Stepping up pediatric TB diagnosis

IRIN PlusNews | March 24, 2011

IRIN/Plus News interviewed Dr Lucy Mathu, a Senior Technical PMTCT adviser at the Foundation about the importance of strengthening the Kenyan government's community strategy – using community health workers to detect the signs of children who might have TB, and to quickly refer them to health centers for treatment.

Over the past few years the Kenyan government has significantly scaled up its diagnosis and treatment of tuberculosis with positive results, but officials say diagnosis of children lags behind.

Kenya ranks 13th out of the UN World Health Organization's (WHO) 22 high TB burden countries and has the fifth-highest in Africa. There are an estimated 12,000 TB-infected children younger than 14, representing 11 percent of all infections.

"It is extremely difficult to diagnose tuberculosis in children, unlike in adults, and the low knowledge among many health workers of the symptoms of the disease in children means many children die," said Joseph Sitienei, head of the National Leprosy and TB Control Programme. "Even among children where it is detected, it is done late, meaning they are enrolled late on treatment."

WHO recently said many cases of paediatric TB went undiagnosed or were diagnosed incorrectly, raising children's risk of TB meningitis, which has harmful long-term effects and high mortality.

Kenya's government has released guidelines to health workers on checking for symptoms of TB, especially among children born to HIV-positive mothers.

"It is the main reason the government has now embarked on training and sensitization of health workers on effective paediatric tuberculosis diagnosis," said Sitienei.

Julia Masiga, a 31-year-old HIV-positive mother of five, says she nearly lost a child because a health worker failed to spot TB.

"My child was coughing most of the time... she had fever also but when I went to the clinic, they said the child had pneumonia and they gave me drugs," she said. "I believed it because she had been vaccinated [against TB] when I gave birth to her. She was taking her medicine but this pneumonia they were telling me about was not going away."

Eventually her child fell so ill she had to be admitted to Mbagathi District Hospital in the Kenyan capital, Nairobi; it was there that Masiga was finally told her child had TB.

"Now she is taking her medicine and doing better; I am very happy that even though I thought she might have HIV, she doesn't," she said.

According to Sitienei, about 20 percent of TB-infected children are also HIV-positive. The low levels of paediatric HIV treatment - just 10 percent of HIV-positive children access antiretrovirals (ARV) - increase the risk of HIV-infected children contracting TB.

A 2009 study in western Kenya to ascertain the clinical burden of tuberculosis among HIV-positive children found that the use of combination ARVs reduced the probability of an HIV-infected child being diagnosed with TB by 85 percent.

Fast Fact
There are an estimated 12,000 TB-infected children younger than 14, representing 11 percent of all infections
Community works

Dr Lucy Mathu, a senior technical prevention of mother-to-child HIV transmission adviser at the Elizabeth Glaser Pediatric AIDS Foundation, says the problem of TB treatment in children is compounded by the emphasis by health workers on infectious tuberculosis, which is rarely manifest in children.

"When it comes to children, health workers tend to ignore the need to diagnose tuberculosis and concentrate on other diseases like malaria," she said. "They seem to be more preoccupied with symptoms of transmissible tuberculosis like coughing, which are rarely manifested in children."

She noted that there was a need to strengthen the government's community strategy to ensure that children who might be TB infected were not missed.

The government is working with EGPAF and US government-supported AIDS, Population and Health Integrated Assistance II (APHIA II) community workers to ensure children and adults who might show symptoms of tuberculosis access health facilities.

"Using the community strategy like the employment and use of community cough monitors can greatly help in ensuring that children who might be TB-infected and who might be missed are linked to health facilities," said Mathu.

More than 80 percent of all Kenyan newborns receive the BCG vaccine, but according to Sitienei, this is insufficient to fully protect against TB.

"Our BCG vaccination coverage is very impressive but it is important to note that BCG is never fully protective against tuberculosis infection; that is why children born to TB-infected mothers are put on treatment for nine months to protect them," he said. "That is another reason it is important to sensitize mothers to the importance of delivering in health facilities as opposed to at home."