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The Impact of Missed Childhood Tuberculosis. Cases on Global TB Control Goals
Nearly 0.34 million children <15 years of age in India are estimated to get TB disease every year; while children in this age group are estimated to contribute about 13% of the total TB caseload, only 6% are notified.
Missed childhood tuberculosis (TB) cases can indeed impede the progress toward achieving global TB control goals. Childhood TB is often challenging to diagnose because its symptoms can be less specific than in adults, and young children may not be able to produce sputum samples for testing. As a result, many cases of childhood TB go undetected and untreated, leading to ongoing transmission and a higher burden of the disease in communities.
With childhood TB continuing to remain a “staggering problem” in world, “eliminating” TB by 2025 might be extremely challenging. Children are more likely than adults to get infected with TB and get sick with the disease. TB is now thought to be the viral disease that kills the most children of all ages around the world. As per a study that looked at 31 studies, the estimated mortality of children with TB who fail to receive treatment is about 22%; the case fatality ratio in children less than five years is 43%.
If the pandemic has taught us anything, it’s that with solidarity, determination, innovation and the equitable use of tools, we can overcome serve health threats. Let’s apply those lessons to tuberculosis. It is time to put a stop thing long-time killer. Working together, we can end TB.
— Dr Tedros Adhanom Ghebreyesus Director-General World Health Organizationr
Childhood TB caseload According to the WHO, there are critical gaps in detecting TB cases among children despite significant progress and greater understanding of the challenges faced in addressing TB in children. For example, at least 1.2 million children under the age of 15 get tuberculosis (TB) every year around the world, and about 67 million children get affected, putting them at risk of getting TB disease in the future. However, 56% of the 1.2 million children who develop TB annually are not detected, says an October 2022 paper.
As per the 2022 WHO global TB report, last year, children aged less than 15 years across the world accounted for 11% of the total estimated incident TB cases. Notwithstanding the 56% estimated TB detection gap in children globally,
“Under diagnosis of paediatric TB remains a challenge. The most pressing challenges include limited capacity for case detection, lack of sensitive diagnostics…” For instance, while the total notifications in 2022 were over 2.4 million, paediatric TB cases notified were just 1,35,734 — which is 5.6% visavis an estimated contribution of 13%
Here are some key ways in which missed childhood TB cases can hinder progress toward achieving TB control goals:
Transmission: Children with undiagnosed TB can continue to spread the disease within their households, schools, and communities. This ongoing transmission can fuel the TB epidemic in a region.
Severity of Disease: TB can be particularly severe in young children, leading to severe illness and, in some cases, death. Missed cases can result in unnecessary suffering and mortality.
Drug Resistance: Undiagnosed and untreated TB cases can lead to the development of drug-resistant TB strains, further complicating treatment and control efforts.
Underreporting: When childhood TB cases are missed or not reported, it can result in underestimates of the true burden of TB in a given region, making it difficult to allocate resources effectively and plan appropriate interventions.
To address these challenges, it’s essential to strengthen TB control efforts with a focus on childhood TB. This includes improving diagnostic methods suitable for children, raising awareness among healthcare providers and communities about childhood TB symptoms, and ensuring that children have access to appropriate TB treatment and care.
Efforts to find and treat childhood TB cases early are crucial for achieving global TB control goals, reducing transmission, and ultimately working toward the elimination of TB as a public health threat. Coordination between healthcare systems, TB control programs, and international organizations is essential in this regard.
