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SOUTH AFRICA: Tuberculosis in Children Neglected

Kristin Palitza

DURBAN, South Africa, Jun 3 2010 (IPS) - Even though tuberculosis (TB) is a major cause for illness and mortality in children, South Africa lacks the political will to tackle the disease, health experts say.

TB goes undiagnosed in many South African children. Credit: Kristin Palitza/IPS

TB goes undiagnosed in many South African children. Credit: Kristin Palitza/IPS

And the country’s health system is not up to scratch to diagnose and treat children who have contracted the bacteria.

“TB in children is neglected, and we need to urgently redress this,” said Health Systems Trust senior researcher Dr. Tsholofelo Mhlaba at the 2nd TB Conference, held in Durban from Jun. 1-4. “To do this, we would basically need an overhaul of the health system and allocate major finances for childhood TB programmes.”

About nine million people get infected with TB each year, a third of them live in Africa, according to the World Health Organisation. Up to 15 percent, or 450,000, are African children.

There are no detailed statistics available for the number of paediatric TB cases in many African countries, including South Africa. This makes it extremely difficult to develop effective health programmes to control the epidemic, experts say. “Until we know how many children are infected and where, we won’t be able to appropriately intervene,” cautioned Mhlaba. “We need much more research in South Africa and better reporting and recording systems.”

She said the national department of health (DoH) has neglected to focus on children up until now because children – unlike adults – rarely transmit TB: “That’s why paediatric TB is not seen an emergency issue and sidelined.”


In South Africa, 75,000 children die before the age of five, and health experts believe that about six percent of these deaths are due to TB. “If we want to improve child health, we have to look at TB,” urged Ben Marais, researcher at the department of paediatrics and child health at the University of Stellenbosch. “Children are severely affected, and the younger the child, the more severe the disease.”

Medical experts are now pushing for dedicated childhood TB programmes to be made part of countries’ existing, national TB programmes. “(The research community is) finally at a point to realise how critical TB in children is. But (paediatric) diagnosis, care and treatment are very complex and complicated, even without considering HIV and TB co-infection or (multi) drug resistant TB,” said Peter Vranken, Swaziland director of United States public health agency Centres for Disease Control and Prevention.

In children, TB can manifest in many different symptoms compared to adults, for instance as acute pneumonia. This means that a lung X-ray might not necessarily show the infection in a child. Additionally, if a child is too small to cough, health workers are unable to conduct a sputum test (test of the secretion from lungs and bronchi to identify bacteria) to diagnose the illness. All this leads to paediatric TB being left undiagnosed and untreated.

TB is particularly common in HIV-infected children due to their compromised immune system – 40 to 60 percent of them have at least one incident of TB in their lives. And when children are HIV-positive, the diagnosis for TB is even more difficult.

“Their test results are not as clear and it is difficult to differentiate TB from other opportunistic lung infections in children,” explained Prakash Jeena, professor of paediatrics and child health at the University of KwaZulu-Natal in Durban.

“Paediatric TB is poorly studied and both clinical and radiological diagnosis systems are unreliable,” agreed Heather Zar, chair of the department of child health at the Red Cross Children’s Hospital in Cape Town. She says that paediatric TB should receive the same amount of budget and attention as adult TB programmes and that the same diagnosis standards should be applied.

To change this, it will be crucial to provide additional training to health workers to ensure they have better skills to diagnose and treat childhood TB – not only in the country’s key hospitals but also in public clinics in peri-urban and remote rural areas.

As a first step towards to this goal, international medical aid organisation Médecins Sans Frontières (MSF) launched a pilot programme in 2009 with a patient-centred and decentralised approach to TB treatment in Khayelitsha, South Africa’s third-largest township, 35 kilometres outside of Cape Town.

As part of the programme, MSF paediatricians teach primary health workers how to diagnose and treat TB, multiple drug resistant (MDR) TB and extremely drug resistant (XDR) TB in children.

“Because TB screening of children is often neglected, we knew it’s high time to bring diagnosis and treatment closer to the people,” said MSF Khayelitsha field team coordinator Andiswa Vazi.

Since patients usually have to get to their nearest hospitals for TB diagnosis, many who live outside of urban centres and are too poor to pay for public transport, are unable to regularly access treatment and care. The results are high drop-out rates, which in turn leads to high levels of unsuccessfully treated cases as well as drug resistance.

“This is particularly important in the case of children, who rely on a caregiver in terms of care, adherence to treatment and follow-up visits,” Vazi explained. “If they can access all this at their local clinic, there’s a far higher likelihood that caregivers will take children (for treatment), that children are treated and that they survive.”

 
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