Involuntary detention and compulsory treatment of non-adherent tuberculosis patients in Kenya: an ethical discourse

Martin Ng'ang'a Muigano


Tuberculosis (TB) is a major public health problem in sub-Saharan Africa due to its highly infectious nature and co-infection with HIV/AIDS. The Kenyan government has implemented various programs and strategies to control TB including the controversial jailing of patients lost to follow-up. In 2010, a Kenya court detained, in a prison facility, two TB patients who were non-adherent to treatment. A similar incidence occurred in 2016 when another TB patient who refused to adhere to TB treatment was jailed. This article analyses the ethical implications of these interventions. It is argued that jailing of patients non-adherent to TB treatment may be in contravention to the ethical principles of autonomy, justice, and equity. A central argument of this article is that incarceration not only contravenes the internationally recognized human rights to autonomy and self-determination but also predisposes the poor population to further risks of TB infection and re-infection thus depriving them of social justice and equity. The principle of the overall benefit to the society is also explored in the context of the Kenyan cases. It is further argued that mandatory isolation strategies may not only be ineffective but also inappropriate and as such, alternative isolation strategies are suggested. The need to streamline the Kenyan health system to accommodate cases of isolation is recommended.


Tuberculosis, Involuntary detention, Non-adherent, Treatment, Ethical issues

Full Text:



Sitienei J, Nyambati V, Borus P. The epidemiology of smear positive tuberculosis in three TB/HIV high burden provinces of Kenya (2003-2009). Epidemiol Res Int. 2013;1-8.

World Health Organization. Global Tuberculosis Report. Geneva: World Health Organization. 2015. ISBN 978 92 4 156505 9. bitstream/10665/191102/1/9789241565059_eng.pdf

World Health Organization. A brief history of tuberculosis control in Kenya. Geneva: World Health Organization. 2009. ISBN 978 92 4 159692 3.

Maleche-Obimbo E, Wanjau W, Kathure I. The journey to improve the prevention and management of childhood tuberculosis: the Kenyan experience. Int J Tuberc Lung Dis. 2015;19:S39-42.

Kipruto H, Mung’atu J, Ogila K, Adem A, Mwalili S, Masini E, et al. The epidemiology of tuberculosis in Kenya, a high TB/HIV burden country (2000-2013). Int J Pub Health Epidmiol Res. 2015;1:002-13.

Todrys KW, Howe E, Amon JJ. Failing Siracusa: governments' obligations to find the least restrictive options for tuberculosis control. Public Health Action. 2013;3:7-10.

Kenya Legal and Ethical Issues Network on HIV and AIDS. Judgement for Petition No. 329 of 2014 In The High Court of Kenya at Nairobi. Milimani Law Courts, Constitutional and Human Rights Division, 2016. Available at Accessed 10 June 2016

Food and Agricultural Organization. Public Health Act Chapter 242. Laws of Kenya. Available at Accessed 10 June 2016

World Health Organization. The Global Plan to Stop TB 2006–2015: actions for life towards a world free of tuberculosis. Geneva: WHO. 2006.

World Health Organization. Guidance on ethics of tuberculosis prevention, care and control. Geneva: WHO. 2010. bitstream/10665/44452/1/9789241500531_eng.pdf

Phua K. Ethical Dilemmas in Protecting Individual Rights Versus Public Protection in the Case of Infectious Diseases. Infect Dis (Auckl). 2013;6:1–5.

Blais CM, White JL. Bioethics in Practice - A Quarterly Column about Medical Ethics: Ebola and Medical Ethics - Ethical Challenges in the Management of Contagious Infectious Diseases. Ochsner J. 2015;15:5-7.

Lee LM, Heilig CM, White A. Ethical Justification for Conducting Public Health Surveillance without Patient Consent. Am J Public Health. 2012;102:38-44.

Selinger CP. The right to consent: Is it absolute? BJMP. 2009;2:50-4.

United Nations. International covenant on economic, social and cultural rights, international covenant on civil and political rights and optional protocol to the international covenant on civil and political rights. New York: United Nations. 1966.

Mburu G, Restoy E, Kibuchi E, Holland PJ, Harries A. Detention of people lost to follow-up on TB treatment in Kenya: the need for human rights-based alternatives. Health Hum. Rights. 2016;18:3-54.

Meek R. The possible selves of young fathers in prison. J Adolesc. 2011;34:941-9.

Kizito KW, Dunkely S, Kingori M, Reid T. Lost to follow up from tuberculosis treatment in an urban informal settlement (Kibera), Nairobi, Kenya: What are the rates and determinants? Trans R Soc Trop Med Hyg. 2011;105:52-7.

Wasonga J. Factors contributing to tuberculosis treatment defaulting among slum dwellers in Nairobi, Kenya. International congress on drug therapy in HIV. The Gardiner-Caldwell Group Ltd 2006;310.

Muture BN, Keraka MN, Kimuu PK, Kabiru EW, Ombeka VO, Oguya F. Factors associated with default from treatment among tuberculosis patients in Nairobi province, Kenya: a case control study. BMC Public Health. 2011;11:1.

Kawachi I, Subramanian SV, Almeida-Filho N. A glossary for health inequalities. J Epidemiol Commun H. 2002;56:647-52.

Verma G, Upshur RE, Rea E, Benatar SR. Critical reflections on evidence, ethics and effectiveness in the management of tuberculosis: public health and global perspectives. BMC Medical Ethics. 2004;5:1.

United Nations Economic and Social Council. Siracusa Principles on the Limitation and Derogation Provisions in the International Covenant on Civil and Political Rights. U.N. Doc. E/CN.4/1985/4, Annex.1985.

Johnstone-Robertson S, Lawn SD, Welte A, Bekker LG, Wood R. Tuberculosis in a South African prison: a transmission modelling analysis. S Afr Med J. 2011;101:809-13.

O’Grady J, Hoelscher M, Atun R, Bates M, Mwaba P, Kapata N, Zumla A. Tuberculosis in prisons in sub-Saharan Africa–the need for improved health services, surveillance and control. Tuberculosis. 2011;91:173-8.

Amwayi AS, Kikuvi GM, Muchiri EM. Modifiable factors associated with active pulmonary tuberculosis in a Kenyan prison. East Afr Med J. 2010;87:43-8.

United Nations. Special rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Report of the Special Rapporteur. New York: United Nations. 2010

Division of Leprosy, Tuberculosis, and Lung Disease. Annual report. Nairobi, Kenya: Ministry of Health. 2012.

Aboo, A. Man to serve 6 months in jail for refusing to take TB drugs 2016. Available at Accessed 9 July 2016

Maleche A, Were N. Petition 329: A Legal Challenge to the Involuntary Confinement of TB Patients in Kenyan Prisons. Health Hum. Rights. 2016;18:103-8.