Children fall through cracks of TB programme
‘My name is Blessing Mohoje Tshegofatso. I’ve been a patient at Sizwe Hospital for two months. I have TB of the lungs. I started getting TB when I was young. Now it’s my second time with TB’, says 11-year old Blessing.
‘According to the history taken by the mother, his first episode of TB was at the age of one. He completed treatment. He was fine until July last year. He broke down with all the symptoms classical for TB in July and he was admitted for a while and treated at Sebokeng Hospital and, then, discharged to the clinic. But he was not better. He was actually deteriorating and apart from the cough he became very short of breath. Meanwhile, the results came and he was diagnosed in September (with) MDR TB and referred here where he arrived in January’, adds Dr Tanya Viscovic, a paediatric doctor at Sizwe Hospital.
Viscovic is not sure if Blessing defaulted on treatment during his second brush with TB.
‘We are not sure. Was he compliant or not? But he did not improve on treatment given’, she says.
But ‘most of the children that come here is because they defaulted the initial sensitive TB treatment at home’, says hospital CEO, Dr Rianna Louw.
‘And, therefore, it is so much important that when you discharge them here you need to make sure that they now take their treatment because, as I said, they’ve already ‘ most of them – defaulted initially and that is why their TB became resistant’, Louw continues.
Blessing is under strict medical care at Sizwe and in the two months that he’s been here, his doctor says his condition is improving.
‘He’s getting lots of TB medicines in addition to other medicines. We’re giving antibiotics, for example, for associated chest infection. He is feeling better and we are happy with his progress’,Dr Viscovic says.
When asked if he is feeling ill at all, the young patient answered: ‘No. I’m great!’
Blessing is one of the thousands of children known to have contracted TB in South Africa. But reliable statistics regarding the extent of the disease – both sensitive and drug-resistant TB in children – are non-existent. Conservative estimates are that there are almost 50 000 children under the age of 15 who have TB in the country. But there is a serious under-diagnosis of child TB in the country.
‘In terms of child MDR-TB, we know that at any given time we admit about 17, but we’re still very worried that there is an under-diagnosis of children because we admit about 40 adults in a month with MDR-TB and, yet, you would have expected that children would have contracted the MDR from them. But our numbers in terms of children are not so much increasing’, says Dr Louw.
At a national level ‘we don’t have proper estimates’, David Mametja, head of the Department of Health’s TB programme, admits.
‘It’s a challenge’¦ and we are engaging with the research community to assist us in terms of providing those estimates. But I’ll be surprised if it’s not very, very high. With the large numbers that we have with adults having TB; and we know that adults live amongst kids; and kids are more vulnerable to be infected with TB’¦ So, the numbers should actually be higher than the numbers that we are currently seeing’, Mametja concedes.
At Sizwe, Dr Viscovic says the biggest contributor to MDR-TB under-diagnosis in children is the current diagnostic method.
‘It’s very hard to obtain the specimen for diagnosis. (The) most common specimen which proves MDR-TB is the sputum. As we know, children cannot cough out sputum’, she says.
Often, doctors have to perform a procedure known as gastric washing in order to obtain a diagnosis.
‘It’s very simple technically. You just take a naso-gastric plastic tube and you insert the tube through the nose and oesophagus into the stomach and you just draw gastric fluids. It’s not a painful procedure, but it might be a little bit unpleasant’, Dr Viscovic explains.
While waiting for laboratory-confirmed results, clinical staff often relies on what they observe of the child to determine whether it has drug-resistant TB. What they observe for includes whether the child lives with a family member who has drug-resistant TB or whether there has been a death in the family as a result of the disease as well as X-ray evidence and other clinical symptoms. Often, Sizwe will admit and treat children without proof of infection until they have the lab results.
In the meantime, Blessing still has four months to spend at the hospital before he can be released as an out-patient. As an out-patient, he will be followed up for up to three years before clinicians can be absolutely sure that he is cured. While in here, there is so much that he misses about life back home in Evaton.
‘I miss my friends, TV, my mother too, and my family’, he says.
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