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Concern as cases of Pulmonary TB increase

Written by Mary Mwendwa

For the past year, Jackline Imali has literally stared at death in the eye and lived to tell the tale.

Community members in Northern Kenya listening to talks on how to prevent and cure TB. Extra Pulmonary TB has become a new headache to health practitioners in Kenya. Picture: File

The mother of one who is in her early 30s started experiencing constant headaches, fever and general body pains in her house in Nairobi’s Kangemi estate.


To Imali, it was just a normal typhoid or malaria that was manifesting in some weird manner. Her frequent visits to health facilities took her six months before the worst and shocking news in her life was confirmed, at Mbagathi Hospital in Nairobi.

One of the doctors attending to her after diagnosing her called her to a private room and broke the bad news that she was suffering from spinal Tuberculosis.

Recalls Imali: “My sickness started in December 2012; I could not imagine or even think of anything close to TB. I knew TB as a highly infectious disease that could only manifest through coughing. “
By then she was having a constant headache which could only stop for a short time after taking pain killers. She also hard a persistent fever that its origin could not be explained in addition to feeling weak all over her body.

“As a woman and a mother, I was deeply affected because I could not take care of my baby and husband; all my household chores were stalled during that time. It was not easy, ’’ Imali recalls.


It took her almost six months before she was diagnosed with the TB of the spine. Many Kenyans suffer similar tribulations as Imali and move from one health facility and doctor to another in vain.

For her, the clinic she visited the nurses kept telling her it was pneumonia and typhoid.

But in a separate interview, Dr Thomas Ongaro, Nairobi County TB Coordinator; the diagnosis of Extra Pulmonary TB is very difficult in most of Kenyan local health facilities.

Says Dr Ongaro: “Most of the cases are discovered by surgeons when they decide to operate on any lump that has manifested on any part of the body. Lack of facilities, which can easily detect this type of TB, remains a challenge to the small clinics, which many people prefer to visit, as they are cheaper and easily accessible.“

Extra pulmonary TB is a type of TB transmitted normally through a cough, but instead of manifesting in the lungs it affects any of the body organs. It can affect, lymph nodes (lymph node TB), bones and joints (skeletal TB), the digestive system (gastrointestinal TB), the bladder and reproductive system (genitourinary TB) and the nervous system (central nervous system TB).

’’For Jackeline’s case, she suffered from TB of the brain and that’s why she experienced constant headaches which also led to her central nervous system being affected, hence the paralysis. However, it is important to note, in all types of TB, fever that has unknown origin is experienced by the patients,” says the TB expert.


Imali was enrolled on treatment, which took six months, and has since fully recovered.

Looking back, Dr Ongaro says he is glad that doctors at Mbagathi District Hospital, near Kenya National Hospital, were able to discover what almost killed her.

A happy Imali says: “I’m back to be back to my normal life as a mother and wife. My advise to people out there is to ensure that when they fall sick, they visit a good and well equipped health facility which has qualified medical personnel.”

On his part, Wilson Maina from Thika, shares similar experiences to Imali’s. He had an abnormal swelling on his reproductive organ - one testicle. He says it took him three months moving from one hospital to another until a surgeon performed an operation, only to discover he had TB.

“It was a very traumatising experience for me; I was weighing 70 kg, lost weight to 34 kg. I got paralysis on one side of my body and that’s when I sort for further treatment in a public Hospital in Thika, where TB was discovered. I never knew TB could affect my reproductive organ,” Maina confesses.


He has since fully recovered and has been carrying his normal duties without any hitch.

“I’m glad now I’m healed and I can perform my normal duties, in fact we conceived a baby after the sickness,” Maina says.

Generally any type of TB is spread when a person with TB coughs, sneezes, speaks or sings, the bacteria is released in the air without covering the mouth with a handkerchief or fingers.

A person nearby may breath in the bacteria. The bacteria, Mycobacterium tuberculosis, the bacillus that causes tuberculosis (TB), and then enters the lungs of the second person, where it may develop TB.

It can also spread to other parts of the body such as the brain; here it is referred to as, Extra pulmonary TB. In very rare cases the TB germ can spread through raw uncooked milk. If the milk is contaminated with the germ a person who drinks it may get infected and develop TB of the intestines.

TB of the lungs may cause symptoms such as, a bad cough that lasts three weeks or longer, pain in the chest and coughing up blood. Other symptoms of TB disease are weakness or fatigue, weight loss or appetite, chills, fever, sweating at night and headache.

Extra pulmonary TB can commonly be diagnosed by collecting either fluid from a swelling and lymph node biopsies.

Dr Evans Amukoye, TB Researcher KEMRI, says Extra Pulmonary TB is tricky to diagnose by many medical practitioners operating at community level.

‘’The catabolic nature of TB makes it to be confused for pneumonia and other common diseases. Patients must seek proper medical services in recognised health facilities whenever they fall sick, some clinics lack well trained personnel and will always diagnose diseases in their own way without following the medical procedures,’’ Dr Amukoye says.


According to WHO, globally by 2012, the TB mortality rate had been reduced by 45 per cent since 1990. In 2011, it was estimated that 12 million people had TB. Africa is the continent where TB is most common.

In Africa one out of every 4,000 people die due to TB. Almost one million people died from TB globally in 2012. It is reported 9,500 Kenyans died of TB in 2012.

Mombasa, Nairobi and Homa Bay counties have the highest levels of TB with more than 400 cases per every 100,000 people. Makueni County has the lowest levels of TB with just 52 cases per 100,000 people – the same level as in Europe. Two out of every five people (or 41 per cent) who have active TB are also living with HIV.

Dr Ongaro attributes the high number of TB cases in Nairobi, to increased informal settlements which have very large populations living in very deplorable conditions.

The TB experts lists the most vulnerable as the elderly, people living with HIV, children under five years, smokers and people living with Diabetes condition.

”Immune systems of these people are generally weak and therefore they are prone to many infections including TB,’’ Dr Ongaro says.

Extra Pulmonary TB can be prevented by early diagnosis and treatment. TB should be treated early in order to prevent deterioration of the disease and spread of the infection.

Patients with active pulmonary tuberculosis can attend any government chest clinic for treatment.

The World TB Day is marked every March 24, and the theme was: “Reach the 3 million.”


This article was originally published in the Reject Issue 97 .

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