Role of the Agricultural sector in improving TB outcomes: A case study of Cereal board of Kenya and one Acre in Bungoma
This was the third time Joshua visited the TB clinic with TB symptoms. He had been treated the first time and the second time and by his own admission, he had not followed the Doctors instruction on treatment adherence. “I got concerned that he would develop drug resistant if he already had not been developed”. Reveals Dorothy a TB advocate in Bungoma. I sought to find out why he could not keep to his treatment. Adds Dorothy.
Joshua, a father of five and a grandfather to one who was under five years of age is a small scale farmer and the wife tills land for a paltry half a dollar to one dollar per day, bearly enough for their fairly large family. Joshua was too weak to continue working on their small farm. Due to poverty Joshua could hardly afford the badly needed food for his TB treatment. He often felt too weak whenever he took his treatment on an empty stomach. He had eventually stopped taking the TB treatment altogether if only to avoid the bad effects of the TB drugs on his weak body.
In his company, I visit his family and conducted contact tracing in the house hold and would be expected, two other members of the family turned out positive for not just TB but already resistant to one of the strong treatment of TB, isoniazid. They too had signs of malnutrion and this definitely posed a danger to their lives if not addressed even as they took their TB treatment.
Drug resistant TB patients in Kenya qualify for a social protection scheme of Kes 6000 to support their treatment of which this family already qualified. However I could already see this would not be sustainable given the support would have to benefit the entire family.
Cereal board of Kenya and One Acre intervenes
It is at this point that I decided to look out for a sustainable solution to help the family access proper nutrition not just for the patients but for the entire family. I decided I would start with any resources they had to provide a solution for them. Talking to Joshua’s wife she revealed that the family has a little piece of land, part of which was sold to support TB diagnosis. The remaining piece had nappier grass, yet the family does not own any livestock. However, Joshua revealed that he had entered an agreement with a local member of his village to provide the napier grass to him for eight months for a meagre kes. 500 monthly. This of course is not value for his land as the Kes 500 per month could not feed his family
On behalf of the family, I approached the Cereals Board of Kenya and the One Acre Land to find out whether they had a viable solution that would offer assistance to Joshua’s family and many others food security from their small pieaces of land. The Cearel board of Kenya agreed to provide the seesds while One Acre agreed to teach on basics of farming to make the most from their land. The two organisations have since been working together to help small scale farmers from the area add value to their farms and produce enough for their local consumption. The families are now able to provide three balanced meals from their land.
Joshua was able to adherently complete his treatment now that he had a good diet. The other two members too completed their treatment and only used the Kes 6000 to supplement what they got from the land and to access treatment. This model, if successful will change the lives of so many TB clients who come from poor households.
Poverty and food insecurity in households with people with TB are one of the main factors affecting TB treatment adherence. Though the Government supports the TB patients with the Kes 6000 to support their treatment, this is not sustainable beyond the TB treatment period. Agricultural companies have a great role in supporting food security in house holds and this would positively impact on TB treatment outcomes.