1.0 INTRODUCTION
1.1 Background Information of the Study
Kenya ranks 13 th on the list of the 22-high burden TB countries in the World and
has fifth highest burden in Africa. According to the World Health Organization’s
[W.H.O’s] Global Report 2009, Kenya had approximately more than 132,000 new
T.B cases. In Nairobi’s Lang’ata, Embakasi, Westlands and Starehe constituencies,
government continues to treat more and more T.B patients each year. However
widespread co-infection with HIV [close to 48 %on new TB PATIENTS] makes
TB treatment difficult. This is because patients may stop taking the TB drugs since
they may feel better hence resistance is developed. The TB drugs may run out,
become scarce or forget to take medication from day to day. The case becomes
worse since bacteria are now increasing the body of patient which could be easily
be passed from one person to next through air whenever patient coughs, sneezes,
spits or talks. It’s also very important to be tested once you have finished the dose
of multiple drugs of TB to ensure that all bacteria are over in the body. Failure to
do so patients may develop resistance in their bodies. Approximately 85% of
population in Nairobi’s constituencies of Lang’ata, Westlands, Starehe and
Embakasi use public service vehicles. Most of the windows of these vehicles are
always closed and this is very risky since it’s rare to lack one or two TB patients in
these vehicles. Bacteria spread widely and very fast in poorly ventilated crowded
places. Print media which involves magazines, posters and newspaper is doing well
on teaching and informing people on how to prevent spread of TB but they should
do it in simple language for viewers, listeners and readers to understand the
message. Electronic media which include TV channels and radio stations don’t use
simplified language as they announce issues to do with TB. Embakasi and Starehe
constituencies have low and medium income earners compared to Westlands and
Lang’ta. It’s therefore important to use simple and understandable language since
people vary levels of education so as to avoid misinterpretation of message
whenever teaching and announcing issues of TB which is a major concern of the
society. Media also need to need to be producing programs [radio] in different
vernacular language to cater for those residents who neither Kiswahili nor English
due to their level of education. It is also very important to provide information of
all about TB I the websites of Ministry of Public Health and Sanitation and all
other TB organizations also provide information involving TB in different
international languages like French, Italian, German, Spanish and so on for the
sake of migrants and foreigners who are in the constituencies. The reality was that
TB was extremely prevalent, most in the urban slums where the conditions were
perfect for the disease; airless, damp, and congested living spaces. Having
identified 10 Ministry of Health clinics spread across all areas in Nairobi, Malteser
International equipped each one with a laboratory and testing centre for TB.
Diagnosis is now immediate and the treatment can now start within 24hours. The
treatment for TB is a course of drugs that must be taken for six months. Rather like
antibiotic for a minor infection you start to feel better so don’t complete the course
and the infection comes back with TB treatment if you stop taking the course of
drugs you will need to take a further course for two years which is most
expensive. To tackle this problem Malteser International have e a team of 60
Community Heath Workers [CHW.] .These are volunteers who live in Nairobi’ s
slums in which they work . They are not paid, but are given small incentives such
as lunch and transport money. When TB patients are too ill to get out of bed and
attend the clinics the Health Community Workers cares for them at home. The
project has been extremely successful and the government has been awarded it on
two separate occasions. They have also adopted the Malteser International model
for C.H.W.’s and using it for their own clinics and projects. Malteser International
has exceeded Millennium Development Goal 6, set by World Health Organization
to combat TB. APHIA 2 Nairobi supports the expansion and quality improvement
of comprehensive HIV care and treatment, TB and malaria services in public,
private and N.G.O heath facilities. Training, technical assistance, mentoring
continues medical education laboratory networking, supportive supervisions, small
amounts of facility renovations and equipment comprise the package of support.
The project has also filled health sector staffing gaps by hiring clinical officers,
nurses, laboratory technologists and data clerks to enable the provision of
expanded services with a goal to transitioning these staff to the Government of
Kenya. Project partners address TB prevention through Community Theater, radio,
school-based life skills programs, education and testimonies by people living with
TB patients, work place policy development and peer education about TB.
Organizations which relate to TB such as World Health Organization, Ministry of
Health, United States Agency International Development [U.S.A.I.D] among
others have to offer the following to TB patients and those affected:
1. food/nutrition
2. shelter and care
3. health care
4. psychological support
5. education
6. Economic strengthening-G.O.K and implementing partners have benefited
from capacity building in program, financial and data management skills
1.2 Problem Statement
Tuberculosis among residents in Nairobi County is increasing in number day by
day. Its often deadly infectious disease caused by various strains of micro-bacteria
usually mycobacterium tuberculosis in humans. Tuberculosis usually attacks the
lungs but can also affect other parts of the body. Large population of people stays
in congested duty places while others use public services [P.S.V] when all
windows are closed yet there might be someone who is tuberculosis positive
coughing and sneezing hence transmitting the bacteria. This type of lifestyle leads
to spread through air when people who have disease cough, sneeze or spit. Most
infectious in human result in an asymptomatic, latent infectious and about one to
ten infectious eventually progresses to active disease which if left untreated, kills
more than 50%of its victims. Many people (residents) are used to buying
antibiotics and painkillers direct from shops and chemists without being examined
by doctor. Whenever resident’s sneezes or coughs they always assume its cold or
ordinary flu and that is why they buy medicines and painkillers to relieve pain
without consulting any physician. This can lead to multiplication micro bacteria if
one is tuberculosis positive hence the patient would have spread to several other
people lack without him/her knowledge . This is because most people lack detailed
information about TB. Others don’t want to be treated because its treatment is long
course of multiple antibiotics. Some people hate to be identified that they are TB
positive because they are believed to be HIV positive which is no affect. One can
be HIV positive but TB negative. TB patients are treated but most of them don’t
complete the dosage hence they become resistant to the antibiotics given and their
health worsens. Though these treatment needs proper dieting, reports states that
57%of patients can’t afford proper dieting while under treatment since they are
weak to work. Large percent of patients (TB) have blue collar jobs hence they cant
be productive on their economic issues since they are weak and inactive. Most of
posters magazines, newspapers, and adverts on electronic media(radio, TV,
internet) involving are done in complicated English which only people in medical
field of professional can understand sine education and profession vary from one
person to another. Organizations such as Ministry of Public Health and Sanitation,
World Health Organization, National Leprosy and Tuberculosis Program
(N.L.T.P), United States Agency International Development (U.S.A.I.D) have not
taken their full responsibility of provision of: enough food, understandable and
simplified information in different ethnics and international languages about
prevention of spread TB in Nairobi which has the largest population in Kenya.
This is an issue/problem that needs to be investigated so as to establish ways on
how to prevent TB resistance and its spread in the society or Kenya at large.
1.3 Objectives of the Study
1. To establish ways of creating awareness about Tb resistance which may
contribute to reduction of further spreading of TB bacteria to other residents
2. To identify how many ways of promoting Tuberculosis education via TV and
radio adverts.
To find out how many ways of teaching people (residents) and creating awareness
of tuberculosis
1.4 Hypothesis
H 0 There is no one best way of stopping the spread of TB from one resident to the
next since it’s an air-borne infection.
H 1 Stickers matatus simplified English and Kiswahili in the P.S.V is one way of
creating awareness on the stopping spread of TB since stickers can warn
passengers to open the windows for good and ventilation.
H 2 There is different ways of creating awareness about the stop of TB resistance
across the four constituencies and also farther spread of it.
H 3 Radio programs and TV announcement just before or after the news is better
way of creating awareness on TB to larger population will listen or view this and
hence they will be informed of TB resistance when almost everyone is resisting
waiting for news.
1.5 Significance of the Study
This study will enlighten the media the government of Kenya and organizations
concerned of TB spread and resistance on how to effectively inform the resistance
on how to effectively inform the residents in a simpler way. This is because most
of the radio and TV announcements and programs are on the air when most of the
patients have gone to work. The language used to broadcast is not the simple
English hence not everybody understands the information ends up making no sense
to the larger population of residents than expected. Since such details have already
been investigated, the concerned organizations should work on it to improve their
services to the TB patients for the wellbeing of even TB negative people. The
study will help in reducing TB residents and further spread of TB. The media
should be using simple language since citizens are not the first language to the
97%of population of the residents. Media owners and entrepreneurs will be
producing programs in vernacular different tribes so that those who do not know
national and official languages can still access information about TB. The
organizations concerning TB will not leave out the migrants who are living in that
residence of Lang’ata, Westlands, Starehe and Embakasi; they will open websites
of different international languages like French, Italian, German, and Spanish and
so on.
1.6 Scope
The area that study took place was Nairobi’s county four constituencies which are
Starehe, Westlands, Lang’ta and Embakasi. Westlands and Lang’ta are sparsely
populated compared to Embakasi and Starehe which are densely populated. This
enhances comparison since lifestyles are totally different. This also affects how TB
spread and resistance. For instance in Westlands and Lang’ta few people are
infected by TB compared to Starehe and Embakasi where residents are greatly
affected. Most residents in Langa’ta and Westlands constituencies can afford
proper dieting compared to Embakasi and Starehe where most of the residents are
low and medium income earners.
1.7 Operational Definition of Terms
Multi-drug resistant tuberculosis [MDR-TB] is defined as TB that is resistant at
least to ionized [INH] and rifampicin [RMP], the two most powerful first lines anti
TB drugs. MDR-TB develops during treatment of fully sensitive TB when course
antibiotics are interrupted and the levels of drug in the body are insufficient to kill
100% of bacteria. This can happen for a number of reasons:
1. Patient may feel better and stop their antibiotic course
2. Drug supplies may run out or become scarce
3. Patients may forget to take their medication from time to time
Tuberculosis [TB] describes on infections disease that has plagued human since
old times. Two organisms cause tuberculosis:
(a) Mycobacterium tuberculosis
(b) Mycopaciurrium bovid
CHAPTER TWO
2.0 LITERATURE REVIEW
Public hospitals and dispensaries, through the Ministry of Health and Sanitation,
have been concerned with the provision of TB drugs towards managing the spread
of TB and its resistance. Kenya continues to gain more and more TB patients each
year. However, wide co-infection with HIV [close to 48%of new TB patients]
makes TB treatment difficult. While the number of patients requiring re-treatment
has increased, the government placed the National Leprosy and Tuberculosis
Program [N.L.P.T] World Health Organization (W.H.O) and United States Agency
International Development [U.S.A.I.D] to have the following Approach and key
activities towards Lang’ata, Starehe, Westlands and Embakasi constituencies:
1. Strengthening the TB drug logistics system focusing in forecasting and
distributing TB and other drug and supporting staff supervision.
2. Providing support on implementation of patient packs which contains enough
anti-TB drugs to fully treat one patient
3. Improving partner coordination, program management and information
management systems.
However these organizations have not done enough on their third role of program
management and information management system. Most of residents have no time
to view and listen to programs since when they are on air, patients are busy
working. Others cant understand Swahili or English used by the media to pass on
information, while others cant access media(radio, TV, newspapers) Its therefore
important to make use of vernacular radio stations available for instance Kameme
fm , Inooro fm among Kikuyu, Ramogi fm among Dholuo, Musyi fm among
Akamba, Egesa fm among Gusii , Kass fm among Kalenjins among other tribes.
This will help in broadcasting in vernacular on TB related programs to make those
residents who don’t understand Swahili and English access detailed information
about TB resistance and prevention. The government and other organization will
simplify the way the broadcast and their transmission time whereby they can be
working when people (residents) will be available. On the print media (magazine,
newspapers, notices, posters, stickers) the information should include pictures
which are to see and the content should be straight forward and the headlines
should mean it so as to avoid finding different content. Once every resident has
accessed details unbiased and clear information about TB resistance and spread of
TB, the possibility of treating residents in these constituencies is higher since
information is power. The government and other TB organizations should also be
aware that media can’t make good news out of the bad practices of the society and
every citizen has the right to access information. In the context of wide-ranging
partnerships for TB control, advocacy to influence policy changes and sustain
political and financial commitment; two-way communication between the care
providers and people with TB as well as the communities to improve knowledge of
TB control policies, programs and services, and social mobilization to engage
society, especially the poor, and all allies and partners in the campaign to stop TB.
Each of these activities can help build greater commitment to fighting TB.
Advocacy is intended to secure the support of the key constituencies in relevant
local, national and international policies discussions and is expected to prompt
greater accountability from governmental and international actors. Communication
is concerned with informing, and enhancing knowledge among, the general public
and people with TB and empowering them to express their needs and take action.
Equally, encouraging providers to be more receptive to the expressed wants and
views of people with TB and community needs. Social mobilization is the process
of bringing together al feasible and practices inter sect oral allies to raise people’s
knowledge of and demand for good quality TB care and health care in general,
assist in the delivery of resources and services strengthen community participation
for sustainability. Thus advocacy , communication and social mobilization is
essential for achieving a World free of TB and this is relevant to all aspects the
stop TB Strategy. The efforts in TB Control should be linked with overarching
efforts in TB Control should be linked with overarching efforts to promote public
health and social development. Research should be well promoted and enabled.
The main focus of the stop TB Strategy is on making the best use of currently
available tools for diagnosis, treatment and prevention of TB(i.e. program-based
operational research) and the improved tools that are likely to become available in
future [through research to develop new diagnostics, drugs and vaccines]. Stop TB
department should be introduced. The first edition of the Stop TB Department
newsletter should be published with a series of the short articles and we blinks on
some of the department’s key areas of work. The newsletter, which should be
published regularly will be available on the department’s website and distributed
widely. Each newsletter should also feature a special focus section which explores
in details an area of important work, or an issue, that relates to tuberculosis in
different languages that is Kiswahili and English. These newsletters should be
made available in all public and private hospitals.
Mix public hospitals and private hospital in offering TB services. In most
resources –poor countries capital cities for instance Nairobi, which have a high TB
burden patients which symptoms suggestive of TB seek care from a wide array of
health-care providers. These care providers, often not linked to public sector based
N.L.T.P, may serve a larger proportion of TB suspects. The size, types and roles of
TB care providers vary greatly within and across 4 constituencies in Nairobi. In
some settings there is large private commercial sector and numerous N.G.O’s
while in others there are hospitals that operates outside the scope of N.T.P.
Evidence suggest that failure to involve all care providers used by TB suspects and
patients hampers case detection, delays, diagnosis, leads to inappropriate and
incomplete treatment, contributes to increasing drug resistance and places an
unnecessary financial burdenon patients. Engaging all relevant health care
providers in TB care and control through public-private mix approaches is an
essential component of the W.H.O‘s stop TB Tragedy. Currently, nearly all high
TB-burden countries were implementing public –private mix activities. Fifty eight
of 93 countries and multi-country recipients of Global Fund supported TB grants
had public-private mix activities in 2008. Several projects evaluations have shown
that public –private mix could help increase case detection [between 10% and
60%], improve treatment outcomes [over 85%], reach the poor and save costs.
News release 11 th October 2011/Geneva – W.H.O 2011 global TB report that for
the first time that the number of TB patients is decreasing each year. Yet, current
progress is at risk from the under funding, especially efforts to combat drug-
resistance TB. Most of these TB organizations would not be recognize were it not
for their collaboration with media. Media has played a role in society by informing
members of constituencies of Embakasi, Starehe, Westlands and Lang’ata on
issues to do with TB, though a lot still have to be done.
CHAPTER THREE
3.0 RESEARCH DESIGN AND METHODOLOGY
3.1 Research Design
Both primary and secondary data were used in the research. Primary data was
gathered through carrying out of interviews on concerned areas, where
newspapers, journals, books and magazines related to TB were some of the
secondary data used.
3.2 Population
The study was carried out in population of people who include men, women youths
and young children in the four constituencies.
Embakasi 8000
Starehe 5500
Westlands 2500
Lang’ata 4000
Total population=20,000
3.3 Sampling
Probability methods were used to determine the population. A population of 1000 was chosen
from the sample frame.
Sample frame N=20000
Sample size n=1000
Sample fraction =sample size/sample frame
n/N=1000/20000 = 0.05
Strata stratum size sample fraction
Embakasi 8000 8000*0.05=400
Starehe 5500 5500*0.05=275
Westlands 2500 2500*0.05=200
Lang’ata 4000 4000*0.05=125
Sample fraction= n/N=1000/20000=0.05
3.4 Instrument
The data collected for the study was through distribution of questionnaire 20 to each of the four
constituencies.
3.5 Data Collection
The data was collected through presentation of questionnaires containing open ended questions
for each person to respond as much he/she could interpret the question. For the young children
who can’t fill them, their parents/guardians could fill for them.
3.6 Data Presentation and Analysis
From the data collected 80 questionnaires were compiled, 20 given to each of the 4
constituencies. Out of the 15 questionnaires from Starehe ,10 from Embakasi, 12 from Lang’ata
and 8 from Westlands constituencies were returned . The distribution from the sample size was
1.5 from Starehe, 0.1 from Embakasi , 1.2 from Lang’ata and 0.8 from Westlands constituency.
The above graph illustrates why the TB fails in Nairobi County. Media (print or electronic) have
to take position and redefine their roles for community and highlight issues which directly
means economic and social and political uplift from the media to a greater percentage will
increase awareness among its readers, listeners and viewers who have developed. Media
preferences as a result of their watching, listening or reading habits unconsciously natured over
one’s life time. This could be best done in packaging of message either in broadcast
or print media, in a language category and give it a critical interpretation to get the
actual meaning that was intended by some sender in his/her first step of conceiving
the idea he/she has relayed through the media . The language used to convey
information should be simple since level of education varies from one person to the
next. Vernacular languages can be used to share information since he limiting
factor has been when not everyone can understand English whereas Kiswahili
language is tough to some residents.
CHAPTER FOUR
4.0 RESEARCH DESIGNING
4.1 Questionnaire
Fill in where necessary and tick inside the bracket:
1. Name ……………………………
2. Age
3. Sex male [ ] female [ ]
4. Location: Westlands{ } Langa’ta [ ] Embakasi [ ] Starehe [ ]
5. Educational level: primary [ ] secondary [ ] college [ ] university [ ]
6. Occupation: student [ ] self employed [ ] employed [ ] employee [ ]
employer [ ] none
7. Marital status: single [ ] married [ ] divorced [ ]
8. What do you understand by the term tuberculosis…
9. Have you ever been tested for TB? yes[ ] no [ ]
10. Has any of your friend/relative been infected with TB? Yes [ ] no [ ]
11. Do you think TB patients disclose their TB status to the public? Yes [ ]
why…………………………………………………………………………..
No [
] why……………………………………………………………………………
12. When you start sneezing /coughing what do you do? Assume it’s a common
cold [ ]
Take
aspirin from the chemists and shops [ ]
Visit a
doctor [ ]
Get
tested for TB [ ]
13.Is there clinic near where you live? Yes [ ] no [ ]
14. Is TB clinic near you active or dormant? Active [ ] dormant [ ]
15. What would you like TB clinic to be doing for society?
Teach them more about TB [ ]
Test people within the estates [ ]
Campaign a lot in the streets and do some walks [ ]
16. How often do you cover your mouth/nose as you sneeze/cough using a
handkerchief?
Always [ ]
At times [ ]
Never [ ]
17. Which media do you access easily?
Radio [ ]
Television [ ]
Newspapers [ ]
Internet [ ]
18. What language do you prefer to be used during passing information to do with
TB?
Swahili [ ]
English [ ]
Vernacular [ ]
Other international languages [ ]
19. What challenges do you face as you access information about TB?
Difficult vocabularies [ ]
Unqualified information [ ]
Difficult language [ ]
Others [ ] (specify)…………………………………………………..
Note: The above information will be only assist in conducting Tb research and
will remain confidential.
CHAPTER FIVE
5.0CONCLUSION AND RESEARCH FINDINGS
5.1 Policy Recommendation
The parliamentarians should be In the fore front to support the government’s
policy on required long course of multiple antibiotics in their constituencies
The media stations particularly those which transmit programs (radio) in diverse
vernacular language in Kenya. Dholuo, Kamba, Kikuyu, Kalenjin,
Kisii,Maasai,Luhya, Somali among others should increase the number of programs
produced dealing with respiratory health whereby health practitioner are invited to
discuss the topics involved so that not to mistake TB to other diseases and
infections like H.I.V. In TV channels should also include such programs using
simple and understandable language. The print media (magazines, newspapers)
should also increase their articles on TB where specialists on concerned fields are
interviewed. This should be a government regulating body to make sure that all the
antibiotics of tuberculosis and information are accessible to everyone. Also the
government should identify reliable donors adequate funds to TB health programs
in the constituencies and countrywide at large.
CHAPTER SIX
5.1 REFERENCE
Reports and Data were collected from:
Tuberculosis Control Assistance Program (website)
National Leprosy and Tuberculosis Program me’s (file)
Kayole (two) sub district Hospital where I was a TB patient
World Heath Organization (W.H.O) website
United States Agency International Development (U.S.A.I.D) website
The logistical unit of Medical Supplies Agency-2009
Global Report 2009