Bill & Melinda Gates Foundation

Ending Childhood Tuberculosis

October 04, 2013

Tuberculosis (TB), as we know, is preventable and treatable.  Then why are we still grappling with it? 

TB is still a major infectious cause of disease and death in adults globally, and infants and young children are particularly vulnerable to severe and fatal disease. We know that tuberculosis in children is common wherever tuberculosis in adults is common, but we still do not know the true burden of disease in children.

Mavuto’s Story

The story of Mavuto, a nine-month old Malawian infant whose name means “trouble” in the local language, illustrates the situation of childhood TB up until today.

Mavuto came to the hospital with seizures and coma.  His mother who brought Mavuto to the hospital, said that Mavuto’s father had been diagnosed with TB when Mavuto was 2 months old but was now better after treatment. Mavuto was diagnosed with TB meningitis, a disease that is caused by tuberculosis bacteria invading the fluid surrounding the brain and spinal cord. TB meningitis is often fatal despite treatment. Mavuto spent 2 months in hospital and required feeding by a tube. When he went home, he was disabled and unable to feed himself.. 

Mavuto’s story is even more profound when you consider that many children don’t recover from this disease —in fact, 74,000 children all over the world die each year from TB, and yet they do not need to.

The Roadmap for Childhood Tuberculosis

Finally, this neglected but important contributor to child morbidity and mortality is gaining recognition. The Roadmap for Childhood Tuberculosis – Towards Zero Deaths launched earlier this week in Washington, D.C., is a landmark report that outlines a clear path towards diagnosing, preventing and ultimately eliminating this disease in our children.

The Roadmap recognizes critical future research needs, while providing a strong focus and direction on applying the tools we already have. Addressing the current wide policy-practice gap will require strengthening linkages and collaborations between tuberculosis control programs and other health sectors, especially the child health sector. Furthermore, contact screening of infectious cases that are managed within the tuberculosis control program can be supported by community-based health workers that provide services for maternal and child health.

The Roadmap’s Key Steps to Eradicating TB

The Roadmap offers a number of common sense steps that can help reach the goal of eradicating childhood TB:

  • Think about and recognize tuberculosis in the context of common childhood illnesses especially acute and chronic respiratory disease or malnutrition.
  • Include children as an important priority in national health programs and seek to implement contact screening and management.
  • Increase collaboration  between the tuberculosis program and other health providers, especially maternal and child health sectors, leading to a more integrated, family-centered and mutually supportive approach that improves case-finding, care and accuracy of data for monitoring and evaluation. USAID has a great new video that shows how this would work.
  • Educate the health care community about the misperception of the difficulty in diagnosing the disease in children and find new diagnostic tools that recognize the different disease pattern in children
  • Fund childhood TB for prevention, management and research. The Roadmap estimates that $120 million a year will be necessary to achieve this goal.
  • Invest in developing more effective and child-friendly diagnostic tools and medicines for the future.

With improved overall TB control, children like Mavuto won’t have to suffer or die from this disease.  Child contact screening and management is universally recommended but rarely implemented right now, and yet it will help detect the disease earlier and provide preventive therapy to protect well child contacts from developing TB.  

 
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