1. By Asha Yusuf MPH student Walden University PUBH 6165-6 Environmental Health Instructor: Dr Howard Rubin. Spring Qtr 2012 Reference Stop TB partnership. (2010). Tuberculosis country profiles. Retrieved from, http://www.stoptb.org/countries/tbdata.asphttp://www.stoptb.org/countries/tbdata.asp Tuberculosis (TB) in Kenya

2. Objectives Tuberculosis facts TB burden in Kenya prevention and treatment Barriers to Tuberculosis control Environmental interventions.

3. TB facts What is TB? Bacteria infection caused by Mycobacterium tuberculosis. Types of TB Latent phase of TB Active TB MDR-TB XDR-TB Reference Center for Diseases Control (CDC). (2012). TB facts. Retrieved from,http://www.cdc.gov/tb/topic/basics/default.htm.http://www.cdc.gov/tb/topic/basics/default.htm

4. TB symptoms  Cough> 3 weeks  Chest pain  Coughing up blood or sputum,  Night sweats  Fever and chills  Loss of appetite  Weight loss Reference Center for Diseases Control (CDC). (2012). TB facts. Retrieved from, http://www.cdc.gov/tb/topic/basics/default.htm.http://www.cdc.gov/tb/topic/basics/default.htm

5. Diagnostic tests Chest X- ray Diagnostic microbiology Sputum Spear microscopy Sputum Culture. References Center for Diseases Control (CDC). (2012). TB facts. Retrieved from,http://www.cdc.gov/tb/topic/basics/default.htm.http://www.cdc.gov/tb/topic/basics/default.htm Stop TB partnership (2009). Approaches to improve sputum smear microscopy for tuberculosis diagnosis.Retrieved from, http://www.stoptb.org/wg/gli/assets/documents/EGM%20Smear%20Microscopy%20_Agenda.pdf http://www.stoptb.org/wg/gli/assets/documents/EGM%20Smear%20Microscopy%20_Agenda.pdf

6. Tuberculosis in Kenya Ministry of public health and sanitation. (2012). Tuberculosis in Kenya. Retrieved from, http://www.nltp.co.ke/tbcontrol.htmlhttp://www.nltp.co.ke/tbcontrol.html World Health Organization (WHO). (2012). Kenya, Tuberculosis profile. Retrieved from, http://www.nltp.co.ke/docs/WHO_HQ_Reports-G2-PROD-EXT-TB%20Kenya%20CountryProfile.pdf

7. Prevention and intervention Directly Observed Therapy Short Course (DOTS) World Health Assembly global TB control target-not achieved. Millennium Development Goals(MDG) References Center for Disease Control (CDC).(2006). Treatment for tuberculosis. Retrieved from, http://www.cdc.gov/tb/education/corecurr/pdf/chapter6.pdf World Health Organization (WHO).(2007). Tuberculosis treatment success under DOTS (percentage). Retrieved from, http://www.who.int/whosis/indicators/2007TBCasesCuredDOTS/en/index.html.http://www.who.int/whosis/indicators/2007TBCasesCuredDOTS/en/index.html

8. Barriers to effective TB control in Kenya HIV/AIDS co-infection: a)Reactivation of dormant TB b)Shorter latent period c)Weaker immune system d)Increase stigma References Averting HIV & AIDS in Kenya.(AVERT). HIV and AIDS in Kenya. Retrieved from, http://www.avert.org/hiv-aids-kenya.htmhttp://www.avert.org/hiv-aids-kenya.htm Muture, B.N., Keraka, M.N., Kimuu, P.K., Karibu, E.W., Ombeka, V.O., & Oguya, F. (2011). Factors associated with defaults from treatment among tuberculosis patient in Nairobi province, Kenya. A vase control study. BMC Public Health, 11(698), 1-10. Retrieved from, http://biomedcentral.com/1471-2458/11/696http://biomedcentral.com/1471-2458/11/696 Sharif, s.k. (2009). DLTLD guidelines on management of Leprosy and Tuberculosis. Retrieved from, http://www.who.int/hiv/pub/guidelines/kenya_tb.pdf.http://www.who.int/hiv/pub/guidelines/kenya_tb.pdf

9. Barriers to effective TB control cont.. Health care system failure. a)lack of isolation facilities. b)Delay of diagnosis and treatment c)Patient-provider gap References Kenya AIDS NGOs consortium (KENCO). (2012). Lack of TB ward a disaster in the making. KENCO news, 30,1-4. Retrieve from, http://www.kanco.org/atomicDocuments/KANCODocuments/20120227123410-Issue%2030%20Feb%202012.pdf Ojwang, B. O., Ogutu, E. A., & Matu, P.M. (2010). Nurses’ impoliteness as an impediment to patients’ rights in selected Kenyan hospitals. Health and human rights International journal, 12(2). Retrieved from, http://www.hhrjournal.org/index.php/hhr/article/view/372/577 Sharif, s.k. (2009). DLTLD guidelines on management of Leprosy and Tuberculosis. Retrieved from, http://www.who.int/hiv/pub/guidelines/kenya_tb.pdf.http://www.who.int/hiv/pub/guidelines/kenya_tb.pdf

10. Barriers to effective TB control cont.. Environmental contribution a)Low socioeconomic status and poverty- b)Overcrowding. c)Air pollution. References Kenya AIDS NGOs consortium (KENCO). (2012). Lack of TB ward a disaster in the making. KENCO news, 30,1-4. Retrieve from, http://www.kanco.org/atomicDocuments/KANCODocuments/20120227123410-Issue%2030%20Feb%202012.pdf Muture, B.N., Keraka, M.N., Kimuu, P.K., Karibu, E.W., Ombeka, V.O., & Oguya, F. (2011). Factors associated with defaults from treatment among tuberculosis patient in Nairobi province, Kenya. A vase control study. BMC Public Health, 11(698), 1-10. Schmidt, C. W. (2008). Linking TB and the environment. Environmental health perspective, 116 (11), A479- A485. Sharif, s.k. (2009). DLTLD guidelines on management of Leprosy and Tuberculosis. Retrieved from, http://www.who.int/hiv/pub/guidelines/kenya_tb.pdf

11. Indoor air pollution References Baobab Africa. (2012). Masai chefs.retrieved from, http://www.economist.com/blogs/baobab/2012/01/new-cookery-schoolhttp://www.economist.com/blogs/baobab/2012/01/new-cookery-school Schmidt, C. W. (2008). Linking TB and the environment. Environmental health perspective, 116 (11), A479- A485.

12. Barriers to effective TB control cont.. Health literacy Traditional healer (mganga) Financial burden References Kenya AIDS NGOs consortium (KENCO). (2012). Lack of TB ward a disaster in the making. KENCO news, 30,1-4. Retrieve from, http://www.kanco.org/atomicDocuments/KANCODocuments/20120227123410-Issue%2030%20Feb%202012.pdf Muture, B.N., Keraka, M.N., Kimuu, P.K., Karibu, E.W., Ombeka, V.O., & Oguya, F. (2011). Factors associated with defaults from treatment among tuberculosis patient in Nairobi province, Kenya. A vase control study. BMC Public Health, 11(698), 1-10. Sharif, s.k. (2009). DLTLD guidelines on management of Leprosy and Tuberculosis. Retrieved from, http://www.who.int/hiv/pub/guidelines/kenya_tb.pdf

13. Changing environment References World Health Organization (WHO). (). Social determinants of health. retrieved from, http://www.who.int/social_determinants/en/http://www.who.int/social_determinants/en/ Schneider, M. (2011). Introduction to public health (3rd ed). How psychology factors affect health behaviors. Sudbury, MA. Jones and Burlett publishers.

14. Changing environment Changing environment- to change behavior Physical and social environment public health policy References Mauch, V., Woods, N., Kirubi, B., Kipruto, H., Sitienei, J., &Klinkenberg, E. (2011).Assessing access barriers to tuberculosis care with the tool to estimate patiens’ cost: pilot result from two district in kenya. Miomed central, 11(43) 1-9. doi:10.1186/1471- 2458-11-43 Muture, B.N., Keraka, M.N., Kimuu, P.K., Karibu, E.W., Ombeka, V.O., & Oguya, F. (2011). Factors associated with defaults from treatment among tuberculosis patient in Nairobi province, Kenya. A vase control study. BMC Public Health, 11(698), 1- 10. Retrieved from, http://biomedcentral.com/1471-2458/11/696http://biomedcentral.com/1471-2458/11/696

15. s References Holyland Africa safari. (2012). Kibera slums tour and volunteer program. Retrieved from, http://www.holylandafricasafaris.com/index.php?option=com_content&view=article&id=53&Itemid=71 Prison ministry international (n.d). I was in the prison and ye came into me. Retrieved from, http://www.prisonministryinternational.com/ Travelpod (20120.crowded hospital ward. Retrieved from, http://blog.travelpod.com/travel-photo/shalynnpack/2/1300902345/crowded-hospital-ward.jpg/tpod.html Conducive environment for the spread of TB infection.

16. References National institute of health. (2010). Visual and cultural health posters. Retrieved from, http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/VCBBBL Schneider, M. (2011). Introduction to public health (3rd ed). How psychology factors affect health behaviors. Sudbury, MA. Jones and Burlett publishers. Conclusion

17. References Averting HIV & AIDS in Kenya.(AVERT). HIV and AIDS in Kenya. Retrieved from, http://www.avert.org/hiv-aids-kenya.htmhttp://www.avert.org/hiv-aids-kenya.htm Baobab Africa. (2012). Masai chefs.retrieved from, http://www.economist.com/blogs/baobab/2012/01/new-cookery-schoolhttp://www.economist.com/blogs/baobab/2012/01/new-cookery-school Center for Disease Control (CDC).(2006). Treatment for tuberculosis. Retrieved from, http://www.cdc.gov/tb/education/corecurr/pdf/chapter6.pdf Center for Diseases Control (CDC). (2012). TB facts. Retrieved from,http://www.cdc.gov/tb/topic/basics/default.htmhttp://www.cdc.gov/tb/topic/basics/default.htm Holyland Africa safari. (2012). Kibera slums tour and volunteer program. Retrieved from, http://www.holylandafricasafaris.com/index.php?option=com_content&view=article&id=53&Itemid=71 Kenya AIDS NGOs consortium (KENCO). (2012). Lack of TB ward a disaster in the making. KENCO news, 30,1-4. Retrieve from, http://www.kanco.org/atomicDocuments/KANCODocuments/20120227123410-Issue%2030%20Feb%202012.pdf Mauch, V., Woods, N., Kirubi, B., Kipruto, H., Sitienei, J., &Klinkenberg, E. (2011).Assessing access barriers to tuberculosis care with the tool to estimate patiens’ cost: pilot result from two district in kenya. Miomed central, 11(43) 1-9. doi:10.1186/1471- 2458-11-43 Muture, B.N., Keraka, M.N., Kimuu, P.K., Karibu, E.W., Ombeka, V.O., & Oguya, F. (2011). Factors associated with defaults from treatment among tuberculosis patient in Nairobi province, Kenya. A vase control study. BMC Public Health, 11(698), 1-10. Retrieved from, http://biomedcentral.com/1471-2458/11/696http://biomedcentral.com/1471-2458/11/696 Ministry of public health and sanitation. (2012). Tuberculosis in Kenya. Retrieved from, http://www.nltp.co.ke/tbcontrol.htmlhttp://www.nltp.co.ke/tbcontrol.html

18. references National institute of health. (2010). Visual and cultural health posters. Retrieved from, http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/VCBBBL Ojwang, B. O., Ogutu, E. A., & Matu, P.M. (2010). Nurses’ impoliteness as an impediment to patients’ rights in selected Kenyan hospitals. Health and human rights International journal, 12(2). Retrieved from, http://www.hhrjournal.org/index.php/hhr/article/view/372/577 Prison ministry international (n.d). I was in the prison and ye came into me. Retrieved from, http://www.prisonministryinternational.com/ Schneider, M. (2011). Introduction to public health (3rd ed). How psychology factors affect health behaviors. Sudbury, MA. Jones and Burlett publishers. Schmidt, C. W. (2008). Linking TB and the environment. Environmental health perspective, 116 (11), A479- A485. Sharif, s.k. (2009). DLTLD guidelines on management of Leprosy and Tuberculosis. Retrieved from, http://www.who.int/hiv/pub/guidelines/kenya_tb.pdf Stop TB partnership (2009). Aproaches to improve sputum smear microscopy for tuberculosis diagnosis.Retrieved from, http://www.stoptb.org/wg/gli/assets/documents/EGM%20Smear%20Microscopy%20_Agenda.pdf Stop TB partnership. (2010). Tuberculosis country profiles. Retrieved from, http://www.stoptb.org/countries/tbdata.asphttp://www.stoptb.org/countries/tbdata.asp

19. references Travelpod (2010).crowded hospital ward. Retrieved from, http://blog.travelpod.com/travel-photo/shalynnpack/2/1300902345/crowded-hospital-ward.jpg/tpod.html World Health Organization (WHO). (). Social determinants of health. retrieved from, http://www.who.int/social_determinants/en/http://www.who.int/social_determinants/en/ World Health Organization (WHO).(2007). Tuberculosis treatment success under DOTS (percentage). Retrieved from, http://www.who.int/whosis/indicators/2007TBCasesCuredDOTS/en/index.html.http://www.who.int/whosis/indicators/2007TBCasesCuredDOTS/en/index.html

20. Reading sources Kenya AIDS NGOs Consortium (KENCO). (2012). Supporting Community action on HIV & AIDS and TB. Retrieved from, http://www.kanco.org/web/guest/home;jsessionid=8DFF6D568993B5 FAE83C2355777C4B79.node1 http://www.kanco.org/web/guest/home;jsessionid=8DFF6D568993B5 FAE83C2355777C4B79.node1 Ministry of public health and sanitation. (2012). Tuberculosis in Kenya. Retrieved from, http://www.nltp.co.ke/tbcontrol.htmlhttp://www.nltp.co.ke/tbcontrol.html Stop TB Partnership. (2012). The national Stop TB Partnership in Kenya. Retrieved from, http://www.stoptb.org/countries/partnerships/np_ken.asp http://www.stoptb.org/countries/partnerships/np_ken.asp World Health Organizations (WHO). (2012). Tuberculosis (TB). Retrieved from, http://www.who.int/tb/en/.http://www.who.int/tb/en/