Alarm as TB testing gadgets run out of stock in public hospitals

A procession during a past World TB Day. The country has run out of cartridges used for printing out results for TB patients in public hospitals. PHOTO | FILE | NATION MEDIA GROUP

What you need to know:

  • There are fears that many people could have been infected since it is difficult to follow up on those who have tested positive.
  • According to WHO, Kenya has recorded about 8,000 deaths from TB in the past one year.
  • TB remains a global public health threat especially in Sub-Saharan Africa.

The country has run out of cartridges used for printing out results for tuberculosis (TB) patients in public hospitals.

The gadgets are normally used as an advanced technology in TB diagnosis.

A spot check by the Nation revealed that for five months now, patients have been waiting for long for their results with others giving up, with no immediate plans to ensure stocks are replenished.

The shortage of cartridges has forced health facilities to revert to microscopy testing, a process that takes long for suspected patients to know their TB status.

ASSOCIATED STIGMA

Previously, it took three or four days for results to come out, unlike in the technology which gives results almost immediately.

Already there are fears that many people could have been infected since it is difficult to follow up on those who have tested positive for the airborne disease.

This is for various reasons including time and distance for the hard-to-reach majority, cost of transport and the associated stigma as explained by TB crusaders.

According to the World Health Organisation (WHO), Kenya has recorded about 8,000 deaths from TB in the past one year.

This is about 3.15 per cent of the total deaths with a death rate of 39.16 per 100,000 of the population. This justifies the country's ranking in the fight against the disease at number 44 in the world.

TB remains a global public health threat especially in Sub-Saharan Africa. Most patients are also infected with HIV.

WHO recently ranked TB number seven out of 20 highest killer diseases in Kenya after diarrheal diseases, pneumonia, HIV and Aids, stroke, coronary heart diseases and road traffic accidents.

TB is traditionally diagnosed by a combination of chest X-rays, the staining of sputum with special dyes followed by microscopy (the growth of mycobacterium tuberculosis in culture). The sputum smear microscopy is easy to do and is cheap. It has been used alongside X-rays for a long time by TB control agencies worldwide.

However, the sputum smear microscopy test has some problems and might not detect real cases of TB. It is not so efficient in children since it is difficult to get their sputum.

But the modern geneXpert test exhibits high sensitivity and specificity for detecting pulmonary TB. It contributes to the rapid diagnosis of TB and drug resistance in two hours hence helping in selecting relevant treatment and making infection control decisions fast.

EFFECTIVE DIAGNOSIS

According to Mr Jeremiah Okari, who is the geneXpert coordinator, there are currently 70 geneXpert machines in Kenya.

He said that with the installation, validation and training on the use of the machines, Kenya can now guarantee quick and effective TB diagnosis, particularly among the vulnerable groups: the children, multi-drug resistant clients and those living with HIV and Aids.

Since inception, there has been an increase in the uptake of the technology. As a result, many more cases have been diagnosed — 15,000 in 2015 — with reduced turnaround time for TB diagnosis.

Ms Evaline Kibuchi, chief national coordinator of STOP TB Partnership — Kenya, confirmed that there have been cartridge stockouts since July and that a number of health facilities with TB desks either use the traditional way or send away patients.

“This situation has been complicated by a sudden government directive restricting a consignment of imported cartridges from entering the country. The National TB Programme directed that the cartridges be inspected and certified before being allowed into the country. For six months now, they are still inspecting,” she said.

She adds: “We don’t understand why this sudden change of policy, yet it is not the first time the country is procuring cartridges.”

She termed the directive weird, and one that has never been there before.

Worse still, Ms Kibuchi says, she has tried to get in touch with top Afya House officials to explain the situation, in vain.

When the Nation contacted the Health department on the same, the calls and short messages went unanswered.

“This is a national crisis that requires immediate attention,” Ms Kibuchi told the Nation on phone.

The matter has been complicated for patients whose sputum samples had already been taken and referred to centres with geneXperts for testing, she said.

This, she said is even more depressing owing to the fact that no one is following up the patients, and they could be infecting unsuspecting Kenyans.

FURTHER SCREENING

“The situation is complex as most of the patients won’t understand that there is a shortage of cartridges since they were not told to give sputum again for further screening. Above all it is the time being taken to clear the cartridges because we are losing many people,” she explained.

For instance, she said that in Makueni, the situation is serious because the cartridges ran out much earlier. Mr Peter Ng’ola, a TB advocate in the county has raised this issue before and even reported deaths.

At a sub-county health facility in Kangemi, Westlands, Nairobi and at the Rhodes Chest Clinic in the City, advocates operating in those institutions have reported similar challenges.

According to Steve Anguva in Kangemi, the geneXpert stopped functioning in June forcing facilities to revert to microscopy testing. “We briefly relied on borrowed cartridges but since August there was none,” he said.

There could also be unrecorded deaths besides infection concerns. Amid it all, the Health ministry is silent going by the slow response to emerging concerns.