Childhood TB cases spark calls for wider screening

The new breast milk bank is expected to help feed orphan infants as well as those in the care of guardians like grandmothers (File photo)
Children comprise between 15 and 20 percent of TB cases in South Africa

Refilwe Mosito is a security guard at Soshanguve Block BB Clinic outside Pretoria. She is also a new mother to a seven-month-old baby girl who until recently had been the picture of health.

“My baby lost her appetite, and she was weak and coughing,” Mosito told OurHealth. “I took her to KT Motubatse Clinic and she was given treatment, which didn’t help.”

Desperate to find answers to her daughter’s ailments, Mosito then consulted a private doctor for a second opinion. The doctor referred mum and baby back to Soshanguve Block BB Clinic for X-rays, which confirmed the baby had TB and needed immediate treatment.

When people are diagnosed with TB, health care workers often try to trace people with who TB patients have been in close contact. This allows health workers to offer people who might have TB and not know it quicker access to testing and treatment.

When nurses repeatedly asked Mosito who at home had TB, she said she could not think of anyone.

“I had forgotten about my neighbour, who sometimes holds the baby during his visits,” said Mosito, who adds that while she cannot be certain, she believes her child may have contracted TB from her neighbour and close friend.

Because she works at the clinic, she has always collected her friend’s TB medications at the clinic. He then comes to her house to collect the medicines and she makes sure that he takes them as prescribed.

Weaknesses in paediatric TB diagnosis and treatment

People with weak immune systems, like children, the elderly, and HIV and diabetic patients are at increase risk of developing active TB. To help protect children, HIV-negative babies in South Africa are inoculated against TB at birth with the Bacillus Calmette–Guérin (BCG) vaccine.

In Tshwane, about 94 percent of children receive their BCG vaccination – just like Mosito’s daughter.

The BCG vaccine is about 70 percent effective against some of most severe forms of childhood TB but is less effective in preventing TB of the lungs like that which Mosito’s baby developed, according to the World Health Organisation (WHO).

According to nurses, the baby is now on antibiotics and paracetamol as they await further test results.

Children represent as much as 20 percent of TB cases nationally in South Africa, according to a recently released WHO report. The report notes that many health workers still do not feel comfortable diagnosing TB in children, who often have a difficult time coughing up mucous for further testing.  For those children who are diagnosed with drug-resistant TB, the report noted a lack of child-friendly treatments available.

To address some of these challenges, the WHO review suggested that routine TB screening be provided as part of maternal and child health programmes.

Watch “The Hidden Epidemic” a Health-e documentary on childhood TB in South Africa.


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