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15th March 2009 - The emergence of the multi-drug resistant TB (MDR-TB) strain has reduced labour outlay, raised health care costs and reduced savings and other carry-along expenses.

The devastating disease affects people of all ages across the globe with direct links to low productivity to individuals, households and to national levels.

Studies have shown that countries with a low TB burden grew faster than those that are heavily afflicted.Productive individuals at the 22-50 age brackets are more vulnerable to contracting the disease due to its air borne nature and poor control measures at work places.“Some workplaces are hot beds for the disease spread.

They lack ambient aeration and workers may keep on coughing or sneezing, talk or even spit anyhow- the bacilli is eventually propagated,” explains Mr Francis Ndurangu, an IT expert at Tabaki Freights-Mombasa road. “In addition, some companies do not give sick leaves and sick offs,” she adds.It affects the lungs but can affect almost any part of the body. It spreads through the air when people with TB cough, sneeze or even talk.“TB is caused by mycobacterium tuberculosis and passed through air from an infected person to the rest. It’s the first opportunistic disease to strike HIV/AIDS patients due to their low immune systems,” explains Dr Jane Onteri, Programme officer at Division of Leprosy, TB and Lung Diseases at the Kenyatta National Hospital.

The link between business and well-being now goes beyond philanthropy and brand building as it’s traditionally thought of. It has shifted the TB architecture to clearly demonstrate the correlation between human resource and results achieved in the long run.

The disease is catastrophic for households and companies may incur direct or indirect costs that usually dominant cost component towards the treatment.“TB treatment is very long and costly,” states Titus Kyalo a MDR-TB patient. “Testing means early detection, and that means early treatment and therefore better survival rates,” adds Titus.

He was diagnosed with the TB strain in June 2006 while working at the Aga Khan hospital Mombasa. He could not perform his duties effectively due to pain in the ribs and seizures caused by Cylocrene drugs he took.

The company supported him for his 6 months therapy leaving behind a 1.6 million bill behind.Infectious diseases, such as tuberculosis, affect the size of the labor force and the productive capacity of the economy and massive job losses universally.

“At times you are obliged. You have no resort other than to relieve duties to a TB patient at an early time. He’s a risky asset to the rest of the group working together with. Moreover, he must seek treatment whatever may,” says Mr Moses Wainaina who operates a photocopy shop at a crowded basement shop in town. In January 2008, he (Titus Kyalo) was terminated on medical grounds but his pension of more than Ksh 300,000 was all consumed in the process.“I just wanted to die after loosing my job. I had contemplated of committing suicide especially when my father sold his 3 bulls to offset my molding hospital bills,” he says.

He had sought for sick leave of three months and the human resource had warned him of job losses on absconding grounds. “TB is basically linked to poverty,” says Dr Johnston Wafula, consultant physician at KNH respiratory and infectious diseases specialist.

“This could be due to poor housing facilities and access to health care in time”.More than 1.5 million people die of TB every year while millions of others have latent form of TB in their body systems.“If your immune system is compromised, it may not keep any latent infection in check, developing into active TB. It’s much easier to treat TB in its latent form, while your immune system is relatively healthy than waiting for signs of active TB disease, which is harder to test,” explains Dr Wafula.

Tuberculin is injected, a visual test, to see if it creates a lump which would show a response to TB.HIV-TB co–infection has caused treatment of TB a nightmare and victims die within months if not properly treated. 

Direct observation treatment (DOTs) lasts for 6 months. MDR-TB patients cannot be treated on the DOTs formula but will have to undergo a more expensive therapy, usually 1.3 million, and lasts for 24 months. This translates to waste of manpower and money.

“Patients will have to be isolated to avoid further contacts within infectious source and doctors to watch patients self-administer to ensure compliance,” Dr Wafula explains.

Treatment for tuberculosis involves an antibiotic to kill the bacteria that are causing the disease.“You may also be given medications to ease your symptoms until the bacterium is gone. You may be quarantined until the active stage is passed and you are no longer contagious. Treatment is very important to ensure you can live a long and healthy life, even after you’ve had tuberculosis,” says Dr Jane Onteri.

Private sector and the whole business community is seeing TB as a serious threat to the economic growth due to-lay offs and the possible infection to of workers in certain work stations in the industries.

Financing and delivery arrangements and quality of care influences patient interactions with public and private providers and therefore direct costs are greatly incurred from the onset.“A rage of business scopes has folded the cuffs in the fight, pull their creativity and expertise. No man is an island. There is power in numbers and the right combination of resources by working with different arrays of partners in our outreach effort,” Asserts Mr Mark Mutunga, Education & Citizenship Programme Manager Microsoft East & Southern Africa.The company has no specific programme but has partnered with PEFA International closely to educate the people on TB-HIV/AIDS co-infection and working with partners through technology by developing movies and solutions.

Mark adds “We are having a programme at an informal school where informal sectors are rolling out a film project highlighting TB and HIV/AIDS in the slums”.

Developing countries could face a financing gap of between $270 billion and $700 billion this year as a result of the global economic downturn and declining trade income.

Countries that heavily rely on aid, which could be cut off as industrialized countries face domestic budget challenges more severe in lower-income nations, where it would affect vulnerable families living near the poverty line and affected by TB menace and HIV/AIDS.

Thus Kenya will rely heavily on the available resources within the reach.“Obviously funds are short and we don’t have much to throw at another program. But it’s worth pointing out that several studies have showed a high benefit-to-cost ratio from ramping up treatment programs, because if you don’t treat one TB patient today, you have to treat 50 tomorrow,” says Dr Wafula.

“It’s a time bomb we are sitting on”It has (business fraternity) then teamed up to fill in the gaps within the realm of expertise by formulating effective policies to deliver long term results.Provision of treatment and care to employees in companies whose bottom-line is affected by the TB pandemic to counter the sick leaves and deaths of the labor force and to the greater immediate families.“Ultimately coping strategies must seek to sustain the economic viability and sustainability of the workforce and on the immediate families,” quips Mr Peter Waihura, a lecturer at Kingdom Excellence Life Institute, Nairobi. 

The accelerated pace of resistance comes from the world’s neglect of tuberculosis, which is best cured with a cocktail of four drugs, with medicines taken daily for six to nine months. But most patients who start this difficult regime fail to complete it, leading to resistance.

“Some drugs are bitter to swallow and some may lead to diarrhea,” Dr Wafula told Africa Science News Service.

“This calls for direct observation by the nurses to ensure that the patient fully complies with the prescriptions given”.One has to be attending the health facility daily to ensure that he gets the treatment to the last bit which translates to wasted man hours and resources.Kenya boost of only one public-government MDR-TB facility at the Kenyatta National Hospital that looks into 27 MDR-TB patients who attends their clinic in an open area with tents elected to serve the purpose.“The facility here is strained bearing in mind we have more than 400 reported MDR-TB cases in the country. Other stakeholders in the fight should come in the forefront and help with the resources at their disposal,” admits Dr Wafula.

A global TB control target was set within the Millennium Development Goal framework to have TB prevalence halved and reversed by 2015.There has been notable progress in HIV testing among TB patients and in provision of therapies and anti retro viro therapy (ART) to HIV/AIDS patients countrywide.

Diagnostic and treatment services have been decentralized to the community and increased knowledge and awareness of the disease in the community.

Workplace training programmes have been put in place to ensure that workers can get health facilities at their reach.

Some companies have also funded-supported certain radio programmes that highlight to their greater audience on the need of TB early testing and treatment.