adminRumbidzayi Zinyuke
Senior Health Reporter
Although Zimbabwe has made remarkable strides in lessening the burden of tuberculosis, children remain a major under-reported group, with a significant majority of infected children never diagnosed, and calls have been made to increase efforts to correct this.
Zimbabwe reported 16 300 new TB cases in 2021, but there were an estimated 30 000 infections, and among children the figures seem worse with only 5 percent of reported cases being children aged between 0 and 14 although global figures suggest that the true figure is 10 percent to 12 percent.
TB remains a public health emergency, with 30 000 people falling ill, and more than 4 000 lives lost each day globally.
Statistics show that globally, more than 60 percent of all children with TB are never even diagnosed with the disease and 96 percent of children who die from TB are never put on treatment.
About 80 percent of them are younger than five years old.
The very low Zimbabwean figures, a lowish percentage of infected people diagnosed and a small percentage of infected children never even diagnosed, mean there are many children with TB, a significant majority of infected children, are not being identified and will not get to receive the lifesaving treatment that is available for them.
As Zimbabwe joined the world in commemorating World Tuberculosis Day yesterday, the need to improve case finding among children was highlighted.
The Union Zimbabwe Trust executive director Dr Ronald Ncube said it was worrisome that many children with TB continued to be missed.
“Childhood TB poses a challenge to deal with mainly because of difficulties in reaching diagnosis. Sometimes, children do not show specific signs and symptoms suggestive of TB, but rather present with overlapping symptoms of other common childhood illnesses,” he said.
“Getting a specimen for TB testing is more difficult in a child, who is likely to swallow their sputum. If one does get a specimen, sometimes the result may come back negative, not because they don’t have TB, but because of how TB typically presents in a child, whose immune system is not yet well developed.”
To improve TB testing capacity, Zimbabwe has adopted more sensitive World Health Organisation-recommended rapid molecular TB diagnostic platforms such as GeneXpert which are situated in all districts to improve identification of TB cases.
Newer complementary platforms such as Truenat with comparable sensitivity to GeneXpert are also being scaled up particularly to more remote health facilities as they are battery-powered and do not require complicated laboratory infrastructure.
Dr Ncube said this technology not only tested for the presence of TB, but also determined the presence of bacteria resistant to treatment.
“The country is promoting use of digital chest radiographs (x-rays) as a diagnostic aid for TB in children as well as its use as a more sensitive screening tool for adults. The Tuberculin Skin Test (Mantoux) is another test used to check if one has been exposed to TB infection, and a positive test is of greater diagnostic value, particularly in children in the event other tests are negative in a child with signs and symptoms suggestive of TB,” he said.
He said the country was emphasising the use of diagnostic and treatment decision algorithms in children, which guide health workers with a criterion to even make clinical diagnosis of TB in the absence of a confirmatory laboratory test.
Although sputum is the best specimen for testing for TB, other specimens such as gastric washings and stool can be used in children under the age of five.
Zimbabwe piloted the use of stool specimens in a few districts, and there are efforts to scale up its uptake at all levels.
“The rationale is that younger children tend to swallow rather than expectorate their sputum, with swallowed TB bacteria ending up in the gastro-intestinal tract (gut) including stool. Its benefit includes the fact that stool has some reasonable and acceptable WHO-approved diagnostic accuracy in children; it is easy to collect without special clinical expertise needed; and the stool sample can now be processed using a simple one-step method and tested using the same GeneXpert platform, just like sputum,” he said.
Apart from diagnostic challenges in children, Dr Ncube said there were efforts with funding from USAID through Kunda-Nqob’iTB to train more healthcare workers and establish centres of excellence for prevention, diagnosis, treatment and care of children with TB.
Child-friendly anti-TB medicines have also been adopted and are being used.
While diagnosis, treatment and care of children with TB is important, continued efforts to ensure that all TB cases are identified and put under treatment are ongoing.”Following the recent WHO recommendations, there are opportunities for the country to adopt an even shorter four-month treatment option for uncomplicated forms of TB as opposed to the current six months. Working with community health workers has been instrumental in increasing community reach with TB messages as well as bringing TB screening services to the door step of our community members, thanks to the support from USAID,” said Dr Ncube.
Experts have said the involvement of communities in the identification of TB cases is one of the best models in improving outcomes.
Community Working Group on Health executive director Mr Itai Rusike Government should engage communities in planning and implementing strong, integrated TB and Covid-19 mitigation and response measures.
“There is need to increase financing for TB prevention and care, innovations in care delivery, and research and development, including for new TB vaccines to prevent the development of drug resistant TB. It is time to take urgent action to get back on track and accelerate collective efforts to fulfil the 2022 UN targets on TB to defeat the disease and save lives,” he said.
This year’s World TB Day commemorations were held under the theme, ‘Yes we can end TB’ recognising the shared resolve to harness high-level leadership for increased investment, adoption of innovations, and multi-sectoral collaboration to combat TB.
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