Though there has been an overall reduction in TB cases worldwide, around 500,000 children are infected annually. Newborns and young children are particularly vulnerable, often contracting the illness from their mothers. Each year, an estimated 70,000 children die from TB.
The high death toll is partly due to the fact that in children, the illness is frequently overlooked. The presence of TB is usually signalled by coughing and sneezing when the bacteria attack the lungs. (In the case of extra-pulmonary TB, other parts of the body are affected.) In children, symptoms can also be less specific, such as headaches, vomiting or lack of appetite. In addition, there can be a delay in confirming a child has the disease. Children are usually infected with far fewer organisms, making detection in a sample of sputum much harder, especially when many youngsters are not able to produce a significant amount of sputum.
Even when TB is diagnosed correctly, treatment can be difficult. Speaking to IRIN, a spokesperson at the African Medical and Research Foundation (AMRF), based in Kenya, explained “there are no child-friendly drugs available to treat TB”. This means that adult tablets have to be crushed, which makes getting the right dosage hard.
Children with vulnerable immune systems, such as the very young and severely malnourished, are most at risk of falling ill and dying from TB. These children often live in poor communities where there may be a lack of access to health care. Infants born to women with TB are also at greater risk; among newborns, maternal TB causes a two-fold increase in low birth weight and premature births, as well as a six-fold increase in perinatal death (within the first 28 days of life).
In sub-Saharan Africa, as well as in countries around the world, there is generally a lack of emphasis in preventing mother-to-child transmission of TB, even where screening to prevent the transmission of HIV is prioritised. And yet co-infection of the two diseases is common – in parts of sub-Saharan Africa, two-thirds of TB sufferers are also infected with HIV. Therefore experts at the AMRF believe that preventing the transmission of TB from mothers to their children should be incorporated in all child health intervention programmes. As the AMRF spokesperson says simply, screening for TB as well as for HIV, “can save the life of a woman and the life of her unborn child”.