Hope for pregnant women and babies with TB
Dr Adrie Bekker
Pregnant women, with and without HIV infection, and babies at risk of contracting tuberculosis (TB) are finally starting to get the attention they deserve.
The 46th Union World Conference on Lung Health, held in Cape Town, has outlined evidence and research needs for the better treatment of pregnant women and their babies, while work on integrating health services for pregnant women is beginning to take off.
"Babies under 12 months are the most vulnerable to TB. TB infection can progress very quickly to TB disease in babies if they are not treated. It's essential for us to focus more research on babies and pregnant women if we want to prevent deaths and bring down the TB rate in these vulnerable groups," said neonatologist, Dr Adrie Bekker, of the Desmond Tutu TB Centre (DTTC) at Stellenbosch University.
Bekker has called for a TB registry for pregnant women, so that crucial information on different studies and research can be collated. Evidence from such a global effort could be used to inform the safe and effective treatment of pregnant women. Bekker made her call to childhood TB specialists around the world.
TB among mothers is associated with a six-fold increase in perinatal deaths, and a two-fold increase of premature birth and low birth-weight. TB in pregnant HIV-infected women can also lead to a higher risk of HIV infection to the baby.
Globally, research on TB and pregnant women and babies has been neglected until recently. The Union meetings have heard that TB in pregnancy data is not routinely collected, while the safety of drugs to treat Multidrug-Resistant TB in pregnant women is largely unknown. Trials of new TB medications exclude pregnant women.
Dr Lindiwe Mvusi, director in the TB Control and Management cluster within the Department of Health, said the department was having some success in integrating TB services into maternal and child health programmes. However, she said there was still fragmentation, with pregnant women often going to three different clinic appointments if they were HIV positive and needed to be screened for TB.
"It is possible to integrate TB services into maternal and child health programmes. We are getting there, but it requires advocacy and commitment from all stakeholders," Mvusi told the conference.
Meanwhile, the recent announcement by TB Alliance of more child-friendly TB medicines has been widely welcomed. They are the first treatments to meet guidelines set by the World Health Organisation (WHO) to allow for higher doses of the "first-line" TB drugs to treat drug-susceptible TB in children, which is more than 90% of the TB burden in children. The affordable medication can be dissolved in water within seconds and is palatable, which is especially important for children.
The DTTC is one of several institutions that will be involved in a trial looking at the possibility of shortening the treatment of TB for children from six months to four months. Together with research institutions in India, Zambia and Uganda – the DTTC will participate in the Shorter Treatment for Minimal TB in Children (Shine), a programme initiated by the British Medical Research Council Clinical Trials Unit, and led by Prof Di Gibb. The trial will include 1 200 children, 250 of them from Cape Town.
According to the WHO, at least one million babies and children become ill with TB each year, with 140 000 children dying of this curable disease. Until now, children around the world have not had access to child friendly medicines. It is hoped that if the new formulations are taken up into TB control programmes globally, the care of TB in children would be substantially improved in future.