World Tuberculosis Day: Childhood TB remains a major challenge

Infograph: TBS

The number of deaths from tuberculosis in the country has dropped by half in the last decade as its treatment and medication – which cures 95% patients – is free here. However, diagnosing and treating children with the disease is still challenging here due to lack of testing facilities and parents' awareness, said experts. 

The WHO estimates 11% of all detected tuberculosis patients are children, but Bangladesh could only report 4.2%, which indicates lack of diagnosis and reporting. Over 20,000 children with tuberculosis still remain undiagnosed and untreated in the country.

In 2020, an estimated 33,000 children under 15 years of age fell ill with tuberculosis and around 5,500 children lost their lives from this preventable and curable disease in Bangladesh.

Experts said the country has achieved significant improvement in child health, but tuberculosis remains a major cause of morbidity and mortality for them. To eliminate tuberculosis by 2035, focusing on children with the disease is very important.

There is no accurate data regarding the spread of the disease, but Dr Kamruzzaman, coordinator of Asthma and TB Centre at Bangladesh Shishu Hospital, told The Business Standard that the number of children suffering from tuberculosis is increasing day by day in the country.

Every year, 100-150 tuberculosis patients are diagnosed in the Asthma and Tuberculosis Centre, said sources.

Dr Kamruzzaman, an assistant professor of respiratory medicine at Bangladesh Shishu Hospital, "If tuberculosis was not detected early, the patient later develops pneumonia, loses weight and suffers from malnutrition. Most children die if they develop central nervous system tuberculosis (CNS-TB) or brain tuberculosis."

Reasons for delay in diagnosing childhood TB

According to the latest The National Guidelines for the Management of Tuberculosis in Children, diagnosing child tuberculosis is difficult as symptoms are often non-specific in young children.

Moreover, childhood tuberculosis is paucibacillary, which means it shows no evidence of more advanced disease on biopsy and a microbiological diagnosis is often not possible. Another reason is that obtaining sputum – a mixture of saliva and mucus – from children for bacteriological confirmation is difficult.

The Mantoux Test or Tuberculin Skin Test (TST) is often negative in malnourished children or in severe cases. Besides, X-rays are often nonspecific and prone to various interpretations, according to the guideline.

Doctors said lung tuberculosis is more common in adults, while extrapulmonary tuberculosis is more common in children.

He said symptoms of tuberculosis in children appear late. If a child has fever and cough, his or her parents buy antibiotics over the counter which alleviates the problems for a few days but they get sick again soon as the disease goes undiagnosed. Besides, there is a myth in society that children do not contract tuberculosis.

Dr Kamruzzaman said, "Family members or guardians often do not want to believe that their children have contracted tuberculosis. Even after diagnosing the disease, they do not want to provide children with required medication.

"Besides, when a child's health improves within a few months of starting treatment, his or her parents stop the treatment, thinking that they have recovered. In many cases they do not even care to follow up the child's physical condition, which is a challenge for curing the disease."

He said, "Even diagnosis of pulmonary tuberculosis is often delayed in children, because children cannot speak about their ailment properly. Babies often swallow phlegm instead of spitting it out, so one cannot see if there is anything wrong with it.

"In such cases, stomach juice is extracted for diagnosing tuberculosis, but that facility is not available in district and upazila hospitals. Parents should be more aware to prevent child tuberculosis."

Professor Dr Abul Bashar Mohammad Khurshid Alam, director general of the directorate general of health services (DGHS), said, "Under the DGHS, the national tuberculosis control programme has achieved notable success in controlling tuberculosis over the last decades. However, a lot is still to be done if we want to eliminate tuberculosis from Bangladesh by 2035, including improving the treatment system for childhood tuberculosis.

"Early diagnosis and proper treatment initiation for childhood tuberculosis are essential parts of the first pillar of End TB strategy, which should help prevent mortality and morbidity in children suffering from tuberculosis."

To raise awareness about the problem, the "World Tuberculosis Day" is being observed on 24 March with the theme "We can end TB!"

Symptoms of tuberculosis in children

If a child suffers from cough and fever or any one of these symptoms for more than two weeks, their guardians should suspect that he or she might have contracted tuberculosis.

Moreover, if a child's weight decreases continuously, and they suffer pneumonia which cannot be cured even after giving antibiotics, then he should be tested for tuberculosis, said doctors.

Dr Kamruzzaman said, "Children are more prone to tuberculosis because their immunity is low. Usually children are infected with tuberculosis if someone in the family is infected with it.

"Besides, many children get infected with tuberculosis due to dust. Sneezing and coughing also spread the disease. Drinking unboiled dairy milk also causes tuberculosis in children."