Tuberculosis in School Tuberculosis remains a serious disease and an outbreak in schools can lead to serious and dire consequences particularly because of the close contact between pupils.
Maureen is a form two student a local provincial school in Western Kenya. She is fifteen years old and has been on anti tuberculosis treatment for the last three months. She stopped going to school once she was diagnosed with Tuberculosis to concentrate on her treatment. She had been having persistent coughs and chest pains and because her mother had sent her to school with a cocktail of antibiotics and other over the counter drugs, she diligently self prescribed herself with this drugs but to no avail. The cough persisted forcing her to go to the school dispensary where she was given Paracetamol and advised to sleep in for the day. She was not the only student coughing in the school and so it was brushed off as flu or common cold. However her condition continued to deteriorate and she had to look for someone who contacted her parents to come for her form school so they could take her to hospital. At the school, she was to be punished for going through unofficial channels to contact her parents. She was soon diagnosed with Tuberculosis when she was taken to Kenyatta Hospital in Nairobi. Her mother now wants to transfer her to a nearer school preferably a day school in Nairobi. As it is she has already missed out on school work for the entire term and she will lose out on almost a whole year of school if she continues doing DOTS (Directly Observed Treatment Short Course). She claims to have gotten TB from a fellow student who also had the same symptoms that she had.
Linda is in form four at a school in Nyanza province and three time defaulter. She was diagnosed with Tuberculosis two and half years ago and was put on treatment. However she defaulted for the first time after only two months of treatment and was taken to a different hospital when her cough recurred. She was again put on treatment and she defaulted again and again. She is now taking the same regime that she failed to adhere to in three separate occasions and hopes to complete her treatment come august. At her school she says there are two more students who have been having persistent coughs. She thinks she got her condition from the house mother in her dormitory. It is obvious that there are challenges that have to be addressed when it comes to treating tuberculosis especially in children who attend boarding schools.
Most boarding schools in Kenya have congested dormitories and lack adequate space, a high risk factor considering that TB is an airborne disease. TB medication requires a specialized diet rich in proteins and most patients are recommended to take their medicine with milk or soup. In schools it is difficult for students to get milk and Linda cites this as one of the challenges she faces while continuing with her treatment in schools. Besides it has been very difficult for her to get a transfer to a local health centre which is nearer to her school. Besides, when students get sick in school, they are most often neglected or ignored altogether because they are thought or believed to be pretending. When attention and care is given to them it is normally minimal and unprofessional as all ailments get prescribed with normal painkillers and bed rest. Medical intervention will only be sought when the ailment continues to persist after which parents or guardians will be called to pick their children for further interventions.
Schools ought to be sensitized on how to handle health issues especially when dealing with communicable diseases like Tuberculosis. Despite the lack of conclusive statistics on the TB prevalence in schools, the above and other school conditions such as poor ventilation and overcrowding especially in dormitories, and inadequate or inaccessible medical care and late diagnosis can fan the spread of the disease. Schools can act as a reservoir for TB if not addressed appropriately because of its mode of transmission and can easily spread through the students, staff members who will further pass it on to the wider community as they interact with them.
Schools can act as a reservoir for TB if not addressed appropriately because of its mode of transmission and can easily spread through the students, staff members who will further pass it on to the wider community as they interact with them.
Most schools are not well equipped with information on TB and its management and mechanisms to follow up in pupils who are on TB treatment are lacking. Maureen’s mother normally sends her daughter back to school with a cocktail of antibiotics and other over the counter drugs which are to be hidden from teachers and other staff members. This can have dire consequences.
In as much as the government is scaling up its efforts in TB management, TB control efforts cannot afford to ignore TB in schools. Drawing attention and resources to the problem of TB in schools will benefit the whole community. The priority strategy must be widespread implementation of the Stop TB Strategy in schools by sensitizing and enhancement of capacity building in schools so as to avoid delays in the detection and treatment of TB cases which will further reduce the transmission of infection and pressures to self-treat TB by students.