pediatrics

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

Tuberculosis (TB) claims a life every 15 seconds; it is the single largest infectious killer and is universally recognized as a global epidemic. Nearly 200 children die every day of TB.

The challenges of tackling TB are well known, particularly in settings with limited resources, crowded urban environments, and among high risk groups including people living with HIV, prisoners, and children. The emergence of multidrug resistant strains of the disease (MDR-TB), the result of incomplete or poor managed TB treatment, present further obstacles and add exponential costs to already burdened health systems. Furthermore, challenges with access to, affordability, and proper use of pharmaceuticals and laboratory materials can have devastating consequences on diagnosis and treatment.

The key to ending TB is to work together to strengthen health systems in high TB-burden countries to be able to effectively implement both proven and innovative strategies. Four approaches will help save lives by uniting stakeholders to collaborate, innovate, and end TB:

 {Photo credit: MSH Ethiopia}Atsede Tefera recalls three months of long delays in the diagnosis of tuberculosis for her daughter Nigist, who was eventually able to initiate treatment.Photo credit: MSH Ethiopia

When my daughter got sick, I took her to a clinic in my neighborhood. They gave her cough syrup for seven days.

I thought she was getting better, but it was apparent that she was still ill. After another examination, they referred her to St. Paul Hospital in Addis Ababa where they put her on oxygen and started taking blood sample after sample and injection after injection for a month. Her condition did not get better so they gave her another medicine. The doctors then decided to take blood from her back… only then did they know it was tuberculosis.

~ Atsede Tefera

Tuberculosis (TB) kills more people each year than any other infectious disease, causing over 1.5 million deaths globally. More than a quarter of cases are in Africa, the region with the highest burden of TB disease relative to population. Children are amongst the most vulnerable, and all too often children with TB remain in the shadows, undiagnosed, uncounted, and untreated. Today, more than 53 million children worldwide are infected with TB and over 400 die each day from this preventable and curable disease. 

 USAID's ASH Project, led by MSH, brings together global and African regional partners for a new video on addressing childhood TB.

Tuberculosis (TB) is now the leading infectious cause of death worldwide -- ahead of HIV. While major advances in the diagnosis and treatment of TB have been made since 1990, children suffering from this disease have remained neglected and vulnerable. An estimated 1 million children become ill with TB each year, and at least 200 children die each day from TB around the world.

TB is curable and preventable, but we must recognize and treat it with the least possible delay. For children experiencing TB symptoms, the primary point of health care, often community-level facilities, is an important opportunity to identify and begin treatment. Symptoms such as a persistent cough, loss of appetite and high fevers must be recognized as possible signs of TB (not just of pneumonia, malaria, malnutrition, and other common illnesses among children), and health workers must be empowered to recognize and take appropriate action. Ensuring that children can access treatment close to home is a critical step towards eliminating preventable deaths from TB. 

{Photo credit: Mark Tuschman, Kenya.}Photo credit: Mark Tuschman, Kenya.

On the eve of the 20th International AIDS Conference (AIDS 2014), Rachel Hassinger, editor of MSH’s Global Health Impact Blog, spoke with Dr. Scott Kellerman, global technical lead on HIV & AIDS, to discuss his latest research on prevention of mother-to-child transmission (PMTCT) of HIV and pediatric HIV & AIDS. Kellerman and colleagues will be attending AIDS 2014, July 20-25, in Melbourne, Australia. (Read more about the conference.)

RH: What is the state of HIV & AIDS globally?

[Scott Kellerman]Scott KellermanSK: We are at the threshold of a sea change. In the beginning, our HIV prevention tool box was sparse. We could offer extended counseling and condoms, and impart information, but not much else. Behavioral change was the cornerstone of tackling the epidemic. It worked sometimes, but, not consistently.

Now biomedical advances are propelling treatment as prevention—even what I call “treatment IS prevention”.

Malawi mother and children {Photo credit: MSH.}Photo credit: MSH.

I got a call from the resident doctor to come to exam room 6. As soon as I entered the room, I prepared myself. The little girl, 7- or maybe 8-years-old, didn't look well; she was “floppy,” combative, and not entirely aware of where she was or what we were doing to her. She was HIV-positive, and my colleague needed to get an IV line in her arm to test the latest in experimental treatments for kids with HIV– and needed the four of us interns to help hold her still.

It was 1993 during my residency in pediatrics in Cleveland, Ohio. We were at one of the best children’s hospitals in the world; it didn’t matter. The young girl died a few months later.

With the advent of antiretroviral therapy (ART) a few years later, the whole world changed. The world of HIV medicine blossomed; new drugs and drug combinations literally exploded with amazing effect. HIV-positive mothers could give birth to HIV-negative babies, and HIV-positive children and their moms could get treatment.

Scott Kellerman, around age 5. {Photo courtesy of S. Kellerman.}Photo courtesy of S. Kellerman.

The prevention of mother-to-child transmission (PMTCT) of HIV is taking center stage this week during USAID’s 5th Birthday campaign -- and rightly so.  Preventing mother to child transmission of HIV is one of the most critical, effective tools to helping kids reach their fifth birthdays.

Women, men and children stand in line at the St. Joseph's Health Center in Abricots, Haiti. {Photo credit: Gumy Dorvilmar/MSH.}Photo credit: Gumy Dorvilmar/MSH.

It was 11 o’clock one February morning when the Santé pour le Développement et la Stabilité d’Haiti (SDSH) project technical team arrived on site at St. Joseph Health Center.

The center’s activities were well underway. Dozens of people sat on benches or stood in line, waiting for their turn. One person comes to care for her child who has had a high fever. Another comes for contraception. Another just gave birth to a healthy infant.

St. Joseph Health Center is located in Abricots, a remote community in the department of Grande’Anse, Haiti, far from Port-au-Prince. Abricots is nearly inaccessible because of rough terrain and hazardous mountain trails.

Since 2007, with support from the USAID-funded SDSH project, led by Management Sciences for Health (MSH), St. Joseph Health Center has provided a basic package of health services: pediatrics, maternal health, reproductive health, detection and treatment of sexually-transmitted infections, HIV/AIDS, tuberculosis (TB) and family planning.

This free clinic is the only health institution in this hard-to-reach area, serving an estimated 32,000 people.

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