On World Tuberculosis Day 2022, WHO celebrated that Cambodia has now phased out of the WHO global list of 30 countries with high TB burden (2021-2025). While this excellent news represents a decline in TB prevalence and incidence in the country, it also highlights that there is much more work yet to be done. The country still remains a TB endemic country, and on the global TB watch list.
Finding TB cases in Cambodia is one of the key challenges. The national program has reported that an estimated one-third of TB cases have not yet been identified, or are “missing”. Among these “missing” TB cases are thought to be many children, a particularly vulnerable population.
“Early TB screening, contact investigation, diagnosis, disease treatment and preventive treatment in children is particularly important. Early access to TB prevention, treatment, and care service helps children to stay healthy, engage with schooling, play with their family and friends and lead a long life.” says WHO Representative to Cambodia, Dr Li Ailan.
Young children are at particular risk of TB as their immune system is still developing. Other risk factors include poverty, malnutrition or having other immune suppressing illnesses, such as HIV. Children living in a household with others affected by infectious TB are especially susceptible, and newborn children of mothers with TB are at high risk.
While childhood vaccination against TB is critical, the current BCG vaccine has limited efficacy against other forms of tuberculosis. Vaccinated children are shielded from contracting the most severe forms of TB (meningitis and disseminated TB disease) but not against contracting it from an infectious person, such as a family member.
“My grandson was screened for TB because he lives with his grandfather who was treated for pulmonary TB. I was told by health and NGO staff about the benefits of TB treatment prevention for children living with TB patients to prevent them from catching it. I agreed to have my grandson take medicine for TB prevention.” Says Sin Leang, in Talak village, Kampong Speu. “I crush the drug and mix it with porridge and then feed it to him; it is easy for him to take. My grandson is obedient, when I call for taking the drug he comes and takes it. He looks healthy now. I hope he will not have TB.”
Grandma taking care of children taking TB preventive treatment. Takal village, Kampong Speu province.
© WHO/Deng Serongkea
It can be difficult to diagnose TB in young children as they may not display typical TB symptoms, or it may not be possible to take samples for testing. This makes it very hard to determine the exact number of childhood TB cases in Cambodia. This is why systematic screening for children in households with other people with the disease is so important, as is building TB knowledge among maternal and child health workers.
Combatting childhood TB is one of the WHO “End TB” strategies, and a core priority of Cambodia’s National Strategic Plan to End Tuberculosis 2021-2030. TB preventive treatment was one of the targets set by UN high-Level meetings on TB from 2018-2022. It aimed to reach 30 million eligible people of all ages with receive TB preventive treatment by 2022. TB Preventive treatment of young children living with TB patients will greatly reduce the likelihood of them developing the disease. With support from international partners, TB screening in children, contact investigation, referrals and provision of TB preventive treatment now occurs in ninety-nine Operational Districts. In 2021, over 5,000 childhood cases were notified and treated across the country, using the new drug formulation specific to children.
To support this national effort, Cambodia’s National Center for TB and Leprosy Control (CENAT), has updated and implemented national guidelines incorporating the latest WHO recommendations, including different regimens for children, and extending the age group eligible for preventative treatment to include those over five years of age. Scaling up preventative treatment, WHO has provided enough doses of a new drug regimen – called 3HP - to treat an additional 5,000 patients. Last year, a total of 11,895 eligible people received preventive treatment, continuing an increase from before the new guidelines were implemented in 2019.
On World Tuberculosis Day 2022, WHO congratulated the Ministry of Health and all Cambodian health workers for their continued efforts to stamp out tuberculosis cases across the country, and especially in children. WHO also views the COVID-19 pandemic as presenting a unique opportunity to use lessons to strengthen our current health system. We can use our experiences of responding to, and preparing for, the virus to improve primary health care, including universal health coverage. This systemic approach to reach the unreached will contribute to a healthier, safer Cambodia, including those with TB. The goal of reaching zero tuberculosis deaths among children is in sight, not only here in Cambodia, but indeed across the world.