Unless
adult TB is stopped, children will continue to contract the scourge
Will improving efficiency and efficacy of
tuberculosis control programs within health care facilities help the world meet
2015 targets set by the Millennium Development Goals, the Global Plan to Stop
TB, and the country programs, or is a paradigm shift necessary in the basic
principles of TB control?
To some extent, tuberculosis is a hidden
disease, thought in the west. to be well on its way to eradication. However, as
many as 2 billion people – almost a third of the world population -- are
estimated to be infected with the tuberculosis bacterium and are at risk of
developing the disease. One in every 10 to 20 of those people can be expected
to become sick with active TB in his or her lifetime. If not treated, each of
these persons with active TB can infect 10 to 15 people in their lifetimes.
The disease is a leading killer of people
living with HIV, as they have much weakened immune systems. According to the
latest data, 8.8 million new cases of TB appeared in 2010, killing a staggering
1.4 million people. Many more struggle with the disease, which apart from
causing human suffering, slows economic growth. The annual economic loss is
estimated to be 0.52 percent of the world’s gross national income. Although
poverty driven, TB is present in all continents. It is said that “the situation
is serious in Europe, alarming in Africa and worrisome in parts of Asia.”
Experts have repeatedly emphasized that unless
adult TB comes under control, children will continue to contract the disease.
And unless the change the way TB control is done, adulthood TB is unlikely to
be controlled. The TB program is still very medical despite advocacy,
investment and the gold standard Patients' Charter for TB Care - which is sadly
not implemented to the extent it should have been by the countries.
According to the World Health Organization,
the Patients' Charter for Tuberculosis Care outlines the rights and
responsibilities of people with TB. It empowers people with the disease and
their communities through this knowledge. Initiated and developed by patients
from around the world, the Patients' Charter makes the relationship with
healthcare providers a mutually beneficial one.
"Pediatric TB is difficult to control,
because the infection spreads through the air borne route, and children get it
from adults,” said Somya Swaminathan, MD in Paediatric TB, and a scientist at
the National Institute for research in Tuberculosis of the Indian Council of
Medical Research “So the only way to prevent childhood TB is to tackle adult TB
more seriously. Contact to contact TB testing must be done.
Swaminathan recommends that all family members
of TB patients, especially children, be tested and started on drug regimens to
reduce the burden of pediatric TB. The general awareness level about TB is very
poor, even amongst educated people.
“They do not know how it spreads, how it can
be diagnosed and treated and what they can do to reduce the burden of TB. As it
is an air borne infection, anybody can get it. The most important risk factor
in children is malnutrition, as poor nutrition makes one more susceptible to
it,” the physician continued. “Other social or environmental causes could be
poor housing, overcrowded indoors, indoor air pollution, passive smoking, and
to a much smaller extent HIV infection also, as in India HIV prevalence is
fairly low.”
Dr Surya Kant, the president of Indian Chest
Society (North Zone) and Professor and Head, Department of Pulmonary Medicine,
King George's Medical College, now renamed CSM Medical University, said:
"Another important risk factor is that we have a large number of adult TB
infections that can potentially be transmitted to children. First and foremost
measure that can control childhood TB is to early diagnose and successfully
treat the adult TB. So all adult TB cases must be treated effectively and
priority should be given to those whose sputum is positive for AFB. If we can
intervene in early diagnosing and successfully treating adult TB then a
secondary outcome will be to effectively control childhood TB."
Surya Kant emphasized: "The more
effectively we cure adult TB more effectively we will prevent the childhood TB.
Studies show that children with TB usually don’t infect the adults -- rather
adults with TB infect children. It is only one way transmission of TB from
adults to children."
Unless people who are experiencing the disease
or have successfully completed treatment are engaged as equal partners, TB
control will continue to be dominated by the medical experts who are
undoubtedly doing a great contribution to TB control, but that's clearly not
enough. Engaging people who know the best can be the game changer.
People who have completed TB treatment are
best "community experts" to share the challenges they faced on daily
basis when on TB treatment. These are the challenges which are the potential
barriers for many people in benefiting from existing TB control services and
should be addressed by the program. The realities of their lives, on day-to-day
basis, that continues to put them and their family members at risk of
preventable infections such as TB, needs to be brought in, to increase the
impact of TB programs.
The challenges people face in getting a proper
confirmed TB diagnosis and tolerating the anti-TB treatment, must be recorded
and documented - without which the programme will continue to miss a very
important piece of the puzzle - and is unlikely to reach the zero mark by 2015
in terms of zero new TB infections and deaths.
As experts said if we can control adulthood
TB, childhood TB will automatically taper off. Implementing the Patients'
Charter, empowering communities, especially those who have completed TB
treatment, to get engaged as equal partners with dignity in TB control, and
ensuring the program addresses the needs felt by the people can help us reach
the unreached TB patients - adults and children both.
Bobby Ramakant
Asia Sentinel
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