Children and Tuberculosis: Exposing a Hidden Epidemic

"A lack of political will, inadequate funding, and children's exclusion from research remain barriers to eliminating childhood TB."

From ACTION (Advocacy to Control TB Internationally), an international partnership of civil society advocates working to mobilise resources to treat and prevent the spread of tuberculosis (TB), this report examines the link between the burden of TB and vulnerable children around the world - those who are malnourished, orphans, or living with HIV. The report is premised on the observation that, because, on average, children are less contagious than adults, they have often been overlooked by national TB programmes, and the rates of TB in children are "grossly under-reported".

Several vignettes with communication-related implications for those developing TB programming for children follow. For example: "At first, Kofi's father did not understand what it meant for Kofi to have TB. He blamed Kofi's mother, believing TB to be a hereditary illness passed from mother to son....A community health worker educated both Kofi's mother and father about TB - how it spreads, how to look for signs and symptoms, and how it was important to take an entire course of treatment to cure the disease. They were assured about the importance of seeking proper health services, rather than self-medicating, when their children became very sick. After nine months of receiving treatment and care, Kofi and his mother were both cured and returned to normal health."

Challenges regarding children and TB are outlined. For instance, "The exclusion of children from clinical trials is the main reason no child-friendly TB treatment options exist....Barriers from including children in clinical trials ostensibly exist to protect children from the potential harm of participating in scientific studies. However, many pediatricians are worried that this attempt to protect children has done the opposite - instead denying children new lifesaving treatment."

Advocacy messages included in the report include:

• "Fighting childhood TB must become a global health priority among both donors and national TB programs...
• Children need universal access to the current tools available to diagnose and treat TB...
• TB diagnostics, treatment, and care services should be integrated with child health primary care, maternal and child health programs, and HIV services.
• The scientific community needs to include children of all ages in clinical trials...
• Innovative research is needed to develop child-friendly TB diagnostics, drugs, and vaccines.
• Through advocacy, civil society must demand equitable prevention, diagnostics, treatment, and care services for childhood TB and monitor the scale-up of these services worldwide.
• Children with HIV should be placed on ART [antiretroviral therapy] immediately upon diagnosis..."