Child Friendly TB medicine launched in Kenya
According to the World Bank Tuberculosis is a disease of poverty. It is widely recognised that the poorer the community, the greater the likelihood of being infected with the Tuberculosis germ and developing clinical diseashe World Health Organisation estimates that low and lower middle income countries, that is, those with an annual Gross National Product (GNP) per capita of less than US$2995 account for more than 90% of TB cases and deaths. 76% of the world’s population lives in these countries. As I travel in a matatu every day to work from one of Eastlands populous neighbourhood, one thing that gets my attention is the big capacity matatus that have their window permanently closed. I have also noticed that some passengers would rather pick an argument when requested to open the windows than have the cold morning breeze hit their faces or the wind blow the ladies well combed hair. Knowing too well that tuberculosis (TB) is easily transmitted through coughing and sneezing and with 644 multi- drug resistant (MDR) cases in Kenya this gives me butterflies in my stomach. I always think of what if I contracted this disease? As a mother of children below 5 years if I contracted TB the chances of transmitting to my children are high. In 2014 alone, 8,448 kenyan children below 15 years were infected with TB. Among this 91% were HIV positive. It has been documented that on average a person with active TB will spread the disease to 1 to 15 people within a year. The rise in MDRand extensively drug resistance (XDR) strains is making TB harder to fight and present a grave threat to health and security in all countries.
Children with TB are diagnosed through a careful history, a lab test and physical examination. Children below 5 years are not able to produce spit on their own most of the time and may need additional tests like chest x-rays. The x-ray machines in the health facilities are few and thus children are often referred for long distance to access these services. Yet, TB is a disease that largely affects the poor members of our society for whom transport to and from the health facilities is not often available.
TB treatment services for children have globally become a centre of focus. This is fundamentally the same as for adults,with a required combination of TB drugs being taken for a number of months. A Kenyan child is on two or three different medicines at a time which causes huge pill burden for them. For children on anti retroviral treatment (ARV) this also means that the pill burden increases. Normally, to administer the medicine the caregiver will split and crush the tablets to get the dosage and give the child. The challenge with this is incorrect dosage and the medicine has a bitter taste and thus the child may refuse to take. Child TB treatment has been reviewed with new child friendly medicines being made available. When started promptly the outcome of TB treatment in children is generally good, even in those children that are very young and have compromised immune system.
In September 2016, the Government of Kenya rolled out new TB pediatric formulation in the country. It is opined that with this treatment that is easily dissolvable in water and with a pleasant strawberry taste, more children will be able to take and complete the right doses. KANCO applauds this initiative of the government of Kenya. However, the Ministry of Health will need to carry out extensive health promotion and education especially in high TB counties noting that in 2015 3,000 children could not be traced through the health system and thus did not access TB treatment.
Rahab Mwaniki is an Advocacy Manager at KANCO
EMPHASIZING IMPORTANCE OF NUTRITION IN KENYA’S DEVELOPMENT AGENDA
Kenya is ranked no 18 globally in malnutrition and this is a crisis in the country that requires quick actions to address. Malnutrition is a condition that occurs when people consistently do not consume or absorb the right amounts and types of food and essential nutrients. This leads to poor physical growth and brain development among children preventing them from thriving and living up to their full potential. This also interferes with performance in school, the country’s future labour force the Gross Domestic Product and human development index. Globally, this contributes to nearly half of all child deaths, approximately more than 3 million children each year. According to the Ministry of Health, this translates to 45% of child deaths in the country as a result of poor nutrition.
The development of Kenya’s future generation lies in the hands of policy and decision makers. Civil Society Organizations (CSOs) in the health sector need to have a common goal on scaling up the work of proper nutrition in the country. They however also require more support from the government to be able to achieve sustainable development goals. KANCO organized a TICAD VI conference breakfast meeting on Friday 26th August with various stakeholders in the health sector ahead of its official opening. The goal of this breakfast meeting was to rally stakeholders in the health sector to push for more comprehensive nutrition efforts in Kenya at the TICAD VI conference if significant progress in better nutrition is to be achieved. KANCO’s Director, Mr Allan Ragi stated that it is important to work with governments and other CSOs so as to register significant gains and to sustain any progress made in achieving better nutrition levels.
In line with this, great efforts were seen at the TICAD VI with the launch of “Initiative for Food and Nutrition Security in Africa (IFNA)” by The Japan International corporation Agency (JICA). This is seen as a new framework for accelerating international/global efforts to alleviate hunger and malnutrition in the African Continent which will focus on implementing practical activities as well as advocacy work; synergy of multi-sectorial activities such as collaboration of agriculture, health and education sectors; evidence-based approach for rational decision-making and monitoring & evaluation; and mid/long terms vision to enhance resilience of the target groups while coping even with emergency aid.
Successfully addressing malnutrition in Kenya will save the lives of 50,000 children and is a more than worthy cause and investment on the future generation. As CSOs focus on tackling Malaria, HIV and TB especially with the latest funding announcements made during the TICAD VI conference, it is imperative that the issue of malnutrition is not overshadowed.
No one is born a good citizen; no nation is born a democracy. Rather, both are processes that continue to evolve over a lifetime. Children must be accorded the right environment right from birth as the years from conception to the first five years are critical period in laying the foundation for the child’s lifelong growth and development. It is essential that all sectors work together as there is no alternative to growth and development but to take appropriate measures to support their full development and growth of their potential. Maybe you’re wondering: Why hasn’t foreign or domestic aid had more impact on economic development and poverty reduction? One major reason is that we’ve so badly neglected Early Childhood Development (ECD). One of the biggest obstacles to this better world is our collective failure to help parents provide adequate nutrition, safe environments and sufficient stimulation to their children during the first 1,000 days of their lives. Scientific and economic evidence shows that this failure has life-long consequences. It can lead to stunting and other limitations in development, which are caused by a lack of nutrition, a lack of sufficient stimulation, and exposure to environments that cause stress among children.
Why invest in ECD?
Governments that don’t invest in a skilled, healthy, productive workforce are harming their future economic growth. Evidence suggests that an additional dollar invested in quality nutrition and preschool programs will yield a return of between $6 and $17 dollars. Parenting programs added to nutrition interventions from birth to 2 years result in higher IQ, reduced depression and violence at age 18 years and above and 50% earning at age 22. If children fail to get what they need – enough nutrition, nurturing, stimulation, and a sense of security – during the most critical years of early childhood, the impact on their lives and futures is enormous as stunting not only leaves children vulnerable to infection, but it can permanently limit their physical and cognitive capacity.
Looking forward, although survival rates of children have improved in Kenya, statistically Kenya still does not prioritize ECD with the effect that 1 in 4 children are stunted, and 1 out of 5 Children are not fully vaccinated. I’m deeply concerned that our failure to tackle this challenge is condemning millions of children to lives of exclusion lives where they won’t have the brain power to succeed in school or in an increasingly digitalized workplace. The good news is that we know the cost-effective, evidenced-based solutions that can solve this problem its early childhood development, or ECD.
What we are doing
At KANCO, we recognize early childhood development covers the physical, cognitive, linguistic, and socio-emotional development of children, starting before birth until they enter primary school. These interventions start with adequate maternal and child nutrition and include early stimulation and learning activities. Providing early childhood development is both morally right and economically smart. Without it, inequality starts at birth, meaning children risk lifelong cognitive deficits through no fault of their own. Children who are poorly nourished, who are stunted, and who do not receive adequate parenting or stimulation before their fifth birthday, are likely to learn less at school and earn less as adults, perpetuating the cycle of poverty across generations. Competing in today’s digital economy requires a workforce with well-developed brains. How do we expect employers to invest in a country if its workforce is not sufficiently developed physically and or cognitively?
One important factor is a substantial shortfall in political and financial commitment at the national level. New estimates for FY 2015/6 budgetary allocations further affirms that point in that the vote-head on School Health, Nutrition and Meals, which is an important solution to enhancing school attendance for children from poor households, reduced from KSh 2,304,070,927 to KSh 1,475,706,546, representing a 36% reduction.
We must end childhood stunting and promote optimal development of young children through delivering universal access to ECD services as quickly as possible. The time also has come for a “whole of government” approach across different ministries and multiple sectors, and coordinated and sustained engagement with the private sector, foundations and civil society to scale up ECD interventions. We also need a National plan to hold all of us accountable for our policy decisions, financing, and faster progress. Depending on the path we choose, the journey to a world where everyone has the opportunity to reach their full potential can be long and arduous, but the path has shortcuts! More investment in ECD!
 (Gertler et al., 2014