Case Finding -The Care section of NTLD- P is tasked with surveillance of new TB patients in the country, tracking their numbers and keeping a tab on their condition. In 2015, a total of 81,518 cases were notified, a decline of 8.4% of the cases notified in 2014. Of the cases notified in 2015, 74,742 were new while 6,776 were previously treated cases
Treatment Outcomes - The new WHO definition of TB treatment outcomes, where treatment success rate is calculated for all new TB cases, was used in the 2015 report. Based on this new definition, the treatment success rate for Cohort 2014 is 89% against a target of 90%. This can be associated with the increase in TB deaths (6%), especially among patients with cases of pulmonary TB, which is approximately three times more than deaths among patients with extra pulmonary TB. In addition, mortality among TB/HIV co-infected patients and those with low body mass index (BMI) was observed.
- TB/HIV Co-infection - Approximately 25,030 (31%) of the 81,518 persons who developed TB in Kenya in 2015 were HIV positive. There has been a gradual decline in the TB/HIV co-infection rate among notified TB cases from 45% in 2008 to 33% in 2015. Though higher than the 12% global TB/HIV co-infection rate, this rate is lower than 39% in the African region.
IPT - Isoniazid Preventive Therapy (IPT) was officially launched on March 24th 2015 for PLHIV targeting five high burden HIV Counties. It was later rolled out to the whole country with a target of enrolling 90% (919,391) of PLHIV (839,797 adults and 79,594 children) on IPT by December 2016.
- DRUG RESISTANT TB -Drug resistant TB is a major public health concern and poses a threat to global TB control. In Kenya, case finding strategies are in accordance with WHO recommendations, including DR-TB surveillance among populations most at risk i.e. previously treated cases, DR TB contacts, symptomatic health care workers, refugees and prisoners, and patients who are smear positive at month two of treatment. Over the years, despite the decline in case finding for drug sensitive TB, Kenya has seen a gradual increase in DR TB case notification from 112 cases in 2010 to 433 in 2015, with a 50% increase compared to 288 cases in 2014.
- NUTRITION SITUATION -According to 2015 TIBU data, 51% of newly diagnosed drug susceptible and 65% of drug resistant TB patients are malnourished at the time of diagnosis. Although Kenya has made tremendous improvement in achieving WHO targets, for children below the age of five years, in curative areas and particularly TB, little or no improvement has been noted. The NTLD-Program has recorded high proportions of severely wasted patients, at 18% of drug susceptible and 27% among drug resistant TB patients, which is a serious concern as most of these patients ended up with undesirable treatment outcomes. The NTLD Strategic Plan recognizes good nutrition as an essential element promoting health and quality of life of patients. Nutrition has also been recognized in the Constitution of Kenya 2010 under the Bill of Rights 43 1(a, c, e) 2 and 53 1(c) where health, food, social protection and nutrition are basic rights.
- LEPROSY- More males at 67% were found to be suffering from Leprosy compared to their female counterparts in 2015. A total of 124 cases were reported, two of which were children between ages of one and fourteen. Leprosy in children is an indicator of continuous community transmission and warrants intensive case finding and treatment. There have been concerted efforts to enhance HCW skills in diagnosing Leprosy. A training curriculum is in place and HCW trainings will be conducted in 2016 especially in high endemic areas. Resource mobilization for post elimination strategies for Leprosy is also on going.
- LUNG HEALTH AND PAL - Asthma is one of the most common non-communicable diseases in Kenya. Treatment of Asthma has been going on in many health facilities; however, routine collection of asthma data is yet to begin. Several health facilities have incorporated Asthma services into the TB services while others still have a standalone Asthma Clinic. All efforts will be made to ensure that HCWs are trained in Asthma and other chronic obstructive lung diseases, and are supported to implement the lessons learnt. Implementation of the Practical Approach to Lung Health (PAL) will assist in tracing missed TB cases, reducing unnecessary prescriptions, especially of antibiotics, and thus minimizing antibiotic resistance and saving on costs. In 2015, 33 health facilities were equipped with spirometers and peak flow meters to enable them diagnose and manage patients with Asthma. In the coming year, all the remaining facilities will be equipped to ensure that at least all county hospitals are able to adequately run Asthma Clinics. Data collection and reporting for Asthma will be enhanced and information updates included in subsequent phases of the electronic data system TIBU.