Ending a Global Epidemic: Tuberculosis in Children

Ending a Global Epidemic: Tuberculosis in Children

 {Photo credit: MSH Ethiopia}Atsede Tefera recalls three months of long delays in the diagnosis of tuberculosis for her daughter Nigist, who was eventually able to initiate treatment.Photo credit: MSH Ethiopia

When my daughter got sick, I took her to a clinic in my neighborhood. They gave her cough syrup for seven days.

I thought she was getting better, but it was apparent that she was still ill. After another examination, they referred her to St. Paul Hospital in Addis Ababa where they put her on oxygen and started taking blood sample after sample and injection after injection for a month. Her condition did not get better so they gave her another medicine. The doctors then decided to take blood from her back… only then did they know it was tuberculosis.

~ Atsede Tefera

Tuberculosis (TB) kills more people each year than any other infectious disease, causing over 1.5 million deaths globally. More than a quarter of cases are in Africa, the region with the highest burden of TB disease relative to population. Children are amongst the most vulnerable, and all too often children with TB remain in the shadows, undiagnosed, uncounted, and untreated. Today, more than 53 million children worldwide are infected with TB and over 400 die each day from this preventable and curable disease. 

The serious, yet historically neglected global childhood TB epidemic is preventable through prompt diagnosis and treatment and by reducing risks related to co-morbidities, such as malnutrition, that can make tuberculosis even more lethal to children. The disease, which is passed on by coughing or sneezing, often spreads in communities where people are living in close proximity to each other, putting those living in poor socio-economic conditions particularly at risk.

In recent years, progress has been made to combat childhood TB. The emergence of policies and guidelines across the Africa region that incorporate childhood TB, coupled with innovative treatment and child-friendly medicine, have moved us closer to tackling one of the oldest and most persistent diseases in the world. However, a new analysis released on this year’s World Tuberculosis Day, shows that in African countries, a persistent divide between policy and practice threatens progress gained for addressing childhood TB across the region. The analysis, a collaboration between the US Agency for International Development (USAID) and its African Strategies for Health (ASH) project, presents the landscape of childhood TB programming in 12 countries in Africa and suggests three focus areas critical for moving the dial on this intractable issue:

  1. Strengthen the capacity of health workers to identify and diagnose children infected with TB. For children experiencing symptoms, the first contact with the health sector at a primary health care or maternal and child health clinic is an important opportunity to identify TB symptoms early and refer for treatment. Symptoms, such as a persistent cough, loss of appetite, and high fevers, must be recognized by all providers as possible signs of TB. Health workers at all levels of the health system must be empowered to take appropriate action such as referral for treatment and follow-up.

  2. Implement active case finding strategies for early identification of child TB. Delays in diagnosing TB and initiating appropriate treatment are often long, particularly where access to health care is poor. Systematically identifying children who have come into contact with a person with active TB, as well screening children with HIV and those who are malnourished, are critical steps to identify sick children.

  3. Ensure adequate care closer to home. Health systems must be strengthened to guarantee a regular supply of tools and child-friendly medicines at all levels where sick children may access care. Clear guidance on the optimal interaction and links between service delivery platforms, including maternal and child health, HIV, and nutrition programs, is vital.  

No child should die from TB, which is preventable and curable. We have the policies, guidelines, medicines, and health service delivery platforms needed to make this vision a reality. The time to apply these instruments--to end preventable child deaths due to TB--is now.

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The ASH project, led by Management Sciences for Health (MSH), works in close collaboration with USAID, African governments, and partners to expand the body of knowledge around childhood TB. ASH provides technical leadership and engages stakeholders to build consensus around regional priorities for addressing childhood TB.

A version of this post also appears on PLoS.

Visit the ASH website to download the report and additional childhood TB resources