Battling TB amidst persistent challenges of stigma, poverty and gender gaps

When Jackson Mwendwa was diagnosed with tuberculosis (TB) in 2017, his toughest battle wasn’t just the disease—it was breaking free from alcohol.

For years, drinking had been his refuge, a way to escape life’s hardships. But with his treatment requiring total sobriety, he was thrust into sudden withdrawal, battling restlessness, irritability and an overwhelming urge to return to the bottle he could no longer afford to touch.

As the disease took hold, his body weakened—his once-strong frame reduced to frail bones and sagging skin. He lost weight rapidly, his energy drained by persistent coughing and night sweats.

Every breath felt heavier; every step more laboured. The illness not only ravaged his body but also stripped him of the one thing he had relied on to cope.

"Since I was determined to get well, I struggled a lot, but you know, those drugs are really heavy. Living alone, sometimes it’s easy to miss a dose because you also want to integrate with the community and even fend for yourself."

The medication drained him, leaving him exhausted and weak.

Daily battle

Without a strong support system, staying consistent with his treatment became a daily battle. Despite the challenges, he remained committed and took the medication for six months—though he often avoided regular clinic visits and checkups.

In the densely packed neighbourhood of Majengo slum where homes are tightly clustered and spaces are shared, isolation was not an option for Jackson. The reality of living in such an environment meant constant interaction with the community, making it nearly impossible to keep his illness private.

He knew all too well that admitting he had tuberculosis would lead to social exclusion—people would keep their distance, afraid of infection.

For seven months, he fought to stay sober, determined to complete his treatment. But every encounter with old drinking friends tested his resolve. They would offer him alcohol, their gestures filled with familiarity and expectation.

Saying no felt like severing ties, like marking himself as different.

"I didn’t want to offend them or be seen as weak," he admits.

Back to alcohol

So, he took a sip. One sip turned into another, and before he knew it, the habit he had struggled to break had once again taken hold, pulling him back into its grip.

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• Battling TB amidst persistent challenges of stigma
• poverty and gender gaps

“Although I occasionally missed a dose, I completed the six-month treatment. However, I never went back for testing—I simply assumed that finishing the medication meant I was cured.”

Wagema Esther, a community health promoter in Digo, Majengo, highlights a critical challenge in managing TB cases—many patients continue to consume alcohol while on medication. This dangerous combination weakens their bodies, worsens their condition and in some cases even leads to death.

"One of the biggest struggles we face is that some TB patients don’t stop drinking, even when they are on treatment," she explains.

"Alcohol interferes with the effectiveness of the medication, making recovery difficult. Instead of getting better, they become weaker, and some don’t survive."

Having battled TB herself, Wagema understands just how easily the disease spreads in her neighbourhood.

"I contracted TB because it moves from one person to another so quickly. here, many people get infected in crowded spaces like local hotels and illicit brew dens, where they share cups with others. Unfortunately, many TB patients frequent these places, making it nearly impossible to stop the spread."

Food insecurity

Beyond the stigma and poor living conditions, a major issue affecting TB patients in Majengo is food insecurity.

The medication is strong and requires proper nutrition, yet many patients struggle to find enough to eat.

"Some end up defaulting on treatment altogether because they simply don’t have the strength to do anything—not even to eat," Wagema explains.

She recalls a recent case of a young man on TB treatment who was wasting away. When she followed up, she realised he was too weak to continue his medication because he had no food.

"I contacted his mother, and together, we managed to raise money for his transport back to his rural home, where he could receive better care," she says.

Lack support system

Wagema points out that many TB patients lack a support system, making it difficult to adhere to isolation protocols or stay consistent with their medication.

"Some forget to take their medicine, while others have no one to remind them," she says.

Another significant challenge is the financial burden of her work. The little funding provided by the government for community health workers is quickly exhausted on patient follow-ups and assisting those in dire need.

"The work is overwhelming, and sometimes we have to dig into our own pockets to help," she admits.

She also highlights the difficulty in tracking foreign nationals in Kenya who have TB. Many do not comply with follow-ups, and some even go into hiding, making it nearly impossible to ensure they complete their treatment.

"It’s a huge challenge because, without proper monitoring, TB continues to spread, putting more lives at risk," she says.

Tuberculosis is a disease caused by germs that mainly attack the respiratory system like the lungs but can also affect other parts of the body. It spreads through the air when a person with TB coughs, sneezes, or talks, releasing tiny germs that others can breathe in.

Dangerous

If not treated properly, TB can be dangerous, but it can be cured with the right medication taken for several months.

According to Dr Esther Mukuhe, a Nairobi-based physician, tuberculosis remains highly prevalent and spreads easily due to a lack of proper safety measures. She emphasises the need for vigilance, especially when dealing with persistent coughs and recurring pneumonia cases, as these can escalate into full-blown TB.

"TB often starts with a persistent cough lasting more than two weeks, night sweats, unexplained weight loss, fatigue, fever, and chest pain these symptoms may seem mild at first, but if left untreated, the disease can progress and become life-threatening."

To prevent TB from spreading, Dr Mukuhe stresses the importance of early diagnosis and strict adherence to treatment.

"TB medication requires a proper diet, as the drugs can be very strong and draining. Some patients even take prophylactic treatments to reduce side effects," she notes.

However, she observes that many people, especially those in informal settlements and rural areas, struggle to complete their six-month treatment due to various challenges, including lack of food and stigma.

Slow recovery

"When someone defaults on TB medication, the drugs have to be changed, which can slow down recovery and even lead to drug-resistant TB," she warns.

"Some patients pretend to be taking their medicine, but in reality, they skip doses or throw away the pills. This weakens their immune system and makes the bacteria harder to treat."

Dr Mukuhe stresses that proper integration of TB treatment with good nutrition, community support, and strict monitoring is crucial.

"Beyond just taking medication, patients need a strong support system to ensure they follow through with treatment. Without this, TB will continue to spread, affecting more vulnerable people in the community."

Kenya has made significant progress in the fight against tuberculosis, according to the Ministry of Health.

Despite TB and HIV remaining major health challenges, the country's TB programme has successfully initiated treatment for 96,865 individuals.

Second-line treatment

Public Health Principal Secretary Mary Muthoni, speaking on World TB Day, highlighted the strides made in managing drug-resistant TB, with 750 patients currently receiving second-line treatment.

"The introduction of a shorter, patient-friendly regimen for multidrug-resistant TB has significantly improved patient adherence and health outcomes," she stated.

Kenya remains among the top 20 high-burden TB and HIV countries, contributing to 80 per cent of global TB cases. In 2023, the country recorded 124,000 TB cases and 15,000 deaths, making TB the leading cause of mortality.

Dr Diallo Abdourahmane, the World Health Organisation (WHO) representative, has praised Kenya for its efforts, noting a 41 per cent reduction in TB incidence and a 60 per cent drop in TB deaths. The country has also advanced digital tools, rapid diagnostics, and shorter, more effective treatments.

However, many TB cases remain undiagnosed, with multidrug-resistant TB (MDR-TB) a major concern—60 per cent of cases go undetected.

Global figures

According to the WHO, TB affected 10.8 million people in 2023, up from 10.7 million in 2022. Among them, 1.25 million were children, and nearly 1.2 million people died from the disease.

According to Leaving No One Transforming Gendered Pathways to TB Care Health (LIGHT), TB remains a significant public health challenge in Kenya, disproportionately affecting men.

According to the Light Consortium, 55 per cent of TB cases occur in men, while 33 per cent affect women and 12 per cent impact children. The Global TB Report 2024 highlights that adult men have a 1.7 times higher incidence of TB than women, emphasising the gendered nature of the disease burden.

In 2023, an estimated 340 people developed TB daily in Kenya. Men accounted for six in ten cases, followed by women at three in ten and children at one in ten. Alarmingly, one in five people with TB missed out on treatment and care, exacerbating health risks and increasing transmission.

A major challenge in TB management is the lack of gender-disaggregated data, particularly in the early stages of diagnosis and care. This gap limits efforts to tailor interventions to the unique needs of different groups.

Experts stress that TB policies must be people-centred and gender-sensitive, ensuring that no one is left behind in the fight against the disease.

By transforming health pathways and addressing gender disparities, Kenya can strengthen its TB response and improve health outcomes for all.