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In Los Angeles: Stephanie Bowen Communications Manager 310-826-7800 sbowen@imcworldwide.org

In Nairobi: Natalia Cieslik Emergency Response Communications +25472771483 ncieslik@imcworldwide.org

Nairobi, Kenya - Health workers report an increasing number of tuberculosis (TB) patients missing check-ups and treatment appointments. In the Kibera District Office, a clinic on the outskirts of the vast slum in the Kenyan capital Nairobi, the default rate reached 35 % this week and is usually around 5%. Clinic workers have also observed a decline in the number of people with TB symptoms presenting for testing.

These lapses are worrisome. Tuberculosis programs need to detect at least 70% of new TB cases and successfully treat 85% of these cases to help control the worldwide epidemic. According to the World Health Organization, globally, Kenya is considered a high-burden country, ranking 10th for the total number of TB cases and 6th for the number of TB cases per capita.

Many patients have been displaced during the post-election violence that turned Kibera into a battleground for political opponents and criminal gangs. Others are still not able to move around freely. Given the high prevalence of TB and immuno-suppressed people in Kenya, and increased crowded living conditions for the displaced as a result of the current crisis, it is even more important to detect and treat cases to prevent the long term development multi-drug resistant TB.

To be cured, TB patients must complete an oral medication course that lasts an average of eight months and is extremely sensitive to interruptions. Depending on the phase, the course must be restarted if too many days are missed. This can be the case after a gap of seven days during the early intensive treatment phase and one month during the later continuation phase. In some cases patients who discontinue the treatment can develop a resistance to the oral medication and must then have their medication administered intravenously, which is more expensive, often painful and can result in strong side effects such as severe skin rashes, liver toxicity and visual impairment.

A Health-Setback for Kenya It is too early to say how many of the current defaulters will have to restart the course. Some of the displaced patients might be able to get their medication in other clinics. But health professionals worry that default rates will be even higher in areas with long-distance displacement as has been seen in the west of the country.

"This development is a serious setback for Kenya's fight against TB," says Peter McOdida, IMC country director Kenya. "The large-scale displacement and prolonged insecurity in many areas could throw us back for many years."

Kibera, where more than 700,000 extremely poor people live in overcrowded conditions in an area roughly the size of New York's Central Park, is a breeding ground for tuberculosis. High HIV rates, poor diet, crowded living quarters, and lack of hygiene contribute to the high rate of TB infection. Many people are co-infected with TB and HIV and depend on casual labor for their livelihood. The recent violence has left them without any income and often without a home.

Hunger Contributing to Defaulting Treatment The lack of food is contributing to the TB default rate. When faced with the choice, parents often prioritize feeding their families over making it to the clinic for medication. Many TB patients report that they have gone for days without food making it difficult for their bodies to tolerate the strong medication. Co-infected patients, who are on treatment for both TB and HIV, especially suffer under the current food shortages.

Most members of an IMC-supported group of HIV positive mothers based in Kibera said that they interrupted their anti-retroviral drug regime for up to a week because violence prevented them from refilling their prescriptions or they got sick from taking their medication on an empty stomach. Prices for staples like flour, cabbage, and sugar have skyrocketed in the slum where people have been attacked and robbed of the little food they can obtain.

International Medical Corps has been supporting TB clinics in Kibera and 13 other districts since 2005. IMC's programs involve not only testing and treating tuberculosis but also providing patient education and defaulter tracing through community workers.

"Our patients are well aware of the consequences of missing treatment days. If they do not come to refill their medication, it is simply because something is preventing them from reaching us," says McOdida.

Usually, community workers visit patients in their homes and remind them of missed appointments. Now however, defaulter tracing relies exclusively on calling patients who own a mobile phone, meaning that many patients are not reached for follow-up. The current insecurity has made Kibera inaccessible for health workers who themselves have become a target of the violence. In addition some of the community workers have also been displaced making defaulter tracing even more challenging.

IMC staff in Kibera is trying to reach their patients through word of mouth and announcements on the local radio station, informing them that the TB clinic is open and gives out medication. For patients who have been displaced to nearby Jamhuri Park IMC has opened a temporary TB treatment and diagnostic clinic.

International Medical Corps is extremely concerned and while it is doing all that it can to track its patients, a swift political solution is necessary to assure that the chronically ill can maintain even the most basic level of care.