Nakuru County government, with support from the national government and development partners has adopted advanced lung disease diagnostic equipment giving doctors an edge in the fight against a hard-to-treat form of tuberculosis.
County TB and Leprosy Coordinator, Dr Neimah Barasa said the advanced diagnostic tools have helped in easier and faster diagnosis including edging closer to finding the estimated 40 percent of missing cases thereby reducing further community transmission of TB.
Dr Barasa indicated that the use of ultra-portable digital chest X-ray machines with Artificial Intelligence (AI) had enhanced efficiency and accuracy in TB screening, besides enabling a larger number of people to be screened.
“The use of X-ray with a Computer Aided Detection (CAD) is a game changer in the fight against TB and is of great help in finding missing cases,” stated the coordinator.
Dr Barasa disclosed that the devolved unit had acquired a new AI-powered portable X-ray machine which will be stationed at Molo Sub County Hospital and will serve residents from Njoro, Kuresoi South and Kuresoi North Sub-Counties.
“We expect the new equipment to support active case finding strategies and strengthen surveillance efforts aligned with national TB control priorities within the regions. The new equipment builds on earlier county investments in portable digital X-ray technology that have significantly improved TB case finding, reduced diagnostic delays and eased congestion at referral hospitals. By enabling same-day screening and results, the AI-supported system enhances timely linkage to care and improves treatment outcomes,” explained the coordinator.
She said the machines can trace people who have no symptoms of TB but have been infected.
The X-ray machines display wounds on the chest and lungs.
Dr Barasa observed, “Since they are digital machines, it means the results are instant. The new X-ray machines are better than the older versions of screening for TB such as sputum test microscopy which would miss out on some cases.
“These compact, battery-operated machines—small enough to be carried in backpacks—emit lower radiation doses and are especially suited for hard-to-reach communities. When paired with AI-powered Computer-Aided Detection (CAD) software, the devices provide instant image analysis, improving diagnostic accuracy and significantly shortening the time between screening and potential diagnosis,” she added.
Dr Barasa pointed out that deployment of the new technology had led to the detection of multiple conditions, including chronic obstructive pulmonary diseases (COPD), lung nodules, asthma, bronchitis, pleural effusion and pneumothorax, with patients promptly referred to link facilities for management.
She however added that health care facilities run by the devolved unit use multiple modern diagnostic tools, such as a combination of chest x-ray and the GeneXpert which can detect if a patient has drug resistant TB or not.
The advanced technology adopted by the County Government at its health care facilities also includes spirometry for lung function testing, molecular TB tests and TrueNat point-of-care nucleic acid amplification test equipment to enhance the precision and efficiency of TB diagnosis, facilitating appropriate treatment.
While noting that up to 50 percent of people with TB do not have the classical symptoms of the disease, Dr Barasa noted that the only way they will be diagnosed early and before they have symptoms is through new advanced technologies.
She said that the devolved unit has made significant strides in TB management, with 637 health facilities spread across the county out of which 250 are TB treatment sites, with 102 diagnostic sites.
Dr Barasa disclosed that Nakuru now has in place eight TB sample referral sites equipped with advanced technology, including one digital Artificial Intelligence-enabled X-ray machine, seven GeneXpert machines and one TrueNat point-of-care nucleic acid amplification test equipment.
She indicated that in 2024 the Nakuru County Teaching and Referral Hospital (NCTRH) was among eight facilities nationwide that initiated the programme of Digital Chest X-ray (DCXR) with AI, introducing the new diagnostic tools in accordance with World Health Organization recommendations under the TB Programme supported by USAID through the STOP TB Partnership.
Five years ago, the World Health Organization (WHO) endorsed the rapid molecular test TrueNat.
TrueNat, which is more advanced in testing, is a chip-based molecular test for TB which is battery-powered to operate in peripheral laboratories and can generate results in one hour.
The coordinator further said that in addition to fast detection of tuberculosis, it can detect resistance to Rifampicin in an additional one hour, meaning that if a patient is found to have this strain that is resistant to Rifampicin, they will be put on the right medication without further delay.
” TrueNat point-of-care nucleic acid amplification test, which is a portable digital Chest X-ray equipment, has improved access to TB testing for patients with signs and symptoms of TB, especially in hard-to-reach areas where sample referral systems are unavailable or not properly constituted. It has a short test turnaround time reducing overall test turnaround time and time to TB treatment,” she pointed out.
GeneXpert diagnostics have become the gold standard for TB testing, particularly for drug-resistant TB (DR TB), which is difficult to diagnose through the traditional sputum smear technologies or chest X-rays.
GeneXpert can also rapidly detect rifampicin-resistant TB (a proxy for DR-TB diagnosis) along with drug-susceptible TB. But the diagnostic machines need electricity and are expensive to operate.
Dr Barasa pointed out that back in the day when health care facilities used to rely on the old x-ray machines and other methods, so many TB cases would be missed, and also it would take many days before getting the results.
The digital Artificial Intelligence-enabled X-ray machine at the NCTRH was acquired through support from the National TB Programme, the African Medical Research Foundation and Qure.ai, an AI solutions provider.
The technology provides automated interpretation of radiology exams like X-rays, CTs and ultrasound scans, enabling faster diagnosis and speedier treatment of the disease.
Eradication of TB in Africa has been challenging due to various social, economic, healthcare and biological factors.
Limited access to healthcare due to poverty, the high cost of treatment, and the inability to maintain proper nutrition, which is crucial for TB recovery, have exacerbated the situation.
Tuberculosis remains a major cause of morbidity and mortality in Kenya. It affects all age groups, but has its greatest toll in the most productive age group of 15 to 44 years.
The major factor responsible for the large TB disease burden in Kenya is the concurrent HIV epidemic.
Kenya is ranked fourth in Africa with the highest TB burden after South Africa, Nigeria and Ethiopia. In 2020, Kenya recorded 72,943 TB cases, 5,663 of these were pediatric cases translating to eight out of every ten infections.
According to Kenya Demographic Survey 2022, 12,000 people are infected with TB every year, while 32,000 die annually. Deaths reported were 21,000, a reduction from 31,000 in 2019.
Dr Barasa said the County Government has stepped up efforts to prevent and manage Tuberculosis (TB) through various interventions including training over 100 Community Health Promoters (CHPs) to enhance early TB prevention, detection and treatment at the grassroots level.
She said the devolved unit was also continuously carrying out surveillance among county residents who did not exhibit symptoms of the disease as a significant proportion of Kenyans are carriers of Latent TB.
“We need to catch the condition early and treat it before it makes people sick. This will bring down the cases of Active TB in the country. We are widening the scope of latent TB screening and treatment,” noted the official.
“Some sections of the population due to their low immunity that may be as a result of various factors, are likely to develop Active TB if they are carriers of Latent TB. So, to prevent that from happening, we need to screen them and treat the condition. Generally, if your immunity is likely to be low for one reason or another, then it’s important you present yourself to be screened for Latent TB,” advised Dr Barasa.
Other high-risk groups that are targeted for Latent TB screening and treatment include people receiving dialysis, those preparing for organ transplants as well as people with non-communicable diseases like cancer and diabetes as their immunity is usually low.
By Jane Ngugi
