Anika’s Story: Intensified Case Finding of Pediatric TB in Bangladesh

 {Photo credit: Francis Hajong/MSH}Anika and her mother.Photo credit: Francis Hajong/MSH

Anika was a 22-month-old baby girl living in Belai Chandi Kuthipara in the northern part of Bangladesh when she became sick with fever, cough, and weight loss. She was admitted to the LAMB’s Missionary Hospital in Parbotipur, run by one of the many NGOs where the US Agency for International Development (USAID)-funded Challenge TB project, led by Management Sciences for health (MSH) in Bangladesh, is funding active tuberculosis (TB) case finding among high-risk groups such as children, people living with HIV, and diabetics.

Anika had classic TB symptoms combined with a suspect chest X-ray. However, diagnosing TB in children is extremely difficult because of their inability to provide a sputum sample. Instead, a process called gastric lavage, in which gastric juice and sputum are collected by nasal intubation, and sputum-smear microscopy are used to complete the diagnosis. For Anika, this showed a positive result for TB.

The divisional health staff and community volunteers conducted contact tracing to find the origin of the TB and screened Anika’s parents and those around her and in the neighborhood, but no one suffering from TB symptoms was found. After six months of directly observed treatment (DOT) under the care of the DOT provider who assisted Anika’s mother, Anika was finally cured.

Unfortunately, one year later, Anika became ill again with the same symptoms, and her parents returned to the hospital. As it was a relapse case, the doctor also sent her sample for GeneXpert testing. GeneXpert is a highly sensitive test that can also detect drug resistant strains of TB. The test results showed that this time Anika did indeed have drug resistant TB (DR-TB).

She was immediately referred to the National Institute of Chest Diseases and Hospital (NIDCH) in Dhaka, where Challenge TB supports treatment initiation for DR-TB. Anika was hospitalized for two months until she showed improvement, before being allowed to continue her treatment at home under community-based programmatic management of DR-TB (cPMDT), provided by Challenge TB-trained outpatient teams.

Initially the drugs upset her stomach and made her nauseous and vomit, but after the doctor taught her parents how to administer the medicine with sugar and milk, she was able to tolerate her medication. Anika’s family is also receiving social support from Challenge TB in the form of food and all costs relating to her treatment, and as a result, her physical condition is slowly improving.

Anika’s parents were grateful and said:

Thanks to the doctor in the hospital who taught me how to mix the drug with milk and sugar to make them palatable to my child, I can now administer her drugs myself. By the blessing of Almighty God, we are getting all kinds of help and support. Otherwise, how would we able to cure our daughter of this dreadful disease?

Currently, childhood TB cases constitute approximately 3 percent of the total cases reported in Bangladesh, but the actual disease burden of childhood TB is unknown. However, it is suspected that only a small proportion of the estimated number of childhood TB cases are being diagnosed and that DR-TB is on the rise (12 children have been treated for multidrug resistant TB since 2008).

Anika’s story shows that intensified case finding, investing in training, and new technologies are saving lives.

[This is 1 of 12 stories in the 2016 special edition Global Health Impact newsletter. Click here to read more.] {Photo: Gwenn Dubourthournieu}This is 1 of 12 stories in the 2016 special edition Global Health Impact newsletter. Click here to read more.Photo: Gwenn Dubourthournieu