Where is TB in maternal & child health? September 7-9, 2016

Wednesday – September 7: Maternal and child health and tuberculosis – what brings us together?

Welcome to day one of our seminar ‘Where is TB in MNCH?’, we look forward to engaging with all of you over the course of the next three days.

From the perspective of the TB community the problem and its solution is clear: we need to better link with services providing care for women and children. TB should be an integral part of the services provided at community and primary care level. This will lead to increased case finding, prevention and improve adherence and outcomes.

But is TB perceived as a ‘problem’ that needs attention by those responsible for maternal and child health (including nutrition and HIV) and primary care? Where does TB ‘sit’ in the current priorities of the ‘Ending preventable maternal and child deaths’ agenda, where child health and the ‘traditional’ key diseases are only one priority besides newborn and adolescent health, NCDs, etc.

Are the existing data on TB burden and the linkages between TB with diseases affecting child survival convincing?

By the end of today we would like to clarify and understand the perception of the MNCH community about TB – is it viewed as relevant and important by the MNCH community; why do we as TB and MNCH communities need to address TB jointly and how can we strengthen our interaction and impact?

Let’s get started

We, Rudi and Anne, are here to facilitate – the floor is open to all of you and it is your thoughts, experience and guidance that we are seeking. If you feel more comfortable writing in your own language please go ahead and we will translate. Below you will find two questions. Click on either of them to respond and you will automatically be guided to the discussion forum.

We would also like to introduce and welcome three discussants who agreed to respond and further stimulate our discussion by providing a perspective from MNCH: Karen Waltensperger, Jon Rohde and Luis Tam.

Check in anytime during the day to see what others think, where the discussion is going.

Best, Rudi and Anne

Day 1 Discussion Questions

D1Q1: Is childhood TB viewed as relevant and important by the MNCH community?

Why is childhood TB neglected in the MNCH space? We would like to start by understanding the ongoing neglect of childhood TB as a disease affecting child health and survival and thinking about ways to change that before moving much more into aspects of service delivery and health system requirements in the
coming days. Share your thoughts!

D1Q2: How do we make an appealing case for childhood TB?

How can we ensure that children affected by TB get the attention and care they deserve? What can we as TB and MNCH community do, at the global, regional, country level? How can we increase leadership and high level commitment, to take action and mobilize much needed resources? What are the arguments that will convince decision makers? What are the data/evidence needed?

Day 1 Resources

Here are a few suggested readings and links that you might want to scroll through.

Day 1 Summary

Thank you to everyone who participated in day one of our seminar! We had an active day of discussion, with over 120 participants from across the globe. Today’s discussion centered on the role of the MNCH community in the fight against childhood TB. We tried to understand whether TB is seen as relevant by MNCH stakeholders and how we can better make a case for childhood TB in the context of child health and survival.

Question one asked, “ Is childhood TB viewed as relevant and important by the MNCH community?” and over 10 participants responded, sparking a lively conversation that looked at the causes and (potentially devastating) effects of the lack of awareness around childhood TB in the MNCH community. Many people had stories of missed opportunities and failures of the care system to share.

  • Discussant Karen Z. Waltensperger admitted that despite multiple decades working in the MNCH field, she was only now becoming aware of the critical challenge of TB in children. She asked why community and health leaders don’t raise the issue of childhood TB as a local health challenge even though many of them must have experienced TB in their communities.
  • Luis Tam shared a story that highlighted the lack of awareness and attention to childhood TB in a clinical setting, that multiple participants agreed is an issue that continues in the current day.
  • Andrew Etsetowaghan and Ochuko Urhioke both noted a lack of clinical training and execution in childhood TB treatment in Nigeria.
  • MULINDWA Venuste of Rwanda spoke about successes by creating awareness with community health workers (CHWs) to ensure that all family members in a TB-affected household receive treatment, especially children under five.
  • Similarly, Zewdu Gashu from Ethiopia highlighted recent progress following the development of a national roadmap for childhood TB, better collaboration at the ministry level leading to the adaptation of IMCI tools to include TB risk assessment.

Question two focused on raising awareness for childhood TB: “How do we make an appealing case for childhood TB?”

  • Many participants commented that data is an important tool for making governments aware of and receptive to the severity of health issues. Jon Rohde cited the tactic used by UNICEF Executive Director Jim Grant, in which he would ask a President (or Prime Minister), “Mr president, do you realise that some 2,800 kids die in your country EVERY DAY for lack of ORS? and 760 from lack of measles vaccine? …..”.
  • Luis Tam stressed the importance of building TB-MNCH coalitions to bring awareness to the issue and divert resources that would otherwise be absent in the fight against childhood TB.
  • Felicia Mairiga pointed to an initiative led by the Nigerian Minister of health to revamp the Primary Health Care system in Nigeria. He was also part of the National TB conference themed “The hidden face of TB: challenges in identification and management among vulnerable groups in Nigeria” that held in May 2016.This indicates the importance of political will in pushing an agenda such as childhood TB

We seem to agree childhood TB indeed is an issue in the context of MNCH, and many ideas and suggestion already came up on where to link with primary care and what kind of interventions might be key. This brings us straight to day 2.

The topic of day 2 is ‘Making TB part of the package’. Please check out the ‘Day 2’ Tab on the home screen of the seminar where we introduce the topic as well as a graphic that should stimulate our thinking.

Thanks to all of you for your great contributions, we look forward to continuing on day 2.

P.S. Feel free to invite colleagues to join the seminar for day 2 and 3. Please direct them to the seminar homepage to register.