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Tuberculosis Control in Kenya

Aims of DLTLD

For the nation - That TB is no longer a public health
For the community - To reduce the number of infectious cases in the community and hence reduce the disease burden
For the individual patients - to cure their disease, quickly restore their health so as to resume their daily normal activities and preserve their position in the family and society

Objectives of DLTLD

To interrupt transmission of infection
To reduce morbidity mortality and disability
To prevent drug resistance

Activities of the Division

Early case detection of TB
Treatment of the detected cases
Health education to the Health workers, community and the patient
Invite contacts of patients for screening and offer necessary assistance
Recording and reporting for monitoring and evaluation purposes
Training of health workers and the community
Tracing of patients who have defaulted from treatment
Supervision of the health workers
Conduct operation research

Background
Tuberculosis remains a major cause of morbidity and mortality in Kenya. It affects all age groups, but has its greatest toll in the most productive age group of 15 to 44 years. The major factor responsible for the large TB disease burden in Kenya is the concurrent HIV epidemic. Other factors that have contributed to this large TB disease burden include poverty and social deprivation that has led to a mushrooming of peri-urban slums, congestion in prisons and limited access to general health care services. In the last decade TB case notification has been increasing at an average of 16% annually. Within the same time period the DLTLD has been confronted with the challenge of providing integrated TB and HIV services in addition to other interventions without a commensurate increase in the human resource available for TB control. Additionally there have been increasing concerns about the emergence of drug resistant TB, a threat that would pose major challenges in the fight against TB in this resource limited country.

In order to address the new challenges posed by the tuberculosis epidemic in the face of the HIV epidemic and the socio-economic environment, the ministry of health through DLTLD has identified the following areas for increased support: Strengthening of the human resource capacity at all levels of the DLTLD for effective coordination of TB control activities, decentralisation of TB control services down to the community level to increase access to these services, a stronger collaboration between TB and HIV control programmes in order to promote delivery of integrated TB/HIV services, private public partnerships to increase the number of private providers integrated into the TB service provider network and a sustained public education campaign coupled with health care worker training and support to promote early care seeking and adherence to treatment at community level and better TB case management by health care providers. In the last few years great strides have been made in all these areas thanks to the many stakeholders dedicated to making a difference.

The Division of Leprosy, Tuberculosis and Lung (DLTLD) is implementing initiatives towards achieving internationally agreed TB control targets including the TB relevant Millennium Development Goals (MDGs). The immediate short term goal is to achieve the 70/85 targets – that is to detect 70 % of infectious TB and cure 85% of the detected cases and then sustain this effort over a long time to achieve the MDGs. The TB MDGs are, to have halted and begin to reverse the incidence and mortality due to TB by 2015.

The Kenyan TB program adheres to the DOTs strategy as the most cost effective strategy to address the problem of tuberculosis and has used the DOTS strategy since 1993 when the DOTs program was piloted and implemented in the whole country by 1997.

The strategy embraces the following 5 key elements:

Sustained political commitment to increase human and financial resources and integrating TB control into the national health system.
Access to quality assured TB sputum microscopy
Standardised short course chemotherapy to all diagnosed cases of TB and case management under direct observation of treatment (DOT).
Uninterrupted supply of quality assured drugs with reliable procurement and distribution systems.
Recording and reporting system enabling outcome assessment of each and every patient and overall assessment of the program.