Do you know that before the advent of Covid-19 pandemic tuberculosis (TB) was the cause of death from a single infectious agent surpassing HIV/Aids? It is quite unfortunate that this infection was not given much attention, despite the number of lives it has claimed globally due to inadequate allocation of resources or complete neglect through stigmatisation in society.
The World Health Organisation (WHO) approximates that one-quarter of the world’s population has a TB infection that is waiting for an opportunity to manifest when one’s immune system is compromised. Being an airborne disease, case reports have shown that TB can attack the lungs and other body organs (extra-pulmonary TB). It can be transmitted from person to person through coughing, singing, spitting or sneezing, especially in enclosed and non-ventilated settings. Its signs and symptoms can take long to manifest but generally, it is associated with cough of any duration, fever, night sweats or weight loss.
A report released by Global Tuberculosis for 2020 has some shocking statistics that warrant urgent action to avert the situation. The report estimates that 9.9 million people fell ill with TB and of these, 1.5 million died from the disease, including 214,000 people with HIV.
This translates to over 4,100 people dying each day globally from TB and close to 28,000 people falling ill with the disease. However, there is hope since the situation was worse several decades ago, but now, through concerted efforts from various countries, agencies and partners, more than 66 million lives have been saved from the year 2000 to date.
High burden country
Back at home, Kenya remains a high burden country for TB, TB/HIV and Drug-Resistant TB, with a prevalence of 426 per 100,000 population. Although, prior to Covid-19 pandemic, Kenya had made a steady progress in combating TB, when you compare the data pre and during Covid-19 (2019 and 2020), annual TB report (2020) recorded a case notification rate of 154 per 100,000 population, a decline from 165/100,000 population in 2019.
The decrease signifies 48 per cent estimated incident TB cases were either missed or not notified in the year. This is perilous in that this population is freely interacting with everyone in the community and exponentially transmitting the infection.
Astonishingly, there is now a worrying trend of Drug-Resistant TB (DRTB), which even attacks people who have never taken anti-TB drugs in their entire lives. Statistically, Kenya recorded 40 per cent increase in DRTB from 689 in 2019 to 961 in 2020. This is where the rubber meets the road, hence necessitating declaration for investment in TB control.
From the health economics point of view, Value-TB research that was conducted by Kairu et al (2021), showed the cost of treating Drug Sensitive TB (DSTB), including monitoring tests, in Kenya ranged between $135 and $160 (Sh15,400 and Sh18,300) while for DRTB ranged between $3,230.28-$3,926.52 (Sh369,700 and Sh449,400).
Despite TB being curable and preventable, and cost-free drugs and tests, patients are still incurring catastrophic costs directly and indirectly. This has been cemented and augmented by TB patient cost survey that was carried in 2017 showing appalling figures of how people have been impoverished with TB due to out-of-pocket expenditures. The survey unveiled the agony of patients in spending a whopping Sh26,041.49 and Sh145,109.53 for an episode of DSTB and DRTB, respectively.
In cognizant of the above information, the world is uniting to commemorate World TB Day on March 24 every year. In this year’s theme, ‘Invest to End TB. Save Lives’, WHO conveys the urgent need to invest resources, which include but are not limited to human resource for health, health products and diagnostic technologies, infrastructure and staff capacity building to cobble up the fight against TB in a mission to achieve the milestones and targets that were unanimously agreed upon by the global honchos.
The investment will be of great impetus towards ensuring equitable access to prevention and quality of care, which is in tandem with WHO’s and Kenya’s Big 4 Agenda towards achieving the Universal Health Coverage.
As a country, we are grappling to put more investment in the fight against TB as per the TB programme national strategic plan, with a projected annual budget of $60,072,511.39 but only gets allocated $34,169,895.81, conspicuously leaving a 43 per cent unfunded gap.
In conclusion, for us to reduce and control TB, we need to recognise that everyone has the responsibility to fight and destigmatise TB through gather all scatter none phenomenon right from the community to the executive level, private to public sectors (public-private mix), civil society organisations to technical partners, healthcare workers, care givers to researchers. Otherwise, if you are not infected, you are affected.
Mr Maragia is a Field Epidemiology and Laboratory Training Programme (FELTP) resident – Nairobi. Dr Rosalba is a medical officer at Lodwar County Referral Hospital in Turkana County.