Tuberculosis (TB) remains a serious disease. An outbreak in schools can lead to serious and dire consequences because of the close contact between pupils.
Maureen is a Form Two student at a local provincial school in Western Kenya. She is 15-years-old and has been on anti tuberculosis treatment for the last three months. She stopped going to school after being diagnosed with TB in order to concentrate on her treatment. Before being diagnosed, Maureen was experiencing persistent coughs and chest pains. Her mother sent her to school with a cocktail of antibiotics and other over the counter drugs, which she diligently took while at school 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 so she asked someone to contact her parents to come to her school and they could take her to hospital. For going through unofficial channels to contact her parents the school said she was to be punished.
Despite this, she went to Kenyatta Hospital, Nairobi where she was diagnosed with TB. 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 will lose out on almost a whole year of school if she continues with the same treatment course she is now on. 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 has defaulted on her TB treatment three times. She was diagnosed with TB two and a half years ago and was put on treatment. However , she defaulted for the first time after only two months of treatment. She was taken to a different hospital when her cough recurred and again put on treatment from which she again defaulted. She is now taking the same regime that she failed to adhere to on three separate occasions and hopes to complete her treatment come August. At her school she says there are two more students who have persistent coughs. She thinks she got her condition from the house mother in her dormitory.
It is obvious that there are challenges that need to be addressed when it comes to treating TB in children, especially those who attend boarding schools. Most Kenyan boarding schools 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. Linda cites this as one of the reasons she struggled to continue with her treatment. It has also been very difficult for her to get a transfer to a local health centre which is nearer to her school.
When students get sick in school, they are often neglected or ignored altogether because they are thought to be pretending. When attention and care is given it is normally minimal and unprofessional, involving the perscription of painkillers and bed rest. Medical intervention will only be sought if an ailment persists, after which parents or guardians will be called to collect their children for further interventions.
Schools ought to be sensitized on how to handle health issues, especially when dealing with communicable diseases like TB. Despite the lack of conclusive statistics on TB prevalence in schools, poor ventilation and overcrowding, especially in dormitories, plus inadequate or inaccessible medical care and late diagnosis, can fan the spread of infection. Schools can act as a reservoir for TB if not addressed appropriately. This is due to its mode of transmission, which can easily spread through the students and staff members, who can then pass it to the wider community as they interact with them.
Most schools are not well equipped with information on TB and its management. The mechanisms needed to keep a check on pupils who are on TB treatment are lacking. For example, Maureen’s mother sent her daughter back to school with a cocktail of antibiotics and other over the counter drugs, which were hidden from teachers and other staff members. This can have dire consequences.
As the government scales up its efforts in TB management, it cannot afford to ignore TB in schools. Giving attention and resources to the problem of TB in schools will benefit the whole community. The priority strategy must be a widespread implementation of the Stop TB Strategy in schools, to build the capacity of schools to detect TB and manage its treatment. By doing this, late detection and the pressure students feel to self-treat may be avoided and the transmission of TB reduced as a result.
