Left untreated, child TB appears to be ‘silent epidemic’

Child tuberculosis has grown into a ‘silent epidemic’ as 90 percent of children who die from TB every year went untreated worldwide, a new report released in Geneva says.

Nurul Islam Hasibbdnews24.com
Published : 23 May 2018, 11:18 AM
Updated : 25 May 2018, 04:40 PM

The International Union Against Tuberculosis and Lung Disease (The Union) published the report Wednesday on the sidelines of the World Health Assembly, calling for urgent action to protect children from tuberculosis.

Worldwide, one million children under the age of 15 develop TB and 239,000—nearly one in four—die annually.

Yet most of these deaths are treatable and preventable with simple, cost-effective public health measures.

“This massive toll of deaths among children results from systematic disregard for children’s rights to health,” according to the report titled “Silent Epidemic: A Call to Action Against Child Tuberculosis”.

“Children with TB rarely die when they receive standard treatment for the disease - of the 239,000 children who die from TB every year 90 percent were those left untreated,” said Dr Paula I Fujiwara, Scientific Director, The Union.

“This neglect can no longer be excused on grounds of economy or expediency. TB is preventable, treatable, and curable. The continuing medical neglect of child TB, resulting in millions of avoidable deaths, constitutes a human rights violation by any reasonable measure.”

Within global public health, it is an open secret that health systems neglect children with TB because children are less contagious than adults— stopping the spread of TB is a priority—and because the standard tools used to diagnose TB work less well in children.

According to the report, ending the child TB epidemic requires local interventions, sensitive to social and cultural context, to reach at-risk children using simple tools for active screening and diagnosis.

Even in resource-limited areas, projects like DETECT Child TB, spearheaded by The Union, are demonstrating that medical professionals can be equipped with the knowledge and tools to diagnose and treat TB in children, with access to care provided at the community level.

“By following a simple process to screen, diagnose and treat children in households with adults suffering from TB, we have been able to make a tremendous impact in a short space of time,” said John Paul Dongo, director of The Union’s Uganda office.

BANGLADESH EXPERIENCE

Screening households where an adult is diagnosed with TB to see if children have been exposed in the home must become the standard implemented everywhere, according to the report.

Implementing this approach, where The Union has piloted this approach in Uganda, 72 percent of at-risk children were able to receive preventive TB treatment, up from less than 5 percent previously.

Prof Shakil Ahmed, a Bangladesh expert on child TB, told bdnews24.com that it is also a policy of the Bangladesh government.

“In Bangladesh like many other TB high burden countries the detection rate is lower among the children under-5 years of old. So the death rate is higher in this age group as they left untreated.”

“WHO is now trying to address this issue globally,” said Prof Ahmed, also a core member of the WHO’s child and adolescent TB working group.

He said children under-5 “if they come close to a family member who have lung TB is advised to give a six-month long preventive drug even if he or she does not show the symptoms.”

“But it is difficult to make people understand that because naturally family members would not want to feed a long time drug to their child if he or she does not show any symptoms. But we need to make them aware of that,” he said.

“It’s a policy of the Bangladesh government now.”

In Bangladesh, the TB detection rate under-14 years of old, which is known as child TB, was much less even a decade ago.

Of the total TB cases, 10 percent are child TB, according to an estimate. But in 2007, it was around 2.5 percent. In 2013, it was less than 3 percent.

But after a training programme for the doctors and healthcare workers, the rate increased to nearly 4.5 percent in 2016.

The National Tuberculosis Programme of the government and Bangladesh Paediatric Association conducted those training in Sylhet and Dhaka divisions with the support of the USAID. The training model is later adopted by Nepal also.

“If we could implement the model across Bangladesh, then the detection rate would go up significantly,” Prof Ahmed said, a fund crisis stopped them to train all healthcare providers across Bangladesh.

The Union said, in the long run, greater investment in research and development needs to deliver better diagnostics, treatments and an effective vaccine that prevents TB.

The UN High Level Meeting on TB in September 2018 needs to generate concrete action, where governments are held accountable for achieving time-bound targets, for investing in new research and delivering the care to which all children with TB have a fundamental right.

“The public health sector cannot end the TB epidemic alone, because TB is driven by economic and demographic factors as much as it’s driven by health factors,” said José Luis Castro, executive director of The Union.

“We are dealing with an airborne disease that is becoming increasingly resistant to the few antibiotics we have to treat it, and children are bearing some of the worst impacts. We simply cannot continue like this.

“Heads of state are the only leaders with the power and influence to mobilise resources to end the epidemic. They must act.”