Breaking the Silence: Confronting the Paediatric TB in India

Tuberculosis (TB) remains a serious public health crisis in India and its impact on children is particularly devastating. Despite significant strides, paediatric TB continues to remain undiagnosed and not timely treated, which leaves thousands of children vulnerable to long-term health complications and mortality (WHO, 2022). Addressing these issues is crucial for India’s goal of eliminating TB.

India accounts for nearly one in every four TB patients globally, and an estimated 342,000 children (aged 0-14 years) develop TB annually (India TB Report, NTEP, 2023). Despite paediatric TB accounting for around 13% of the total TB caseload, only 6% of these cases are notified. In 2022, 135,000 TB cases were officially notified within the 0-14 years age bracket. Paediatric TB goes undetected due to the difficulty of diagnosing the disease among children. Unlike adults, children with TB frequently present non-specific symptoms, and their sputum samples, rarely yield positive results, making the existing diagnostic methods inadequate (ICMR, 2022).

Through the National Tuberculosis Elimination Programme (NTEP), Government of India has made considerable efforts to eliminate TB. However, management of paediatric TB requires some more focused approach. Molecular diagnostic tools, like Nucleic Acid Amplification Tests (NAAT) have improved detection, but these are not widely accessible to rural areas (Lancet Global Health, 2023). Expanding access to these tools and increasing training of healthcare workers to recognize paediatric TB symptoms are key steps in filling the diagnostic gaps (Lancet Global Health, 2023).

Treatment adherence found to be another major challenge among children diagnosed with TB. The standard six-month long treatment is difficult for children, especially those from the lower socio-economic background, who have limited healthcare access. Moreover, the stigma associated with the disease may be making many children suffer in silence. And children with TB also face nutritional deficiencies (UNICEF, 2023).

Prevention is critical to managing the paediatric TB crisis. While the BCG (Bacillus Calmette Guerin) vaccine provides some protection, but the community level active case finding, household screening, identifying the malnourished children through contact tracing, and providing them with preventive therapy are necessary steps (WHO, 2023). Since, malnourishment makes the children more susceptible to TB, integrating the TB elimination efforts with nutritional support programs can help address the problem.

A multi-faceted and multi-sectoral initiative is necessary to fight paediatric TB. Increased community awareness campaigns, comprehensive program strategy, integration of vertical programs and increased research support can accelerate the progress in this regard. In order to achieve the Country’s goal towards secure and healthy society, India’s TB elimination efforts should also prioritize strategies around paediatric TB which has been an overlooked crisis.

References:

• WHO. (2022). Global Tuberculosis Report. Retrieved from [WHO website]
• ICMR. (2022). Paediatric Tuberculosis in India. Retrieved from [ICMR website]
• NTEP. (2023). National Tuberculosis Elimination Programme Overview. Retrieved from [NTEP website]
• Lancet Global Health. (2023). Advances in TB Diagnosis and Treatment.
• UNICEF. (2023). Challenges in Paediatric TB Treatment Adherence.
• WHO. (2023). Preventive Strategies for Tuberculosis Control.