The patients will be held in the unit for about three months to see if they are cooperating with the treatment requirements and can tolerate the drug regimen which is known to be very toxic.

This treatment, which lasts for at least two years, is in line with World Health Organisation (WHO) guidelines on the treatment of people with Multidrug Resistance Tuberculosis (MDR TB) .

According to Kenya Medical Research Institute (Kemri) scientists Dr Willie Githui and Dr Helen Meme-Murerwa, who conducted the surveillance study, patients who participated in the research were resistance to two key and most powerful anti-TB drugs- Isoniazid and rifampicin.

Nairobi, Coast, Nyanza, and North Eastern provinces catered for the majority of these patients. Siaya in Nyanza and Busia in Western Kenya, were some of sites registering patients with MDR TB.

MDR-TB is a man-made phenomenon resulting from poor management of the disease. This may come about when those taking the drugs fail to adhere to the treatment guidelines, use low quality drugs, or when there is improper diagnosis and prescription of drugs.

When this happens, the population of naturally mutated TB strains existing in the body system increases substantially, leading to the development of MDR TB.

The two Kemri scientists have been following 1255 patients for the last two years during the study, which was commissioned by WHO and Centre for Disease Control of America.

Their findings have been subjected to a Supranational Reference Laboratory in East Dulwich, UK, which, in line with WHO guidelines, is supposed to test and establish if what Kemri scientists found reflects the true picture.

Dr Davy Koech, Kemri Director, says it is only after the laboratory affirmed Kemri scientists findings that they can now be released to the public.

The results, he adds, are interesting because in 1995 when they did a surveillance study that was published by WHO, no MDR TB was recorded.

Now, the current study gives a totally different picture.

To be published before the end of the year in The International Journal of Tuberculosis and Lung disease , a senior Ministry of Health (MoH) official says the current surveillance findings have shocked and disappointed his colleagues, some of whom have all along argued that things were not that bad.

In a letter reference No DC/7/3/27, the Director of Medical Services, Dr James Nyikal, says whereas he is saddened with the emergence of MDR TB, he is pleased to report that the Ministry is planning to start an isolation unit to cater for patients with these strains.

The ministry official says they are now looking at ways of raising money for this purpose as well as communicating with the Green Light Committee that looks at such issues, to see if they can be assisted.

Mid last year, the MoH denied MDR TB existed in the country in significant numbers when Horizon carried a story indicating that of the 149 TB patients who were referred to Kemri by private and public hospitals in Nairobi, 11.4 per cent had multidrug TB resistant strains.

The ministry was categorical that the country's MDR TB magnitude was only 0.03 per cent, which, they argued, did not warrant an elaborate government management response to the problem.

It later emerged that the 0.03 per cent figure was the same one cited in a ten year review of TB drug resistance in Kenya published in the October 1993 East African Medical Journal, Vol 70, No 10.

This time around, following the current results, the ministry is looking at the issue with renewed seriousness.

The gravity of having such strains circulating in the country, where over 800,000 are infected with TB, is however going to sink sooner than later as the government and families spend more than one million shillings to treat just one person.

Patients with the MDR TB are also inevitably going to shift to the second line drugs, which are more toxic to organs such as the liver and kidneys.

In cases where the resistance strains have done much damage, part of the patients lung will have to be removed.

With these new findings, Dr Koech says health personnel will have to be trained to master the techniques of picking-out somebody who is resistance to more than one TB drugs.

Dr Githui and Dr Meme-Murerwa add that simple procedures and characteristics to diagnose a person with TB resistant strains will too have to be used especially in resource poor settings.

Currently, testing of drug resistance TB costs about Sh 3,500 at Kemri compared to less than Sh 50 charged by public hospitals to test for normal TB strains.

The bad news about the presence of resistant strains in the country come at time when the government is preparing to present a report to the Millennium Development Goals meeting in New York next week on how it is managing HIV/Aids related opportunistic infections.

TB is one of the major opportunistic infections assaulting HIV positive people.

They are also coming when some European countries are requiring people to be screened first of TB before being issued with a visa.

But the biggest fear now is that those who were found to have MDR TB strains are freely mingling with other people, and spreading the strains.

Majority of them are too poor to raise even 0.1 per cent of the one million shillings required to manage their condition.

Although the government was about four years ago alerted to the issue of MDR TB and how to help such poor patients access medication, much of its policies have not been translated into action.

In 2002, the then Director of Medical Service, Dr Richard Muga , instituted a 20-person task force to look into the matter, after 30 people reported to Kemri with the super TB strains.

“Sporadic cases of MDR-TB have been notified to the National Leprosy and Tuberculosis Programme in the last quarter. At least 30 patients are now confirmed to have MDR-TB on sputum and culture and sensitivity done at Kemri,” says Dr Muga in the letter dated 4 th September, 2002.

According to the letter, the task force terms of reference were to prepare guidelines for registration and treatment of MDR-TB; its prevention; and surveillance.

Concern was particularly raised by the fact that the method used in the TB national programme to diagnose TB cases does not capture patients with resistance TB.

The team was also expected to give recommendations on the identification and establishment of a referral and isolation centre for treatment of MDR-TB patients.

As an immediate response, the team was required to prepare an application to the Global Fund and the Green Light WHO committee to enable Kenya access funds and cheaper drugs to help in the management of the strains.