Kenyans are known as some of the the most techno-savvy people in Africa, with mobile phone penetration in Kenya’s 44 million large population estimated at 35.6 million subscriptions or 87 per cent.
While the overwhelming popularity of mobile phone technology can rightly be seen as a sign of a people in touch with modern trends, tuberculosis continues to be a major cause of morbidity and mortality in Kenya.
WORLD TB DAY
As the World TB Day is marked on Saturday March 24, Kenya’s TB prevalence rate is still pegged at a 558 per every 100,000 people.
This year’s theme is “Mulika TB, Maliza TB, Ni Jukumu Langu,” with focus on early testing and proper care of patients to prevent spread of the disease through adherence and safe health practices.
Although it affects people of all ages, its greatest impact has been felt in the most productive age group of 15 to 44 years.
According to the National TB Control Program, the major factor responsible for the large TB disease burden in Kenya is the concurrent HIV epidemic.
“Other factors that have contributed to this large TB disease burden include poverty and social deprivation that has led to a mushrooming of peri-urban slums, congestion in prisons and limited access to general health care services,” the agency says.
In the last decade TB case notification resulting from diagnosis had been increasing at an average of 16 per cent annually. There has however been a decline in TB cases from 2005 following a decline in cases of individuals co-infected with TB and HIV cases that began in 2004.
A group of community health specialists have however seen the opportunity provided by the universal access and preference for mobile phones and related messaging technology to reduce the burden of TB in the country.
Keheala, a non-governmental organisation named after the Hebrew name for “community”, is taking the fight against TB to the digital sphere by suing mobile messaging and telephony.
“We enroll people in the interactive SMS program which is free of charge and use it to monitor their adherence to the TB treatment regimen,” says Program Officer Edwin Nyakan.
The mobile-based patient support platform uses a system of short message service (SMS) texts, which alerts the client on the agreed time to take the medicine, and also allows for the user to chat with the support sponsors.
“We send out an alert at the time which the patient told us, and when he or she responds that he has taken the medication, we send a congratulatory text to encourage him. We also have an option for him to contact us by asking questions through the platform, which is provided in English and Swahili,” Mr Nyakan told the Nation.
Support Sponsor Mr Louis Muriuki says the system has so far proved a viable option for the National TB Program to use as a prototype for a future nationwide program, saying 96 per cent of the clients enrolled successfully completed their treatment regimen.
“We did a study on the first batch of 1,200 patients that were enrolled in the program and tracked them throughout the duration of the treatment. For control purposes, half of the participants were not enrolled in the mobile-based adherence tracking program. Findings showed that 96 per cent of the enrolled patients completed their treatment course awhile 87 percent of the non-enrolled ones completed,” Mr Muriuki said.
It is on the basis of the success rate of the pilot phase that the program coordinators have decided to roll it out in eight counties in the next phase.
“For our next phase, we intend to target a total of 15, 500 clients in the eight counties,” he added.
Trish Atieno, another support sponsor, says the team sometimes encounters cases of stigma among patients, saying it discourages them from adherence to the treatment program.
“We occasionally have to deal with cases of patients unable to take their medicines because of challenges and constraints at their places of work, slowing down the recovery process,” said Ms Atieno.
She said the system offers patients the privacy of asking questions and sharing concerns on their condition, something they might not be comfortable to do in the often crowded public health facilities where they go for medication and consultation with health workers.
Among other strategies to reduce the TB burden, the program is focused on early diagnosis of tuberculosis including universal drug-susceptibility testing, and systematic screening of contacts and high-risk groups.
“We are working in conjunction with the national government to ensure that patients not only receive treatment but receive it early enough, with appropriate counselling, encouragement and information to enable them enjoy positive health outcomes through full recovery,” said Ms Faith Kavata, a support sponsor.
Ms Kavata called on medics to handle patients humanely, saying patients are people who also need love and understanding.
“The disease is not a death sentence and is no longer associated with HIV infection. By supporting patients and embracing them in that state, we will help them recover faster and contribute positively to the economy as they recover and resume their normal lives,” she said.