Planning for PPM-DOTS implementation in urban slums in Kenya: knowledge, attitude and practices of private health care providers in Kibera slum, Nairobi.

SETTING: Kibera, the largest slum in Nairobi, Kenya. OBJECTIVE: To determine the tuberculosis (TB) knowledge, attitude and practices (KAP) of private health care providers (PHCPs) to identify their training needs and willingness to participate in a National Leprosy and Tuberculosis Control Programme (NLTP) guided TB control effort in the slum. DESIGN AND METHODOLOGY: A cross-sectional survey. The KAP of PHCPs was assessed using an interviewer administered questionnaire. RESULTS: Of 75 PHCPs interviewed, the majority (96.0%) were paramedics; 51 (77.1%) did not consider sputum smear microscopy crucial in patients presenting with prolonged cough or when a chest X-ray was suggestive of TB; of 29 (38.7%) who indicated familiarity with the drugs used in TB treatment, 20 (58.5%) would have chosen the NLTP-recommended regimens for the treatment of the various types of TB; 16 (21.3%) PHCPs indicated that they treated TB, six (37.5%) of whom were not familiar with anti-tuberculosis drug regimens. All the PHCPs referred TB suspects to the public sector for diagnosis. CONCLUSION: This study reveals a significant gap in TB knowledge among the PHCPs in Kibera slum. However, given appropriate training and supervision, there is potential for public-private mix for DOTS implementation in this setting.

HIV sero-prevalence among tuberculosis patients in Kenya.

OBJECTIVE: To determine HIV seroprevalence among tuberculosis patients and the burden of HIV attributable tuberculosis among notified patients in Kenya. DESIGN: A cross-sectional anonymous unlinked HIV seroprevalence survey. SETTING: Tuberculosis diagnostic clinics of the National Leprosy Tuberculosis Programme in 19 districts. SUBJECTS: One thousand nine hundred and fifty-two newly notified tuberculosis patients. INTERVENTIONS: Selection and registration of eligible subjects followed by obtaining 5 ml of full blood for haemoglobin testing and separation of serum for HIV testing by ELISA. MAIN OUTCOME MEASURES: HIV seroprevalence per district and burden of HIV attributable tuberculosis among tuberculosis patients. RESULTS: A total of 1,952 eligible patients were enrolled. The weighted seroprevalence in the sample was 40.7% (range 11.8-79.6% per district). The seroprevalence was significantly higher among females and patients with sputum-smear negative tuberculosis. Chronic diarrhoea, female sex, oral thrush and a negative sputum were independent risk factors for HIV infection. The Odds ratio for HIV infection in female tuberculosis patients aged 15-44 years, was 5.6 (95% CI 4.5-6.9) compared with ante-natal clinic attenders. The population attributable risk was 0.22 in 1994. CONCLUSION: The HIV epidemic has had a profound impact on the tuberculosis epidemic in Kenya and explains about 41% of the 94.5% increase of registered patients in the period 1990-1994 and 20% of all registered patients in 1994. Repetition of the survey with inclusion of a more representative control group from the general population may provide a more accurate estimation of the burden of HIV attributable tuberculosis.

PIP: This cross-sectional survey determined HIV seroprevalence among tuberculosis patients and the burden of HIV attributable tuberculosis among notified patients in Kenya. Data were collected from 1952 patients. The information gathered included demographic data, date of treatment initiation, type of patient, type of tuberculosis, sputum-smear results, and data concerning the signs and symptoms related to tuberculosis and HIV disease. Findings demonstrated that the weighted seroprevalence in the study sample was 40.7% (range, 11.8-79.6% per district), which is significantly higher in females and patients with sputum-smear negative tuberculosis. Chronic diarrhea, female sex, oral thrush, and negative sputum were independent risk factors for HIV infection. The odds ratio for HIV infection in female tuberculosis patients aged 15-44 years was 5.6 compared with antenatal clinic attenders.