Bangladesh’s child TB detection now a regional model

Once grappling with finding out ways of maximising childhood tuberculosis detection, Bangladesh now serves as a model in South Asia.

According to the World Health Organisation, TB in children under 15 years of age should be 10 percent of the total detected cases in Bangladesh.

Based on that calculation, Bangladesh should have 20,000 children with TB. But the government could so far detect 8,104 cases, with about 3,000 new cases detected in just two years – 2014 and 2015.

“After adopting a new approach, we witnessed this significant jump,” says Dr Shakil Ahmed, a child TB expert and associate professor of Shahid Suhrawardy Medical College and Hospital.

They developed a training module and extensively trained doctors and health workers to achieve the success.

“SAARC took this model and now it is being used by the SAARC HIV/TB detection centre in Kathmandu,” he said at a discussion with health journalists in Dhaka on Wednesday.

“This is innovated from Bangladesh and we have given this to the world,” he said.

BRAC the NGO that implements the government’s TB programme organised the discussion with Bangladesh Health Reporters’ Forum.

TB is one of the oldest diseases to infect humans and now it ranks alongside HIV/AIDS as the top infectious killer worldwide.

South Asia contributes 41 percent of the total global TB burden in the world. The rate is 225 per 100,000 population in Bangladesh.

However, child TB detection had been neglected in Bangladesh as elsewhere in the world as it was difficult to detect this airborne disease in them. Doctors say childhood TB came into focus across the world only recently.

The number was 4,184 in 2006 in Bangladesh.  It rose to 5044 in 2013 with only 860 new cases in eight years.

But in 2014, the figure rose to 6262 and in 2015, to 7,984 after the new programme was taken up.

Dr Asif Mujtaba Mahmud, associate professor for respiratory medicine at the IEDCR, said the situation changed when paediatricians took the lead and developed a new content for case detection and training.

“We got the success when technical people were engaged in the programme,” he said.

In the new module, they suggested some symptoms in children, adjacent to a TB patient’s home, should be seriously taken care of --- two weeks of persistent fever and cough despite having antibiotics, weight loss, and not playing like before.

Then they should be taken to the doctors, child specialist Ahmed said.

According to him, if the child is below five years of age and anyone in his family is infected with TB, then the child must be administered one drug, Isoniazide, for six months as preventive measures following doctor’s consultation.

“Then the child will never get TB,” he said, “the drug has no remarkable side-effects.”

Dr Shakil said they had trained up health workers at the field level who can easily refer a suspect to the doctor.