Childhood TB and the ‘ending preventable deaths’ agenda

The why doesn’t seem to be the issue. Anyone who has worked in the field and managed sick children knows that tuberculosis (TB) is a probable cause of disease in children presenting with signs of common childhood illness (cough, fever, malnutrition) and agrees that TB indeed affects maternal and child health.

The why was also not questioned by any of the 151 participants of a recent LeaderNet seminar on ‘Where is TB in Maternal and Child Health?’ or 80 global stakeholders participating in ‘Strengthening community and primary care systems for TB – a consultation on childhood TB integration’.

Yet, over 60% of the estimated 1 million children that fall ill with TB are never diagnosed. Field practices are not aligned to ensure TB becomes an integral part of maternal and child health services, especially in high TB burden settings. There are misconceptions, a lack of clear guidance and tools for service providers, and the underlying problem of responsibility and reach; TB managed through a vertical disease control program, operating with disease specific funding and with limited reach to a level of care and services where children access care: the primary level. On the other side, maternal and child health programs covering a range of services with a broader reach especially at primary care level, hesitant to take on additional responsibilities especially in a more uncertain funding environment.

Integration is a means to improve prevention, case detection and outcomes for childhood TB, but it will also have an impact on broader child health outcomes by improving quality of care. SIMPLE interventions followed by CLEAR ACTIONS with good DOCUMENTATION can improve risk assessment and referral of sick children for diagnosis and management. Existing community systems are ideally placed to take on the screening of TB affected households to ensure children access prevention and diagnosis.
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What is in the interest of all of us, whether we come from the TB or the MNCH world: we need not only effective but efficient interventions for child health that are sustainable and scalable.

What we need are strong coalitions between TB and MNCH, with leaders and champions from both constituencies advocating for the cause, for switching our thinking and approaches from the disease standpoint to the perspective of the child at risk, the sick child.

To increase awareness, resource mobilization, and to inform programming we need data. Data on the burden of childhood TB and its effect on child health outcomes at global as well as at country level. Data on the cost of not preventing and treating childhood TB. We need stories on the social and emotional impact TB has on children, their families, their communities who are all too often already struggling, marginalized and disadvantaged.

Activities like the LeaderNet seminars help to increase visibility of the issue and engage a larger pool of stakeholders who can carry on the discussion in their settings, with their constituencies.

To read more visit the homepage of the LeaderNet Seminar on ‘Where is TB in Maternal and Child Health’ with a summary of the discussions or read the report from UNICEF’s consultation on ‘Strengthening community and primary health systems for TB’. Systems thinking to integrate childhood TB into broader health systems was applied in two recent UNICEF country case studies in Malawi and Uganda.

How can MNCH and TB programs improve the detection and case management of childhood TB? -Conclusions from the Seminar

  • Increase awareness and knowledge of TB among health providers at all levels as well as in communities
  • Estimate from local data the numbers of children exposed and likely child TB cases; share these numbers and gaps in case detection with providers at all levels
  • Institute SIMPLE measures to start finding childhood TB cases
  • Follow up all new adult cases at home to identify likely contacts
  • Place all child contacts
  • Suspect all children with poor weight gain, fever or cough of TB and refer
  • Record and report TB cases found and treated and give credit to NTP and MNCH programs for dealing with this important problem

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