TUBERCULOSIS & LEPROSY SITUATION
Kenya is one of the 22 high burden TB countries that together account for more than 80% of the world’s TB cases. WHO estimated that there were 120,000 new cases of TB in Kenya in 2012. The estimated 9,500 (5,400-15,000) deaths due to TB make it the fourth leading cause of mortality in the country. Since 2006, a gradual decline in case notification has persisted, suggesting that incidence may be declining following years of high treatment success, currently over 88%. Case detection has been enhanced through community engagement, inclusion of the private sector, intensified case finding, pro-poor enablers such as nutritional support, TB/HIV collaborative activities, and an increased focus on identifying TB in children.
In Kenya, the number of notified TB cases (all forms) increased from approximately 95,000 cases in 2003 to a peak of over 116,000 cases in 2007. After 2007, the number of notified TB cases steadily declined until 2013, when the number of notified TB cases was approximately 89,000 – the lowest it has been in over a decade. The relative numbers of new bacteriologically confirmed (smear positive) cases and extra pulmonary TB cases have remained fairly consistent over time. From 2003 to 2012 the percentage of new cases that were bacteriologically confirmed ranged from 37.3 – 43.0%. However, the percentage of new extra pulmonary cases increased gradually since 2003 but maintained a narrower range: 15.1% to 18.2%. Males had higher TB case notification rates than females among all age groups, except for children (0-15 years) and young adults (15-24 years) where there were equal numbers of males and females affected. Adults aged 35 – 44 years had the highest case notification rates in both males and females; however, rates of TB among males in this age group were approximately 30% greater than rates of TB for females in the age group.
HIV/AIDS continues to be an important driver of the TB epidemic in Kenya. The NTLD-Program has continued to successfully screen about 93% of all notified TB cases for HIV. Approximately 37% of patients with TB patients are also living with HIV (TB/HIV). TB-related deaths among people living with HIV have declined from a high of 12% in 2004 to 5% in 2012, as access to anti-retroviral therapy (ART) and cotrimoxazole preventive therapy (CPT) have increased. Approximately 74% of TB patients co-infected with HIV were initiated on HAART in 2012. Nearly all (98%) HIV infected TB patients were initiated on CPT in the same year.
Programmatic management of drug-resistant TB (PMDT) was initiated in 2007. In 2013, 248 cases of multi-drug resistant TB (MDR-TB) were identified and started on treatment.
WHO currently estimates that there are 2,750 cases of MDR-TB in the country? A drug-resistance survey is ongoing to define the estimates of prevalence of DR-TB in the country.
Kenya is considered to be in the post elimination phase of leprosy control, having achieved the WHO elimination target of less than 1 case per 10,000 people in 1989. The number of new reported leprosy cases in the country has continued to steadily decline over the past three decades from 6,558 to 139 cases in 1986 and 2013 respectively. Despite the low number of reported cases, leprosy continues to cause high morbidity among those infected with 48% of new cases notified in 2013 having advanced disease with disability grade 1 and 2.
Active transmission is ongoing in communities in both endemic and non-endemic areas with childhood cases (the marker of active transmission) accounting for 1 in 5 (21%) of all new cases. Recent active leprosy case finding exercises conducted in some counties yielded remarkable numbers of new cases. Most cases were infectious Multi-Bacillary (MB) leprosy, including in children.
A large proportion of disability grade 2 among patients reported in 2013 implies late diagnosis of leprosy in Kenya.
The country continues to build the capacity of county and sub county TB/Leprosy coordinators (CTLCs & sCTLCs) to diagnose and manage uncomplicated cases and has recently developed a training curriculum for training of health care providers. Guidelines for leprosy management have been integrated within the National TB treatment guidelines and are available countrywide. Similarly, recording and reporting structures have been integrated within the national web-based surveillance system (TIBU), making leprosy case-based data available at the national level.
Leprosy is a debilitating disease common among the poor and thus, there is need for a multi sectorial approach to ensure successful integration of those affected into the community. Other than physical presence of disease, social, economic and legal issues need to be addressed. Deliberate efforts need to be made to ensure that leprosy patients with disabilities benefit from the disability management program as provided for in the constitution.