By J, KNA
For six months, Mzee Sylvester Amugune, 66, a resident of Kaptembwa estate on the suburbs of Nakuru town, had a persistent cough and chest pains. He was also experiencing difficulty in breathing.
But on September 12, he realised he had been battling tuberculosis symptoms. This was during a sensitisation campaign on prevention and treatment of tuberculosis which was being spearheaded by the County Government with support from the National TB Programme and AMREF in the devolved unit’s five sub-counties.
“I was diagnosed with TB during a free TB screening exercise and Iam now on medication,” says Amugune.
Amugune was among more than 6,000 residents of Nakuru East, Nakuru West, Bahati, Rongai, and Njoro sub-counties who turned up for the six-week TB awareness and screening outreach programme.
County TB and Leprosy Coordinator, Dr Neimah Barasa, says the residents were screened using advanced diagnostic tools which 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 says use of ultra-portable digital chest X-ray machines with Artificial Intelligence (AI) during the outreach programme 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.
She says the machine can trace people who have no symptoms of TB but have been infected.
The X-ray machine will display wounds on the chest and lungs.
Dr Barasa observes “Since it is a digital machine, it means the results are instant. The new X-ray machine is 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 adds.
Dr Barasa points out that deployment of the new technology during the screening exercise further 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.
Both clinical and bacteriological TB cases were also diagnosed and successfully linked to care.
She however states 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 notes that the only way they will be diagnosed early and before they have symptoms is through new advanced technologies.
She says 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 discloses 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 notes that last year 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 Organisation recommendations under the TB Programme supported by USAID through the STOP TB Partnership.
Dr Barasa expresses optimism that with the new tools they are edging towards finding the 40 per cent of missing cases thereby reducing further community transmission of TB.
Four years ago, the World Health Organisation (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 indicated 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 detected to have this strain that is resistant to Rifampicin, they will be put on the right medication.
” 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 points 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 points 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.
The co-infection of HIV/Aids and TB is a major challenge as it weakens the immune system, making individuals more susceptible to TB and complicating the management of both diseases.
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 paediatric 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 says 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 says 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,” notes 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,” advises 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.