Tackling the Hidden Epidemic: Childhood TB in Ethiopia
The World Health Organization (WHO) estimates that up to 80,000 children die from tuberculosis (TB) each year and that children account for over half a million new cases annually. Unfortunately, global figures likely underestimate the burden of childhood TB worldwide due to missed diagnosis, causing TB in children to be a ‘’hidden epidemic.”
Identifying children with TB depends on the alertness and knowledge of nurses, public health officers, and doctors, which in turn depends on the availability of diagnostic tools. Ultimately TB in children is often missed or overlooked due to non-specific symptoms and difficulties in obtaining sputum particularly in young children.
This was the challenge in the case of Fisseha*, a three-year-old boy who suffered from cough, fever, and weight loss. His mother, who herself had been treated for a drug-resistant strain of TB, took him to the Muja Health Center in the Wollo zone of Ethiopia to be assessed. But, Fisseha could not produce a sample.
The TB focal person at Muja Health Center, Sister Banchayehu Aneley, who was trained by Help Ethiopia Address Low TB Performance (HEAL TB) project, a US Agency for International Development (USAID)-funded project implemented by Management Sciences for Health (MSH) in the Amhara and Oromia regions of Ethiopia, suspected that Fisseha might have drug-resistant TB like his mother.
Sister Banchayehu referred him to Boru Meda Hospital, and Fisseha was put on second-line anti-TB drugs. The rest of his family was screened and tested negative.
Ethiopia, with a population of over 90 million, is the second most populous country in Africa, and children under age 15 comprise almost half of the total population. In 2012 alone, 19,500 children under age 15 were diagnosed with TB, accounting for 14 percent of all reported TB cases in the country.
HEAL TB is making childhood TB a priority. In its third year, the project allocated a dedicated budget and plan of action to improve the diagnosis and management of TB in children and helped to establish a national childhood TB task force.
At the core of the HEAL TB project’s programmatic support of childhood TB is the development of a national guiding roadmap on prevention and control of childhood TB in Ethiopia. Launched on July 29, 2015, the plan is expected to boost collaboration between TB and maternal and child health services. HEAL TB has worked with the Government of Ethiopia to integrate key childhood TB control activities into standard pediatric service packages at the facility and community levels.
In collaboration with local universities and regional health bureaus, HEAL TB is also providing more direct support to providers through the development of continuing medical education (CME) material on childhood TB. Nearly 550 health care workers have received CME training and are better equipped to diagnose and treat common forms of TB in children, recognize severe forms of TB and refer when it is required, and manage children who are in close contact with others infected with the bacteria.
The project has also held workshops on childhood TB within health centers and hospitals and has trained 471 district TB focal persons on identification and management of TB in children.
These efforts have increased coverage of isoniazid prevention treatment and the identification of children with TB. They are also expected to improve the quality and accuracy of childhood TB data used by the National Tuberculosis Program for monitoring and evaluation.
HEAL TB encourages the use of GeneXpert as an initial diagnostic tool for children, since it is the best available tool for diagnosing sputum samples with low bacteria yield, as children’s samples commonly are. Heal TB conducts on-site sensitization for health professionals to boost utilization of GeneXpert and ultimately improve identification of children with TB.
Said Sister Banchayehu:
Diagnosing and then curing a child, the future generation, gave me all the motivation and the desire to work harder. The trainings and on-the-job supports that we received from USAID and partners enable us to provide better care to the patients.