The deaths of more than 74 000 children worldwide from tuberculosis (TB) could be prevented each year through measures outlined in the first ever action plan developed specifically on TB and children.
The Roadmap for Childhood TB: Toward Zero Deaths launched by global health leaders in the fight against TB including the World Health Organization (WHO), the International Union Against Tuberculosis and Lung Disease (The Union), Stop TB Partnership, UNICEF, U.S. Centres for Disease Control and Prevention (CDC), United States Agency for International Development (USAID) and Treatment Action Group (TAG), estimates that US$120 million per year could have a major impact on saving tens of thousands of children’s lives from TB, including among children infected with both TB and HIV.
In Viet Nam, TB is often undiagnosed in children from birth to 15 years old. Children either lack access to health services or health staff are unprepared to recognize the signs and symptoms of TB in this age group. With better training and harmonization of the different programmes that provide health services for children, serious illness and death from TB could be prevented.
According to WHO estimates, children in high TB burden countries can account for six per cent of infection cases. In Viet Nam this translates to at least 7,800 TB cases among children. Vietnam has a high proportion of children in the population (24%, 21 million) and a high rate of malnutrition (7.1% malnutrition, 30 % stunting). However, the number of children under 15 years of age diagnosed and reported is only 1,000-1,300 cases annually, accounting for 1-1.3% of total TB cases notified.
The launch of the first roadmap on TB and children follows increasing awareness on the urgent need to address the issue. In June 2012, more than 175 nations pledged their commitment to a global child survival movement entitled A Promise Renewed, to redouble efforts to stop children from dying of preventable diseases, including tuberculosis.
A small price tag to halt a global disease
The US$120 million a year in new funding for addressing TB in children from governments and donors includes US$40 million for HIV antiretroviral therapy and preventive therapy (to prevent active TB disease) for children co-infected with TB and HIV.
The funds will also go towards improving detection, developing better medicines for children and integrating TB treatment into existing maternal and child health programmes. Getting more paediatric health professionals to actively screen for TB with better tools, i.e. drugs, diagnostics and vaccines, will help capture the full scope of the epidemic and reach more children with life-saving treatment sooner.
Ten actions to save young lives
The Roadmap for Childhood TB: Toward Zero Deaths recommends ten actions at national and global levels:
- Include the needs of children and adolescents in research, policy development and clinical practices.
- Collect and report better data, including preventive measures.
- Develop training and reference materials on childhood TB for health workers.
- Foster local expertise and leadership among child health workers at all levels of health systems.
- Use critical intervention strategies, such as intensive case finding, contact tracing and preventive therapy; implement policies enabling early diagnosis; and ensure there is an uninterrupted supply of high-quality anti-TB medicines for children.
- Engage key stakeholders and establish effective communication and collaboration between the health sector and other sectors that address the social determinants of health and access to care.
- Develop integrated family- and community-centred strategies to provide comprehensive and effective services at the community level.
- Address research gaps in the following areas: epidemiology, fundamental research, the development of new tools (such as diagnostics, medicines and vaccines); and address gaps in operational research and research looking at health systems and services.
- Close all funding gaps for childhood TB.
- Form coalitions and partnerships to study and evaluate the best strategies for preventing and managing childhood TB, and for improving tools used for diagnosis and treatment.
National TB programme in Viet Nam
Addressing this challenge of childhood TB in Viet Nam, the National TB programme has established a childhood TB working-group in 2011. The group has revised the national guidelines for TB in children. In 2012 with support from USAID the national TB programme introduced a pilot programme in 4 provinces (Hanoi, Ho Chi Minh City, Thai Binh and Can Tho) to improve diagnosis of childhood TB.
With support from the Global Fund, Viet Nam will increase its activities between 2013-2015 to address TB in children across 18 provinces through training programmes, health education, provision of child friendly combination drugs, monitoring and coordination within paediatric hospitals. The aim of these activities is to increase the percentage of notified TB cases in children (who currently account for 34% of the total population) at provincial level to six per cent by 2015-2016.