Building community participation in the prevention and treatment of Tuberculosis

Community health workers display TB treatment packs.

Irene Nyambura and other community health workers at the Riruta Health.

Canadian High Commissioner, David Collins speaks to a member of the local community in Kawangware.

Four years ago, 38 year-old Irene Nyambura’s husband contracted Tuberculosis (TB) – a potentially fatal contagious disease that is spread through the air. At the time, she had little knowledge about the disease that her husband had contracted. Suddenly in need of information and support, many of her friends and neighbors shunned her family due to the stigma associated with TB. Irene’s husband sought medical help from a local Nairobi hospital upon contracting the disease.

“It was a hard time then. He was not able to work effectively and I was worried,” says Irene. “When he was treated, he did not adhere to the treatment schedule and he relapsed. I tried to learn as much as I could about TB so that I could help him, and I also committed myself to help others to know more about this disease as well as to try and break the stigma.”

Today, Irene is a community health worker and is part of a team of six others who work in the community in the low income settlement area of Kawangware, about 15 kilometres from Kenya’s capital city, Nairobi. The team works tirelessly to break down the stigma and teach the community about how to prevent and treat TB.

The efforts of Irene and the other community health workers are part of a TB community project by Malteser International that has received funding from the Canadian International Development Agency (CIDA) through its Canada Fund for Local Initiatives.

The project is based at a small health centre in Kawangware that sees over 700 patients each day, treating various ailments – including TB. The project area has a population of 600,000 with 80 percent of the homes headed by single parents, the majority of whom are women.

“I was selected as a community health worker because I live in this area and I know its people and terrain well. I was also selected because of the help I gave my husband when he was sick,” says Irene. “This year we have had 216 clients from the community that we have worked with and followed up to ensure they completed their TB treatment.

“But most importantly, our clients and their families – especially the mothers and their children – are assured that they are not alone,” she adds.

TB medication is free in Kenya, but the stigma associated with the disease keeps many of the inhabitants in Kawangaware who live in close living quarters from seeking treatment from hospitals or health centers. Many individuals try to self-medicate. Due to this, Irene and her colleagues also go door to door and confidentially take TB samples from those that are afraid of going or being seen at the health centres. 

Many times, it is the community that will inform Irene and her colleagues where they think a suspected TB patient might be located. In addition, residents whose immune systems have been weakened by HIV face a very high risk of developing active TB. Irene and the community health workers try to reach these individuals before it happens. 

Once the community health workers identify people who have contracted TB, they then refer them to the Riruta Health Centre for treatment, and also follow up on them.

“Because the community knows us, we are able to easily follow up by making home visits on those patients that are on TB medication to ensure that they complete their course of medication and avoid relapse of the disease,” says Irene. “We also work together with the area chiefs, women groups, youth groups as well as church groups to encourage patients to complete their medication.”

According to Kenya’s National TB programme report 2010, Nairobi constitutes 20 percent of the national TB burden. About 80 percent of the TB cases in Nairobi are located in the slums and in low income settlements with about 45 percent of all TB cases also co-infected with HIV. Poor housing and living standards in Nairobi slums and low income settlements increase the transmission of TB.

The main purpose of the project is to strengthen the roles of households and communities in the response to health-related development issues. With a special emphasis on TB, individuals like Irene help increase knowledge and skills within vulnerable communities.

Through the project, it is expected that within a year, over 700 TB patients will have been traced and referred for treatment. Additionally, on-going training is being conducted for over 40 community health workers and community leaders in relation to TB management, nutrition and health education methods. Further, the project will also enable the tracing of 120 TB treatment defaulters. In the long term, these activities will contribute to an increased and sustained TB case detection rate in the community.

Although the task seems herculean, community health workers like Irene who volunteer their time to this cause will continue to play pivotal in the success of the project.

“Having seen first-hand the work of the community health workers, which borders on almost heroism, I am glad that Canada is playing a positive role in the community in Kawangaware,” said Canadian High Commissioner to Kenya David Collins, after a recent visit to the TB project. “Indeed, TB affects the entire community, especially the most vulnerable – the mothers and children. Hopefully the TB project will improve the health conditions of those affected the most.”

Kenya ranks 13th on the UN World Health Organization's (WHO) list of 22 high-burden TB countries globally, and has the fifth-highest burden in Africa. According to WHO, Kenya has more than 130,000 new TB cases every year.  More than 80 percent of all TB cases are diagnosed amongst young people aged 15-45. However, there is hope: Kenya is also one of the top sub-Saharan African countries to attain the global targets of 70 percent TB case detection and 85 percent treatment success rates. Canada has supported similar efforts in the past, providing equipment and training of medical personnel through cooperation with Dutch organizations.

In Kawangware, it is believed that with improved access to treatment and follow up of patients, patients will be able to regain their place in society and continue supporting their families. Canada is empowering individuals like Irene Nyambura to foster the healthy growth and healing of their communities.