JOIN USNot only does India have the largest burden of tuberculosis in the world, we also have the largest burden of paediatric TB. A total of 27% of all childhood TB cases among 22 countries with the highest burden of TB are from India.
A large number of active TB cases in children go undetected every year, which means that the prevalence of TB amongst our children is a lot higher than estimated. India has committed itself to the ambitious universal goal of zero TB deaths, which includes ending mortality and suffering due to TB in children. While this will no doubt be a challenging feat, through a collaborative, multi-stakeholder approach, we can overcome barriers in the prevention and man-agement of childhood TB, thereby improving child survival.
As per a WHO report on Childhood TB, progression from M tuberculosis infection to disease is quite rampant in children, with most children developing TB disease within a year of getting infected. The most common type of TB in children is pulmonary TB that attacks the lungs. Young age and immunodeficiency caused by HIV infection, measles or malnutrition puts children at risk of getting the disease. The global report is indicative of the childhood TB scenario in India.
The magnitude of paediatric TB is large and the challenges in addressing it are highly complex. India has the largest number of childhood tuberculosis ca-ses among 22 countries with the highest burden of the disease.
Perhaps the biggest challenge is the gap in case detection and reporting. A large number of active TB cases in children go missing every year because the symp-toms resemble those of other childhood diseases leading to inaccurate and missed diagnosis.
Undiagnosed children further spread the infection to others. Many pregnant women who have active TB during pregnancy can infect the foetus causing congenital tuberculosis, wherein the babies are born with TB. A lack of accurate TB diagnostic tests specifically for newborn babies and children further amplifies this problem.
Unsanitary environments
More than 3,00,000 children in India drop out of school every year because of TB. In most cases, parents affected by TB pass the infection to children and sometimes children contract infection due to the crowded and unsanitary environments they live in. Children with TB usually have to leave school due to the stigma associated with the disease and also because of the treatment regime that they need to undergo. This leads to dropping out of school, missing out on critical educational milestones and, thereby, going to work at an early age.
Some of the other major challenges in the fight against childhood TB include socio-economic disparities; lack of awareness amongst children, their families and communities; inadequate reporting of cases to national pr-ogrammes; lack of access to qua-lity treatment facilities; funding gaps; malnutrition; insufficient clinical research for paediatric TB drugs; stigma and HIV TB co-infection cases and drug resi-stant TB cases that are much harder to treat and have a higher mortality rate, amongst others.
Under the national immunisation programme, every child is given the Bacillus Calmette–Guérin (BCG) vaccine at birth against tuberculosis. In India, 9 out of 10 children receive the vaccine, but many children still contract TB. In April 2015, recognising that TB is an epidemic that needs urgent control, the Ministry of Health and Family Welfare launched the Call To Action for a TB Free India, an advocacy programme that calls for increased participation of all stakeholders to control TB, including childhood TB.
The Revised National Tuberculosis Control Programme (RNTCP) is the state-run tuberculosis control initiative of the Government of India that includes guidelines specifically for the diagnosis and treatment of paediatric TB. But gaps between policy formulation and implementation still remain and need to be addressed. Paediatric TB management has to be given more impetus in the overall child survival framework. As human beings and as conscious citizens of society, it is our responsibility to ensure our children have the resources and opportunities to succeed, but before that, it is even more important to ensure they are healthy and disease-free.
(The writer is neonatologist and Chairman, Cloudnine Hospital, Bengaluru)