Author: John AyisiAnna vant HoogJanet AgayaWalter MchemberePeter NyamthimbaOdylia MuhenjeBarbara Marston
Credits/Source: BMC Public Health 2011, 11:515
The two issues mostly affecting the success of tuberculosis (TB) control programmes are delay in presentation and non-adherence to treatment. It is important to understand the factors that contribute to these issues, particularly in resource limited settings, where rates of tuberculosis are high.
The objective of this study is to assess health-seeking behaviour and health care experiences among persons with pulmonary tuberculosis, and identify the reasons patients might not complete their treatment.
Methods:
We performed qualitative one-on-one in-depth interviews with pulmonary tuberculosis patients in nine health facilities in rural western Kenya. Thirty-one patients, 18 women and 13 men, participated in the study.
All reside in an area of western Kenya with a Health and Demographic Surveillance System (HDSS). They had attended treatment for up to 4 weeks on scheduled TB clinic days in September and October 2005.The nine sites all provide diagnostic and treatment services.
Eight of the facilities were public (3 hospitals and 5 health centres) and one was a mission health centre.
Results:
Most patients initially self-treated with herbal remedies or drugs purchased from kiosks or pharmacies before seeking professional care. The reported time from initial symptoms to TB diagnosis ranged from 3 weeks to 9 years.
Misinterpretation of early symptoms and financial constraints were the most common reasons reported for the delay.We also explored potential reasons that patients might discontinue their treatment before completing it. Reasons included being unaware of the duration of TB treatment, stopping treatment once symptoms subsided, and lack of family support.
Conclusions:
This qualitative study highlighted important challenges to TB control in rural western Kenya, and provided useful information that was further validated in a quantitative study in the same area.
http://7thspace.com/headlines/387782/care_seeking_and_attitudes_towards_treatment_compliance_by_newly_enrolled_tuberculosis_patients_in_the_district_treatment_programme_in_rural_western_kenya_a_qualitative_study__.html
Showing posts with label Tuberculosis statistics(Kenya). Show all posts
Showing posts with label Tuberculosis statistics(Kenya). Show all posts
Thursday, 7 July 2011
Thursday, 19 May 2011
TUBERCULOSIS: KENYA: For want of a mask – how TB targets health workers
NAIROBI, 17 May 2011 (IRIN)
Photo: David Gough/IRIN
Is a life-saving mask too much to ask?
A lab technologist at a government-run health facility in the Kenyan capital, Nairobi, recently took the last dose of his six-month course of tuberculosis medicine; he is fairly sure he contracted the disease at work.
"This is a big facility and we come into contact with many patients infected with TB - it is by no accident that I got infected," he told IRIN. "As health workers, we can't escape coming into contact with people with highly infectious diseases like TB because it is our work to help them."
Kenya ranks 13th on the UN World Health Organization's (WHO) list of 22 high-burden TB countries globally, and has the fifth-highest burden in Africa. According to WHO, the country has more than 130,000 new TB cases every year.
Safety equipment - including protective masks and proper waste disposal facilities - are rarely available in rural centres, something health workers say must be addressed urgently.
According to Victor Were, a clinical officer in western Kenya's Mumias town, over-crowded and poorly ventilated clinics pose a big risk to health workers.
"We don't have protective gear and only one hospital in Mumias has proper waste disposal facilities where they incinerate their medical waste," he said. "We have about 40 TB health workers in Mumias - we don't regularly screen them for TB, but last year four who presented with signs of the disease were tested and treated."
Were said the government urgently needed to address the issues of training health workers on risk reduction, provision of masks and ensure proper ventilation or even outdoor clinics to reduce the risk of infection.
"Many health workers are bogged down by heavy workloads and therefore even those who are infected [with TB] stay for long without treating themselves and by the time they do, they might have infected quite a number of people, including their colleagues," said Andrew Suleh, medical superintendent of Nairobi's Mbagathi District Hospital.
Supply chain problems
Government officials say problems with the supply chain and funding shortages are the main reason for the lack of protective gear.
"Health personnel cannot stop treating or offering services to patients even without these [safety] commodities and during that time, they risk getting infected by the very patients they treat, so it is [down to] us as the government to ensure facilities don't run out - at times stock-outs do occur and this is due to procurement challenges, which makes it hard to expedite the delivery of these commodities to health facilities," said Joseph Sitienei, head of the National Leprosy and TB Control Programme. "Sometimes health facilities delay in requesting these much-needed materials and only do so when they completely run out.
"One cannot ignore the financial challenges faced at times and they do lead to stock-outs, but we have seen increased funding to the health sector recently and I hope this will soon change for the better," he added. "What we have started doing is to make waiting areas in health facilities well ventilated, making the consultation rooms more spacious, and of course providing protective masks... the government is streamlining procurement and supply of commodities including protective gear to health facilities."
According to local NGOs, corruption within the health system is also to blame for the haphazard availability of medical supplies, with drugs often 'disappearing' from government health facilities and sold to private pharmacies by government pharmacists.
Sitienei noted that the risk of TB infection ran both ways between patient and health worker, and the government encouraged "frontline" staff such as nurses and lab technologists to regularly test for TB and if found positive, to seek treatment immediately.
"Also, availability does not always translate to use - we have to constantly sensitize personnel on the need to use the protective gear," he said. "To reduce stigma, it is also important - we have done this - to sensitize patients too on why those attending to them must have a mask, for example."
He said that to reduce health facility-related infection, isolation wards were being established in health centres that attended to large numbers of TB patients.
In November 2010, WHO, UNAIDS and the International Labour Organization launched international guidelines to protect health workers against HIV and TB. Among the recommendations were development and implementation of free regular TB and HIV screening, free HIV and TB treatment for infected health workers and the incorporation of training for all health workers on HIV and TB prevention, treatment, care and support into existing training programmes.
A Turkana boy herds his family's cows
http://www.irinnews.org/report.aspx?reportID=92736
Photo: David Gough/IRIN Is a life-saving mask too much to ask?
A lab technologist at a government-run health facility in the Kenyan capital, Nairobi, recently took the last dose of his six-month course of tuberculosis medicine; he is fairly sure he contracted the disease at work.
"This is a big facility and we come into contact with many patients infected with TB - it is by no accident that I got infected," he told IRIN. "As health workers, we can't escape coming into contact with people with highly infectious diseases like TB because it is our work to help them."
Kenya ranks 13th on the UN World Health Organization's (WHO) list of 22 high-burden TB countries globally, and has the fifth-highest burden in Africa. According to WHO, the country has more than 130,000 new TB cases every year.
Safety equipment - including protective masks and proper waste disposal facilities - are rarely available in rural centres, something health workers say must be addressed urgently.
According to Victor Were, a clinical officer in western Kenya's Mumias town, over-crowded and poorly ventilated clinics pose a big risk to health workers.
"We don't have protective gear and only one hospital in Mumias has proper waste disposal facilities where they incinerate their medical waste," he said. "We have about 40 TB health workers in Mumias - we don't regularly screen them for TB, but last year four who presented with signs of the disease were tested and treated."
Were said the government urgently needed to address the issues of training health workers on risk reduction, provision of masks and ensure proper ventilation or even outdoor clinics to reduce the risk of infection.
"Many health workers are bogged down by heavy workloads and therefore even those who are infected [with TB] stay for long without treating themselves and by the time they do, they might have infected quite a number of people, including their colleagues," said Andrew Suleh, medical superintendent of Nairobi's Mbagathi District Hospital.
Supply chain problems
Government officials say problems with the supply chain and funding shortages are the main reason for the lack of protective gear.
"Health personnel cannot stop treating or offering services to patients even without these [safety] commodities and during that time, they risk getting infected by the very patients they treat, so it is [down to] us as the government to ensure facilities don't run out - at times stock-outs do occur and this is due to procurement challenges, which makes it hard to expedite the delivery of these commodities to health facilities," said Joseph Sitienei, head of the National Leprosy and TB Control Programme. "Sometimes health facilities delay in requesting these much-needed materials and only do so when they completely run out.
"One cannot ignore the financial challenges faced at times and they do lead to stock-outs, but we have seen increased funding to the health sector recently and I hope this will soon change for the better," he added. "What we have started doing is to make waiting areas in health facilities well ventilated, making the consultation rooms more spacious, and of course providing protective masks... the government is streamlining procurement and supply of commodities including protective gear to health facilities."
According to local NGOs, corruption within the health system is also to blame for the haphazard availability of medical supplies, with drugs often 'disappearing' from government health facilities and sold to private pharmacies by government pharmacists.
Sitienei noted that the risk of TB infection ran both ways between patient and health worker, and the government encouraged "frontline" staff such as nurses and lab technologists to regularly test for TB and if found positive, to seek treatment immediately.
"Also, availability does not always translate to use - we have to constantly sensitize personnel on the need to use the protective gear," he said. "To reduce stigma, it is also important - we have done this - to sensitize patients too on why those attending to them must have a mask, for example."
He said that to reduce health facility-related infection, isolation wards were being established in health centres that attended to large numbers of TB patients.
In November 2010, WHO, UNAIDS and the International Labour Organization launched international guidelines to protect health workers against HIV and TB. Among the recommendations were development and implementation of free regular TB and HIV screening, free HIV and TB treatment for infected health workers and the incorporation of training for all health workers on HIV and TB prevention, treatment, care and support into existing training programmes.
A Turkana boy herds his family's cows http://www.irinnews.org/report.aspx?reportID=92736
Sunday, 10 April 2011
TUBERCULOSIS: KENYA: Risking TB in Nyanza's gold mines
NYATIKE, 6 April 2011 (PlusNews)
Photo: Kenneth Odiwuor/IRIN
Research shows that gold miners are at particularly high risk of TB
Timothy Omuya spends most days chipping away at stones in search of gold and inhaling fine particles of dust without protective gear in western Kenya's mines. It was not a huge surprise, therefore, when he tested positive for tuberculosis.
His local hospital put him on TB medication, but his long working hours meant he did not stick to the schedule.
"At times I fail to take them because I don't go in good time to take new ones from the hospital when I finish the ones I have," he told IRIN/PlusNews. "Here at the mines, we work both day and night, so the time you are supposed to go and take your medicine, you are deep down in the mine."
What Omuya did not realize was the risk to his family; his wife and youngest child are now both infected. His wife Peres says she and the child adhere to their medications strictly, but fears that if Omuya continues to miss doses of his medication, he may re-infect them.
Fatalism
According to Ruth Muga, a senior nursing officer at the Nyatike District Hospital, many miners have a fatalistic attitude towards death because of the dangerous nature of their work.
"We counsel many of them who come here and they tell us the reason they default is because they are busy; also many of them cite the dangerous nature of the mines as the reason they don't take drugs," she said. "They will simply tell you that the mines can collapse and kill them any time. To them, death is always lingering somewhere."
Julius Owino, another gold miner in Nyatike, is HIV-positive and knows that he risks death every day in the mines, but says mining is the only way he knows how to feed his family.
"We risk our lives to earn a living and we must earn it until we no longer live; I think we are careless with our lives," he added. "Many of us are very sick and do not seek treatment... at times I ask myself why we are so busy chasing money until it kills us."
On top of widespread TB, Nyatike, where most residents earn less than US$1 a day, also has one of the country's highest levels of HIV; it is located in Nyanza Province, with an HIV prevalence of over 15 percent. Sex work is prevalent around the mines.
High risk
Joseph Sitienei, head of Kenya's National Leprosy and Tuberculosis Control Programme, says miners and their families are considered a high-risk group for TB.
Gem Slaves
"The dusty conditions there increase chances of getting tuberculosis amongst miners and the crowded nature of mines and poor ventilation provide a perfect ground for the spread of TB; remember, these people go back home and interact with others and therefore they can very easily spread the disease in big communities."
According to a 2010 study published in the American Journal of Public Health, mining for gold was associated with considerably higher TB incidence than other mining.
"The implication for policy is not to close mines but to reduce levels of risk," said the authors, who recommended that healthcare programmes for miners facilitate earlier diagnosis and improve working conditions to reduce the risk of incident infection, for example by reducing poor working conditions, cramped hostel living quarters, or exposure to silica dust.
Sitienei noted that the government was working to build awareness of TB in high-risk communities, to encourage people to visit health centres for screening and to ensure those who began treatment adhered to it.
"When people don't get full treatment, they risk developing drug resistant tuberculosis and even those who are on medication can be re-infected by those who default on treatment," he said.
Kenya ranks 13th on the list of 22 high-burden TB countries in the world and has the fifth-highest burden in Africa.
Http://www.plusnews.org/report.aspx?reportID=92395
Photo: Kenneth Odiwuor/IRINResearch shows that gold miners are at particularly high risk of TB
Timothy Omuya spends most days chipping away at stones in search of gold and inhaling fine particles of dust without protective gear in western Kenya's mines. It was not a huge surprise, therefore, when he tested positive for tuberculosis.
His local hospital put him on TB medication, but his long working hours meant he did not stick to the schedule.
"At times I fail to take them because I don't go in good time to take new ones from the hospital when I finish the ones I have," he told IRIN/PlusNews. "Here at the mines, we work both day and night, so the time you are supposed to go and take your medicine, you are deep down in the mine."
What Omuya did not realize was the risk to his family; his wife and youngest child are now both infected. His wife Peres says she and the child adhere to their medications strictly, but fears that if Omuya continues to miss doses of his medication, he may re-infect them.
Fatalism
According to Ruth Muga, a senior nursing officer at the Nyatike District Hospital, many miners have a fatalistic attitude towards death because of the dangerous nature of their work.
"We counsel many of them who come here and they tell us the reason they default is because they are busy; also many of them cite the dangerous nature of the mines as the reason they don't take drugs," she said. "They will simply tell you that the mines can collapse and kill them any time. To them, death is always lingering somewhere."
Julius Owino, another gold miner in Nyatike, is HIV-positive and knows that he risks death every day in the mines, but says mining is the only way he knows how to feed his family.
"We risk our lives to earn a living and we must earn it until we no longer live; I think we are careless with our lives," he added. "Many of us are very sick and do not seek treatment... at times I ask myself why we are so busy chasing money until it kills us."
On top of widespread TB, Nyatike, where most residents earn less than US$1 a day, also has one of the country's highest levels of HIV; it is located in Nyanza Province, with an HIV prevalence of over 15 percent. Sex work is prevalent around the mines.
High risk
Joseph Sitienei, head of Kenya's National Leprosy and Tuberculosis Control Programme, says miners and their families are considered a high-risk group for TB.
Gem Slaves
"The dusty conditions there increase chances of getting tuberculosis amongst miners and the crowded nature of mines and poor ventilation provide a perfect ground for the spread of TB; remember, these people go back home and interact with others and therefore they can very easily spread the disease in big communities."
According to a 2010 study published in the American Journal of Public Health, mining for gold was associated with considerably higher TB incidence than other mining.
"The implication for policy is not to close mines but to reduce levels of risk," said the authors, who recommended that healthcare programmes for miners facilitate earlier diagnosis and improve working conditions to reduce the risk of incident infection, for example by reducing poor working conditions, cramped hostel living quarters, or exposure to silica dust.
Sitienei noted that the government was working to build awareness of TB in high-risk communities, to encourage people to visit health centres for screening and to ensure those who began treatment adhered to it.
"When people don't get full treatment, they risk developing drug resistant tuberculosis and even those who are on medication can be re-infected by those who default on treatment," he said.
Kenya ranks 13th on the list of 22 high-burden TB countries in the world and has the fifth-highest burden in Africa.
Http://www.plusnews.org/report.aspx?reportID=92395
Thursday, 24 March 2011
TUBERCULOSIS: KENYA: Stepping up paediatric TB diagnosis
Photo: Manoocher Deghati/IRIN: It's difficult to diagnose TB in children
NAIROBI, 24 March 2011 (PlusNews) - Over the past few years the Kenyan government has significantly scaled up its diagnosis and treatment of tuberculosis with positive results, but officials say diagnosis of children lags behind.
Kenya ranks 13th out of the UN World Health Organization's (WHO) 22 high TB burden countries and has the fifth-highest in Africa. There are an estimated 12,000 TB-infected children younger than 14, representing 11 percent of all infections.
"It is extremely difficult to diagnose tuberculosis in children, unlike in adults, and the low knowledge among many health workers of the symptoms of the disease in children means many children die," said Joseph Sitienei, head of the National Leprosy and TB Control Programme. "Even among children where it is detected, it is done late, meaning they are enrolled late on treatment."
WHO recently said many cases of paediatric TB went undiagnosed or were diagnosed incorrectly, raising children's risk of TB meningitis, which has harmful long-term effects and high mortality.
Kenya's government has released guidelines to health workers on checking for symptoms of TB, especially among children born to HIV-positive mothers.
"It is the main reason the government has now embarked on training and sensitization of health workers on effective paediatric tuberculosis diagnosis," said Sitienei.
Julia Masiga, a 31-year-old HIV-positive mother of five, says she nearly lost a child because a health worker failed to spot TB.
"My child was coughing most of the time... she had fever also but when I went to the clinic, they said the child had pneumonia and they gave me drugs," she said. "I believed it because she had been vaccinated [against TB] when I gave birth to her. She was taking her medicine but this pneumonia they were telling me about was not going away."
Eventually her child fell so ill she had to be admitted to Mbagathi District Hospital in the Kenyan capital, Nairobi; it was there that Masiga was finally told her child had TB.
"Now she is taking her medicine and doing better; I am very happy that even though I thought she might have HIV, she doesn't," she said.
According to Sitienei, about 20 percent of TB-infected children are also HIV-positive. The low levels of paediatric HIV treatment - just 10 percent of HIV-positive children access antiretrovirals (ARV) - increase the risk of HIV-infected children contracting TB.
A 2009 study in western Kenya to ascertain the clinical burden of tuberculosis among HIV-positive children found that the use of combination ARVs reduced the probability of an HIV-infected child being diagnosed with TB by 85 percent.
Fast Fact
There are an estimated 12,000 TB-infected children younger than 14, representing 11 percent of all infections
Community works
Dr Lucy Mathu, a senior technical prevention of mother-to-child HIV transmission adviser at the Elizabeth Glaser Pediatric AIDS Foundation, says the problem of TB treatment in children is compounded by the emphasis by health workers on infectious tuberculosis, which is rarely manifest in children.
"When it comes to children, health workers tend to ignore the need to diagnose tuberculosis and concentrate on other diseases like malaria," she said. "They seem to be more preoccupied with symptoms of transmissible tuberculosis like coughing, which are rarely manifested in children."
She noted that there was a need to strengthen the government's community strategy to ensure that children who might be TB infected were not missed.
The government is working with EGPAF and US government-supported AIDS, Population and Health Integrated Assistance II (APHIA II) community workers to ensure children and adults who might show symptoms of tuberculosis access health facilities.
"Using the community strategy like the employment and use of community cough monitors can greatly help in ensuring that children who might be TB-infected and who might be missed are linked to health facilities," said Mathu.
More than 80 percent of all Kenyan newborns receive the BCG vaccine, but according to Sitienei, this is insufficient to fully protect against TB.
"Our BCG vaccination coverage is very impressive but it is important to note that BCG is never fully protective against tuberculosis infection; that is why children born to TB-infected mothers are put on treatment for nine months to protect them," he said. "That is another reason it is important to sensitize mothers to the importance of delivering in health facilities as opposed to at home."
http://www.plusnews.org/report.aspx?reportID=92277
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