Need to increase public awareness on tuberculosis among children

Tuberculosis can affect any age, caste or class and it is one of the top 10 causes of death across the globe, ranking above HIV and malaria. According to the World Health Organization (WHO), in 2015, there were 10.4 million new cases of TB worldwide. Six countries account for 60% of the total TB deaths, with India leading the count, followed by Indonesia, China, Nigeria, Pakistan and South Africa. As per WHO, each year about 2.2 million people develop TB in India and an estimated 220,000 die from the disease.

However, very few people know that the disease affects children too. In 2015, an estimated 1 million children became affected with TB and 170,000 children died of TB (excluding children with HIV) worldwide. Almost 10% of total TB cases in India are among children, but only 6% are reported. Childhood TB is often not given adequate attention by healthcare providers as it is difficult to diagnose and treat. This World TB Day, 24 March, 2017, is an occasion to call for increased public awareness on the rising cases of TB among children. According to Dr. Rahul Nagpal, Director, Pediatrics, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, “There has been a steep rise in TB cases among children in India. In a month, I see nearly 7 to 10 new cases. It is sad to see children below the age of 5 years in the OPDs with TB but the most unfortunate part is the lack of awareness, proper diagnosis and treatment in case of childhood TB. The youngest TB case handled by me was a 1500 gm baby boy, who was born premature with congenital TB. I have seen other similar cases too but what makes me remember this one was that his mother had uterus TB and was unaware of it. Many people aren’t aware that TB can happen anywhere and can transfer from anyone. While 60% of TB in children are pulmonary, the rest 40% are extra-pulmonary and are on rise by 20-30% each year, with people knowing very little about it.”

It is important to know that TB is a disease which is preventable and curable. Dealing with childhood TB is difficult and crucial because there are several challenges in diagnosis and treatment. At the time of birth, BCG vaccine is compulsory for children. In case a child under the age of 5 years develops TB symptoms, the mantaux test, a very economical and reliable screening test in adults, is done to detect the signs. However this test may have little value in a child who has already taken the BCG vaccine.

According to TB FACTS.ORG:

Signs and symptoms of TB disease in children include:

• Cough
• Feelings of sickness or weakness, lethargy, reduced playfulness
• Weight loss or failure to thrive
• Fever, night sweats

Signs of TB in other parts of the body among children depend on the area affected. Infants, young children, and immunocompromised children (e.g., children with HIV) are at the highest risk of developing the most severe forms of TB such as TB meningitis or disseminated TB disease. A pediatric TB expert should be consulted in the treatment of TB in children and infants. It is very important that children or anyone being treated completes the course and takes the medicines exactly as instructed. The medication for children is usually prescribed according to their weights and hence the treatment for each child needs to be customized.  Taking blood repeatedly for tests is also a problem as the pain is not easy to bear for them or their parents.

According to Mr Sandeep Guduru, Facility Director, Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, “TB in children is ignored, goes unnoticed and is under-reported. While there are many campaigns to create awareness about pulmonary TB, we need to work more aggressively towards creating knowledge about extra-pulmonary TB cases. Also, the rise in Multi-Drug-Resistance (MDR-TB) among children has drawn very less attention of caregivers. The government and private sector healthcare providers need to come on a single platform to ensure the next generation is TB free.”

While there has been significant progress in the fight against TB, with 43 million lives saved since 2000, the battle is only half-won: over 4 000 people lose their lives each day to this leading infectious disease. Many of the communities that are most burdened by tuberculosis are those that are poor, vulnerable and marginalized. WHO is calling on countries and partners to "Unite to End Tuberculosis" this year. The call comes as we enter the era of the Sustainable Development Goals (SDGs). Ending tuberculosis (TB) by 2030 is a target of the SDGs and the goal of the WHO End TB Strategy.

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