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“Innovative Methods For Diagnosing TB in Children”

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“Innovative Methods For Diagnosing TB in Children”



Tuberculosis, a preventable and curable disease, continues to claim thousands of lives in Zimbabwe annually, with children being the most vulnerable due to delayed diagnosis and inadequate treatment.
Tuberculosis diagnosis in children is challenging due to their inability to communicate and the lack of bacteriological confirmation in over 50% of cases.
This was communicated by Dr Fungai Kavenga, Deputy Director in the Department of TB Prevention and Control in the Ministry of Health and Child Care, (MoHCC).
He was educating editors from various publications and station managers at a National Aids Council workshop in Chinhoyi.
Dr Kavenga spoke on the challenges of diagnosing TB in children due to many factors.

He, however, said there were innovative methods to break the barrier.
“TB spreads through airborne droplets when an infected person coughs, sneezes, or talks. TB is airborne and is caused by a bacteria called mycobacterium tuberculosis. Since it is airborne, everyone is at risk of acquiring the disease. TB diagnosis in children is challenging. We therefore miss other children from the correct diagnosis spectrum,” said Dr Kavenga.
“Locally, our first port of screening is paper based on these questions asked.
Has one had chronic coughing lasting more than a week?
“Is the person coughing up phlegm (gararwa)?

“On bacteriological confirmation, with childhood TB, over 50% of cases are bacteriologically negative. So, using the tests mentioned earlier will not help. Child-friendly specimens are only recently being scaled up with the use of stool.”

Does one feel any chest pain, shortness of breath or discomfort, fatigue (feeling weak or tired), weight loss, loss of appetite, fever (recurring or persistent), and night sweats If yes, then a test to determine if one has tuberculosis is done,” Dr Kavenga educated the forum.
“For adults, one is asked to cough out a phlegm, and this is used for the sputum test. This is a test to see if there are TB germs in the phlegm. Another method is the smear test, which is also a laboratory based test that can find the TB germs in a sample.
A chest x-ray can also be used to check for signs of TB in the lungs.
“There is also what is called a culture test. This test can find the TB germs in a sample and determine which medicines can kill them,” said Dr Kavenga.
Dr. Kavenga said children got TB infection through exposure. Exposure is when one is living with a TB patient. TB patients are infectious before treatment. On commencing treatment one is no longer infectious after two weeks. By nature of children being unable to communicate, if they are not coughing, TB in children may take longer to be detected.
He, therefore, urged parents and caregivers to take note of any changes in their children.
“With an epidemiological estimate of 12% of adult cases, no actual verification studies have been done. This translates to about 4000 annual cases. However, we have been able to diagnose just half of those annually.
There was a challenge in collecting specimens in children because they could not cough up phlegm to do the sputum test.
“Usually, with no TB exposure in a family, there is a low index of suspicion among clinicians.
“We have suboptimal chest X-ray coverage (CXR). This diagnostic aide is not available in all health facilities.
“We also have suboptimal CXR interpretation skills. Not all health care workers are fully trained in presumptive TB interpretation for children.
“We also have suboptimal use of Mantoux.
“Low health care worker capacity is a limitation as trainings were limited and more mentorship is needed,” said Dr Kavenga.
Dr. Kavenga said good nutrition plays an important role in preventing TB.
“In screening symptom, using the TB screening tool and nutritional assessment helps.
“Diagnosis of childhood TB, we use the Gene Xpert or Truenat if these modern tools are available. Not many facilities have these two. We are scaling up as modern tools to simplify diagnosis.
“Specimens from children include stool, sputum, gastric lavage, nasopharengeal aspirates. “Additionally, children living with HIV can be tested using urine LF LAM,” said Dr Kavenga.
Lateral Flow Lipoarabinomannan (LF-LAM) test detects a component of the TB bacteria in urine, making it a useful tool for diagnosing TB in children and people with weakened immune systems, such as those living with HIV.
The LF-LAM test is a simple and quick test using urine. The results are out in 20-30 minutes.
It is a good method as it is non-invasive.
It uses urine instead of blood or sputum.
It is very useful for children and those with difficulty producing sputum.
The test is more sensitive in people with HIV/TB co-infection.
“The LF-LAM test is a valuable addition to the diagnostic arsenal, especially in resource-limited settings where TB is prevalent,” said Dr Kavenga.
When asked about the number of children born with TB, he said that although there are children born with TB, it is very rare.
“Although there is what is known as Congenital TB, children born with TB, it is rare. It can either be transmitted through the placenta or TB in a neonate contracted within the first 28 days of life. This form of TB needs early diagnosis and treatment,” he stated.
“For babies with a parent or living under the same roof with a TB patient, they are exposed to TB and, therefore, require prevention precautions.
“In terms of babies exposed to TB, yes, we give isoniazid for 6 months, based on weight. This TB drug prevents progression from TB infection to TB disease,” educated Dr Kavenga.
There are now child-friendly strawberry flavored syrups for children overcoming the pill burden and nasty pill taste.
TB is a notifiable disease.
In 2021, an estimated 29 000 people in Zimbabwe contracted TB, with 6 300 dying from the disease. (WHO) .

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