Timing and Determinants of Tuberculosis Treatment Interruption in Nairobi County, Kenya

Tuberculosis (TB) treatment is a key pillar in the management and control of TB. Service delivery within the treatment facilities plays an important role in ensuring treatment adherence by TB patients. A prospective cohort study involving 25 health facilities, 25 facility in-charge officers and 291 patients diagnosed as new sputum smear positive (SM+) between December 2014 and July 2015 was undertaken. The aim of the study was to estimate the median time to treatment interruption, associated factors and overall predictors of non-adherence to TB treatment. A total of 19 (6.5%) treatment interruptions were observed. The median time to default was 56 [95% CI, 36-105] days. Treatment in a non-public facility [AOR=0.210, 95% CI (0.046-0.952)] and facilities perceived to have adequate number of health care workers to offer Directly Observed Therapy (DOT) [AOR=0.195, 95% CI (0.068-0.56)] showed a lower odds of treatment interruption whereas attainment of secondary level education [AOR=5.28, 95% CI (1.18-23.59)] indicated a higher odds of treatment interruption. Non-clinical aspects of health care service delivery influence patient adherence to TB treatment. Health seeking behavior of groups considered to be high risk for treatment interruption should be incorporated into the design and delivery of TB treatment

A Comparative Study on the Quality of Life of Leprosy Patients in Kilifi and Kwale Counties in Kenya

Background:Kenya at present is in the post-elimination phase of leprosy having achieved a prevalence of <1 case per 10,000 persons in 1989. In 2019 Kenya notified 163 leprosy patients, highest being in Kilifi and Kwale counties. About a quarter (26%) of the notified leprosy patients had grade 2 disability at the time of diagnosis, this being the most severe form of disability that may indicate a late diagnosis. This study aimed at assessing the quality of life of leprosy patients to guide policies and programs intended to enhance the health and well-being of leprosy patients.Materials and Methods:This was a case-control study conducted in Kilifi and Kwale Counties. For every leprosy index patient enrolled, two controls were identified within the same village to match the case. Descriptive statistics were used to summarise demographic and clinical variables. The World Health Organisation (WHOQOL-BREF) tool was used to measure the quality of life. The tool derived four (4) domains of physical health, psychological status, social relationship, and environmental profile. These were transformed into a scale between 0 to 100 for analysis. The F-test was used to compare mean scores in the four domains between cases and controls. The quality of life among the index cases against their controls was further analysed using conditional logistic regression models.Results: A total of 98 leprosy patients and 167 controls were evaluated for quality of life. On the perception of quality of life, leprosy patients had significantly lower mean transformed scores of 39 (SD 25) versus 49 (SD 25) p= <0.0001 compared to controls. Similarly, index cases had lower health satisfaction scores of 42 (SD 26) compared to controls scoring 61(SD 27) p=<0.001. Overall leprosy patients had statistically significant poorer scores on physical health, psychological health, social relationships and environmental QoL domains. Differences were most remarkable in the psychological domain, with a mean transformed score of 53 (SD 20) versus 68 (SD 16) p= < 0.0001 for controls. The overall quality of life model revealed that leprosy patients who were found to have either diabetes or hypertension enjoyed a better overall quality of life with OR of 10.98 and 1.22 respectively with a p-value <0.00001. Patients with tuberculosis and HIV presented the poorest quality of life with ORs of 0.49 and 0.14 respectively.Conclusion: The quality of life of the leprosy patients was significantly lower than that of the community controls in all the domains. Governments and communities need to prioritize rehabilitation measures such as the provision of artificial limbs, cataract surgery, and social protection disbursements to help leprosy victims improve their quality of life

Assessing access barriers to tuberculosis care with the tool to Estimate Patients' Costs: pilot results from two districts in Kenya

<p>Abstract</p> <p>Background</p> <p>The poor face geographical, socio-cultural and health system barriers in accessing tuberculosis care. These may cause delays to timely diagnosis and treatment resulting in more advanced disease and continued transmission of TB. By addressing barriers and reasons for delay, costs incurred by TB patients can be effectively reduced. A Tool to Estimate Patients' Costs has been developed. It can assist TB control programs in assessing such barriers. This study presents the Tool and results of its pilot in Kenya.</p> <p>Methods</p> <p>The Tool was adapted to the local setting, translated into Kiswahili and pretested. Nine public health facilities in two districts in Eastern Province were purposively sampled. Responses gathered from TB patients above 15 years of age with at least one month of treatment completed and signed informed consent were double entered and analyzed. Follow-up interviews with key informants on district and national level were conducted to assess the impact of the pilot and to explore potential interventions.</p> <p>Results</p> <p>A total of 208 patients were interviewed in September 2008. TB patients in both districts have a substantial burden of direct (out of pocket; USD 55.8) and indirect (opportunity; USD 294.2) costs due to TB. Inability to work is a major cause of increased poverty. Results confirm a 'medical poverty trap' situation in the two districts: expenditures increased while incomes decreased. Subsequently, TB treatment services were decentralized to fifteen more facilities and other health programs were approached for nutritional support of TB patients and sputum sample transport. On the national level, a TB and poverty sub-committee was convened to develop a comprehensive pro-poor approach.</p> <p>Conclusions</p> <p>The Tool to Estimate Patients' Costs proved to be a valuable instrument to assess the costs incurred by TB patients, socioeconomic situations, health-seeking behavior patterns, concurrent illnesses such as HIV, and social and gender-related impacts. The Tool helps to identify and tackle bottlenecks in access to TB care, especially for the poor. Reducing delays in diagnosis, decentralization of services, fully integrated TB/HIV care and expansion of health insurance coverage would alleviate patients' economic constraints due to TB.</p

The effects on tuberculosis treatment adherence from utilising community health workers: a comparison of selected rural and urban settings in Kenya.

INTRODUCTION: Community Health Workers (CHWs) have been utilised for various primary health care activities in different settings especially in developing countries. Usually when utilised in well defined terms, they have a positive impact. To support Kenya's policy on engagement of CHWs for tuberculosis (TB) control, there is need to demonstrate effects of utilising them. OBJECTIVES: This study assessed TB treatment adherence among patients who utilised CHWs in management of their illness in comparison to those who did not in urban and rural settings. METHODS: A retrospective cohort study was conducted in selected health facilities using standard clinical records for each TB patient registered for treatment between 2005 to 2011. Qualitative data was collected from CHWs and health care providers. RESULTS: The study assessed 2778 tuberculosis patients and among them 1499 (54%) utilized CHWs for their TB treatment. The urban setting in comparison with the rural setting contributed 70% of patients utilising the CHWs (p<0.001). Overall treatment adherence of the cohort was 79%. Categorizing by use of CHWs, adherence among patients who had utilized CHWs was 83% versus 68% among those that had not (p<0.001). In comparison between the rural and urban settings adherence was 76% and 81.5% (p<0.001) respectively and when categorized by use of CHWs it was 73% and 90% (p<0.001) for the rural and urban set ups respectively. Utilisation of CHWs remained significant in enhancing treatment adherence in the cohort with unadjusted and adjusted ORs; OR 2.25, (95% 1.86-2.73) p<0.001 and OR 1.98 (95% 1.51-2.5) p<0.001 respectively. It was most effective in the urban set-up, OR 2.65 (95% 2.02-3.48, p<0.001) in comparison to the rural set up, OR 0.74 (95% 0.56-0.97) p = 0.032. CONCLUSION: Utilisation of CHWs enhanced TB treatment adherence and the best effects were in the urban set-up

Treatment Adherence by potential risk factors, sorted by utilisation of CHWs.

<p>* All data are n(%).</p><p>CHW, Community Health Worker, PSP Pulmonary Smear Positive, PSN Pulmonary Smear Negative, EPTB Extrapulmonary TB.</p

Framework of Study.

<p>H/F Health Facility.</p

The spatial epidemiology of leprosy in Kenya: A retrospective study.

BackgroundLeprosy elimination defined as a registered prevalence rate of less than 1 case per 10,000 persons was achieved in Kenya at the national level in 1989. However, there are still pockets of leprosy in some counties where late diagnosis and consequent physical disability persist. The epidemiology of leprosy in Kenya for the period 2012 through to 2015 was defined using spatial methods.MethodsThis was a retrospective ecological correlational study that utilized leprosy case based data extracted from the National Leprosy Control Program database. Geographic information system and demographic data were obtained from Kenya National Bureau of Statistics (KNBS). Chi square tests were carried out to check for association between sociodemographic factors and disease indicators. Two Spatial Poisson Conditional Autoregressive (CAR) models were fitted in WinBUGS 1.4 software. The first model included all leprosy cases (new, retreatment, transfers from another health facility) and the second one included only new leprosy cases. These models were used to estimate leprosy relative risks per county as compared to the whole country i.e. the risk of presenting with leprosy given the geographical location.Principal findingsChildren aged less than 15 years accounted for 7.5% of all leprosy cases indicating active leprosy transmission in Kenya. The risk of leprosy notification increased by about 5% for every 1 year increase in age, whereas a 1% increase in the proportion of MB cases increased the chances of new leprosy case notification by 4%. When compared to the whole country, counties with the highest risk of leprosy include Kwale (relative risk of 15), Kilifi (RR;8.9) and Homabay (RR;4.1), whereas Turkana had the lowest relative risk of 0.005.ConclusionLeprosy incidence exhibits geographical variation and there is need to institute tailored local control measures in these areas to reduce the burden of disability