The re-emergence of tuberculosis among theeconomically productive age group in Kenya: thecase of Mombasa districtJOELK. KIBOSS1 AND NICHOLAS K. KBBITOK2ABSTRACTIn this investigation 43 cases of smear positive patients undergoingTB treatment at satellite treatment centres situated withinMombasa municipality were observed and interviewedretrospectively. The span of the study was five months commencingfrom April 1997. The study was carried out in collaboration withthe National Leprosy and Tuberculosis Programme at Port Reitz,Coast General and Ganjoni centres of infectious and contagiousdiseases in Mombasa district. The data seem to indicate that thehighest number (97%) of persons affected by TB come from theeconomically productive age (15-50 years). The possible cause ofrecurrence ofTB in Mombasa district is lifestyle. The majority of thepeople with sputum smear positive earn below the poverty line.They live in rented or overcrowded houses with inadequateventilation, insufficient sanitary and transport facilities and poorhealth systems. In addition, there is a general lack of awareness ofdangers of infection, spread and prevention ofTB. Areaswarranting"closer attention by future research are highlighted inthe study.KEYWORDSeducation, health, life style, poverty, Mombasa, TB1 Department of Curriculum and Instruction, Egerton University,Njoro, Kenya2 Department of Animal Science, Egerton University, Njoro, KenyaVOL 18 NO 2 JULY 2003 JOURNAL OF SOCIAL DEVELOPMENT IN AFRICA 121IntroductionThe re-emergence of infectious and communicable diseases such astuberculosis in Africa has been blamed on various problems such aspoor epidemic surveillance; lack of medicine and medical services; weakhealth systems and poor health conditions and hazards (Bobbin 1984,Pratt 1995). Tuberculosis (TB) is a disease caused by the Mycobacteriumtuberculosis. It has been a misery of mankind for centuries, as accountsin the earliest surviving literature show (Barnes and Barrows 1993, Evans1994). A review of the literature shows that estimated cumulativetuberculosis deaths stood at 30 million during the period 1990-1999, ofwhich about six million occurred in sub-Saharan Africa (Kochi, 1991). TBis perhaps the most important contagious disease in the world thatcauses millions of avoidable deaths worldwide (Pratt 1995, WHO/TB1997).A global survey reveals that generally, TB has affected about half ofthe world's population and kills seven million people per year (Evans1994, Kochi, 1991). This comprises 25 per cent of avoidable deathsoccurring in developing countries and the highest percentage of TBcases (95%) and TB-related deaths (98%) occur in developing countries.Of those severely affected, 75% are in the economically productive ageof 15-50 years old (WHO/TB 1997). In addition, the recent WHOestimation indicates that one-third of the world's population, over 1.72billion people, are currently infected by M. tuberculosis.According to the National Leprosy and Tuberculosis Programme(NLTP1996), there were then 43,860 TB cases in Kenya (with the patients'statuses categorized as either chronic, relapse, sputum smear positiveor sputum smear negative and with Mombasa district alone having5,661 TB cases. The survey showed that the incidence of new patientswith sputum smear positive tuberculosis (patients diagnosed as severelyill) in Kenya was about 18,909 cases. The leading district was Mombasawith approximately 2,459 (13%) of the TB cases reported nationally. Ofall the 360 newly diagnosed TB cases reported (with all the fourcategories mentioned above) in Mombasa district, 52.4% (187) weresputum smear positive, 39% (141) were sputum smear negative andrelapses and chronic cases were 8% and 0.6% respectively. This is an122 JOURNAL OF SOCIAL DEVELOPMENT IN AFRICA VOL 18 NO 2 JULY 2003Kiboss/RE-EMERGENCE OF TB IN MOMBASAincrease of 25.39 % compared with previous TB cases reported inMombasa district. Considering this, Mombasa district appears to be aTB epidemic area in Kenya.Causes and spread of TBIn essence, M. tuberculosis is transmitted from an infected person (acarrier) to a non-infected person (non-carrier) by means of the inhalationof the tubercle bacilli released from a carrier as droplet nuclei duringcoughing, sneezing and talking. In addition to the infectiousness of thesource patient, the risk of infection is related to the closeness andintensity of exposure. In other words, anyone sharing the same air spacefor a prolonged period such as a family member, a fellow patient and ahealthcare worker, is at more risk of contracting the infection than thoseindividuals who are only briefly exposed to the source patient (such asone-time hospital visitors). Also, exposure of any length, especially insmall, confined, poorly ventilated environments, is dangerous. This mayinclude facilities in hospitals used for cough-inducing procedures suchas physiotherapy, sputum induction and administration of aerosoltherapy. The likelihood that an exposed person will become infected anddevelop TB is related to that person's susceptibility.Another factor that may increase an individual's susceptibility toprimary infection is immunodeficiency, which includes immunodeficiencysecondary to HIV/AIDS infection (Barnes et al. 1991). This poses apotential thread to susceptible non-carriers who can easily becomeinfected when they breathe these droplet nuclei. The literature showsthe following as the possible potential causes of the re-emergence ofthe TB epidemic:• Inappropriate diagnosis due to limited diagnostic knowledge andskill;• Improper treatment due to lack of sufficient diagnosis;• Negligence of private practitioners;• Lack of a guiding policy regarding the role of private practitionerson the eradication, prevention and control of TB;• A debilitating disease such as HIV or diabetes which reduces thepatient's immune system;VOL 18 NO 2 JULY 2003 JOURNAL OF SOCIAL DEVELOPMENT IN AFRICA 123• Lack of community awareness of the dangers of TB and its spread(Bobbin 1984,EmokorandTukei 1982, Evans 1994,Pratt 1995, WHO/TB 1997).Causes related to HIV/AIDS and diabetesDebilitating diseases-such as the HIV/AIDS and diabetes reduce thepatient's immune system. Individuals infected with HIV/AIDS are atsignificantly greater risk of a progression to active disease than thosewho are not infected with HIV/AIDS. HIV-infected individuals who havenot been infected with M. tuberculosis in the past commonly develop TBwithin a few months of exposure to a