After years of neglect, childhood tuberculosis — which accounts for over
six per cent of the global TB burden — is finally getting due
attention. WHO recently published its first-ever targeted road map
outlining the steps needed to move towards zero childhood TB deaths. The
report comes close on the heels of the organisation including for the
first time the estimates of the global TB burden in children below 15
years in its 2012 global tuberculosis report. Last year also saw
childhood TB getting special focus in the World TB Day theme. Though
over half-a-million new cases are reported every year from across the
world in those who are HIV negative, the actual TB burden must be much
higher. The reasons are pretty obvious. Most of what is reported are
only the cases of sputum smear-positive pulmonary TB. However, sputum
smear-negative disease is most frequent even in pulmonary TB. Most
often, all cases of extra-pulmonary TB go unreported even though this
category of TB accounts for “approximately 20-30 per cent.” Unlike
adolescents, children under five may not produce sputum for examination.
In the absence of sputum samples, there is no highly reliable and
easily usable diagnostic tool to confirm the disease, especially in
developing countries where TB is endemic and malnourishment is high.
Hence, developing reliable and affordable tests has become a great
research priority.
As a result, high burden countries like India, where 10-20 per cent of
all TB occurs in children, need to find alternative strategies to target
vulnerable children who are more prone to becoming infected and
diseased. Implementing the WHO’s close contact screening of children
under five from households where an adult has been newly diagnosed with
sputum smear-positive pulmonary TB would go a long way in achieving the
desired results. Adults would have spread the infection to children in
the same household before seeking treatment. A clinical examination of
children combined with laboratory confirmation in suspicious cases would
go a long way in revealing their TB status. This approach has twin
advantages. While the diseased would be put on treatment without delay,
the asymptomatic children would end up getting a preventive therapy. A
prophylactic treatment using a single drug — isoniazid — once daily for
six months would cut down the number of young ones who may become
diseased. It would reduce the TB load and the mortality rate. Yet, in
India’s TB control programme, contact screening is way down in the
priority list. There are challenges, but training health workers and
adopting minor changes to the existing system alone can yield good
results. What’s the government waiting for?
No comments:
Post a Comment