PRIMARY LEVEL CARE OF TUBERCULOSIS

PRIMARY LEVEL OF CARE OF TUBERCULOSIS

PRESENTERS: • Emmanuel Wekesa• Keagan Kirugo

SUPERVISOR• Professor Francis E. Onyango

• Dr Boniface O. Osano• Professor Ruth Nduati

OUTLINE

Introduction Classification Magnitude of morbidity and mortality Risk factors Stop TB strategy

INTRODUCTION 1

Causative agent-Mycobacterium genus. Species are varied but mainly Mycobacterium tuberculosis.

It is an obligate aerobe and an acid-fast bacillus. TB is a re-emerging disease of global concern. The HIV pandemic has led to a resurgence of TB in both

adults and children, The burden of TB in children depends on the burden of

the disease in the adult population. Children have an increased risk of developing primary

progressive TB because of the associated severe immune suppression resulting from their young age and HIV.

Extrapulmonary TB is seen more often in HIV-infected children.

INTRODUCTION 2

There is a higher case fatality rate for children who are co-infected with TB and HIV.

It is important to look actively for TB in children with a chronic cough and to provide treatment as early as possible.

The highest reported sero-prevalence was reported in southern africa;10-60%, the lowest prevalence in West Africa.

CLASSIFICATION1

It is for childhood tuberculosisA. ACCORDING TO SITE Pulmonary Extrapulmonary.B. ACCORDING TO SEVERITY, TREATMENT HISTORY

AND DRUG RESISTANCE

1Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition: pg 34

1. Non-severe TB

2. Severe TB

3. Retreatment

4. MDR TB

•PTB without extensive parenchymal disease•TB lymphadenitis•TB pleural effusion

•PTB with extensive lung disease•Miliary TB•All other forms of extrapulmonary TB

MAGNITUDE OF MORBIDITY AND MORTALITY 1

Globally2: 2nd to HIV/AIDS as the greatest killer due to a single infectious agent.

Amongst those sick in 2012; 530,000 were children of whom 74,000 were HIV negative.

2http://www.who.int/mediacentre/factsheet/fs104/en/ reviewed March 2014

2010 2012

Morbidity 8,800,000 8,600,000

Mortality 1,400,000 1,300,000

MAGNITUDE OF MORBIDITY AND MORTALITY 2

TB is the leading killer in PLWHIV causing 1/5 of all deaths.

Locally3: Kenya is position 15/22 of the high TB burden countries

2012: prevalence 103,159 of which 39% were HIV infected.

3Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition: pg 9

MAGNITUDE OF MORBIDITY AND MORTALITY 3

RISK FACTORS4

A. Major HIV infection. Most common risk factor locally. Poorly treated previous TB Low socioeconomic statusB. Minor Non-modifiable: Age-extremes of age; Sex. M>F Immunosuppressive states: Malnutrition; Diabetes

mellitus; Immunosuppressive agents; Malignancies. Drugs: Alcoholism; Tobacco smoking Pulmonary diseases: Silicosis

4Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition: pg 3-4

STOP TB STRATEGY5 1

A. BACKGROUND 1991: World Health Assembly recognized TB as a world health

problem. 2 targets were set up: i) Detection of 70% of new smear positive cases

ii) Cure 85% of the new cases. All these by 2005

1994: DOTS launched. Componentsi) Govt. commitment

ii) Case detection through sputum microscopyiii) Standardized short-course chemotherapy under supervision

iv) System of regular drug supplyv) Monitoring and evaluation of the programme

STOP TB STRATEGY5 2

2003: Cure rates of the new sputum positive cases was 83%

2004: Case detection rate 53%

2006: Launching of Stop TB Strategy to run from 2006-2015

STOP TB STRATEGY5 3

TARGETSi) MDG 66: Combat HIV/AIDS, malaria and other

diseases. Target 8: Have halted by 2015 and begun to reverse incidence of malaria and other diseases.

ii) Stop TB partnership: By 2015, the global burden of TB will be lowered by 50% relative to 1990 levels

VISIONA world free of TB GOALTo reduce dramatically the global TB burden by 2015 in

line with the MDGs and the Stop TB partnership targets and to achieve major progress in the research and development needed for TB elimination.

5WHO (2006). The Stop TB Strategy.6http://www.milleniumproject.org/goals/gti.htm/

STOP TB STRATEGY5 4

PRINCIPAL COMPONENTS1. PURSUE HIGH-QUALITY DOTS EXPANSION AND

ENHANCEMENTa) Political commitment with increased and

sustained financingb) Case detection through quality-assured

bacteriologyc) Standardized treatment with supervision and

patient supportd) Effective drug supply and management

systeme) Monitoring and evaluation system and impact

measurement

STOP TB STRATEGY5 5

2. ADDRESS TB/HIV, MDR-TB AND OTHER CHALLENGES

3. CONTRIBUTE TO HEALTH SYSTEM STRENGTHENING

4. ENGAGE ALL CARE PROVIDERS5. EMPOWER PEOPLE AND

COMMUNITIES WITH TB6. ENABLE AND PROMOTE RESEARCH

REFERENCES

Division of Leprosy, Tuberculosis and Lung Disease. Guidelines for Management of Tuberculosis and Leprosy in Kenya. July 2013 Edition.

http://www.who.int/mediacentre/factsheet/fs104/en/ reviewed March 2014.

WHO (2006). The Stop TB Strategy. http://

www.milleniumproject.org/goals/gti.htm/

THANK YOU

AHSANTE MERCI XIEXIE