05:38am Monday 01 June 2020

A Call to Prioritize Children in the Global TB Response

This is a stark violation of their right to health as per Article 24 of the Convention on the Rights of the Child. Attention is focused primarily on adults with TB because they are symptomatic, readily diagnosed and considered potential transmitters of infection.

Children are particularly vulnerable to severe disease and death due to TB. It is estimated that at least one million children develop TB each year (1). This unacceptably high toll of disease and death among children is made worse by the HIV epidemic. TB manifestations are more severe and progression to death is faster among HIV-positive children, yet they are at risk of diagnostic error and inappropriate treatment.

Increased international travel and immigration have led to an increase in childhood TB rates in traditionally low burden, industrialised countries, and threaten to promote the emergence and spread of multidrug-resistant strains. Children with latent TB infection become a reservoir for future transmission when the disease reactivates in adulthood, fuelling future epidemics (2). We need to simultaneously address many risk factors for TB, especially HIV and AIDS and undernutrition (3) as well as addressing the social determinants of tuberculosis (4).

A child usually gets TB infection from being exposed to a sputum-positive adult–usually a parent. Because of their immature immune systems, young children under age ten are especially at risk of not only becoming infected but of developing active tuberculosis.

Children also suffer when their mothers have TB, often requiring them to leave school to care for their family or leaving them as orphans when their mother dies. Tuberculosis is the third highest cause of death among women of reproductive age (5) and therefore has a massive impact on the lives and health of children. Annually 700,000 women die of TB (6). Without rapid scale-up of TB programs, as many as four million women will die between 2011 and 2015, leaving millions of children orphaned.

World Vision’s Experience:

World Vision works with children, families, communities and donors all over the world to improve the well-being of children. World Vision’s global Child Health Now campaign calls on governments to meet their commitments and increase their efforts to improve child health in order to meet MDG 4 by 2015. Throughout its experience with TB over the past decade, World Vision has identified critical needs and gaps in the response to TB among children, including:

  • Children with TB are not detected: Diagnostic tests appropriate for children are not accessible.
  • Children with TB are not notified: Glaring gaps in epidemiological data.
  • Children with TB are not treated: Paediatric formulations and doses of drugs are not available, nor compatible for treatment with HIV.

World Vision’s Call on behalf of the “Silent Sufferers” of TB

  • Increase political commitment: Include a focus on childhood TB in global TB efforts, including the Global Plan to STOP TB, and ensure that 10% of global TB funding is designated to address TB in children.
  • Heed the call to Children’s Rights: Address TB in children as a basic human right.
  • Improve point-of-care diagnostics for TB in children by 2015.
  • Ensure paediatric formulations and doses of TB Preventive Therapy and anti-TB drugs compatible with antiretroviral drugs for HIV treatment are available by 2015.
1 Guidance for National Tuberculosis Programmes on the management of tuberculosis in children, Stop TB Partnership, View pdf.
2 Pediatric Tuberculosis: The Lancet Infectious Diseases
3 Malnutrition and Tuberculosis: Macallan DC
4 The Social Determinants of TB; From Evidence to Action: April 2011, Vol 101, No. 4 | American Journal of Public Health 654-662
5 Women’s Health Fact Sheet; WHO
6 WHO: Tuberculosis and Gender

Geraldine Ryerson-Cruz

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