Efforts on to manage little-known childhood TB

Challenges are plenty in the treatment and management of tuberculosis (TB). More so, in the case of childhood TB.

However, ongoing efforts, at various levels, to improve management of the disease, may just make all the difference.

As the country gears up to observe World TB Day on Monday, experts stress the need for involving paediatricians in the management of TB, bringing in better diagnostic facilities and rationalising drug dosage for children.

“TB is a huge challenge as its burden is large. The number of children with TB, as per the Revised National TB Control Programme (RNTCP), and of those undergoing treatment is between 85,000 and 90,000. This is about seven per cent of TB cases, overall. However, epidemiology shows childhood TB comprises about 20 per cent of the cases, overall,” said Soumya Swaminathan, director of National Institute for Research in TB (NIRT).

The complete picture may be missing as a large number of children, especially those in the younger age group, are treated in the private sector and are not taken into account.

“Notification of TB is not really happening in a big way. A large number of children are either missed or misdiagnosed,” she said.

K. Murugesan, State TB Officer-Tamil Nadu, said a Central order mandates that private hospitals notify the authorities of TB cases. “Any practitioner who diagnoses and treats TB should notify us. We will then register the details and track the case,” he said.

While under-estimation is one of the issues, treatment is another. As of now, TB drugs do not cater to children weighing less than six kg.

“The treatment regimen needs change. Those reported are mainly in the 5-14 age group, but epidemiology shows there are more number of cases in the 0-4 age group,” said Dr. Swaminathan. There is neither data on drug-resistant TB in children, nor a formulation on treating children with multi drug resistant-TB, she said.

However, efforts are on to improve the situation. Currently, RNTCP is working with the Indian Academy of Paediatrics to evolve algorithms for diagnosis and treatment, and train paediatricians at the State and district level in management of childhood TB.

“Primary health centres do not have paediatricians. Paediatricians in nearby areas could be roped in. Child health workers could be trained in picking up the warning signs of TB,” said Dr. Swaminathan.