Rise In TB Infection Rate  In Children, Adolescents

Last Tuesday, March 29, 2022, the Federal Government  declared a State of Emergency on Childhood Tuberculosis. This was disclosed in Abuja by the Coordinator, National Tuberculosis, Buruli Ulcer and Leprosy Control Programme (NTBLCP), Dr Chukwuma Anyaike, at the bi-weekly meeting of the Federal Ministry of Health (FMOH) on COVID-19 and other infectious diseases in the country.
The declaration of emergency may be sequel to the fact that about six percent of all forms of notified TB cases in 2021 were Children less than 15 years. The effects of TB on children in terms of morbidity and mortality are more than that of adults and the ugly development may not be unconnected with the difference.
According to World Health Organisation (WHO) reports “Nigeria has recorded a 50 percent inacrease in Tuberculosis (TB) notification from 138, 591 TB cases in 2020 to 207,785 TB cases in 2021.
The world body also stated that “Tuberculosis in children is usually primary, paucibacillary, characterised by difficulties in diagnosis of both drug susceptible and resistant TB. This is associated with poor uptake of preventive therapy for those with latent infection, contacts and people living with HIV and AIDS (PLWHA) in most developing countries like Nigeria”.
However, the NTBLCP coordinator said that these disturbing statistics calls for a change in narrative of the country’s child TB scourge, stressing that, there is need for concerted response from stakeholders.
He noted that the management of TB in children was characterised by difficulties due to both peculiarities of children and the disease.
“With detailed clinical assessment and examination of necessary specimen, in addition to strict adherence to the guideline of the national TB control programme, more cases of TB in children can be prevented, diagnosed, treated and reported”, he said.
Chukwuma said “we now have a National Steering Committee for Childhood TB, which will now be the central advisory body of the programme. It consists of representatives  from donor partners in the programme and includes vast expertise in TB research, academia and staff of NTBLCP”.
He also noted that the capabilities of pediatricians and medical officers were being built in the country to improve early diagnosis and prompt treatment of childhood TB.
“We are improving clinical diagnosis by introducing digital chest X-Ray machines  with Artificial Intelligence  (AI). The Global Fund is supporting this with USAID. The drug formula for children has improved,” he said.
Chukwuma said that the programme was also collaborating with the National Primary Health Care Development Agency to improve on BCG immunisation to primarily  protect children from TB, Leprosy and even Buruli Ulcer.
The Director-General Nigeria Centre for Disease Control  (NCDC), Dr. Ifedayo Adetifa said the agency was working to strengthen sub-national disease surveillance systems in the country.
He noted that outbreak detection needed a system to succesfully identify an epidemic at the earliest possible stage through complete and timely reported data.
Adetifa said that “the agency’s  priorities remained testing, testing and testing.
“Currently, we have increased Rapid Diagnosis Test (RDT) due to an ongoing surge testing project in Ekiti, Sokoto, Kebbi, Abia, Kwara, Akwa Ibom, Edo and Ondo States,” he added.
Here in Rivers State, the statistics shows that as at 2019, there were 202 Childhood (0-18years) cases seen over a four-year study period.
According to the report by Balafama Alex – Hart, Nsirimobu Paul and Ugwu Rosemary  of University  of Port Harcourt Teaching Hospital, Nigeria, published in Journal of  Tuberculosis Research stated  out of the cases, 109 (53.96%) were males and 93 (46.04%) females. Majority of them were 1-4 years of age. There were 194 (96.04%) new cases, 6 (2.9%) transfer and 2 (0.99%) retreatment cases. One hundred and six had pulmonary TB, 23 had TB adenitis, 10 had TB spine, 3 had TB abdoma and 3 had TB meningitis. TB/HIV co infection rate was 48.45%. One hundred and eight completed treatment, 10 were cured, 22 died, 46 defaulted and 16 were transfered out.
In their conclusion, pulmonary TB was the commonest type of TB found and treatment success rate was just above average.
Tuberculosis  is a leading cause of death in young children and the risk of progression from infection to disease is higher in very young ones, especially  among those with Human Immuodeficiency Virus (HIV) infection.
Infants become infected when they are exposed to Mycobacterium tuberculosis when exposed in several ways. According to Brenda Tesini, MD, University  of Rochester School of Medicine and Dentistry in 2020 said that before birth, infection occurs if the bacteria cross the placenta and infect the fetus. During birth,  infection occurs if the newborn breaths in or ingests  infected fluid from the birth canal. After birth, infection occurs if the newborn inhaled infected droplets that have been coughed or sneezed into the air by family members or nursery personnel.
About 50% of children born to mothers  who have an active tuberculosis infection in their lungs develop the infection during the first year of life unless preventive  antibiotics  or a vaccine called  Bacille Calmette- Guerin  (BCG) is given.
Symptoms of TB in newborns include looking ill with fever, reduced energy, difficult breathing or difficult to treat pneumonia. Also, they may have a delay in weight gain or physical growth (failure of thrive). This is because tuberculosis usually affects multiple  organs and newborns  may also have enlarged liver and spleen.
TB in children can be inactive with no symptoms.When the body no longer keeps the TB bacteria under control, then the child becomes unwell with fever,tiredness, sweating at night time,weight loss,coughing, chest pain and chills. In most cases TB affects the lungs, but it can also affect the lymph glands, brain, kidneys or spine. it is most common for children to have TB that affects multiple parts of the body than it is for adults, and TB is likely to be more serious in children according to reports.
TB can be succesfully treated by taking a full course of antibiotics. A child with TB disease may need to take antibiotics for six months or longer. Sometimes antibiotics used to treat TB can cause side effects but these are less common in children than in adults.
Children with TB rarely  die when they receive standard treatment for the disease but 90 percent of children who die from TB worldwide go untreated. Health systems often neglect children with TB because children are less contagious than adults and stopping the spread of TB is priority.

By: Ibinabo Ogolo