Multi-drug resistant tuberculosis is spreading in the slums of Kenya's capital, Nairobi, some health workers have said recently, IRIN News reports. //
According to a 2004 report by the Kenya Medical Research Institute, about 70% of Nairobi's population lives in slums, and a large proportion of HIV-positive people who also have TB reside in slums.
Liesbet Ohler, a TB coordinator for Medecins Sans Frontieres, said that the "dark and airless" homes in the slums provide the optimal environment for TB to thrive. She added that stigma also might cause people with TB to interrupt their treatment regimens, which can lead to the development of MDR-TB. "Here in Kenya, so many people are HIV and TB coinfected, so if you say (you have) TB, people assume (you are infected with) HIV," Ohler said.
Kenya has recorded 46 cases of MDR-TB, but the actual figure could be much higher, Dave Muthama, program officer for Kenya's National Leprosy and TB Control Program, said. Sputum tests often do not detect TB in people with HIV, so the most effective way of diagnosing TB in HIV-positive people is by culture testing.
"It is difficult to get good cultures, therefore it is difficult to work out what proportion of patients" has MDR-TB, Christine Genevier, MSF's head of mission, said. According to Ohler, people with HIV have reduced levels of the TB bacilli in their sputum, so their sputum tests often come back negative and their chest X-rays might look normal.
She added that the "immune system is weakened, so the disease develops with less visible signs -- less TB is needed to make a person ill with the disease -- so people need to be treated on clinical signs before it is too late." In addition, there are not enough laboratories in the country, difficulties in diagnosing HIV in people with TB and insufficient follow-up among people taking TB treatment, Genevier said.
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