1. PRESENTERS:
•Emmanuel Wekesa
•Keagan Kirugo
SUPERVISOR
•Professor Francis E. Onyango
•Dr Boniface O. Osano
•Professor Ruth Nduati

2.  Introduction
 Classification
 Magnitude of morbidity and mortality
 Risk factors
 Stop TB strategy

3.  Causative agent-Mycobacterium genus. Species are
varied but mainly Mycobacterium tuberculosis.
 It is an obligate aerobe and an acid-fast bacillus.
 TB is a re-emerging disease of global concern.
 The HIV pandemic has led to a resurgence of TB in
both adults and children,
 The burden of TB in children depends on the burden of
the disease in the adult population.
 Children have an increased risk of developing primary
progressive TB because of the associated severe
immune suppression resulting from their young age
and HIV.
 Extrapulmonary TB is seen more often in HIV-infected
children.

4.  There is a higher case fatality rate for children
who are co-infected with TB and HIV.
 It is important to look actively for TB in children
with a chronic cough and to provide treatment
as early as possible.
 The highest reported sero-prevalence was
reported in southern africa;10-60%, the lowest
prevalence in West Africa.

6. It is for childhood tuberculosis
A. ACCORDING TO SITE
 Pulmonary
 Extrapulmonary.
B. ACCORDING TO SEVERITY, TREATMENT
HISTORY AND DRUG RESISTANCE
1Division of Leprosy, Tuberculosis and Lung Disease.
Guidelines for Management of Tuberculosis and
Leprosy in Kenya. July 2013 Edition: pg 34

7. 1. Non-severe
TB
2. Severe
TB
3.
Retreatment
4. MDR
TB
•PTB without
extensive
parenchymal
disease
•TB
lymphadeniti
s
•TB pleural
effusion
•PTB with
extensive
lung disease
•Miliary TB
•All other
forms of
extrapulmon
ary TB

8.  Globally2: 2nd to HIV/AIDS as the greatest killer
due to a single infectious agent.
2010 2012
Morbidity 8,800,000 8,600,000
Mortality 1,400,000 1,300,000
 Amongst those sick in 2012; 530,000 were children
of whom 74,000 were HIV negative.
2http://www.who.int/mediacentre/factsheet/fs104/en/
reviewed March 2014

9.  TB is the leading killer in PLWHIV causing 1/5
of all deaths.
Locally3: Kenya is position 15/22 of the high TB
burden countries
2012: prevalence 103,159 of which 39% were HIV
infected.
3Division of Leprosy, Tuberculosis and Lung
Disease. Guidelines for Management of
Tuberculosis and Leprosy in Kenya. July 2013
Edition: pg 9

11. A. Major
 HIV infection. Most common risk factor locally.
 Poorly treated previous TB
 Low socioeconomic status
B. Minor
 Non-modifiable: Age-extremes of age; Sex. M>F
 Immunosuppressive states: Malnutrition; Diabetes
mellitus; Immunosuppressive agents; Malignancies.
 Drugs: Alcoholism; Tobacco smoking
 Pulmonary diseases: Silicosis
4Division of Leprosy, Tuberculosis and Lung Disease. Guidelines
for Management of Tuberculosis and Leprosy in Kenya. July
2013 Edition: pg 3-4

12. A. BACKGROUND
1991: World Health Assembly recognized TB as a world health problem.
2 targets were set up: i) Detection of 70% of new smear positive cases
ii) Cure 85% of the new cases. All these by 2005
1994: DOTS launched. Components
i) Govt. commitment
ii) Case detection through sputum microscopy
iii) Standardized short-course chemotherapy under supervision
iv) System of regular drug supply
v) Monitoring and evaluation of the programme

13. 2003: Cure rates of the new sputum positive cases was 83%
2004: Case detection rate 53%
2006: Launching of Stop TB Strategy to run from 2006-2015

14.  TARGETS
i) MDG 66: Combat HIV/AIDS, malaria and other
diseases. Target 8: Have halted by 2015 and
begun to reverse incidence of malaria and other
diseases.
ii) Stop TB partnership: By 2015, the global burden
of TB will be lowered by 50% relative to 1990
levels
 VISION
A world free of TB
 GOAL
To reduce dramatically the global TB burden by 2015
in line with the MDGs and the Stop TB
partnership targets and to achieve major progress
in the research and development needed for TB
5WHO (2006). The Stop TB Strategy.
6http://www.milleniumproject.org/goals/gti.htm/

15. PRINCIPAL COMPONENTS
1. PURSUE HIGH-QUALITY DOTS EXPANSION
AND ENHANCEMENT
a) Political commitment with increased and
sustained financing
b) Case detection through quality-assured
bacteriology
c) Standardized treatment with supervision and
patient support
d) Effective drug supply and management
system
e) Monitoring and evaluation system and impact
measurement

16. 2. ADDRESS TB/HIV, MDR-TB AND OTHER
CHALLENGES
3. CONTRIBUTE TO HEALTH SYSTEM
STRENGTHENING
4. ENGAGE ALL CARE PROVIDERS
5. EMPOWER PEOPLE AND COMMUNITIES
WITH TB
6. ENABLE AND PROMOTE RESEARCH

17.  Division of Leprosy, Tuberculosis and Lung
Disease. Guidelines for Management of
Tuberculosis and Leprosy in Kenya. July 2013
Edition.
 http://www.who.int/mediacentre/factsheet/fs104
/en/ reviewed March 2014.
 WHO (2006). The Stop TB Strategy.
 http://www.milleniumproject.org/goals/gti.htm/

18.  AHSANTE
 MERCI
 XIEXIE