20100927
reuters

Nairobi — Treatment drugs are becoming weaker by the day. Such is the case with two types of tuberculosis, multi-drug resistant TB and extremely resistant TB, which are on the rise not only in the East Africa, but also globally.

The emergence of the deadly strain bacterial infection has failed to catch the international attention it deserves. The most lethal -- extremely resistant TB -- has garnered almost no attention worldwide since it emerged at the turn of the century.

It is only in 2007 that the world woke up, after Andrew Shepherd, the young Atlanta lawyer, flew to Europe two days after being diagnosed with multi-drug tuberculosis. The incident exposed how easy it was for the lethal disease to spread, and how difficult it is to control.

"Drug resistant tuberculosis cases are spreading. We have already seen a rise in Kenya and we believe the case is the same in other parts of East Africa," says Dr Joseph Sitienei, the head of the National Leprosy and Tuberculosis Control Programme.

Extremely resistant TB is caused by poor treatment, mis-diagnosis and the unwitting use of counterfeit drugs. It is a case where a normal TB disease transforms itself becoming resistant.

Dr Sitienei says the TB problem might be serious due to poor surveillance in the EAC.

"Surveillance, an integral part of containing disease spread is not well developed in the region."

As a result information sharing, which one would expect countries under the threat of a lethal disease to undertake, is almost non-existent in the EAC region.

At the country level, Kenya has seen multi-drug resistant TB cases rise to 552, with only 170 on government funded medication programme. It means about 382 patients are moving freely in the country without proper medication, risking further spread of the airborne disease. That is scary.

In neighbouring Uganda, the situation is no different. The red flag on TB was raised three years ago, when the medical fraternity warned of increasing cases of multi-drug resistant tuberculosis.

At the time, nurses from the Uganda National Association for Nurses and Midwives cited the districts of Arua, Gulu, Hoima, Kabale, Kampala, Mbale, Mbarara and Soroti as the worst hit. In Tanzania, the disease has been on the rise in the cities and in the poverty-stricken areas.

According to the latest World Health Organization Global Report on high-burden TB countries, Kenya ranks highest in East African, occupying the 13th position with more than 132,000 new cases reported in 2007, representing an incidence rate of 142 cases per 100,000 population.

Tanzania and Uganda follow closely at 15th and 16th positions with an estimated 120,191 and 102,000 new TB cases respectively new in 2007. Rwanda and Burundi, however, are not on the list of the high burden countries, but there is fear they might be in future, if the EAC countries do not cooperate.

In fact none of the five East African countries have an up-to-date facility for isolating high risk patients, a problem that has made surveillance of the disease and monitoring of patients even harder.

"It's now that we are developing a proper isolation facility at Kenyatta National Hospital," Dr Sitienei says. It is hoped other EAC countries will follow suit.

Apart from surveillance and monitoring problems, the health ministries of the three East African countries on the WHO list, have to grapple with the skyrocketing cost of treatment.

Generally, drugs used to treat normal TB are effective and very cheap -- $20 (Sh1,600) for six months of treatment in the developing world, but it is the multi drug-resistant types that are a major problem for the regional governments.

According to the World Health Organization estimates, the drugs used to treat the two types can cost up to $20,000 for the two years of treatment required.

The cost is prohibitive, and hard to sustain without donor aid, given the increasing numbers of patients in need of treatment for TB, and other lethal diseases.

Kenya has already sent out an appeal for more help. According to Dr Sitienei, Kenya receives about $12.5 million every year from the Global Fund established to help poor countries fight Aids, Tuberculosis and Malaria (GFATM).

Between 2003 and 2008, for example, Kenya received $62.5 million. But the rise in cases is putting more pressure on the government to seek extra funds.

Figures from the National Leprosy and TB Control Department show that Kenya has so far benefited from rounds two, five and six, under the tuberculosis component of the Global Fund.

In the first two, it received $28,522,874, before qualifying for $26,964,867, in the sixth round, yet to be received.

A chunk of the money, the department adds, is used to buy drugs, train medical staff and provide transport for distributing the medicine in various parts of the country.