By Samwel Doe Ouma
Jane Wakesho (not her real name) a former community health volunteer at the Coast General Hospital experienced an unusual bout of coughs with consistent chest pain and breathing complications. Her condition and discomfort lead her to the nearest health care center where a doctor examined her and recommended a dose of antibiotics and a cough syrup.
“After two days of medication, my cough resurfaced. I went to another health centre where the doctor prescribed a very strong antibiotic,” she said adding that, “I remember the antibiotics cost over Kshs1000. But the pain did not stop and was still consistence and I was losing appetite and weight at an unprecedented speed.”
She adds, “When my condition was deteriorating first, family took me to a nearest bigger healthcare Centre where a sputum test and chest x-ray was taken and when the results came out, I was informed that I had a multi drug resistant T.B (MDR T.B).”
After her diagnosis, she was made aware of her predicament, counselled briefly by the healthcare worker and told that she was a health risk to others and was informed to self-isolate. She was later given some pills and told to wait for two months so that her MDR TB drugs would be sourced from Nairobi to Voi.
Her story reveals the low suspicion index of our healthcare workers in diagnosis of T.B and the challenges one has to face before being accurately diagnosed and delay in starting T.B medication. As the country race to accelerate progress towards eradicating T.B by 2035, gaps related to screening and diagnosis of T.B need to be addressed.
According to Eva Kibuchi, Stop T.B partnership- an advocacy arm of national T.B unit- Kenya, low health worker suspicion index, erratic supply of equipment and supplies ecosystem coupled with lack of awareness among members of the public is hindering prompt T.B diagnosis.
She said, “We should increase diagnostic sites in the hard to reach areas and adhere to existing T.B diagnostic guidelines to reach our elimination targets.” While the primary aim of tuberculosis (TB) control programs is to reduce the transmission from infectious TB cases, late diagnosis prolongs the length of exposure to an infectious patient therefore escalating the spread of T.B to other members of the public, Eva said.
Barriers to access to health centers especially in the periphery counties where patients are forced to travel long distance enduring poor road conditions are adding up the hidden costs of care to already financially impoverished patients therefore impeding diagnosis goals, she adds.
Screening and diagnosis of T.B is also interrupted by scarcity of human resources forcing screenings to be done mainly at the T.B outpatient departments and antiretroviral therapy (ART) clinics with less emphasis on integrating it into other health facilities clinics. “Shortages of laborator y supplies especially due to problems of quantifications and procurements is a problem to diagnosis,” Eva Said.
