MDR-TB Spreading in Slums of Nairobi, Kenya, Health Workers Say

Multi-drug resistant tuberculosis is spreading in the slums of Kenya's capital, Nairobi, some health workers have said recently, IRIN News reports.

According to a 2004 report by the Kenya Medical Research Institute, about 70% of Nairobi's population lives in slums, and a large proportion of HIV-positive people who also have TB reside in slums.

Liesbet Ohler, a TB coordinator for Medecins Sans Frontieres, said that the "dark and airless" homes in the slums provide the optimal environment for TB to thrive. She added that stigma also might cause people with TB to interrupt their treatment regimens, which can lead to the development of MDR-TB. "Here in Kenya, so many people are HIV and TB coinfected, so if you say (you have) TB, people assume (you are infected with) HIV," Ohler said.

Kenya has recorded 46 cases of MDR-TB, but the actual figure could be much higher, Dave Muthama, program officer for Kenya's National Leprosy and TB Control Program, said. Sputum tests often do not detect TB in people with HIV, so the most effective way of diagnosing TB in HIV-positive people is by culture testing.

"It is difficult to get good cultures, therefore it is difficult to work out what proportion of patients" has MDR-TB, Christine Genevier, MSF's head of mission, said. According to Ohler, people with HIV have reduced levels of the TB bacilli in their sputum, so their sputum tests often come back negative and their chest X-rays might look normal.

She added that the "immune system is weakened, so the disease develops with less visible signs -- less TB is needed to make a person ill with the disease -- so people need to be treated on clinical signs before it is too late." In addition, there are not enough laboratories in the country, difficulties in diagnosing HIV in people with TB and insufficient follow-up among people taking TB treatment, Genevier said.

The Kenyan government does not provide MDR-TB treatment, which costs roughly $6,000 for a full course, compared with roughly $20 for a course of regular TB treatment, IRIN News reports.

According to Muthama, the government is taking action to curb the spread of MDR-TB. "We have treatment centers where we are monitoring treatment as well as watching the patients," Muthama said, adding, "The patients are tested after one-and-a-half months to see if they are responding well, and from here we should be able to see if people have resistant strains." He also said that the number of treatment centers in the country has been increased to 1,800 because many patients have to walk to them.

Health workers and advocates are concerned that if the spread of MDR-TB is not brought under control in Kenya, the country could experience an outbreak of extensively drug-resistant TB, TB that is resistant to the two most potent first-line treatments and some of the available second-line drugs. Some Kenyan medical experts said recently that Kenya and its surrounding region lack the capacity to handle XDR-TB if the disease spreads to the region.

Source-Kaiser Family Foundation
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