Children, tuberculosis and socio-economic development

RESULTS Sydney City group member, Tima Sannah Brewah, reflects on the barriers to adequate prevention and treatment for TB and HIV, particularly for children. 

Image courtesy ACTION. From the report Childhood TB: From neglect to Action

Developing countries are defined by their varying poverty levels and low socio-economic development. Most lack efficient and effective health systems to ensure much needed health services are available to their population. Tuberculosis is one such disease that places enormous constraints on health systems. Children account for approximately 11% of the global burden of TB according to 2010 estimates however because of the increasing number of under-diagnosed cases, this figure may be higher. More worrisome is TB co-infection in HIV-infected children. Most countries are presently striving to increase BCG vaccination coverage, but the BCG vaccine does not protect children and adults from the most common form of TB. Additionally, maintenance of an efficient cold chain mechanism is often challenging, especially in hard to reach areas as such the effectiveness of the vaccine at the time of administration may be low. Underlying socio-economic issues such as poverty, food security, overcrowding, poor road infrastructure, illiteracy further increases the risk of acquiring TB infections and delays care- seeking and response to therapy. DOTS has proven successful in improving patient compliance to TB drug therapy, however for children the unavailability of fixed-dose combinations of anti-TB drugs results in inaccurate dosage regimens for children, poor compliance to therapy and high administrative costs. In addition, most developing countries lack adequate number of skilled health professionals and health infrastructure to cater for the needs of children infected with TB. Laboratories services are often slow; with inefficient health information systems and cases may often be missed or misdiagnosed. 

The Global Fund to Fight AIDS, TB and Malaria has provided a platform for the integration of TB and HIV programming for the most-at –risk children. However, despite the high burden of these diseases and their inter-relatedness, in most developing countries, TB prevention, treatment and diagnostic services are not part of current child health services and there is poor coordination among the National Programmes for Malaria, TB and HIV.  

In order to ensure aid effectiveness, key international aid donors need to prioritize the funding of research and development of new TB vaccines, diagnostics and treatment that are more effective for children, and those people living with HIV. A comprehensive assessment of current national, regional and global maternal and child survival policies is required to ensure well-coordinated TB response mechanisms for children. If countries are to make progress socio-economically and otherwise, the next generation of leaders, policy makers and workers, need to be much better protected from these diseases of poverty. 

 Our guest blogger Tima Sannah Brewah