The Desmond Tutu TB Centre Supports Global Plan To Reduce Childhood TB Deaths


South African researchers have thrown their weight behind the first ever global action plan specifically targeted for children with tuberculosis (TB), in the hope of bringing down the country’s extremely high childhood TB rate.

About 45,000 children in South Africa get TB every year, while many more go undiagnosed or are not reported, says Professor Anneke Hesseling, director of the Paediatric TB Research Programme at the Desmond Tutu TB Centre (DTTC) at Stellenbosch University.

Hesseling believes up to 60% of TB cases in children could be prevented if symptoms were detected early and children in contact with an adult with infectious TB could be given TB preventative therapy.

She says it’s particularly important to get the message out about high TB risk in pregnant mothers and those with babies, and in young children. The prognosis for babies and young children can be far more serious than for many adults, as children are more prone to severe forms of TB, such as TB meningitis. A high index of suspicion for TB is therefore required in countries like South Africa where there is a high risk of TB exposure early in life.
The Desmond Tutu TB Centre has been closely involved in helping to draft the “Roadmap for Childhood TB: Towards Zero Deaths” – a plan announced by the World Health Organisation which outlines steps to end childhood TB deaths. Every day 200 children around the world die needlessly of TB, a disease which is both preventable and curable.

“The TB burden among children in South Africa is huge. We need to strengthen the health care system and use more practical measures to prevent TB. There needs to be a lot more cross-cutting implementation of TB control across programmes, as we’re not picking up and preventing the cases,” says Hesseling.
She suggests that tuberculosis prevention and treatment needs to be incorporated into relevant child and maternal health care programmes in South Africaincluding the Expanded Programme on Immunization (EPI), the Integrated Management of Childhood Illness (IMCI) , which adopts an integrated approach to health focusing on the well-being of the whole child, and the prevention of HIV transmission (PMTCT) programmes, to prevent babies and children at risk of TB from falling through the cracks.
Hesseling says more children would receive TB care if nurses and clinic staff were trained to be acutely aware to look out for symptoms of TB even if children come to the clinic with other ailments or are accompanying their mothers. They should also receive TB preventive therapy if a close contact is diagnosed with TB.
“Every time a mother and child visits a clinic or a health care centre, it’s a good opportunity for TB control. The nurse should look out for and ask the mother or child about any possible symptoms for TB, such as a persistent cough or weight loss. They should also enquire about anyone in the household on TB treatment or who may have suggestive symptoms like a cough.

Hesseling says people in communities could also play a vital role in helping to detect children who may have TB.
“We need all levels – from family members and people in the community to nurses and doctors in primary health care clinics and hospitals to be involved.”

Hesseling believes recording and reporting of TB cases is also crucial. TB cases don’t always end up in national registers as information is not always conveyed between surveillance systems by health care providers.
“The number of childhood TB cases globally is under-reported, including in most developing countries like South Africa. If we can link data from hospitals to community clinics and ensure that every child with TB is recorded and reported, this will help greatly to get an idea of the TB burden and the severity of disease.
“TB in young children is a reflection of recent TB transmission and an indication of how well control programmes are doing ,” says Hesseling.
In a country like South Africa which has the highest number of TB-HIV associated cases in the world, an integrated approach is also key. Many children who have TB are HIV positive and HIV care is an opporunity for TB prevention. Hesseling says the likelihood of contracting TB is five times higher if a child is HIV-positive.

“Babies who start Antiretroviral Therapy (ART) early, are less likely to die fromTB, as TB and HIV are so closely linked. It’s important to use our resources well and to integrate our TB, HIV and maternal and child health care programmes to get more impact.”
Hesseling has also called on the government to invest more resources in operational research on TB in children, as this could make a big difference in showing which practical strategies are needed to sustainably prevent and treat TB in children in South Africa.

Archbishop Emeritus Desmond Tutu has fully supported the drive to end childhood TB deaths in South Africa and globally.
He has called for an increase in funding to fight TB and for a drive to raise awareness in communities where there is a high likelihood of children contracting TB.

Tutu, who is the patron of the Desmond Tutu TB Centre, had TB when he was 14 and spent 18 months in hospital receiving treatment. He has consistently backed the Centre’s work in helping to prevent and treat TB.

In a recent blog for the Huffington Post following the launch of the ‘Roadmap to End Childhood TB’ he said greater commitment to tackling TB was vital.

“It is a sad statement that childhood TB still kills as many children as it does. But it is an eminently solvable problem. All the world needs is a more aggressive approach to end the disease. This would make this TB survivor – and millions like me – very happy.”

The Desmond Tutu TB Centre is also committed to working with people in other countries to reduce the burden of childhood TB and increase global awareness. Last week the Centre led its 7th international childhood TB course in Goudini near Worcester in the Western Cape, which attracted 50 participants from 22 countries.

A clean bill of health: Nobuntu Mahlatshana and her daughter, Siyamthanda, after a check-up at Tygerberg Children's Hospital. Siyamthanda has fully recovered after being treated for Multidrug-Resistant TB (MDR-TB) (pic by Kim Cloete)

A clean bill of health: Nobuntu Mahlatshana and her daughter, Siyamthanda, after a check-up at Tygerberg Children’s Hospital. Siyamthanda has fully recovered after being treated for Multidrug-Resistant TB (MDR-TB) (pic by Kim Cloete)