“When my daughter got sick, I took her to a clinic in my neighborhood. They gave her cough syrup for seven days. I thought she was getting better, but it was apparent that she was still ill. After another examination, they referred her to St. Paul Hospital in Addis Ababa where they put her on oxygen and started taking blood sample after sample and injection after injection for a month. Her condition did not get better so they gave her another medicine. The doctors then decided to take blood from her back…only then did they know it was tuberculosis.” — Atsede Tefera and her daughter Nigist, photographed above.
By Rudolph (Rudi) Thétard and Catherine (Keri) Lijinsky
Tuberculosis (TB) kills more people each year than any other infectious disease, causing over 1.5 million deaths globally in 2014 alone. More than a quarter of cases are in Africa, the region with the highest burden of TB disease relative to population. Children are among the most vulnerable, and all too often children with TB remain in the shadows, undiagnosed, uncounted, and untreated. Today, more than 53 million children worldwide are infected with TB and more than 400 die each day from this preventable and curable disease.
The serious, yet historically neglected, global childhood TB epidemic is preventable through prompt diagnosis and treatment and by reducing risks related to co-morbidities, such as malnutrition, that can make tuberculosis even more lethal to children.
TB is an airborne disease, which is passed between people with active symptoms by coughing or sneezing. TB often spreads in communities where people are living in close proximity to each other, putting those living in poor socio-economic conditions particularly at risk.
In recent years, progress has been made to combat childhood TB. The emergence of policies and guidelines across the Africa region that incorporate childhood TB, coupled with innovative treatment and child-friendly medicine, have moved us closer to tackling one of the oldest and most persistent diseases in the world. However, a new analysis released on World Tuberculosis Day 2016, shows that in African countries, a persistent divide between policy and practice threatens to impede progress gained for addressing childhood TB across the region. The analysis, a collaboration between the U.S. Agency for International Development (USAID) and its African Strategies for Health (ASH) project, presents the landscape of childhood TB programming in 12 countries in Africa, and suggests three focus areas critical for moving the dial on this intractable issue:
- Strengthen the capacity of health workers to identify and diagnose children infected with TB. For children experiencing symptoms, the first contact with the health sector at a primary health care or maternal and child health clinic is an important opportunity to identify TB symptoms early and refer for treatment. Symptoms, such as a persistent cough, loss of appetite, and high fevers, must be recognized by all providers as possible signs of TB. Health workers at all levels of the health system must be empowered to take appropriate action, such as referral for treatment and follow-up.
- Implement active case finding strategies for early identification of child TB. Delays in diagnosing TB and initiating appropriate treatment are often long, particularly where access to health care is poor. Systematically identifying children who have come into contact with a person with active TB, as well screening children with HIV and those who are malnourished, are critical steps to identify sick children.
- Ensure adequate care closer to home. Health systems must be strengthened to guarantee a regular supply of diagnostic tools and child-friendly medicines at all levels where sick children may access care. Clear guidance on the optimal interaction and links between service delivery platforms, including maternal and child health, HIV, and nutrition programs, is vital.
No child should die from TB, which is preventable and curable. We have the policies, guidelines, medicines, and health service delivery platforms needed to make this vision a reality. The time to apply these instruments – to end preventable child deaths due to TB – is now.
Join the conversation on World Tuberculosis Day by following #WorldTBDay, #UnitetoEndTB, and #LouderThanTB.
The ASH project, implemented by Management Sciences for Health (MSH), works in close collaboration with USAID, African governments, and partners to expand the body of knowledge around childhood TB. ASH provides technical leadership and engages stakeholders to build consensus around regional priorities for addressing childhood TB. Visit the ASH website to download the report and additional childhood TB resources: www.africanstrategies4health.org/resources/tuberculosis
- Report: The Policy and Practice Divide for Childhood Tuberculosis in Africa: A Landscape Analysis
- Technical Brief: Strengthening Guidelines for Childhood Tuberculosis to Accelerate Diagnosis and Treatment
- Video: Opportunities for Tackling Childhood Tuberculosis through Maternal and Child Health Platforms
The contents of this publication are the responsibility of the authors and do not necessarily reflect the views of USAID or the United States Government — or PLOS.
Rudolph (Rudi) Thétard, Project Director and Infectious Diseases Specialist
African Strategies for Health project, Management Sciences for Health
Rudi Thétard is a physician with more than 25 years of clinical and health management experience in Africa. He has worked as a clinician at community, district, and regional levels, and managed the delivery of primary health care services from a regional municipality in South Africa. He brings strong technical skills in the areas of child health, TB, HIV, malaria, and systems strengthening. Rudi is the Project Director for the African Strategies for Health (ASH) project, funded by USAID and implemented by Management Sciences for Health. Rudi oversees the project’s technical activities and leads the infectious diseases portfolio for ASH. Within the project, his areas of focus include collaboration with the Center for Disease Control and WHO’s Regional Office for Africa to expand integrated disease surveillance and response, strengthen programming of childhood TB, and address aspects of malaria treatment and control. Previously, Rudi was Chief of Party for the USAID BASICS program in Malawi.
Catherine (Keri) Lijinsky, HIV/AIDS and Tuberculosis Advisor
U.S. Agency for International Development (USAID), Bureau for Africa
Keri Lijinsky is the HIV/AIDS and Tuberculosis Advisor on the Health Team of the Office of Sustainable Development in the Bureau for Africa at the U.S. Agency for International Development (USAID). In that role, she gains an understanding and appreciation for the central functions of a decentralized donor agency in program planning, implementation and evaluation. She provides technical support and oversight on strategies, activities, and other areas related to USAID’s HIV/AIDS and TB programs in Africa. Prior to her fellowship, Keri worked with the Asian Development Bank in Manila. She has worked with the World Health Organization, and at the Global Fund. Keri earned her MPA at the London School of Economics and Political Science, and her BA in International Relations and French Studies from Smith College.
Also of interest
Published by PLOS Medicine in the last year:
- Translational Research for Tuberculosis Elimination: Priorities, Challenges, and Actions Christian Lienhardt, Knut Lönnroth, Dick Menzies, et al. Collection Review.
Exposure to Second-Hand Smoke and the Risk of Tuberculosis in Children and Adults: A Systematic Review and Meta-Analysis of 18 Observational Studies. Research article by Jayadeep Patra and colleagues
Transmission of Multidrug-Resistant and Drug-Susceptible Tuberculosis within Households: A Prospective Cohort Study. Research article by Louis Grandjean and colleagues
Achieving Systemic and Scalable Private Sector Engagement in Tuberculosis Care and Prevention in Asia. Policy Forum by William A. Wells and colleagues
Effectiveness of Electronic Reminders to Improve Medication Adherence in Tuberculosis Patients: A Cluster-Randomised Trial. Research article by Shiwen Jiang and colleagues
Moving Beyond Directly Observed Therapy for Tuberculosis. Perspective on above by:John Z. Metcalfe, Max R. O’Donnell, and David R. Bangsberg
Evolution of Extensively Drug-Resistant Tuberculosis over Four Decades: Whole Genome Sequencing and Dating Analysis of Mycobacterium tuberculosis Isolates from KwaZulu-Natal. Research article by Alexander S. Pym, Ashlee M. Ear and colleagues
Association between Regimen Composition and Treatment Response in Patients with Multidrug-Resistant Tuberculosis: A Prospective Cohort Study. Research article by J. Peter Cegielski and colleagues
Speaking of Medicine blog:
–Drug-resistant tuberculosis: Not just a precursor to the post-antibiotic apocalypse By Jay Achar of Médecins Sans Frontières
–Tackling tuberculosis: new models for an old disease By Lucy Bell of University College London
–Step up to Stop TB By Grania Bridgen of Médecins Sans Frontières
- From the Feb 10, 2016 PLOS Science Wednesday, redditscience ‘Ask Me Anything’ AMA: Claudia Denkinger (Harvard University), David Dowdy (Johns Hopkins School of Public Health) discussed: Do We Need to Detect Isoniazid Resistance in Addition to Rifampicin Resistance in Diagnostic Tests for Tuberculosis? 2/10 AMA archive. Read the PLOS ONE article.