BENIN CITY –The Institute of Child Health Seminar room was set aglow with luminous ideas recently, when medical experts in collaboration with the World Health Organisation (WHO), teamed up to fashion out plans to end the scourge of tuberculosis with the theme, “finding the invisible child TB cases, during the world tuberculosis day celebration”.
Though the Institute came up with its own sub-theme, “Unite to end Tuberculosis,” health experts did not fail in their attempt to educate and enlighten on the scourge of the diseases.
The WHO stated through its representative that tuberculosis (TB) is an infections air-borne diseases caused by the bacilli of the genus mycobacterium which affects the Lungs of humans.
Every year, according to the WHO report, an estimated 9 million new TB cases are reported worldwide despite the huge investments in health services in countries. About 3 million of these cases are still not diagnosed and treated or are diagnosed but not registered by the national TB control programmes.
The WHO report said that although the increasing trend of TB had been halted in the African region, there is the need to reach, treat and cure all patients, especially vulnerable people including children and women and people living with HIV/AIDS.
The WHO report indicated that in 2015, only 101 under fives and 739 above 5 yrs TB cases were reported through the Integrated Disease Surveillance and Response system (IDSR) in Edo State.
In his paper titled, “Burden of childhood tuberculosis,” Dr. Osarogiagbon Osa Wilson, a consultant paediatrician at the Department of Child Health, University of Benin Teaching Hospital (UBTH), noted that it was difficult to estimate the incidence of TB in children for it was rarely bacteriologically confirmed; paediatrician who diagnosed TB do not always report cases to public health authorities, TB cases among children are less likely to be diagnosed in countries with a high burden of TB compared with adults aside the issue of Latent TB.
The paediatrician who went graphic with details said that every 20 seconds someone died of TB around the world aside the disease being a leading cause of preventable adult death. TB, he said, was responsible for more than five times as many deaths as all natural disasters combined.
He said that despite the implementation of the dots strategy since 1993, the burden of TB in the country was currently increasing with Nigeria currently ranking 3rd highest TB burden country in the world and 1st TB burden nation in Africa.
Current TB notification rate is 16% but with the current rate of transmission, over 4 million cases are expected to occur between 2015 and 2020.
He stated that, of these numbers, one million people are expected to be co-infected with HIV, while 200,000 are expected to have multi-drug resistance.
Dr. Osarogiagbon Wilson concluded his presentation with the point that the TB burden was on the increase globally and children were infected and affected against the backdrop that Nigeria holds its forte in the world chart of TB coupled with the attendant cases of drug resistance on the increase which pushes the need to step up the control plan in Nigeria.
The Director of the Institute of Child Health, Dr. Ayebo Sadoh who talked on. “Finding the invisible child TB cases”, said 10-15% of the burden of TB in Nigeria was found in children.
This accounted for 57,050 cases but only 5,463 are reported; 51, 587 children with TB (90% of children with TB) are not accounted for.
These bulk figures she said, are the invisible child TB cases.
She stated that majority of these cases are undiagnosed, so, they are not treated while the diagnosed cases are not reported, so they remain invisible to the authorities hence their outcomes are unrecorded.
Though she harped on a myriad of problems which made child TB cases invisible, some of the reasons included difficulty in making a diagnosis of TB in children due to non specific symptoms which mimicked other diseases; results of tests difficult to interpret; children often smear negative; no contact tracing, data collection format tend to exclude children in addition with health related factors such as the weak health system, dependence on adults to bring children to hospital; not enough funds (out of pocket expenditure); frequent strikes, poor referral system and a weak monitoring and evaluation system of reporting.
Aside taking the awareness drive to homes and communities, the health expert opined that cases could be identified and treated with an education policy which mandates new students to undergo health/TB tests before gaining admission to schools to help identify and treat. Also, the routine test of HIV infected children and provision of founding for training/retraining and updating of infrastructure, with the strengthening of healthcare system and research.
Dr. Sadoh enumerated the clinical features of TB to include cough, weight loss wheezing, enlarged lymph nodes among others, stating that for effective diagnosis, there was need to study the history of such a patient (contact with adult with TB), physical examination and medical investigations through the sputum tests, Mantoux test, chest X-ray and other available tests, including HIV test in addition with starting the treatment process with the 6 months of anti- TB drugs.
Prof. Oviawe Osawaru, in his remarks stated that there were one million cases of children with TB in 2014 with 120,000 deaths which was not a good report in terms of prevalence and mortality, which was why the MDG 6 (c) and WHO “stop TB strategy” was meant to end in 2015 and replaced with the “Sustainable Development Goals,” hence the need to unite to end TB
Dr. Imoh Ukpong, a National Primary Health Care Expert on his part, said TB was a disease which mainly affected the poor and the marginalized due to a lack of basic health services and poor nutrition. He sued for strengthened primary healthcare, prompt sputum smear diagnosis and need for laboratories and Dots centres in all hospitals to go for prompt identification and treatment of TB.
Health personnel present at the symposium called on the health Ministries at all levels to have a data bank of all health facilities that are into TB, Heath Care practitioners need to have a new regiment /contact (email) to make all work unanimously available to all, to aid information dissemination.
They also harped on the need for regular training and making the results of open symposiums available to public/private health facilities. Regimen (drug treatment) guidelines should be up to date with current Dot centre specification.