TB-infected children dying in negligence

At least one in four children who get tuberculosis dies each year because health systems routinely neglect children with the disease, a new report by the International Union Against Tuberculosis says.

The report called systemic neglect of children with TB an “open secret” in global public health—because children are less contagious and standards tools for TB diagnosis work less well in children.

Up to a million children aged under 15 get TB every year—and some 239,000 of them die.

This massive toll of deaths among children results from systematic disregard for children’s rights to health, the union said in its report launched at the 71st World Health Assembly in Geneva.

This massive toll of deaths among children results from systematic disregard for children’s rights to health.

A chest lab donated to Kwali General Hospital, Abuja, to increase case findings of tuberculosis. But less than 10% of children eligible for treatment are actually placed on treatment.

Eligible, but no therapy

Across 10 countries with the highest burden of TB, less than half of children under age 5 eligible for preventive therapy are actually started on therapy.

Among 49,000 children eligible for preventive TB therapy in Nigeria, only 8,562 actually started treatment.

 “Children with TB rarely die when they receive standard treatment for the disease – of the 239,000 children who die from TB every year 90 percent were those left untreated,” said Dr. Paula Fujiwara, scientific director at The Union.

“This neglect can no longer be excused on grounds of economy or expediency. TB is preventable, treatable, curable. The continuing medical neglect of child TB, resulting in millions of avoidable deaths, constitutes a human rights violation by any reasonable measure.”

Nigeria ranks sixth among the top-10 high-TB-burden countries. India alone has 360,000 eligible for treatment, but only around 6,637 get it.

Gaps between numbers of children eligible for treatment and those getting are huge across the Democratic Republic of Congo, Indonesia, Phillipines, and Bangladesh.

The gaps narrow across Kenya and Uganda to Mozambique and Afghanistan.

The Union advocates local public health measures sensitive to social and cultural context to screen and diagnose children at risk.

“By following a simple process to screen, diagnose and treat children in households with adults suffering from TB, we have been able to make a tremendous impact in a short space of time,” said John Dongo, director of The Union’s Uganda office.

“In Uganda, where this intervention was implemented, diagnosis of Child TB cases more than doubled, with the proportion of child TB cases increasing from 7.4 percent at baseline to 17 percent, we have also achieved 82 percent success in treating children diagnosed with TB, up from 65 percent. Screening households where an adult is diagnosed with TB to see if children have been exposed in the home must become the standard implemented everywhere. Where The Union has piloted this approach in Uganda, 72 percent of at-risk children were able to receive preventive TB treatment, up from less than 5 percent previously.”

A high-level meeting of the United Nations this September on TB is expected to generate action where governments are held accountable for achieving targets to invest in research and care.

 “The public health sector cannot end the TB epidemic alone, because TB is driven by economic and demographic factors as much as it’s driven by health factors,” said José Castro, executive director of The Union.

“We are dealing with an airborne disease that is becoming increasingly resistant to the few antibiotics we have to treat it, and children are bearing some of the worst impacts. We simply cannot continue like this. Heads of State are the only leaders with the power and influence to mobilise resources to end the epidemic. They must act.”