We need people – people like those in TB Alert, who are focused and ambitious and care for people at grass roots in the UK, India and Africa. Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership
TB in children is commonly neglected. It is difficult to diagnose, so the scale of the problem is often underestimated. Children are also less likely to pose an infection risk to others: where resources are scarce childhood TB is simply not the priority.
Yet the impact of TB in children is devastating: 500,000 children become ill with TB annually – and 70,000 die. Children are also more likely to be left severely disabled by TB, as they are more vulnerable to complex forms of the disease such as TB meningitis. TB impacts on the youngest and weakest children. Children living with HIV are particularly at risk, as are children suffering from malnutrition, common childhood infections and intestinal worms.
Children are most likely to be infected with TB by
their parents and other close relatives. If a child is simply fed, or cuddled,
by an adult with infectious TB they are at increased risk from TB. Large family
sizes leading to overcrowded living conditions – which are common in the
developing world and in some high-risk communities in the UK – increase a
child’s infection risk.
The impact of TB on children extends beyond the impact simply on their health. If a breadwinner becomes ill with TB, this can drive a family into ever deeper poverty. Children who become ill with TB, or who are required to earn money or look after a sick relative, miss out on schooling and therefore their route to escape poverty. WHO estimates that 10 million children have been orphaned as a result of the deaths of their parents from TB. Children who lose one or more parents are more likely to live in poverty and die young themselves.
The tools to prevent, diagnose and treat childhood TB are simply not fit for purpose. Though this is true also for adult TB, there are specific issues with the tools available to address TB in children:
BCG vaccination: this is not 100% effective or widely available, though it does limit some of the severe forms of tuberculosis which are unique to young children. The BCG is unsuitable for children living with HIV.
Diagnosis: sputum testing remains the most common form of TB diagnosis. Children are less likely to have a productive cough, or to be able to provide a sample. Even if they do, their samples are less likely to contain visible TB bacteria – even when the bacteria are present in their bodies.