Daisy Wambui of Kenya defines “household contacts” as a group of people living together in a house as a family or friends in a situation where one of them has confirmed, active TB disease, which can easily spread to others not yet infected. TB preventive treatment is one way to protect the household and stop TB from spreading.
Daisy Wambui is a housewife and describes herself as a household tuberculosis (TB) contact with seven people in her house. One family member was diagnosed with TB a few years ago. Although Daisy does not have TB, she understood that she had latent TB and was quickly initiated on TB preventive treatment (TPT), while her three children were not started on preventive treatment.
She hails from Kakamega County, located 52 kilometres north of Kisumu, the tenth largest city in Kenya and considered the heart of Lunyaland, and arguably the second most populous county after Nairobi. Daisy learned about TPT from community outreach work conducted by IMPAACT4TB grantee Pamoja TB Group, which is involved in raising awareness of TPT and TB prevention.
In terms of preventive therapy, she notes the regimen is tolerable and has no side effects—something other family members in her household are worried about. Daisy decided to request 3HP as her TB preventive therapy after noting the benefits of the therapy in reducing the risk of TB infection. Firstly, Daisy underwent symptom screening before starting her 3HP short course. According to Kenya’s TB guidelines, household contacts undergo symptomatic screening; if they do not present signs, they are initiated on TPT. However, in Daisy’s household, other adult family members are not on TPT due to fear of side effects, perception of low risk, and general reluctance, among other factors.
Daisy’s kids are aged 7 and 4, respectively. Only one of the adults in the household is a motorbike rider to help the family earn a living. She is concerned that many households with TB contacts in Kenya are not receiving TB Preventive Therapy (TPT) due to a combination of reasons, especially a lack of awareness of the need for people living in households with TB patients to receive TPT to stop the disease from spreading.
When asked to clearly define who is a household contact of TB, she simply explains it is a group of people living together in a house as a family or friends in a situation where one of them has confirmed, active TB disease, which can easily spread to others not yet infected.
“In my house, there are two children who are going to school and four adult family members; one of the family members has TB. I was initiated on TB preventive therapy just to be free of the disease before it becomes active,” says Wambui. Considering that none of the two school-going kids in Wambui’s household are on TPT, it makes it likely that the three children could be affected. Most of her family members do not see it as a necessity to be on TPT because of the perception of low risk and a belief that they cannot be infected as the client affected by TB is on medication.
While it is true that effective treatment lowers the likelihood of transmission, it is possible that other household members may have been infected in the window before treatment began. According to her, that is one reason why it is important to test or screen for TB infection among teenagers and adult household TB contacts. Then those who test positive for TB infection should be offered TPT. “TPT is important in households with TB contacts because it reduces the risk of infection to others. I strongly recommend that all of us be on TPT in my house and all other households,” Daisy stresses.
Note: The Kenya 2019-2023 National TB and Leprosy Strategic Plan notes that a 2015/2016 TB prevalence survey revealed a TB burden of 426 cases per 100,000 in the whole country’s population of 46.6 million people. It is estimated that 158,000 persons fell ill with TB in 2017, yet only about 85,518 were notified. This, therefore, means that about 50 percent of estimated TB cases were not diagnosed, treated, and/or notified annually. The trends for children are presumed to be similar. Mortality among people with TB is high, with an estimated 43,000 deaths. A majority (64 percent) of the notified TB cases are male. Children under 15 years account for nine percent.
Written by: Stephen Anguva Shikoli, Pamoja TB Group
Photo Credit: Stephen Anguva Shikoli, Pamoja TB Group
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