 |
|
Untitled Document
|
|
|
| Queen Elizabeth Hospital |
|
Do you have young children living in your home?
 |
“I am coughing, I have TB”
“Do you have young children living in your home?”
“Bring them on Wednesday to the under 5’s clinic at the QECH Hospital”
“We can give medicine (mankhwala) to stop them getting ill from TB” |
| |
|
| Every adult who is diagnosed with smear positive (infectious) TB at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi is given this leaflet. Adults with TB are a particular risk to children living with them in small, poorly ventilated housing. If they are infected, then they are likely to develop active disease, and often in young children TB takes the form of widespread infection (miliary TB) or infects the meninges to cause TB meningitis. Both are difficult to spot, and can be fatal more quickly than TB of the lungs. |
| |
|
| In Malawi children who are diagnosed with TB are of course treated, but they are not actively sought out. And sometimes by the time they come to the hospital it is too late to prevent permanent damage or even death. But Dr Steve Graham of QECH is determined to find a way to save the lives of as many children as possible. So with a small grant from TB Alert, he is doing a study which will help him prove exactly which children are most at risk, and protect or cure them. |
| |
|
| Steve has already worked out that children under 5 are most at risk (probably because they are still held close by a carer). Also, they are much more likely to be infected if the TB contact is female (a mother or sister) than male. And someone who is smear positive level 2+ (this is a measure of the amount of bacteria in the sputum – the higher the number the more infectious) will be a greater risk to children. |
|
| |
|
Childhood TB in children can be difficult and expensive to diagnose because it needs x-rays, tests and laboratory diagnosis and an expert to assess all the information and recognise the symptoms – and this is just not feasible in resource-poor countries like Malawi. Steve wants to show that despite this, there is a simple (and cheap) solution:
- Assess the children at most risk (child under 5 living with a female contact with smear positive 2+ TB). For those children:
- If the child is “well” put them on treatment to prevent TB
- If the child is “sick” put them on TB treatment. If they do not show weight gain (see the chart below for the very clear weight loss and gain that is indicative of TB before and after treatment) and general improvement in a few weeks consider another diagnosis.
|
| |
|
 |
Currently the national programme can’t afford TB contact tracing for every child and as a result it generally doesn’t happen at all. TB Alert is delighted to be supporting Steve in his study, which could show that by targeting limited money at those children most at risk, and by using a simple strategy as described above, a small budget could provide 80% of the benefit and it could be done by nurses and health workers all over the country, in health centres which may not have doctors or laboratory facilities. |
|
|
|
|
