What ails child TB detection in Bangladesh?

Only last year, after a spell of vigorous training of all health staff and awareness campaign, child TB detection rate went up to 3.35 percent of the total tuberculosis cases in Bangladesh.

This is still far below the WHO’s estimation that in Bangladesh TB to children under 15 years of age is 10 percent of the total detected cases.
 
So the question comes, why this gross under-detection when Bangladesh has achieved the MDG targets of 70 percent new case detection and 85 percent cure rate in tuberculosis well before the 2015 time frame.
 
“Doctors never took it (TB) seriously in their diagnostic consideration,” Dr Ahmed Hossain Khan, Line Director of Bangladesh’s National Tuberculosis Programme (NTP) told bdnews24.com.
 
“They used to diagnose their (children) symptoms as lung infections and other respiratory problems. But they rarely thought kids can suffer from different types of TB from lung to bone”.
 
In Bangladesh it is believed that almost 50 percent people carry the bacterium that causes TB.
 
But it turns to an active disease only when it gets a favourable environment mostly in immune compromised people. Treatment cures the bacterium, but it can kill if left undetected and untreated.
 
Doctors say this under-detection is due to an almost exclusive focus on ‘sputum smear-positive TB’ that means testing cough, and the absence of training and guidelines for health works.
 
“Children cannot give cough for testing,” pulmonologist Dr Asif Mujtaba Mahmud told bdnews24.com as TB programme was focused on cough testing.
 
“Now we do x-ray instead of taking cough and Mantoux test (a kind of test on skin),” he said.
 
He, however, said child TB detection was neglected across the world. “It’s not difficult to detect them. But it came into focus across the world only recently”.
 
Bangladesh has just begun its first-ever study to find out number of TB patients as it depends on WHO’s estimates to chart out strategies to control the disease.
 
The UN agency estimates that every year Bangladesh should detect 350,000 TB patients. The country detected 191,000 last year.  The NTP Line Director said even this was more than their MDG target.
 
“Globally TB affects nearly nine million people, of them three million go undetected. That’s why, this year’s World TB Day (observed on Tuesday) was themed on detecting those missing three million cases,” the Line Director Dr Khan said.
 
The US Centre for Disease Control says TB in children under 15 years of age also called paediatric tuberculosis is a public health problem of “special significance” because “it is a marker for recent transmission of TB”.
 
It says infants and young children are more likely than older children and adults to develop life-threatening forms of TB disease such as TB meningitis, affecting brain.
 
Training is the key
 
The recent figure of 3.35 percent child TB detection was up from the 2.78 percent in a year.
 
“It was after a vigorous training to health workers in Dhaka city,” the NTP Line Director said.
 
He said they had tied up with the Bangladesh Paediatric Association to train the doctors and other health workers with US funds.
 
“Basically this (child TB) had been overlooked over the years,” he said: “We’ll take the training to across Bangladesh”
 
Pulmonologist Dr Mahmud suggested families to test their children if one of the family members diagnosed TB.
 
“Children can easily get it (TB) since they are less immune (to fight against diseases),” he said.