KENYA: Peter Mwangi arrived at the Makadara Huduma Center, East of Nairobi city, on a scorching hot mid-morning to express his gratitude to the community health volunteers.
The 46-year-old father of three was cured of tuberculosis (TB) thanks to a new screening technology that detected the disease when he volunteered to be screened at government offices when he sought its services.
Mwangi was then a heavy smoker, something he says he’s already quit and is now leading a healthy life.
“I wouldn’t want to lie to you, I have quit smoking right now and it’s helped me a lot in the healing process,” he says.
Smoking increases the risk of contracting TB, increases the risk of recurrent TB, and impairs the response to treatment of the disease, according to the World Health Organisation.
Mwangi was diagnosed after being screened using an Automated TB Screening Machine (ATSM), a new technology used in public areas with high human traffic.
It targets individuals seeking services at public places/offices, including government offices such as Huduma centres, railway stations, and public transport terminus. The innovation taps into the waiting times that customers experience at the selected sites.
Mwangi’s is not an isolated case. He is among the 110,000 people screened at the centre between 2019 and February 2020 who had come to the facility to seek government services. 8,693 were tested for TB, and 368 were positive for the disease. 350 of them were linked to various health centres within the city for treatment, and three of them later died from it.
The Country Director at Amref Health Africa in Kenya, Dr Meshack Ndirangu says that this is the first type of TB screening machine in the region and that his organization has partnered with Sema Limited, the government, and other development partners to place them in Huduma centres and train stations.
“We have five other automated TB screening machines at Huduma Centres and train stations within Nairobi. What we are doing is to analyze more data and see how much it costs to invest in one so that with time, there will be more scale-up of innovations that will help us find the missing cases of TB,” Dr. Ndirangu says.
TB is airborne and can lie dormant in someone infected with the bacteria. When a person develops active TB, symptoms may include a cough, fever, night sweats, and weight loss. Left untreated, TB kills about half of those affected. Someone with active TB can infect five to 15 others through close contact over the course of a year.
After he was screened and tested, Mwangi says that his results were sent back to the Kayole health centre, which is nearer to his place of stay, a few kilometres away. He had left his contact details at the Huduma Centre, and that’s how the health workers connected him for treatment back in Kayole.
After being screened, these clients are assisted by a community health volunteer (CHV) to enter their bio-data and respond to 5 questions displayed on the screen. The machine then issues a ticket showing whether they are presumptive or not and sends an alert to the CHV’s mobile device.
As indicated on their ticket, the CHV encourages those without any signs and symptoms to screen again after six months.
Those who turn out to be presumptive are guided to provide sputum samples at a designated sputum collection point or referred to nearby health facilities for further investigation.
A motorcycle rider transports the samples to diagnostic sites. Once the results are ready, clients are then notified to visit the health facilities for their results and treatment initiation if required.
Dr. Ndirangu says that four out of every ten people who develop TB miss being diagnosed. Healthcare workers can only identify six out of every ten people with the disease.
“That’s big; that’s the elephant in the room! Do you know why? Because the four that we miss have a huge chance of dying of TB; and in Kenya alone, the World Health Organization estimates that we lose more than 30,000 people annually to TB. So many of them are among the four that we miss,” Dr. Ndirangu says.
TB is one of the world’s deadliest infectious diseases and kills more people than HIV and malaria combined. 21,000 people died of tuberculosis in 2020, four times the number of people who died of COVID-19 when the pandemic began in 2020.
About 140,000 Kenyans a year develop TB. Approximately 35,000 people are co-infected with HIV/AIDS. TB is the fourth-largest cause of death in Kenya and is responsible for around 6% of all deaths.
Kenya also suffers from growing antimicrobial-resistant TB (AMR-TB) and multi-drug resistant TB (MDR-TB), which means the bacterium has learned to overcome some medication, making it incredibly difficult and costly to treat.
Acting director-general for health Dr. Patrick Amoth says that TB continues to be a significant public health concern in the country. Kenya is ranked fourth among the high TB burden countries in the continent after South Africa, Nigeria, and Ethiopia.
“In 2020, the country recorded 72,943 TB cases, of whom 8% (5,663) were children; adding that the 2016 prevalence survey showed that the government nearly missed 40% of the estimated cases and that it was paramount that everyone is engaged in the fight against TB,” according to Dr. Amoth.
The new screening technology helps trace these patients and link them to treatment aimed at saving their lives.
“If we continue to do the same things, we will get the same results. So, for us to find the missing cases, we must do things that we have not done before. A lot of what we have done before is that we have waited for people in clinics. But most of the four out of ten we are missing don’t come to the clinics,” Dr. Ndirangu says.
He concludes by noting that Kenya has made significant strides as far as TB stigma is concerned, but more is to be done.
“We have come a long way in recognising that we should not stigmatise anyone with TB, but we stll have a long way to go. And this is a call to all of us in Kenya to fight the stigma that is associated with TB,” he concludes.