How COVID-19 casts shadow on deadly TB in Kenyan coast

That no doubt, the Coronavirus Pandemic has  directed focus away from the fight against the deadly Tuberculosis TB in the country. Ranked Fourth among the leading infectious disease killers in the country, TB kills an average of 52 people daily in Kenya.

At the Kenyan Coast, a dark shadow hangs over people infected with Tuberculosis disease. At the Kakoneni Village in Lungalunga, Kwale county a couple walks into the Kikoneni health center, located in Lungalunga for review and collection of their medication.

Alice Mwikali, 42, and her husband Pius Mbuvi, 56, parents to six children, are both infected with tuberculosis, albeit two different strains. Alice has Multi Drug Resistance (MDR). This means she is under medication for 18 months, while Pius has normal TB, which is, however, a reinfection.

MDR-TB is a form of tuberculosis infection caused by bacteria that are resistant to treatment with at least two of the most powerful first line anti-Tb medications, Isoniazid and Rifampin. Currently, there are at least 600 MDR TB patients in the country.

“Our health has continued to be compromised  due to lack of good nutrition, making it hard to fight the disease, we feed on Githeri cassava and this is not the best nutrition for the disease,” said Mwikali.

Her husband is on the Drug sensitive DS TB is on his third month in taking his daily dosage. His life took a different twist in 2019 when Mbuvi was first infected with Tb. The duo say, what started as a normal cough, has now grounded their operations.

And despite being the only sole breadwinner, Mbuvi was forced to quit his farming job in the village. To worsen the situation, his wife was also infected in September 2020, after being infected by the husband.

“I can no longer go to the farm because the doctor discouraged me to do so. My body has continued to weaken because of the daily drugs I take, sometimes, I feel like absconding and then again, I remember I have a family to take care of,” Mbuvi says.

According to Lungalunga Sub county Tb Leprosy coordinator Peter Jilani, the facility through the community health volunteers is scheduled to undertake contact tracing including screening the couple’s children to effectively manage the disease. 

The couple has further been advised to minimize their engagements to minimize chances of infecting others. He noted that  it is possible that the couple could have infected each other with the bacteria evolving in Mwikali to give her the MDR TB or she could have contracted  it from some else with a similar strain. 

He further noted that it is possible to get re-infected with TB like in the case of Pius, thus precautionary measures are critical.

A few Kilometers away, Zuwa Nyawa 36 years a resident of Vigurungani in Kwale county is a Multi drug resistance MDR tuberculosis patient who has been on medication for the last 10 months since he was diagnosed with the disease in February 2020.

Nyawa says what started as a normal coughing while working as a butcher at his workstation in Ukunda, , he got concerned when he coughed up blood severally, prompting him to quit his job and seek medication.

To worsen the situation, his family had to be separated from him after he was discovered to be a Multi Drug resistant (MDR) Tuberculosis patient. This means that Nyawa is prescribed to take 12 tablets per day for 18 months, a period for the recommended treatment.

For Months now, the father  of three children had gotten a  reprieve from the  sh 6,000 stipend  offered by Amref  Health  Africa every month for  his nutritional support, money he is forced to  share with his wife and children since he is still not working.

“I take twelve 12 tablets per day. But I acknowledge Amref Health Africa because they subscribed me to a monthly stipend of sh 6,000 which helps me buy food and sustain my livelihood, “says Nyawa.

Tuberculosis (TB) is a bacterial infection caused by a germ called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body.

TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes or talks. If you think you have been exposed, you should go to your doctor for tests as soon as possible. You are more likely to get TB if you have a weak immune system.

“I have been on medication for the last 10 months, my life really changed as all my family members have been separated from me to avoid infecting them. Again considering I am jobless, my health was compromised as my diet is not as recommended by the doctor,” Nyawa said.

According to Margret Dama,52,a trained MDRTB champion tasked with peer education  for TB patients in Kwale Sub-county hospital claims most of her TB patients among them Nyawa have been negatively impacted by the Covid-19 period as many of them have their health compromised by the poor diets due to lack of income.

“In Kinagini,Ndavaya and Vigurugani villages to make follow ups on TB patients, I ensure they adhere to the dosage, but what appears  to be  the biggest challenge is that most of the patients are economically challenged,” Says Dama.

Data from Kwale county Tuberculosis and Leprosy coordinator officer Lawrence Tanui shows that transmission of TB disease is on the rise, with recent 2020 statistics showing 16 cases MDR TB recorded up from 6 cases that were recorded in 2019.

According to Tanui,In 2016 Kwale recorded 6 cases of MDR patients, in 2017 only 2 MDRTB patients were recorded before it shot up in 2018 with 7 while 6 in 2019.

Kwale county records overall 1,200 cases per year, and the official points Ukunda, Msabweni Sub-county, Matunga and Lunga lunga as the hotspots’ with men aged between 25-5 years being most affected.

“Patients also minimised visits to healthcare facilities to reduce the risk of acquiring coronavirus. This may adversely affect TB diagnosis, adherence to treatment, the management of side effects and treatment outcomes,” says Tanui.

He adds “For instance, a person with persistent cough (which could be because of TB may feel hesitant to go to health services due to the fear and stigma associated with COVID-19,” 

In Mombasa county, at the heart of Maweni village, Millicent Anna, 30 a mother of one is struggling with Tb.In may 2020,Anna a salonist began coughing. At first she thought it was just a normal throat but later turned out to be TB.

Anna has been on constant adherence to drugs thanks to The Kenya AIDS NGOs Consortium (KANCO) trained community health worker Caroline Kilavire, who has kept daily follow up to TB patients in Mombasa to ensure full uptake of drugs.

“I made sh 300 per day, but since I was diagnosed, the doctor discouraged me from going to the hospital to avoid transmitting it to my customers. I have been on medication for the last four months now. And I have a three years Old child,I am forced to stay under medication both me and my child,” Narates Anna.

According to Mombasa county Tb case management advocacy Champion,Norman Otieno,says one of the factors fuelling the spread of the disease are ignorance, lack of adherence to treatment, delayed treatment, stigma, poor access to services, low levels of TB awareness and TB-HIV co-infection.

Kenya AIDS NGOs Consortium (KANCO) TB Campaign manager Rahab Mwaniki says with the support of the Global Fund, beginning May this year has ensured the fight against Tuberculosis during this covid-19 period was upheld.

She acknowledges that the fight against TB has been derailed by the pandemic, but noting that the, says through the extensive interventions, partners in TB were keen to see the country achieve its health development goals towards ensuring a healthy nation.

“Fifty 50 percent of people living with TB are facing challenges in accessing health facilities, accessing treatment and care, therefore we have interventions  towards ensuring that patients are able to get good nutrition, and tracing the patients, this facilitated through the help of global funding in collaboration with Amref Health Africa  ,”said Mwaniki.

 According to her, Children below 14 years are vulnerable especially because it is hard to diagnose TB infection in them .At least 39 per cent of all TB patients in the country are HIV-positive while the disease is most prevalent among the young and most productive, between 15 and 55 years.

Article first published on pd.co.ke