What about the children......?

Kids can catch TB from the very close contact they need from mothers and family. There's nothing new in this, of course - it's always been that way. 

When there are high rates of HIV in their community, however, the situation becomes a bit more complicated. If the mother herself is co-infected with HIV and TB (as is too often the case in Southern Africa) the odds for the child become dreadful: maternal TB is associated with a 2.5-fold increased risk of vertical transmission of HIV infection to the unborn child (a risk which is normally about one in four); similarly, HIV infection is a known risk factor for developing active TB disease in infants or children.

It is currently estimated that between 10-15% of TB cases each year occur in children.

The WHO suggests that "at least half a million" children worldwide became ill with TB in 2011 - but the figure may really be well over a million. The WHO  also officially estimates that TB kills "more than 64,000 children each year", this figure alone making it one of the leading causes of death in children worldwide. But it's well recognised that this figure is seriously under-estimated: ineffective diagnoses (see below) mean that many kids go both untreated and uncounted; and kids with a primary HIV infection don't get counted at all even if they die of TB - because they are all officially designated as casualties of AIDS. 

Put these two factors together and the true figure is probably well over 150,000.

The number of children affected and killed by drug-resistant TB is completely unknown and, as far as we know, officially unestimated.

All this is awful in itself, but even the most accurate numbers can't begin to capture the suffering and injustices facing children with TB worldwide.

The medical status quo appears to have astonishingly as good as ignored pediatric treatment for TB. Just this  November, one of MSF's doctors bemoaned the unbelievable "sad reality that until just last month, there was little data on the global burden of pediatric TB.” The World Health Organisation has just added recommended fixed-dose drug combinations for treating children with drug-sensitive TB onto their "expression of interest" list for manufacturers to submit products for evaluation for WHO prequalification (so there are still no approved formulations for first line TB drugs - just a plan to finally approve some).

What this means is that clinicians have to cut up or grind up existing adult dosages of TB drugs and administer them based on their own best judgements.

These drugs, it should be remembered, are over forty-five years old!! But at least this offers some hope for proper treatment of kids with drug-sensitive TB in the future.

For children with drug-resistant disease the situation is even more appalling.

MSF report that, of the existing range of approved second-line drugs, only three are licensed for use at all in children. One of these, levofloxacin, has not actually been approved beyond 14 days of treatment though, when two years of treatment is required. And for one of the other two, there is no clarity regarding the safety and efficacy of its use in children - so in essence only one second line drug is properly approved for use on kids when four are required in combination....

(...and all of these drugs are also over forty-five years old.....)

Worse still, MSF reported this November that, in their experience, the standard diagnostic method for detecting TB (sputum testing) is as little as 10% reliable in children. Part of the problem is that kids just don't carry sufficient numbers of bacteria in their sputum to detect using standard smear microscopy. So what do they do? In an attempt to get adequate samples, health workers are forced to use invasive and painful measures, involving forcing vapour into their lungs to make them cough up sputum, or sucking out sputum from their stomach,” said Dr Martina Casenghi, Scientific Advisor for MSF’s Access Campaign.


This sputum test, by the way, is over 125 years old. So it perplexingly appears to have taken over a century and a quarter to conclude that it is so unreliable for kids......

As we suggested - even the most accurate figures (if they existed) cannot begin to capture the suffering and injustice suffered by kids with TB.

And if this weren't enough, in 2010 the WHO published their estimation that there are about 10 million kids who are orphans because of the deaths of their parents from TB.

We've come across a song lyric by an American rap artist called Sage Francis who released a song just last Saturday ("World AIDS Day") about a bunch of kids he'd met in South Africa who had been orphaned by AIDS. It sums it up - especially since he calls it "Ubuntu"...

                                                           UBUNTU.                                                                             (What's bad for you is bad for me).

Zinhle, Sfundo, Snetemba, Zakheni, Ntokozo, Thandiwe,
stay strong…be brave.
I'll make sure this world knows your names. 

You were born on the front lines of a country that isn't mine
With a virus I don't have. Our family has no ties.
Nevertheless, I see you. 

Sawubona. Yebo. Unjani?
I'm fine.
I'm just praying for science to turn water into wine.
I'm just praying for science to turn water into wine.
I'm praying we're not just left with prayer all the time. 

But more importantly here's how you can he