According to the World Bank Tuberculosis is a disease of poverty. It is widely recognised that the poorer the community, the greater the likelihood of being infected with the Tuberculosis germ and developing clinical disease. World Health Organisation estimates that low and lower middle income countries, that is, those with an annual Gross National Product (GNP) per capita of less than US$2995 account for more than 90% of TB cases and deaths. 76% of the world’s population lives in these countries. As I travel in a matatu every day to work from one of Eastlands populous neighborhood, one thing that gets my attention is the big capacity matatus that have their window permanently closed. I have also noticed that some passengers would rather pick an argument when requested to open the windows, than have the cold morning breeze hit their faces or the wind blows the ladies well-combed hair. Knowing too well that tuberculosis (TB) is easily transmitted through coughing and sneezing and with 644 multi- drug resistant (MDR) cases in Kenya this gives me butterflies in my stomach. I always think of what if I contracted this disease? As a mother of children below 5 years if I contracted TB the chances of transmitting to my children are high. In 2014 alone, 8,448 Kenyan children below 15 years were infected with TB. Among this, 91% were HIV positive. It has been documented that on average a person with active TB will spread the disease to 1 to 15 people within a year. The rise in MDR and extensively drug resistance (XDR) strains is making TB harder to fight and present a grave threat to health and security in all countries.
Children with TB are diagnosed through a careful history, a lab test and physical examination. Children below 5 years are not able to produce spit on their own most of the time and may need additional tests like chest x-rays. The x-ray machines in the health facilities are few and thus children are often referred for long distance to access these services. Yet, TB is a disease that largely affects the poor members of our society for whom transport to and from the health facilities is not often available.
TB treatment services for children have globally become a center of focus. This is fundamentally the same as for adults, with a required combination of TB drugs being taken for a number of months. A Kenyan child is on two or three different medicines at a time which causes huge pill burden for them. For children on Anti Retroviral Treatment (ARV), this also means that the pill burden increases. Normally, to administer the medicine the caregiver will split and crush the tablets to get the dosage and give the child. The challenge with this is incorrect dosage and the medicine has a bitter taste and thus the child may refuse to take. Child TB treatment has been reviewed with new child-friendly medicines being made available. When started promptly the outcome of TB treatment in children is generally good, even in those children that are very young and have compromised the immune system.
In September 2016, the Government of Kenya rolled out new TB pediatric formulation in the country. It is opined that with this treatment that is easily dissolvable in water and with a pleasant strawberry taste, more children will be able to take and complete the right doses. Lifeskills Promoters applauds this initiative of the government of Kenya. However, the Ministry of Health will need to carry out extensive health promotion and education especially in high TB counties noting that in 2015 3,000 children could not be traced through the health system and thus did not access TB treatment.