- TB prevalence among children under the age of 14 years is about 10 to 15 per cent.
- Most of the children come from families living below the poverty line, which affects their nutritional care while others share rooms with an adult with TB.
Image: MAGDALINE SAYA
Most of children in the country with Tuberculosis go undiagnosed, posing a risk to the entire population.
Data as per the National Lung and TB 2021 Annual Report shows TB prevalence in children under the age of 14 years at nine per cent.
However, health experts have expressed concern that the prevalence might be as high as 15 per cent due to the missed cases.
Data by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) shows that currently, the country is missing about 44 per cent of the children with TB.
“Unfortunately we know the prevalence of TB among children is about 10 to 15 per cent but we are detecting much less than what we know is the true prevalence, therefore an indication that we are missing a lot of TB in children,” Caren Mburu said.
Mburu is a pediatrician and senior technical advisor for adolescent and pediatric services at Elizabeth Glaser Pediatric Aids Foundation.
She spoke during the ongoing high-level TB meeting taking place in Nairobi.
Mburu has noted that a lot of factors compound the children’s vulnerability to TB.
These include poor nutritional status which makes the child's immunity less and hence prone to attack by the disease.
“We also have a population of children living with HIV and that is double vulnerability because they are children and then they are living with HIV so that increases their vulnerability,” Mburu noted.
Similarly, most of the children come from families living below the poverty line.
This does not only affect their nutritional care, some find themselves in settings where they share a room with an adult with TB.
“Poverty dictates the nutritional care you have, it dictates living circumstances; imagine a child in an informal settlement in a one-roomed house with inadequate ventilation and many people in that house. That child is at higher risk of TB,” she noted.
Mburu has noted that unlike in adults, picking TB cases in children remains a challenge as the disease presents with unclear symptoms that may be elusive.
Image: MAGDALINE SAYA
She has noted that TB in children presents differently compared to adults hence the need to first create awareness that children also get affected by the disease within the community.
“They are actually a group that is at high risk for TB given that their immunity is very low,” she noted.
Some of the signs to look out for that might indicate a child might be having TB include a low-grade fever that might last for about two weeks, having a cough, may becoming less playful while some might not gain weight as it should.
Similarly, since most children below the age of five years might not be able to bring out enough spatum from their lungs for testing, healthcare workers are required to try their best to find other samples like stool.
“Because what they produce is so little we only catch about a fifth of them since we are only able to identify TB through the samples in about a fifth of them,” she noted.
Kenya is among the countries that implemented the Catalyzing Pediatric TB Innovations (CaP TB) project which sought to identify an implementation model to increase case detection of children with TB.
It also sought to increase the proportion of children who have been in contact with people with TB and don’t have TB Preventive Therapy (TPT) services.
It was learned that in low-resource settings, the government can rely on lay providers such as Community Health Promoters to increase case detection for children and improve the uptake of TPT.
During the study, patients who came to the facility who were known to have TB were linked to a CHP who then went to the community, and determined where the patient lived and who their child contacts were.
They then screened the child in the community and linked those with symptoms as per the provided algorithms to the facility for diagnosis.
“Training CHPs on TB and TB screening is instrumental; using a short TB regimen was instrumental in completing TB Preventive Therapy, the regimen is six months but we now have a shorter course and this encourages patients to complete the course,” Mburu said.
The medic noted that a lot of effort has been made to make it easier to find TB cases in children through algorithms to signs and symptoms and some of their diagnostics.