In 2008, Mercy Wanjiru (not her real name) started experiencing a persistent cough, chest pain and fever, which was accompanied by night sweats and weight loss.

With little information about what was ailing her, she sought medical advice and had her sputum tested to check whether she had pulmonary TB.

After taking her medication for six months she underwent a test to ascertain she was clear of the infection.

However, in 2014, Wanjiru started experiencing a burning sensation when passing urine, a frequent urge to urinate, and sometimes severe pain in the abdomen.

“I would get severe pain which often led to vomiting, and anytime tests were done, they always revealed a Urinary Tract Infection (UTI), an infection in the urinary system often caused by bacteria,” she recalls.

Wanjiru narrates that her trips in and out of the hospital often revealed a recurrent UTI, which was often treated by antibiotics. In 2019, after many visits to the hospital with little positive treatment, Wanjiru decided to have tests done at Lancet for a non-sputum diagnosis just to find out what exactly was ailing her.

“The urine tests conducted were split into three; one was meant to show results after two days, two weeks and two months respectively. Luckily, I did not have to wait for that long for the results to be released,” she says.

The results revealed Wanjiru had TB of the urine, scientifically known as genitourinary tuberculosis (GUTB) that involves the urinary tract or genital organs because of the hematogenous spread of chronic latent pulmonary tuberculosis.

Wanjiru immediately started her six-month medication. However, this was not the end of it because in 2020 the symptoms recurred and this time urine would just flow.  “This time it was worse because I could not hold urine so in case I was leaving the house I would often use adult diapers which would help me stay for long without soiling myself,” she says.

Health burden

Wanjiru recalls that she was constantly fighting the battle of this health burden that was slowly consuming her and still hoped that a solution would come out of it.

“I constantly wondered why I was facing so many problems with this particular TB. I often visited a urologist to try to identify the problem it proved futile,” she recalls.

She then resorted to seek further treatment at Kenyatta National Hospital. She received a shocking diagnosis, she had a blockage in one of her kidneys.

“After the tests of having a blocked kidney with only one functioning doctors advised that I undergo a minor surgery where they inserted a catheter to aid in controlling the urge to urinate,” she says.

Wanjiru believes an earlier diagnosis would have helped in dealing with the TB before it advanced to attacking her organs.

“Dealing with post-complications of TB has taken a toll on me emotionally, psychologically, and mentally. I have had to deal with stigma, especially from friends and family because I have to put on diapers, especially if I have to go somewhere for long,” she says. According to World Health Organisation (WHO), close to 28,000 people fall ill with TB daily. Despite the significant progress made so far, TB is still a major public health problem globally.

WHO findings have shown that global efforts to combat TB have saved an estimated 66 million lives since 2000.

However, the Covid-19 pandemic reversed years of progress made in the fight to end the disease and for the first time in over a decade, TB deaths increased in 2020.

According to an annual report by National Tuberculosis, Leprosy and Lung Disease Programme (NTLP) In 2021, the incidence of TB was estimated to be 140,00 indicating that at least 44 per cent of cases were either missed or not notified in the year.

In addition, the country reported a total of 77,854 drug-sensitive tuberculosis (DSTB) cases during the same period. This presented a 6.7 per cent increase compared to 2020 when the country notified 72,943 DSTB cases.

NTLP further showed that in 2020, TB was the third highest cause of mortality in Kenya having killed an estimated 32,000 people compared to 2,092 due to Covid.

On September 26, 2018, former President Uhuru Kenyatta was honoured to be part of the first-ever high-level meeting of the United Nations General Assembly (UNGA) on TB where he committed that Kenya will strengthen strategies and investments to end TB.

Among the strategies was the establishment of an in-country Multi-Sectoral Accountability Framework for ending TB. To assert the involvement of all stakeholders in the fight against TB in line with the commitments under our Constitution, and the Sustainable Development Goals (SDGs) concerning Universal Health Coverage, the Ministry of Health, through the National TB Programme, will soon launch the framework as the country strives to end TB by 2030.

According to Dr Sam Muga, Deputy Chief of the Party, USAid CHS, TB ARC II project new tools in control offer a new opportunity to reach those who have not been reached or treated with TB.

He explains that now unlike before, X-rays are part of the triage phase where radiographic imaging produces an image of the internal structures of the lungs that enable medical professionals to identify any lung abnormalities that may be suggestive of TB.

Black space

“On the chest X-ray images, air in the lungs appears as black space, and lung abnormalities such as lesions caused by TB appear as grey or white shadows,” he explains.

He adds that although such abnormalities may also be suggestive of other diseases such as pneumonia, further testing is required. Another notable tool that can help us achieve the United Nations High-Level Meeting  targets for TB control is the use of digital adherence technology.

Dr Muga explains that for the successful fight against TB, it is important for healthcare providers to follow and support the patient journey as well as identify and prioritise people who require more support in completing their treatment.

“Digital Adherence Technologies (DATs) are digital tools that utilise mobile phone, computer, web-based and/or electronic sensor technology to support the capture of daily detailed patient-specific adherence information,” the medic explains.

He says these technologies help to support people affected by TB with their treatment in a modern and effective way. They help empower TB-affected individuals and their families to take their daily medication at a time and place that suits them best, rather than relying on the traditional approach for monitoring adherence through directly observed treatment. 

Another way of attaining the UNHLM targets is by the use of TB vaccine.

 According to John Omollo, Senior Policy and Advocacy Officer, PATH, explains that for us to reach the last mile as a country we need to ensure maximum vaccination.

“BCG wears off with age, therefore, it is good for an adult to get vaccinated to stop latent TB from developing into active TB. We need to ensure that most adults are vaccinated because they are the leading number of transmitters of TB,” he says.

On her part, Stop TB partnership Kenya National Coordinator Evelyn Kibuchi, explains that community involvement in ensuring advocacy is key, this means everyone has a role to play in ensuring we end TB in the country.

“Multi-sector involvement is through ensuring TB-affected families have access to TB or poverty-related benefits or TB-specific benefits using outreach workers,” Kibuchi explains.

She adds: “Reducing overcrowding improves the nutrition and screening of detainees and prisoners. Housing and food security and health screening for refugees internally displaced persons.”

This year, the high-level meeting aims to strengthen accountability by the Ministry of Health, through NTP, as well as multi-sectoral partners and stakeholders at national and county levels to accelerate progress to end the TB epidemic by 2030.