Introduction
Communicable diseases are illnesses transmitted either directly between individuals or indirectly through vectors like insects. These diseases arise from infectious agents, including bacteria, viruses, fungi and parasites. Transmission methods include direct contact, airborne droplets, contaminated food or water and vector-borne pathways. They include Chickenpox, COVID-19, Ebola, Hepatitis B, Sexually Transmitted Diseases (STIs) and Tuberculosis (TB) to name a few.
Tuberculosis, a contagious bacterial infection caused by Mycobacterium tuberculosis spreads through the air when an infected person coughs, sneezes or talks, releasing tiny droplets containing the bacteria.
Though TB primarily affects the lungs, it can also impact other parts of the body, such as the kidneys, spine and the brain. There are three major types of TB.
Latent TB Infection: This is when bacteria remain in the body in an inactive state and cause no symptoms. However, it can become active, particularly when the immune system is weakened.
Active TB Disease: This occurs when the bacteria multiply and cause symptoms such as a persistent cough, chest pain, coughing up blood, fever, night sweats and weight loss.
Drug-Resistant TB (DR-TB): This occurs when the Mycobacterium tuberculosis bacteria develop resistance to the standard drugs used to treat TB, particularly isoniazid and rifampicin, the two most potent first-line anti-TB drugs.
The successful treatment of tuberculosis (TB) globally has been hindered by several challenges, with one of the most significant being patients' failure to complete the full course of prescribed medication. This issue not only undermines the effectiveness of treatment but also contributes to the emergence of drug-resistant TB strains, complicating global efforts to control the disease.
In Kenya, under the Department of National Strategic Public Health Programs, the Directorate of Preventive and Promotive Health in the Ministry of Health hosts the National Tuberculosis, Leprosy and Lung Disease Program (NTLD-P). The program works with County Governments to formulate policies, set standards, develop capacity, identify and mobilize resources, ensure an uninterrupted supply of commodities, supervise, coordinate, monitor and evaluate the implementation of TB, Leprosy and Lung disease control activities.
Trans Nzoia County, located in the former Rift Valley Province, spans an area of 2,495.5 square kilometers and is home to 990,341 residents, as reported by the 2019 census. The County’s border with Uganda renders it vulnerable to cross-border disease transmission, such as tuberculosis (TB).
Individuals who have not undergone early detection and have familial ties on both the Kenyan and Ugandan sides can inadvertently spread the disease. In such cases, treatment initiated in Kenya may go unnoticed in Uganda, leading to interruptions or inconsistencies in the treatment regimen.
Kenya currently offers a 9-month TB treatment regimen, whereas Uganda still follows an 18-month regimen. This disparity in treatment protocols, combined with frequent border movements and patient transfers, disrupt effective drug administration. Consequently, this leads to the development of drug-resistant TB strains.
Trans Nzoia County continues to face significant human resource for health (HRH) challenges, with various departments suffering from a shortage of healthcare workers and insufficient replacement of retiring staff. This shortage impedes early detection of diseases, leading to delays in diagnosing and treating tuberculosis (TB) and contributing to the development of more aggressive strains and their subsequent spread. Additionally, the County struggles with inadequate isolation facilities for TB patients. The lack of dedicated isolation areas means that TB patients are often placed in wards with other patients, increasing the risk of disease transmission.
The limited availability of genotyping sites for tuberculosis (TB) in the County has presented a significant challenge in accurately identifying drug-resistant strains. Genotyping is a crucial diagnostic tool that allows for the differentiation of drug-resistant TB strains from drug-susceptible ones by analyzing the genetic makeup of the bacteria. It is essential for tailoring effective treatment regimens and managing the spread of resistant strains.
The absence of comprehensive policies and structured protocols has been a challenge. Improved governance would enhance the implementation of standardized protocols, ensure adequate resources for isolation and ultimately contribute to more effective management and containment of TB.
Despite facing various challenges inherent to being a border County, the region has actively collaborated with multiple partners to address and manage TB. In 2021 the County was ranked top 19 according to the National Tuberculosis, Leprosy and Lung Disease Program scorecard used to rank and evaluate TB in the Counties.
The program assessed the County based on the successful completion of the following requirements;
- The number of TB cases diagnosed and documented in healthcare facilities.
- Evaluation of diagnostic tests.
- Transmission rate index.
- Number of screened patients who have received medication.
- Number of patients who have successfully completed treatment.
- The program monitors TB patient contacts by tracking individuals receiving preventive therapy, those undergoing continuous treatment, patients quarantined at home with health workers delivering medication and those on treatment but traveling to Uganda to ensure they can access their medication.
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