Tuberculosis (TB) Day brings into focus the worldwide epidemic of Tuberculosis.
This is, despite the causative agent of TB, Mycobacterium
Tuberculosis, being discovered in the 1880’s, and the first successful
anti-TB drug trial being published in 1948.
Tuberculosis is a preventable disease. A
few simple steps, such as cough hygiene, good ventilation in work areas, and
preventative treatment to those at highest risk of contracting TB, can
dramatically decrease the incidence of new TB infections.
But why with effective preventative
strategies and the existence of effective anti-TB
treatment, does TB remains a huge public health problem in South Africa?
The country has seen the emergence of,
resistant (MDR) Tuberculosis and, later, extensive drug resistant (XDR)
rise of TB
In the past five years there has also been
a rise in the incidence of TB infection among health care workers (including
MDR and XDR Tuberculosis).
This has all happened while the country has
been battling another epidemic – that of HIV.
South Africa is the country with the third highest incidence of TB in the world
and is also internationally known as the country with the largest HIV
does TB spread?
The emergence of HIV has not only changed
the face of public health-care in general, but has had detrimental consequences
in the fight against TB. It is estimated that almost 75% of those ill with TB
are also infected with HIV.
with HIV complicates the diagnosis and treatment of TB. Many of the
symptoms of TB, such as loss of weight, loss of appetite, coughing and night
sweats, can also be explained by HIV infection. Reluctance to seek health care
for fear of being confronted with a diagnosis of HIV, quite often delays the
diagnosis of TB.
is known about childhood TB and HIV
Among all the numbers, discussions, drug
formulations and research is the little known and much neglected epidemic of
childhood HIV/AIDS and TB. Figures describing childhood TB are often out-dated
and mostly underestimate the current situation.
Children in South Africa receive a TB
vaccination at birth, but all children younger than five remain at high
risk of contracting TB once they come into contact with an adult infected with
Globally, the diagnosis of TB in children
remains problematic. The conventional approach to diagnosing TB in adults
(using X-rays and sputum) does not always provide an answer in children with
TB. Radiological features in children are non-specific and they don’t often
cough up sputum.
On top of this, a child co-infected with
HIV is even more difficult to diagnose. Radiological features of HIV quite
often overlap with those of TB.
TB and HIV together?
treatment is possible, but complicated
TB is not only preventable, but is also
curable. Treatment, however, is unpleasant, protracted and consists of multiple
Failure to comply with treatment, missed or
incorrect drug dosages can give rise to drug resistant TB. Once a child has
been diagnosed with drug resistant TB, the treatment becomes even more
unpleasant involving daily injections.
drugs are not child-friendly
Drug formulations are often not child friendly
– large tablets are difficult to swallow and syrups are unpalatable. Dealing
with this for a six month period, is often too difficult for families and
children and, therefore, children often don’t complete treatment.
This can lead to devastating consequences.
Some children need to be admitted to a hospital for the duration of TB
treatment, which has consequences on their education.
do you treat TB?
Even though the fight against childhood TB
and HIV/AIDS remains immense and difficult, it is not all doom and gloom. The need
for research into effective diagnostic procedures and treatment for childhood
TB has been well recognised in the past few years.
is being done about this?
The Desmond Tutu TB centre at Stellenbosch
University received international recognition in 2013 for their work. Their
research on new, more effective vaccines, diagnostic procedures and child
friendly drug formulations is on-going.
The late President Nelson Mandela said:
“There can be no keener revelation of a society's soul than the way in which it
treats its children.”
On World TB day we recognise that the fight against
childhood TB and HIV/AIDS is immense, difficult and far from over, but let the
world look at us and see our soul as we continue working towards beating both
these diseases to ensure healthy children in South Africa.
Written By: Dr Irma Kruger, Faculty of Medicine and Health Sciences, Stellenbosch University
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