent of the world’s TB cases.
Kenya is also among 14 countries globally to have appeared in all three lists of high-burden countries for TB, TB/HIV, and Multi-Drug resistant TB (MDR-TB). Each category or list includes 30 countries, which represent 86 per cent to 90 per cent of the global TB, TB/HIV, and DR-TB burden respectively.
MDR-TB is so infectious that it has been described as Ebola with wings. The burden of the disease is so high that an estimated 62.5 per cent of drug-resistant TB patients in Kenya lose jobs due to the disease.
“I sought leave from work when my TB treatment took two months. I lost my job when I remained absent for so long,” says Walter, who worked as a cleaner at Upper Hill, Nairobi.
Walter ticked many of the boxes that predispose people to TB infection; he lived in a typically congested informal settlement with poor ventilation. Besides, he was an alcoholic and unable to afford proper nutrition.
“An estimated 49 per cent of all TB cases suffer from malnutrition, which is also a pointer to unemployment. Fighting TB calls for an understanding of the contextual factors that hinder access to successful treatment for TB infection. Other factors are smoking and HIV. Due to immune deficiency, people with HIV are highly vulnerable to TB infection,” said Dr Leyla Abdullahi, a senior research and policy analyst at the African Institute for Development Policy (Afidep), which is also part of the LIGHT consortium.
She called for urgent gendered interventions and programming to ensure prevention and response programmes adequately address the nuances in TB infections, for some groups are more affected than others and one size solution will not fit all.
“Why are men more infected with TB? What specific measures are needed to ensure that factors that drive infections among men, as well as those that lead to them dropping out of treatment are addressed,” says Abdullahi.
This is not to say that men are to be prioritised but that programmes should identify drivers of TB infections across all groups and design interventions that are suitable, effective, and efficient for men and women with their specific needs in mind.
The Kenya Medical Research Institute, through its Centre for Respiratory Diseases Research, is working on two ground-breaking TB vaccines for adults and children. Over 1,500 participants in Nairobi and Siaya counties are enrolled in a BCG recombinant Phase III vaccine trial for infants. A Phase III vaccine clinical trial for adolescents and adults is also underway.
Photo Credit I MESHA
