Nairobi leads in new TB cases – study

Nairobi County accounts for one in every ten new cases of tuberculosis.

Delegates at the ongoing Kenya Medical Research Institute (Kemri) Annual Scientific and Health Conference in Nairobi heard that there is active community transmission for drug-resistant tuberculosis with more new cases being reported across the country.

“All counties recorded new cases except Lamu,” James Maragia, the County Medical Laboratory Coordinator, for Turkana and author of the study revealed in a new study that shows Nairobi accounting for 14.8 per cent.

In the study, Embakasi sub-county is leading with 5.1 per cent. The World Health Organisation (WHO) has categorised Drug-resistant tuberculosis (DRTB) a significant contributor to Anti-Microbial Resistance (AMR).

This is closely followed by Meru at 7.9 per cent, Mombasa and Embu tying at 7.1per cent and Nakuru with 5.4 per cent.

“We identified most cases at public facilities about 83.6 per cent, a few in private facilities (9.7 percent) and least in the prisons (1.8 per cent),” Maragia reveals in the cross-sectional study.

According to the WHO, about half a million people are falling ill globally due to AMR and affiliated risk factors.

Drug-resistant tuberculosis remains a major public health crisis, stakeholders within and outside the KASH conference seem to reach a unanimous conclusion.

A total of 2, 578 records were obtained from the Treatment Information from Basic Unit (TIBU) system.

“Of this, 1, 317 about 51.1 per cent, were from the new patient category. Males, an estimated 66.8 per cent aged 24-44, accounted for most DRTB cases,” the study revealed.

Death rate

The data was obtained from National Tuberculosis Program from all the 47 counties, with clinical and social-demographic factors being extracted from the TIBU for further analysis.

“An estimated 68.7 per cent of the DRTB cases were HIV-negative,” he revealed.

Nutritionally, patients with a Body Mass Index (BMI) of less than 18.5 accounted for most of the cases, with a proportion of 46.0 per cent, closely followed by people with normal BMI, at 44.1 per cent.

The data also shows increased Rifampicin resistance of 57.5 per cent and Isoniazid Mono resistance at 29 per cent over time.

Maragia pointed out that poor outcomes were recorded where the death rate stood at 9.1 per cent, the cure rate at 27.5 per cent and loss to follow-up at 3.1 per cent.

While reacting to the study, Stop TB Partnership Chief of Party for Kenya, Evaline Kibuchi noted that the results bring out a grave concern of AMR.

“What the results are showing is that many people are already resistant to antibiotics from “abusing” them, not completing doses, and underdosing among other aspects,” she told People Daily.

What this means, she said, is that there is need for scaling up public education on the dangers of misusing antibiotics, calling for criminalisation of over the counter non-prescription purchase of drugs.

“For example it should be criminal to dispense antibiotics over counter. There’s also need to strengthen guidelines on the use of antibiotics,” she said.

The country adopted three DRTB care delivery models, where most patients are on community ambulatory, adapted for walking at 70 per cent.

“In Kenya, the 2021 tuberculosis annual

report shows that most affected patients are new, a group that has never taken anti-tuberculosis drugs, an indication of active community transmission of the resistant strains,” the study reveals further.

Previous reports have also shown that DRTB is on an upward trend of 40 per cent despite the global picture showing a downward trend with a fall of 22 per cent.

“Therefore, the objective of this study was to share the characteristics and epidemiology of this vulnerable and forgotten group – the new patients – from the data spanning 2019-2021,” Maragia noted.

From the data, 2020 contributed the highest number of new DRTB cases at 39.4 per cent, while 2019 accounted for the lowest number at 25.1 per cent.

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