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Maternal and paediatric tuberculosis still overlooked

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KUALA LUMPUR, 18 June 2013 (IRIN) - The global target of a 50 percent
reduction in tuberculosis (TB) by 2015 may already have been achieved,
but TB remains a neglected disease among women and young children, say
health experts.

In 1993 the World Health Organization (WHO) declared TB a global public
health emergency.

"About one third of the global population is infected with TB, with an
estimated three million cases that remain undetected," said Haileyesus
Getahun,coordinator of the WHO Stop TB Department.

According to WHO
y.pdf> , in 2011, there were an estimated 8.7 million newly diagnosed
TB cases, 13 percent of which were co-infected with HIV. There were an
estimated 1.4 million TB-related deaths, including 430,000 deaths among
people living with HIV (PLHIV).

Though seen as a "man's disease" due to the higher infection rate among
men worldwide, said Getahun, it is actually one of the top (and
under-diagnosed) killers of women. In 2011 some 300,000 HIV-negative
women and 200,000 women living with HIV died of TB-related causes.

"There are several social factors that contribute to women getting
diagnosed later, like the stigma associated with TB. Also, in pregnant
women, TB symptoms are masked," Getahun said.

TB in expectant women increases the risk of birthing complications,
including maternal death.

According to WHO, maternal TB causes a two-fold increase in vaginal
bleeding, eclampsia (pregnancy-induced hypertension), pre-eclampsia,
and a 10-fold increase of miscarriage.

Among newborns, maternal TB causes a two-fold increase in low birth
weight and premature births (both risk factors for childhood death) and
a six-fold increase of perinatal death (within the first 28 days of

While the exact extent of the problem is still unknown, said Getahun,
recent studies from sub-Saharan Africa and India have shown that TB was
a direct cause of an estimated 6-15 percent of all maternal deaths and
an indirect cause of 15-34 percent.

Paediatric diagnoses, treatment lag

TB is usually signalled by coughing and sneezing when TB bacteria
(spread through the air) attack the lungs and other parts of the body
in the case of extra-pulmonary TB.

The disease is notably most infectious in overcrowded areas like jails
and slums.

Children are especially vulnerable. An estimated 500,000 children are
newly infected with TB every year after coming into contact with
infected adults; some 700,000 children die annually

from TB-related causes.

"The diagnosis of childhood TB
agnosis> is very challenging. The children are not able to produce a
significant amount of sputum [mucus tested for TB bacteria] for
diagnosis and TB prevention for child contacts is not practised," said
Meshack Ndirangu of the African Medical and Research Foundation
, a medical NGO headquartered in Nairobi,

But even if diagnosed correctly, treatment is still problematic.

"There are no child-friendly drugs available to treat TB. We need to
crush tablets made for adults and this leads to inaccuracy. We cannot
tell for certain if the children are getting the right dosage for their
weight," Ndirangu told IRIN.

Health system gaps

Current health system gaps such as the collection of data also make it
difficult to effectively track and diagnose TB for all ages.

"There is a diverse set of [medical screening criterion] in adults and
children. We need to standardize screening tools and referral systems
at the community level," said Ndirangu.

According to Ndirangu, globally, many medical groups lack training to
integrate the data they collect with government health data.

The collection and transportation of cultures for testing in a health
facility is also troublesome, especially in remote areas.

Among pregnant women, screening for the prevention of mother-to-child
transmission of HIV is given more priority rather than the transmission
of TB, even though co-infection is common.

An estimated 12-15 million people living with HIV worldwide are
co-infected with both TB and HIV. In parts of sub-Saharan Africa, up to
70 percent of TB patients are co-infected with HIV

According to the WHO, in 2011, there were 3.2 million people enrolled
in HIV care who were screened for TB; compared to 2.3 million in 71
countries in 2010. The goal is to screen all those in HIV care for TB
by 2015.
PLHIV are 50 times more likely than HIV-negative people to develop TB
and 90 percent of them usually die within months
eatment-gains> without proper treatment.

The risk of developing TB is more than 10 times higher among pregnant
women living with HIV than among HIV-negative pregnant women, according
ogy/2012/gr2012/20121120_UNAIDS_Global_Report_2012_en.pdf> .

"We should have TB/HIV incorporated into maternal and child health
intervention programmes. When health workers screen for HIV when they
conduct maternal health care visits, they can also screen for TB,"
Ndirangu said.

"It only takes a few minutes to do a symptomatic diagnosis of TB. It
can save the life
of-life-and-death> of a woman and the life of her unborn child," he

WHO insists prevention of TB is the best cure and has been pushing for
the roll-out of isoniazid preventive treatment
, infection
control and intensified case finding. However, countries have been slow
to roll out this three-part intervention.


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