By Henry Neondo
NAIROBI, Kenya: Kenya’s efforts to tackle respiratory diseases need to move beyond tuberculosis (TB), with a new assessment revealing significant gaps in the availability of equipment, medicines and services needed to diagnose and manage conditions such as asthma and chronic obstructive pulmonary disease (COPD).
The study, “Breathing beyond tuberculosis: a comprehensive lung health service availability and readiness assessment,” published in the International Journal of Tuberculosis and Lung Disease – Chronic Respiratory Disease, examined the readiness of health facilities in Kenya to provide comprehensive lung health services. The study was done by a team led by Dr. Immaculate Kathure, Ag Head-Division of Tuberculosis and Lung Health, Ministry of Health Kenya, Clinton Health Access Initiative, and the Kenya Medical Research Institute.
The assessment was conducted as part of the Integrated Programme on Asthma, COPD and Tuberculosis (iPACT) and sought to identify gaps in lung health services across different levels of healthcare in the country.
Few facilities equipped to assess lung function
One of the major findings was the limited availability of equipment used to diagnose respiratory diseases.
Only 10 percent of the facilities assessed had functional spirometers, the equipment used to measure how much air a person can breathe in and out and how quickly they can exhale.
The majority of the functional spirometers were found in private facilities in Nairobi, raising concerns about access to diagnostic services for patients in other parts of the country and particularly those seeking care in lower-level or rural facilities.
The assessment also found that only 6 percent of facilities had peak-flow meters, which can help assess airflow limitation, while 16 percent had nebulisers, devices commonly used to deliver medicines during acute respiratory episodes.
The findings point to a health system that has historically built considerable capacity around TB but has comparatively limited infrastructure for identifying and managing other chronic respiratory diseases.
Essential medicines also in short supply
The study found similar challenges in the availability of medicines.
Salbutamol inhalers, commonly used to relieve breathing difficulties associated with asthma and COPD, were available in only 39 percent of facilities assessed.
Even fewer facilities stocked inhaled corticosteroids, important medicines for controlling airway inflammation in conditions such as asthma. Their availability was reported at less than 20 percent of facilities.
The gaps have implications for patients whose respiratory symptoms may be caused by conditions other than TB.
For decades, TB has occupied a central position in Kenya’s respiratory health programmes. But patients presenting with persistent cough, breathlessness, wheezing or reduced exercise tolerance may also have asthma, COPD or other chronic respiratory conditions requiring different diagnostic and treatment approaches.
The need to broaden Kenya’s lung health response
The researchers argue that strengthening lung health services requires a broader approach that integrates respiratory conditions rather than treating TB in isolation.
This is particularly important because respiratory problems can persist even after a person has successfully completed TB treatment. Research has shown that a substantial proportion of TB survivors experience continuing respiratory symptoms or abnormal lung function, with post-TB lung disease emerging as an important long-term health concern.
A recent review of evidence on post-TB respiratory disability found that ongoing respiratory symptoms, abnormal lung function and abnormal lung imaging remain common among TB survivors. It also highlighted the limited evidence available on how health systems can effectively provide integrated long-term respiratory care.
Rural and lower-level facilities particularly vulnerable
The findings are consistent with broader evidence of disparities in health equipment across Kenya.
Kenya’s Ministry of Health Health Facility Census has previously documented substantial differences in the availability of essential equipment between lower- and higher-level facilities. For example, among government facilities, 74 percent of Level 2 facilities lacked oxygen equipment, compared with 15 percent of Level 4 facilities. Similarly, 66 percent of Level 2 facilities lacked nebulisers compared with 11 percent of Level 4 facilities.
Such disparities can make it difficult for patients outside major urban centres to obtain timely diagnosis and treatment for respiratory conditions.
Building on Kenya’s TB infrastructure
The iPACT approach seeks to build on Kenya’s experience and infrastructure in TB control while expanding attention to other major respiratory diseases.
The programme brings together asthma, COPD and TB within a broader lung-health framework, reflecting growing recognition that patients should receive appropriate diagnosis and care regardless of the particular respiratory condition causing their symptoms.
For Kenya, the challenge now is not simply to maintain progress against TB but to ensure that the health system can diagnose and manage the wider spectrum of lung diseases.
This will require investment in diagnostic equipment, essential medicines, health-worker training, referral systems and routine lung-health services, particularly at primary healthcare level.
As Kenya strengthens its primary healthcare system, researchers and health-sector stakeholders say lung health should form part of that broader agenda.
The message from the assessment is clear: ending TB cannot be the endpoint of Kenya’s respiratory health response. The country must also ensure that people living with asthma, COPD and other chronic lung conditions can breathe beyond tuberculosis.
Source: International Journal of Tuberculosis and Lung Disease – Chronic Respiratory Disease, “Breathing beyond tuberculosis: a comprehensive lung health service availability and readiness assessment.