According to a new report by Médecins Sans Frontières (MSF), in Africa and elsewhere across the globe, TB services frequently under-diagnose or under-treat children, or even worse, leave them out of treatment programmes altogether.
The medical charity found that nine out of every ten children tested for TB using the most common testing method are not diagnosed as having the disease, despite being confirmed as sufferers later. This finding came from a study of over 2,000 children in countries such as Zimbabwe, where the progress of youngsters was followed over three years. And children infected with both HIV and TB were found to be at an even greater risk of dying.
The authors of the new report admit that diagnosing TB in children is far from easy. Many children, particularly the youngest, are unable to produce enough sputum for their samples to be adequately checked under the microscope for the TB bacteria. And even when they produce a good enough sample, sputum-based tests will not detect paucibacillary or extrapulmonary TB types, which occur more frequently in children.
Speaking to the news agency IRIN, a scientific advisor to MSF commented that for many developing countries, “the ideal test would be something not requiring laboratory infrastructure” but based on something which is easy to obtain from children, such as a stool, sample of urine or a finger-prick blood test. In the meanwhile and until better diagnostic methods are developed, the best tool for discovering paediatric TB remains the GeneXpert test, which still relies on sputum samples.
The new report also highlights how drug formulations and international guidance on how to treat children with TB continues to be inadequate. And many drugs available on the market today are not tailored to deliver the right dosages. The report’s authors called on the medical industry to demand appropriate drug strengths for children. Until that happens, they warn that health professionals will continue to struggle in treating children for this curable disease.