TB Elimination: Paediatric Tuberculosis Needs To Be Addressed With Periodic Screenings

India accounts for 31 per cent the global paediatric Tuberculosis (TB) burden. PTB is one of the major causes of child mortality globally.

India has shown the highest level of political commitment by targeting TB elimination by 2025 with the National Strategic Plan (NSP 2017- 25) END TB to enhance the coverage, quality, equity, efficiency, and effectiveness under National Tuberculosis Elimination Programme (NTEP) framework. India accounted for 34 per cnet of combined total global TB deaths. However, the present rate of approximately 3 per cent annual decline in TB incidence would need to be accelerated to about 11 per cent to achieve the 2030 SDGs targets. Childhood TB has been recently termed a silent epidemic by the International Union against Tuberculosis and Lung Diseases. In India, about 3,42,00 cases of paediatric TB (PTB) are estimated to occur every year accounting for 31 per cent of the global burden and 13 per cent of the overall TB burden in the country.

PTB is one of the 10 major causes of mortality globally among children (population age less than 15 years). The disease also causes high out-of-pocket expenditure (OOPE) and catastrophic costs resulting in huge financial burdens on individuals and families.

Paediatric tuberculosis is emerging as a challenge for the healthcare system

India also has more than a million 'missing' cases every year that are not notified and remain either undiagnosed or inadequately diagnosed. Paediatric tuberculosis notifications (0 14 years) is stagnant for the last few years at 6 per cent, while as per estimate it should be 10 per cent. There is an approximation that we are still not able to notify 55 per cent of pediatric tuberculosis cases. TB reporting gap is highest among the age group 0-5 years of 69 per cent while among 6 to 14 years the gap is 40 per cent. To achieve the 2025 TB goal, it is imperative that priority attention should be given to the paediatric age group (0-18 years) tuberculosis through periodic screening involving multiple stakeholders.

Minimum attempts are made in practice by both public and private healthcare providers to integrate paediatric TB screening into general child health services or to provide active case-detection interventions for children. Low-case detection among children has been identified as a key factor contributing to the overall low-case notification.

How to ensure that the paediatric patients get timely screening, diagnosis and treatment?

• It is required to train healthcare workers on TB in children, including screening, contact tracing, and prevention. Integration of training on childhood TB into routine training and supervision activities of all relevant programs.
• Education to physicians, nurses, health care teams, and communities, emphasizing screening of children with respiratory symptoms and their contacts, the importance of a prompt TB diagnosis, and the advantages of new detection methods.
• To fill the 55 per cent gap in paediatric TB notification it is very much required to strengthen the NTEP collaboration with child and adolescent National health programs like Rashtriya Bal Swasthya Karyakram (RBSK), Rashtriya Kishor Swasthya Karyakram (RKSK), Ayushman Bharat School Health and Wellness Program (AB-SHWP) and Integrated Child Development Scheme (ICDS). The strategy will allow reaching millions of children for comprehensive screening including tuberculosis and universal access to TB control services.
• Periodic household contact tracing of children from households having members of pulmonary bacteriologically confirmed (PBC) index patients should be focused especially on high-burden areas involving TB champions, Self Help groups, youth volunteers, and community health officers.
• Malnourished children are another vulnerable target group, needing priority attention in countries like India. Screening of TB in every malnourished child should also be prioritized as there is a high prevalence of moderate-severe undernutrition in children with active TB in India, especially in MDR-TB.
• Use of a mobile smartphone application should be used to educate and empower frontline health workers to provide TB screening at the community level by our FLWs.

The last word

We are committed to supporting the government to eliminate TB through our association with the Central Tuberculosis Division (CTD), a section of the Ministry of Health and Family Welfare (MoHFW) as Ni-kshay Mitra under the government's initiative called Community Support To TB Patients. We are supporting 270 paediatric children for nutritional support from the State of Haryana to address food insecurity and well-being for better treatment outcomes at the household and community level. We are also supporting Gurugram TB cells in strengthening tuberculosis OPDs, IPDs, and laboratories for the diagnosis of latent TB through the supply of equipment and logistics to deliver quality tuberculosis management services, especially for children and adolescents.

The article is written by Dr. Vikas Kaushal, Head Health, Save the Children (Bal Raksha Bharat).