Lilian Odhiambo, GPJ Kenya
Francisca Kagia holds her son Duncan Momo, who has tuberculosis. Duncan took an adult dose of TB medication up until October, when Kenya rolled out a new drug specifically made for children.
NAIROBI, KENYA — When Duncan Mumo was diagnosed with tuberculosis in August, his mother was both relieved and worried. Francisca Kagia had been seeking a proper diagnosis for her son for about six months and knowing what her son was ailing from gave her some relief. Kagia had been diagnosed with TB in the past, and she knew that with treatment, her son would be cured.
But Duncan’s prescribed treatment regimen worried her. The 5-year-old boy was told to take 10 tablets at a time every night for six months.
“He would chew them one by one until the last tablet,” Kagia says. “I knew they were too much but there was nothing I could do because I wanted him to be healed.”
Duncan is among more than 7,000 Kenyan children who took a high dose of TB medication, until October 2016, when the government introduced a treatment regimen specifically for children. The new drug, which isn’t an entirely new medicine but instead improved formulation in doses appropriate for children, comes in fewer pills which are flavored and dissolve in water.
Kenya is the first country in the world to roll out the drug.
Medical experts have welcomed it, saying it will improve TB management and chances of survival for children with the infection.
The high dosage in the regimen previously given to children contributed to treatment failure and even death, they say.
“Until recently, the child TB treatment regimen comprised of multiple pills of many formulations,” says Dr. Jackson Kioko, the director of medical services at Kenya’s Ministry of Health. “The tablets were big and difficult for the children to swallow, hence (they) had to be crushed and sometimes mixed with food. This resulted in inaccurate dosing and poor adherence.”
Tuberculosis is a major public health concern worldwide. In 2014, at least 1 million children suffered from TB and 140,000 children died from the disease each year, according to the World Health Organization.
Kenya has a high TB burden due to high prevalence of HIV, poor nutrition and overcrowding. The disease is the fourth leading cause of death in Kenya, according to data from the Ministry of Health.
The country reported over 81,000 cases of tuberculosis in 2015 and about 89,000 cases in 2013, according to the National Tuberculosis, Leprosy and Lung Disease Program’s Annual TB 2014 report. About 8,500 pediatric cases were recorded in 2015.
The new TB drug was first unveiled at a conference in South Africa in December 2015. Kenya expressed a commitment to become the first country to adopt it, says Robert Matiru, the director of operations at UNITAID, one of the organizations that funded the development of the medicine.
Kagia is optimistic that the new drug will make her son’s life easier. He received his first cartons of the medicine in late October.
“I know that he will not be healed instantly, but the fact that he will not have to take all the 10 tablets every evening gives me relief,” she says.
Kagia dissolves the pills in water. Her son has no problem drinking the solution, since it is flavored, she says.
Jimmy Nyaga, a TB nurse and a nursing officer at Majengo Health Centre in Nairobi, says the high dosage in the old treatment regimen was a big burden to children.
“An average child…takes nine TB tablets, plus another one which is meant to prevent any complications,” Nyaga says. “This translates into an average of 10 tablets per day. They take this for six months.”
His clinic has recorded 101 cases of TB this year, he says. Out of those 20 have been children.
In the new regimen, Nyaga says, children will take a total of three pills per day.
“There is no tablets burden,” Nyaga says. “Even for me, my work is easier in documenting the medicine. We do not have enough stores to accommodate these drugs and this is also a big relief to me as a nurse.”
The space needed for a drug regimen consisting of 10 tablets each day is significantly more than the space needed for the new drug, he says.
Dr. Immaculate Kathure, the child TB coordinator at the National Tuberculosis, Leprosy and Lung Disease Program says children all over the country, including those in prisons and children’s homes will have access to this medicine. TB testing and treatment is free in all public health facilities.
Stephen Mule, a parliamentarian and member of parliament’s health committee says Kenya has come a long way in achieving widespread use of the new TB medicine.
“In 2013 when I came to government, TB programs had zero funding from the government,” Mule says. “At some point, we borrowed medicine from Malawi and Uganda.”
The committee lobbied the government to allocate funds for TB treatment and since then, TB programs have become a priority for the government, Mule says.
Matiru, the director of operations at Unitaid, says they plan to explore more treatment and testing options with the new TB regimen.
“We want to examine whether there are other ways in which a child can be tested of TB,” Matiru says. “For instance, instead of relying only on sputum tests, we want to explore whether stool tests can be used in diagnosing TB in children. This is because some children are too young to cough out sputum since their respiratory systems are not fully developed for such a task.”
Lilian Odhiambo, GPJ, translated some interviews from Kiswahili.
