Improving TB detection in children

Malita Chipungu, 26,  was all smiles when she gave birth to twins—Aisha and Idah—last August at Thyolo District Hospital.

However, the twins weighed less than two kilogrammes and clinicians admitted the underweight children to the kangaroo ward for almost a month for close monitoring.

In the ward for premature babies, cough monitors trained by the Elizabeth Glaser Pediatric Aids Foundation (Egpaf) to support clinics with active screening of children for tuberculosis (TB) recommended that Aisha and Idah be screened for the disease.

 “Using the paediatric TB intensive case finding screening tool, we noted some symptoms ranging from fever, night sweats, neck swelling and difficulties in breathing,” says Enock Saka, a cough monitor at Thyolo District Hospital.

The healthworkers inserted a tube through the babies’ nostrils to obtain gastric fluids from their stomachs, which tested positive for TB.

“Shortly after being diagnosed with TB, my children were put on treatment. On January 4, I collected the final replenishment at Mataphwa Health Centre within our community where the district hospital has been sending their medication. This is huge relief for me. I could not visit the district hospital due to high transport costs,” Chipungu said.

Now, the twins are improving, thanks to the clinical team supported by Catalysing Pediatric Tuberculosis Innovations (CaP TB) project.

At Chiradzulu District Hospital, a girl, 11, referred from Milepa Health Centre with a thick discharge from her ear, spiking fever and other symptoms received malaria and meningitis treatment though laboratory tests showed she did not have malaria.

Chest X-ray showed no irregularities either and the ear discharge continued despite being on treatment.

The girl was put on eight-month TB treatment after the ear discharge was subjected to microscopy.

Diagnosis of the chronic ear infection, known as  tuberculous otitis media, often delays because it is mostly mistaken for other acute or chronic middle ear conditions.

The twins and the 11-year-old girl are among 321 children diagnosed with TB in clinics supported by  Egpaf with funding from Unitaid.

The project is underway in nine African countries, including Malawi, to end childhood TB and deaths through increased access to innovative models of care for babies.

Egpaf works with the National TB Programme (NTP) in the Ministry of Health to improve the detection and treatment of paediatric TB.

So far, target health facilities have screened nearly 211 000 children, doubling the number of children diagnosed with TB in these clinics.

Diagnosing TB in children is often missed due to non-specific symptoms and child-unfriendly diagnostic tests. Health workers often lack knowledge and capacity to screen children for TB and provide prevention services. 

The project has brought innovations for TB screening for children into all service points.

Besides, cough monitors and 324 health workers have received training in paediatric TB management, improved clinical diagnosis and chest X-ray interpretations.

“Previously, we used to have challenges screening children for TB because of high number of  patients a clinician sees every day. With the introduction of CaP TB, we pay closer attention to children suspected to have TB, and this has improved the way we care for and treat TB patients,” says Dr Precious Kadzamira, senior medical officer at Ndirande Health Centre.

Dr Kuzani Mbendera,  childhood TB programme officer at NTP, attributes the milestones to the joint technical expertise rendered to the health facilities.

Egpaf has procured equipment for advanced sample collection for children in six sites and empowered Paradiso TB Trust, which advocates childhood TB services and spreads key messages.

“The innovative diagnostic and care approaches have become a game-changer in childhood TB care,” says CaP TB project manager Yusuf Bhamu.

“In collaboration with the NTP, we want to ensure that the new differentiated model of care for TB in children is defined as Malawi adopts a patient-centred approach so children are provided with optimal TB care.”

Today is World TB Day themed: It’s Time.

Egpaf  and NTP will scale up the innovative project from 16 to 40 high TB-burden health facilities in seven districts.

TB accounts for nine percent of all new and relapsed TB cases in Malawi.

“Our core mission is to support and work hand-in-hand with the Ministry of Health to deliver services to improve the health of children at risk,” says Veena Sampathkumar, Egpaf country director in Malawi. “TB is preventable and treatable, so it is imperative that we leverage innovations in our public health programmes to stop children from contracting or dying from TB.”