Theme II (e-consultation): Getting to zero TB deaths in children by 2015


(CLICK HERE TO COMMENT!)
The theme II of the time-limited online consultation on childhood tuberculosis (TB) in lead up to the World TB Day is: "Getting to zero TB deaths in children by 2015." Have your say before 11th March 2012 - share with us - how to correctly diagnose and treat TB in children and achieve 'zero TB deaths' in children by 2015, in your local settings. Your perspectives, opinions and voices are important for us and we do look forward to them.

GUIDING QUESTION
How to correctly diagnose and successfully treat TB in children in your local settings?

This e-consultation on childhood TB is being facilitated by the Citizen News Service (CNS), a partner of the Stop TB Partnership, along with many other organizations and networks that have endorsed this initiative and joined as a partner (see the list below).

HOW CAN YOU HAVE YOUR SAY?
Join the new Stop-TB eForum by sending an email to: stop-tb-subscribe@yahoogroups.com and have your say by sending your comments to stop-tb@yahoogroups.com
Be a partner of this online consultation - to be a partner organization, send an email to: bobby@citizen-news.org
Email us your comments, perspectives and experiences at: stopTB@citizen-news.org
- Go online at CNS blog: www.citizen-news.org and publish your comments real time! 
Skype us and we will record your statement (skype id: bobbyramakant ). To schedule skype appointment, email: bobby@citizen-news.org
Tweet us! use #tag: #childhoodTB
- Have your say on our CNS Facebook page
Call us and record your statement! (+91-98390-73355)

TIMELINE for THEME II
Responses to theme II are welcome till 11th March 2012, after which a summary report of Theme II, will be compiled and released to mark World TB Day.

REFERENCE DOCUMENTS:
Call for Action for Childhood TB (launched in Stockholm in March 2011)
PARTNERS
International Union Against Tuberculosis and Lung Disease (The Union)
Irish Forum for Global Health (IFGH)
TB Alliance
McGill TB Research Group
Treatment Action Group
International Council of Women living with HIV (ICW) Zimbabwe
Asian Harm Reduction Network (AHRN)
ACTION
TB Alert
International Treatment Preparedness Coalition-India (ITPC-India)
Global Health Strategies
PATH
Diabetes Foundation (India)
Cambodian Health Committee (CHC)
L’Association de Lutte Contre la Pauvreté en abrégé (ALCP)
Positive Muslim Group, Myanmar
Life Foundation, Pakistan
The Good Neighbour Nigeria
University of Nairobi, Kenya
Medical Care Development Inputs (MCDI) Kenya
Kenya Consortium to Fight TB, Malaria and AIDS (KECOFATUMA)
Partnership for TB Care and Control, India
Karnataka Health Promotion Trust (KHPT)
National Coalition of PLHIV in India (NCPI+) 
PCI India
MAMTA Health Institute for Mother and Child
SNEHA
Institut Pasteur de Madagascar
Institute for Plantation Agricultural And Rural Workers (IPARW)
Advocates for Health International
Rural Youth Advocate for Health and Development in Nigeria (RYAN)
Citizens for Healthy Lucknow (CHL) initiative
Wote Youth Development Projects, Kenya
Saaksham Foundation
TEST Foundation
PREPARE Foundation

JBS Foundation
Abhinav Bharat Foundation (ABF)
Asha Parivar
Samadhan
National Alliance of People's Movements (NAPM)
PRAYAS Health Group
Indian Society Against Smoking (ISAS)
Citizen News Service (CNS)

Looking forward to a meaningful dialogue,

Citizen News Service (CNS)
Email: stopTB@citizen-news.org

47 comments:

  1. How to correctly diagnose and treat TB in children and achieve 'zero TB deaths' in children by 2015?

    Every one in TB or child care work know how difficult it is to diagnose TB among children. My suggestion include:
    1. A large scale campaign by GOI and states to Screen all children by age cohorts of under, 1 year 1-3 years (at home), 3-6 years (at Anganwadi centers) and 6-18 years ( in schools)in appropriate facilities,screening for non-thriving children with no apparent cause and subject them for specialist's examination and investigations.
    2) Once identified manage /treat such children free of cost
    3) Take up health promotion and health education activities through all media particularly TV channels.
    4) Make mandatory for all TV and cable channels to air at least 5-6 times a day showing local TB testing and managing facilities

    Suresh

    ReplyDelete
  2. DEAR ALL,
    GREETINGS.
    To achieve deaths by 2015 first we must diagnose childhood TB at an early stage.

    To diagnose TB in children is a difficult job compared to Aadults.

    As per RNTCP guidelines Suptum examination for AFB is the first choice for diagnosis; but in children it is difficult to bring put sputum.

    But we can try induction methods.

    So, we are left with other diagnostic tolls - like Mantoux test; & Chest X-Ray.

    History of Contact is another important finding that helps the clinician apart from the clinical findings. Inspite of the fact that Sputum is negative ; Tubereculin test is not conclusive and X-ray did not give you any positive finding, it is said that under the RNTCP, the PAEDIATRICIAN'S diagnosis is honoured and Treatment is initiated as per the weight band of the child.

    It is a good step in the right direction that coming Wold TB day is giving special emphasis on Childhood TB and every one of us should contribute our share in this endeavour.

    Dr PS Sarma
    Technical consultant RNTCP
    Founder chairman SMLS Trust
    Email: drpappuss@yahoo.co.in

    ReplyDelete
  3. Comment from Suresh
    ------------------

    How to correctly diagnose and treat TB in children and achieve 'zero TB deaths' in children by 2015?

    Every one in TB or child care work know how difficult it is to diagnose TB among children. My suggestion include:
    1. A large scale campaign by GOI and states to Screen all children by age cohorts of under, 1 year 1-3 years (at home), 3-6 years (at Anganwadi centers) and 6-18 years ( in schools)in appropriate facilities,screening for non-thriving children with no apparent cause and subject them for specialist's examination and investigations.
    2) Once identified manage /treat such children free of cost
    3) Take up health promotion and health education activities through all media particularly TV channels.
    4) Make mandatory for all TV and cable channels to air at least 5-6 times a day showing local TB testing and managing facilities

    Suresh

    ReplyDelete
  4. From: Dr Alex Govender
    Email: AlexG@vwsa.co.za

    Get back to basics – as soon as someone is identified with TB, immediately do contact tracing and consider prophylactic treatment in children.

    From: Dr Alex Govender
    Email: AlexG@vwsa.co.za
    Volkswagen of South Africa (Pty) Ltd. (Reg No. 1946/023458/07)

    ReplyDelete
  5. Being the one connected to the reality existing at the grassroots level, I have an optimistic outlook on that. I see silver linings in as much as the things are changing for the better. The decade-long united efforts by all stake-holders are not going down the drain. We are moving in a right direction with better results today.

    1. With continued success achieved in the recent past, the Revised National Tuberculosis Program [RNTCP] this year has set equal/more than 90% Case Detection rate and similar rate for completed cure as a new target for the year ahead.

    2. The Indian Academy of Pediatrics [IAP] has come out with revised dosages and better diagnostic algorithms for children in a National consultative meet held jointly under the auspices of the WHO and RNTCP on 31 Jan and 1 Feb 2012 in New Delhi is a major gain for this neglected area of Pediatric TB and Pediatric HIV-TB.

    3. With due respect may I take liberty to differ radically from what has been suggested by Dr Aleyamma Thomas, TRC, Chennai, India especially point number 2. when it is advocated to 'Treat all the TB cases irrespective of smear positivity'. It is a sure recipe for creating resistance. Unless there is a sputum positive case, we cannot and must not start anti-tuberculosis therapy [ATT] for Pulmonary Tuberculosis. In Extra-pulmonary TB cases too the emphasis is on finding AFB positive specimen/granulomatous changes. This is in line with expert guidelines for treatment.

    4. Improving nutritional status is an extremely important intervention not only in disease-free population including children but also in patients on ATT.

    5. INH Prophylaxis with 10 mg/kg for 6 month is the revised IPT drug dosage protocol as recommended by the WHO very recently. This needs to be offered with reverse contact tracing. Contact definition for pediatric cases must be specifically followed in all cases.

    6. Early detection of cases goes a long way in prevention and control of the disease.

    7. To boost up and motivate the health system, proper incentives need to be offered in the shape of awards, monetary incentives, concessions in fare etc. in order to enhance rate of case detection, adherence and cure rate.

    8. Easier Fixed Drug Combinations for children in the form of dispersible tablets will do miracles.

    Dr ST WALI
    Consultant Pediatrician and PO [Pediatric Care] - HIV
    NEW DELHI
    Email: drstwali@gmail.com

    ReplyDelete
  6. 1. Strengthen and motivate the health system so as to increase the case
    detection.

    2. Treat all the TB cases irrespective of smear positivity. Comment: To
    eliminate TB we have to eliminate the source of infection. The source of
    infections are those excreting AFB in the sputum.

    3. Strictly implement IPT

    4. Implement Infection control measures at all levels including home, community & Hospital Comment: The best infection control measure is just one and only one: Treat the infectious patient with the proper Anti TB drugs. All other measures are ineffective or not practical.

    5. Improve nutritional status of children Comment: That is a big problem also not helpful.

    6. Proper health education to both ,health providers and the patients.

    Anonymus

    ReplyDelete
  7. It is a hard fact that TB in the paediatric population is overdiagnosed based on CXRs across all the institutions that cater to
    this unique and vulnerable segment of our society.

    It is another hard fact that all these children are put on ATDs ( so
    many many formulations are still around)

    And it is even more sad that these formulations have uncertain
    quantities of the drugs as per bioavailability standards.
    And blanket IPT is hard to find an audience with.

    Point is ARE WE REALLY PROMOTING DOTS?

    A lot needs to be answered to
    the future population riddled with resistance, failure , poverty and
    misery.

    Dr Shanta Ghatak Email: drshantaghatak@gmail.com

    ReplyDelete
  8. (सिटिज़न न्यूज़ सर्विस के राहुल कुमार द्विवेदी ने 4 वर्षीय टीबी रोगी और उनके अभिभावकों से बात की - वो प्रस्तुत हैं)
    (Rahul Kumar Dwivedi from Citizen News Service (CNS) had interviewed parents of a 4 years old child with TB - below are the responses in Hindi. We are translating and soon English version will be published too)
    ******************************

    4 वर्षीय टीबी रोगी का नाम- जुगलकिशोर
    उम्र- 4 वर्ष
    पिता का नाम- शिवप्रसाद
    माता का नाम- राम दुलारी
    व्यवसाय- लेबर

    1- चार साल से बच्चे को खाँसी आती है। एक महीना पहले, जब लोहिया अस्पताल में दिखाया और एक्स-रे कराया और वहाँ पर टीका लगा तब पता चला कि टीबी है. डॉक्टर ने फेफड़े की टीबी बतायी है।

    2- सरकारी अस्पताल में पहले से ही दिखा रही थी और दवा ला रही थी। जब बच्चा छोटा था तभी से दवा ला रही हूँ। पर दवा से कुछ फायदा नहीं हुआ था। और डॉक्टर ने बाहर से दवा लेने को कहा था पर मेरे पास पैसे नहीं थे तो हम बाहर से दवा नहीं लाये। इस बार जब एक्स-रे कराया तो डॉक्टर ने दवा लिखा और बाहर से खरीदने को कहा पर हमने कहा कि मैं दवा बाहर से नहीं खरीद सकती हूँ फिर दवा वहीं से लिखी। हमने बच्चे को गैर-सरकारी अथवा बाहरी डॉक्टर को नहीं दिखाया था। वहीं के डॉक्टर ने बताया कि बच्चे को टीबी है। एक्स-रे भी सरकारी अस्पताल से ही कराया था। हर बार के एक्स-रे के लिए 30 रुपये देने पड़ते थे। एक बार एक्स-रे कराया तो बाहर से दवा लेने को लिखा था पर बाहर से दवा नहीं ले पाये तो दवा नहीं कराये। दोबारा एक लेडी डॉक्टर को दिखाया तो उन्होने फिर से एक्स-रे कराने को कहा और फिर 30 रुपये देकर एक्स-रे कराया। और 35 रुपये भर्ती करने के लिए लिया।

    3- बच्चे को खांसी बहुत आती थी। और सांस लेने में तकलीफ होती थी। खाँसी इतनी ज्यादा आती थी कि घंटों खाँसता रहता था। पीठ पर मालिस किया करते थे। करीब तीन साल से लगातार खाँसी आ रही है। टीबी एक महीना पहले पता चला है। डॉक्टर ने कहा कि दवा खरीद लोगी क्या पर हमने कहा कि मैं खरीद नहीं पाऊँगी तब उन्होने कहा कि ठीक है अभी के लिए दवा ले जाओ। 10 दिनों तक अस्पताल में भर्ती भी थे।

    4- डाट्स सेंटर पर दवा मुफ्त में मिली। कहा गया था कि दवा खरीद लो पर जब हमने कहा कि मैं दवा खरीद नहीं पाऊँगी तो उन्होने दिया। डॉक्टर ने बताया कि टीबी की दवा मुफ्त में दी जाती है हमें पहले से नहीं मालूम था।

    5- डॉक्टर ने पूंछा था कि क्या घर में पहले किसी को टीबी थी? बच्चे के पिता जी को टीबी थी। जिसकी दवा छः महीने तक चली थी और खाँसी अभी तक आती रहती है।

    6- डॉक्टर ने बच्चे की टीबी के उपचार के लिए छः महीने तक दवा लेने को कहा है।

    7- बच्चे में टीबी होने से किसी प्रकार का भेद-भाव नहीं हुआ।

    8- परिवार में और भी बच्चे हैं पर किसी का भी कोई परीक्षण नहीं कराया है। डाट्स सेंटर पर भी इस बारे में कुछ नहीं बताया।

    9- बच्चे के पिता बीड़ी पीते हैं। बच्चे में शूगर की बीमारी नहीं है।

    10- जब बच्चा पैदा हुआ था तो मैं अपने दूध के साथ-2 ऊपर का दूध भी पिलाती थी।

    11- टीबी होने से पहले बच्चा स्वस्थ था। पर बच्चे का वजन कम था और कमजोर था।

    12- खाना लकड़ी जला कर चूल्हे पर पकाते हैं

    13- जैसे पहले खेलता-कूदता था वैसे टीबी की दवा खाने के बाद भी है पर आज सर में दर्द की शिकायत कर रहा था। रोने पर खाँसी पहले भी आती थी और अब भी आती है।

    14- बच्चा घर में पैदा हुआ था और पैदा होने पर कोई टीका नहीं लगा था। पैदा होने की एक महीने बाद टीका लगा था। अस्पताल में लगवाया था पर टीका लगाने के बाद फूला नहीं था। डॉक्टर ने बताया था कि बीसीजी का टीका है। पर जब टीका पका नहीं तो 9 महीने बाद आँगनबाड़ी कार्यकत्रि ने बीसीजी का टीका यहीं पर दूसरी बार लगाया। तब भी हल्का ही पका था। इस बार जब तीसरी बार बीसीजी का टीका लगा तब अच्छी तरह से पका था।

    15- हमें टीबी के बारे में कुछ नहीं मालूम।

    16- डाट्स सेंटर पर भी टीबी की रोक थाम के लिए कोई उपाय नहीं बताया गया।

    ReplyDelete
  9. (सिटिज़न न्यूज़ सर्विस के राहुल कुमार द्विवेदी ने 14 वर्षीय टीबी रोगी और उनके अभिभावकों से बात की - वो प्रस्तुत हैं)
    (Rahul Kumar Dwivedi from Citizen News Service (CNS) had interviewed parents of a 14 years old youth with TB - below are the responses in Hindi. We are translating and soon English version will be published too)

    रोगी का नाम- आकाश
    उम्र- 14 वर्ष
    पिता का नाम- रामखिलावन
    माता का नाम- रामा
    व्यवसाय- होटल पर बैठते हैं

    1- एक साल तक बाहर इलाज करते रहे पर कुछ नहीं पता चला, बच्चे को बुखार होता रहा फिर बाद में एक जन ने बताया कि लोहोया अस्पताल में दिखाओ तो लोहिया में गए दिखाने के लिए। पाँच महीने पहले लोहोया अस्पताल में दिखाने के बाद पता चला कि बच्चे को टीबी है।

    2- फेफड़े की टीबी डॉक्टर ने बताया है। बच्चे को बुखार रहता था और खांसी भी आती थी।

    3- टीबी पता होने से पहले तीन-चार जगह बच्चे को दिखाया था। कई सारे गैर-सरकारी डॉक्टर को दिखाया पर लोहिया अस्पताल में सरकारी डॉक्टर को एक ही बार दिखाने जाना पड़ा।

    4- जब सरकारी डॉक्टर को दिखाने गये तो पैसे नहीं खर्च हुए। गैर-सरकारी डॉक्टर को दिखाने में पैसे लगते थे, पाँच दिनों के दवा में लगभग 500-1000 रुपये लग जाते थे और एक महीने में करीब 4000 से 5000 हजार का खर्च होता था। 100-100 रुपये का तो इंजेक्शन ही लिखते थे और जब इंजेक्शन लग जाता था तब कुछ समय के लिए फायदा हो जाता था और बाद में फिर वैसे ही तबीयत हो जाती थी।

    5- बच्चे की टीबी की बीमारी पता करने में पाँच से छः महीने लग गये पर बच्चे की तबीयत एक साल से खराब थी।

    6- डाट्स सेंटर पर मुफ्त में दावा दी गई थी। डॉक्टर ने बाहर से कोई दावा नहीं लिखी थी।

    7- टीबी की दावा मुफ्त में मिलती है यह मुझे मालूम था।

    8- टीबी की संक्रमण के बारे में हमे नहीं मालूम डाट्स सेंटर पर बच्चे के पिता जी दावा लेने जाते थे। बच्चे के पिता जी से डॉक्टर ने खान-पान के बारे में बताया था। हरी सब्जी, भर्ता, और रोटी, दाल खिलाने को कहा था। साफ-सफाई के बारे में डॉक्टर ने बताया था कि बच्चे को दूध, खाने-पीने की चीजें सफाई से देना। बच्चे को जूठा नहीं खिलाना।

    9- डॉक्टर ने कहा है कि छः महीने तक टीबी की दावा चलेगी।

    10- बच्चे को टीबी होने के बाद किसी ने भी कोई भेद-भाव नहीं किया।

    11- बच्चे को टीबी होने से पहले परिवार में किसी को भी टीबी नहीं थी।

    12- परिवार में अन्य बच्चों का टीबी के बारे में परीक्षण नहीं किया गया है। डाट्स सेंटर पर भी डॉक्टर ने यह नहीं बताया कि परिवार के अन्य सदस्यों का भी टीबी परीक्षण कराएं।

    13- परिवार में लोग तंबाकू का प्रयोग करते हैं। बड़ा वाला लड़का और लड़के के पिता जी तंबाकू और गुटका खाते हैं। और सिगरेट भी हैं। घर की अंदर भी सिगरेट पीते हैं।

    14- बच्चे को और कोई बीमारी नहीं है, हमे नहीं पता है, सिर्फ बुखार होता था।

    15- बच्चे की जीवन के पहले छः महीने तक सिर्फ माँ का ही दूध पिलाया था। कोई अन्य या ऊपर का दूध नहीं पिलाया था।

    16- टीबी होने से पहले बच्चा दिनभर घूमता रहता था और शाम को खाना नहीं खा पाता था।

    17- टीबी की दवा शुरू होने के बाद से अब ठीक है, वजन भी 30 किग्रा है। पहले 25 किग्रा था।

    18- खाना चूल्हे पर पकाया जाता है।

    19- टीबी की दवा जब से खाता है तब से गुस्सा बहुत करता है।

    20- हमारे किसी भी बच्चे को कोई भी टीका नहीं लगा है। एक बार टीका लगवाया था तो बच्चे को फोड़ा निकल आया था तो बच्चे के पिता जी ने टीका लगवाने से मना कर दिया था।

    21- टीबी से बचने के बारे में कुछ भी नहीं मालूम है।

    ReplyDelete
  10. Claire Crepeau Pediatric TB Nurse McGill University, Canada said...
    I would like to comment on Hara Mihalea's post. I agree with what she states as priorities to achieve zero childhood TB by 2015. I have worked in Childhood TB Control for 8 years as a clinical and research nurse and I have also been involved with TB training for nurses in developing countries. Something I would like to add is that for these goals to be successfully met, we need resource allocation to provide training on TB to nurses. This would include education and supervised training on case detection, DOTS, contact tracing, IPT etc. Nurses benefit from close proximity to the patient and are often the first contact person in the health care system.They may be the only health professional in some remote regions.The effect of this investment in human resources can go a long way. It is a way of strenghtening existing resources so that ultimately they become sustainable by partnering with the national TB programs (NTP)Excellent TB patient care can be implemented at the local level to achieve TB reduction globally by strengthening the existing HCW capacities at the ground level. This offers a feasible way to improve communication and to brainstorming for practical solutions to patient and system obstacles (including infection control). I have heard first hand reports from nurses working in Kenyan slums, as well as in Uganda and in the Philippines. These nurses have achieved successes in their work despite their limited resources.
    Certainly, I also agree with maximizing all opportunities for integrating TB into primary health care as well as sensitizing all health care providers on TB. Immunization sessions, postnatal visits, under 5 nutrition clinics and other consultations should be utilized as an opportunity. In these settings, nurses also have much to offer. They can teach community health workers and support personel to identify potential cases. In addition, these settings allow nurses to identify existing structures to assist in this work (ex traditional healers to refer coughing patients to TB services or former TB patients who are assisting via support groups or as community workers). Similarly, educating the public about TB is also a key component. We must strive to manage adult TB properly if we are to decrease childhood TB & also prevent MDR TB. Meanwhile, children are the reservoir of TB for the future, and they cannot be forgotten especially in screening. All health professionals need to partner their efforts to attain this goal with government support. Finally, as Dr Swaminathan, states the two main challenges in dealing with childhood TB are by way of diagnosis and treatment. Teaching on using a systematic approach to childhood TB diagnosis provides a framework in which all health care workers use scientific evidence in combination with available resources to make the best possible diagnosis while under difficult circumstances. Until a new diagnostic tool is available or a better vaccine, we will need to have a high level of suspicion in this most vulnerable group to prevent further morbidities & mortalities.

    ReplyDelete
  11. When do we involve the private practitioners? They see most of the children really all over India? Some meaningful strategy had been taken up in 2007 but then it fell through. Can we achieve anything at all without their compulsory participation?

    Some organisational effort /operational research activity must be made to assess the workability of the topic in hand . If it is found that 90% of the paediatric TB population are being treated in the private sector initially and extensively then NO efforts can match the burning need with our existing resource allocation.

    Paediatric TB drug boxes' utilisation and repackaging strategies have been very uphill task in terms of fund and man power . But we never had the takers for the lower weight bands in the paediatric population for whom the dosage schedule had been worked out for.

    So my opinion would be :
    1) To go all out for the private providers
    2) Notifications of suspects asap (in the paeditric age gruop)
    3) Drug formulations to kept under a tight control
    4) CSO partnerships must have the local private practitioners with them
    5) Accountability of the system for a consistent TB care for children

    Thanks
    Dr Shanta Ghatak
    Email: drshantaghatak@gmail.com

    ReplyDelete
  12. Dear colleagues,

    May I share with you our views on the 'essentials' of the diagnosis of TB in Children? The main means of diagnosing TB in children is undoubtedly, chest X-ray.

    1. Children sometimes may have adulthood TB (post primary TB). Diagnosis is relatively simple. Symptoms are like in adulthood TB: few weeks cough, subfebrile, night sweat, chest pain and sometimes hemoptoe. Every doctor treating TB can easily recognize TB features on chest X-ray: infiltrates or patches usually in upper lung fields, sometimes with cavitation. If cavitation is present, sputum should easily reveal Acid fast bacilli (AFB). This child can expectorate! Treatment will instantly stop infection and cure the disease. Without treatment, the child will die within one or two years.

    2. Child may have miliary TB. After witnessing the miliary shadows in the lung(s) on chest X-ray, even once only, the doctor will remember this X-ray's characteristic feature. Symptoms: weight loss, loss of energy and activity, fever, cough. Without treatment the child may die. Fortunately, this is a rare development after BCG.

    3. Child may have meningitis TB. Symptoms include, longstanding headache, febrile and drowsiness. Very characteristic/diagnostic signs are neck or back stiffness. Without treatment the child may die or suffer from sequellae, like hydrocephalus, blindness, deafness or other neurological defects. This is also fortunately, a rare development after BCG. Chest X-ray may be normal, or miliary TB may be present.

    4. Child may have primary TB. Chest X-ray may show enlarged hilar lymph glands. The primary TB shows no symptoms. Unfortunately, increased bronchovascular markings are often overdiagnosed as enlarged hilar lymph glands. Despite outrageous misjudgment of a number of primary TB cases by our colleagues, we should also realize that there are how many millions of primary cases that go unnoticed and get spontaneously cured ...

    If occasionally, primary TB is developing progressively, then the disease may develop into miliary TB or meningitis TB. Fortunately, such developments become rare after successful BCG vaccination.

    In some cases, if body resistance is low, the primary disease will develop into post primary TB. This condition however, can not be prevented by BCG. But in this case the diagnosis should be relatively simple. After treatment, sputum AFB becomes negative and the disease causes no further infection.

    Who are the main killers of children with TB?

    The main killers are: miliary TB and/or meningitis TB. They are the rapid awesome killers. Unabated, they may kill within several weeks. Fortunately, BCG gives effective protection.

    The other is the mass killer: post primary TB, killing the children slow but sure. Without treatment the child may die within a year or two. These killings are not prevented by BCG.

    The Theme of the First World TB Day 1982 (now thirty years ago) remains
    valid:

    DEFEAT TB! NOW AND FOREVER!

    Dr Muherman Harun
    St.Carolus TB Program 1983
    Jakarta, Indonesia
    Email: muhermanharun@gmail.com

    ReplyDelete
  13. Important diagnostic factors
    *******************

    * Sputum examination of AFB is most successful if lung/bronchial tissue is affected or damaged as in post primary TB. However, in miliary and meningitis TB, the bacilli are spread through the bloodstream i.e. hematogenic spread, hence bacilli are usually not detectable in sputum. In primary TB, bacilli are spread through the lymphatic system (hilar lymph glands) and bloodstream. Therefore, AFB are usually absent in the sputum.

    This explains the difficulty to detect AFB in sputum. We never carried out the gastric lavage for AFB. Such procedure is too drastic and traumatic for too little yield or impact, if any.

    * The tuberculin test in under-fives is particularly useful in the diagnosis of TB (if BCG was not given) However, the higher the age of the patient, the lesser diagnostic value the tuberculin test will have. About the usefulness of the tuberculin test after BCG, there's an old saying which still stands true: "After BCG, the tuberculin reaction goes, as the wind blows!", in other words, the tuberculin test is no more a reliable diagnostic tool after BCG vaccination. There is up till now, no serological or PCR tests for the diagnosis of TB.

    * The presence of a house-hold contact who is expectorating TB bacilli, is an important factor, supporting the diagnosis of TB in children.

    * Lymphatic glands caused by TB can usually be seen in the neck. These enlarged glands may not be painful, and are presented in clusters. If there is discoloration (livid) and fluctuation or abscesses appear, TB diagnosis becomes clear and treatment can be given right away. The presence of TB glands in the neck becomes very helpful in the diagnosis of pulmonary TB. After only a few weeks of anti-TB treatment, the swollen lymph glands will soon reduce in size. This also supports the diagnosis of TB of the lung.

    (But there also are lymph glands in the neck of viral origin. If thoroughly examined, there will be so many small children with enlarged lymph glands in the neck, which are not TB. These glands are usually not directly visible and will come and go with the (febrile) condition of the child. This condition does not need further examination nor treatment. As the child becomes older, the enlarged glands will disappear spontaneously).

    Finally, "How to get to zero new TB infections in children by 2015?" I'd like to answer this STOP-TB question by emphasizing and reiterating the main and grand principle: "Focus on the main reservoir, sources of TB bacilli.

    They are the ones that cough, spreading the AFB into the air". Find, treat and cure them, no more and no less. Contact (centrifugal or centripetal) examination could be carried out on a limited and selective scale.

    The important risk factors i.e. "malnutrition, poverty, environmental pollution, poor housing, overcrowding, indoor air pollution, passive smoking, etc" may not have an important role to play in an effective TB control program. This was spectacularly shown from the historic WHO/ BMRC/ MRCI experiment of Madras in the fifties.

    If we only can persistently treat and diligently cure all of our TB patients who are infectious, eventually, there will be no more children getting infected! Hence, chase without delay retrieve any absconders who and wherever they are, at any cost! Provide patients the fullest treatment with the very best regimen available, so that the disease be completely cured and forever.

    The Theme of the First World TB Day 1982 (now thirty years ago) remains valid:

    DEFEAT TB! NOW AND FOREVER!

    Dr Muherman Harun
    St.Carolus TB Program 1983
    Jakarta, Indonesia
    Email: muhermanharun@gmail.com

    ReplyDelete
  14. The challenges with Childhood TB are timely and correct diagnosis due to two reasons:

    (i) Young children cannot produce sputum whose examination is the cornerstone of TB diagnosis

    (ii) TB in children is pauci-bacilliary: there is more of tissue damage, but less of bacteria. Hence it is more difficult to isolate and examine those bacteria.

    Another reason is the shortage of laboratory facilities in India to do TB cultures. Many states still do not have reference labs for this purpose. So, diagnosis has to rely on clinical evidence and X- Rays which can often lead to a lot of confusion and mismanagement.

    Suggestion is to address these concerns taking the ground realities into consideration the following

    - All the paediatricians and treating physicians in government and private sectors should be provided with dissemination of information on
    1. Childhood TB diagnosis and treatment protocols &
    2. Importance to screen all the household contacts including children of the adult TB diagnosed cases and treat them appropriately with chemo prophylaxis

    - Advocate with the government to have child friendly paediatric TB formulations available

    - Conduct School health programme to enhance awareness on TB among children

    We need multi pronged efforts and a well coordinated public private partnership approach to work towards making “Getting to zero new TB infections in children by 2015” a reality in near future.

    Dr. Subbanna
    Director
    LEPRA India – Blue Peter Public Health and Research Centre
    Email: subbanna@leprahealthinaction.in

    ReplyDelete
  15. (सिटिज़न न्यूज़ सर्विस के राहुल कुमार द्विवेदी ने डा. अभिषेक वर्मा, वरिष्ठ बाल रोग विशेषज्ञ से बच्चों मे टीबी पर बात की - वो प्रस्तुत हैं)
    (Rahul Kumar Dwivedi from Citizen News Service (CNS) had interviewed Dr. Abhishek Varma on Childhood TB - below are the responses in Hindi. We are translating and soon English version will be published too)

    मोस्टली जो बच्चों में होता है वह प्राइमरी काम्प्लेक्स के रूप में होता है प्राइमरी ट्युबरक्लोसिस होता है तो उसमें सिम्पटम बहुत कम मिलते हैं। हम लोगों को प्रीडिक्ट करना पड़ता है कि इस बच्चे को ऐसा हो गया है। नही तो हम देखते हैं बच्चे को भूख न लगना, और बच्चा सालिटेरी बैठा रहे इन्वायरनमेंट के साथ इन्टरैक्ट न करे या बच्चों के साथ खेलता घूमता न हो और कमजोर हो, वेट गेन न कर रहा हो। ऐसे बच्चों को फिर हम लोग इन्वेस्टीगेट करते हैं क्योंकि इन बच्चों में सम्भावना रहती है कि प्राइमरी काम्प्लेक्स हुआ या ट्युबरक्लोसिस हुआ हो। शरीर के किसी भी अंग में हो सकता है तो उनके लिये हम लोग इन्वेस्टीगेट कराते हैं। इनवेस्टीगेशन में एक बहुत बड़ी चीज़ है जो बहुत सारे डाक्टर्स करते हैं कि हाइलर सैडो अगर लंग में है तो उससे मान लेते हैं कि प्राइमरी ट्युबरक्लोसिस है। लेकिन ऐसा नही है। 99 प्रतिशत केसेस में होता है कि हाइलर सैडो ट्युबरक्लोसिस से भिन्न प्रकट होते है और अगर हिलार लिम्फ़नोड बड़े हों तो भी जरूरी नहीं है कि बच्चे में टीबी हों। अगर पैरालाइटिस हो रहा है या बच्चे में कमजोरी हो रही है वजन नही बढ़ रहा है तो जब तक ऐसे सिम्पटम न हो तब तक प्र्राइमरी काम्पलेक्स में ट्युबरक्लोसिस की दवा नही देनी चाहिये आमतौर से हम नही देते हैं और कुछ लोग देते हैं।

    डा.अभिषेक वर्मा
    वरिष्ठ बाल रोग विशेषज्ञ
    डा.राम मनोहर लोहिया संयुक्त चिकित्सालय,लखनऊ

    ReplyDelete
  16. TB Alliance said...
    Children who contract TB most often do so from the adults around them. In that respect, pediatric TB is actually a barometer of overall TB within a community or region. Therefore, in addition to interventions aimed at children, including the research and development of new tools, initiatives to improve TB control in adults will also lead to fewer new pediatric infections. The development of new pediatric-friendly TB drugs will help cure TB in children and help prevent them from spreading the disease. However, in terms of curtailing the sources of initial infection, the development of new and improved, simpler, and more efficient tools to prevent, diagnose, and treat TB in adults will help to reduce the reservoir of infections that subsequently trickle to children.

    Stopping childhood TB simply won’t happen without support from countries at every level. Governments should invest in and support the development of new and improved tools for children and adults, while community education about TB will help raise awareness about transmission and prevention practices that reduce the incidence of childhood TB infection.

    ReplyDelete
  17. Dear STOP TB/ CNS ,

    I know that I am late and the question on childhood TB is over . But I do not know whether somebody mentioned this from the time the discussion was on.

    Poverty, overcrowding in houses, particularly small houses with poor ventilation with proximity to an index adult case, are well know factors.
    This is a very common feature in urban slums of the mega cities in India and the world. Public Health and NTP planners need to factor this in, when striving towards achieving zero TB deaths. This would also call for people in governance to see the link between poverty and overcrowding, leading to poor ventilation and spread of air borne diseases like TB. Those in city governance like city planners need to keep these critical issues in mind.

    We should not be found in a situation where we are pouring all our efforts and funds into diagnostics, research, treatment and care, while ignoring the silent spread of TB through fine droplets in closed rooms where the the poor of this world huddle together.

    Dr. Vijaykumar Edward
    World Vision India

    Vijaykumar Edward MBBS, MD | Director – Health & HIV/AIDS | World Vision India | Phone No: 91-44-2480 7163 | Mobile 98402 00780 | Fax:
    91-44-24807242 | https://www.worldvisionindia.org
    Email: vijay_edward@wvi.org

    ReplyDelete
  18. Just preventing TB in terms of preventing infections is not enough, as you said a rights based approach is a vital must that can lo longer be ignored. Consider these facts:

    In child labor prone areas where children work in industries like metal and polishing works the first hazardous exposure to children are the respiratory diseases among which TB infections tops the list.

    In cities like Moradabad, Aligah etc every third person is diagnosed with some form of TB and 64% of deaths take place due to TB.

    This clearly indicates that treatment approach and follow ups are non existent and children are constantly being exposed to infections on a daily basis. With no intervention.

    Adding to that are the unhygienic living conditions, lack of proper nutrition and health care, worse is lack of screening of children for infections makes it a very volatile situation.

    On the flip side:

    We know through our jail visits that a big number of TB cases exist in the jails. It is a health situation that authorities are struggling with.

    Our worry is that a big number of children who are brought to homes and institutions for Care and Protection or simply for being in conflict with law, are brought into a situation where large number of children are kept in confinement together .

    The first infections they catch is TB. But none are regular screened or treated for it, Though there is a provision for doctors to visit these institutions for medical care of these children, most are not sensitized enough to screen the child for infections on regular intervals.

    Children when brought in also are not put through a medical examination and so never receive any treatment for any chronic infections they may be having including TB.

    In more worrying is that we have no statistics to ascertain how such homes are housing children with such chronic infections without treatment. Neither do we know whether the child was infected in the home or came with the infection. So as far as TB in children in these situations we are groping in the dark.

    This is a policy issue and must be addressed under the protection schemes being run by the government.

    rgds

    Anjali Singh
    Development Journalist/Child Rights Activist
    Director, Saaksham Foundation
    saakshamforchildrights@gmail.com

    ReplyDelete
  19. Dr Dinesh Chandra Pandey, Specialist in Paediatric Medicine at Nelson Hospital of Paediatrics and Neonatal Medicine, Aliganj, Lucknow:
    (Dr Dinesh Chandra Pandey gave the below response in a video interview conducted by Shobha Shukla, CNS)
    **********************************

    Diagnosis of TB is very challenging for the clinicians. There is no golden standard of diagnosis of TB. This includes not only childhood but also adult TB. We need better diagnostic tools. As far as signs and symptoms of TB are concerned, there is no exact classical presentation of the disease. It is often very difficult to differentiate a TB infection from other viral and bacterial diseases.
    Poor adherence, improper acceptance, improper duration for treatment, wrong judgement and incorrect dosage are the factors responsible for the failure of tuberculosis treatment, emergence of disease resistance and increase of the disease burden and associated mortality in developing and developed countries.

    The private sector, particularly in Northern India, is much better than Government sector, as far as TB treatment is concerned. In South India government sector is performing very well. In the private sector, because the patient pays for the treatment, adherence and compliance is better, provided a qualified doctor is treating the patient. We prescribe daily dose regimen in the private sector, which is better than the intermittent regimen given at DOTS centres. The average cost of treatment in private sector, for the common form of TB i.e. primary pulmonary tuberculosis, is about Rs 150 per month, which is very much affordable.
    *******************

    Dr Dinesh Chandra Pandey, Specialist in Paediatric Medicine at Nelson Hospital of Paediatrics and Neonatal Medicine, Aliganj, Lucknow:
    (Dr Dinesh Chandra Pandey gave the below response in a video interview conducted by Shobha Shukla, CNS)

    ReplyDelete
  20. Dr Sudhakar Singh, Specialist in Paediatric Medicine at Nelson Hospital of Paediatrics and Neonatal Medicine, Lucknow:
    --------------
    (Dr Sudhakar Singh gave the below response in a video interview conducted by Shobha Shukla, CNS)
    ***********************************

    Tubercular infection has a very variable pattern of presentation, so it maybe misdiagnosed or undiagnosed. These unidentified cases continue to spread the infection until they are diagnosed. So this is the major problem in control of tuberculosis.
    Many cases of tuberculosis are treated primarily by quacks and unqualified physician. If a fever does not resolve they start giving ATT in an improper manner without any proper categorization and dosage. So tuberculosis resistance is emerging.

    TB can affect any segment of a population. Even with good nutrition and clean environment one cannot ensure that TB will not infect a person. This is because the people around us who carry infection and are misdiagnosed continue to spread the disease. However the places where overcrowding, malnutrition, poor sanitation are prevalent the spread of this disease is maximum.

    None of the currently available diagnostic tests are full proof. So a proper clinical assessment, based on experience and clever examination and history taking, is very important. If done well, it outdoes the efficacy of all tests. Many physicians who do not take history of the patient fail to differentiate TB from other diseases thus leading to misdiagnosis. LRTI (lower respiratory tract infection) can easily be misdiagnosed with TB. I have seen an adult case having taken 3 courses of ATT but not responding. Ultimately he was diagnosed with LRTI and was treated successfully with just a 14 days course of Septran.

    TREATMENT ISSUES
    Toxic effects of drugs like vomiting, nausea and intolerance are there. But if you are treating in proper dosing, with proper combination, these side effects could be minimised. If however an overdose is given then the side effects will be apparent. Good diet is very helpful in preventing side effects.

    One main reason for poor treatment compliance is lack of counselling.
    Patients who are counselled properly are very likely to complete the treatment. Counselling, proper drug dosage, and categorization are very important for effective treatment and for controlling emergence of drug resistant TB.

    TB treatment is very cheap even in private sector and depends upon course of the treatment. For neuro tuberculosis the ATT course should be continued up to one year. Glandular/ pulmonary or abdominal TB treatment varies from six to eight months. The medicine cost is less than Rs 10 per day.
    It is my personal observation that the younger the child, due to poor immunity, the greater is the risk of infection with disseminated and neuro TB which is a dangerous form. In adults the disease is usually localised pulmonary or intestinal TB.
    There is also a misconception that BCG vaccination prevents all forms of TB, which is not true. However after getting the BCG vaccination even if the child gets TB, it is localised pulmonary or intestinal TB, and not of the disseminated form. There is a definite need to spread awareness in the masses. We should be aware that any person sitting near us, who is coughing, may have TB.
    ************************
    Dr Sudhakar Singh, Specialist in Paediatric Medicine at Nelson Hospital of Paediatrics and Neonatal Medicine, Lucknow:
    --------------
    (Dr Sudhakar Singh gave the below response in a video interview conducted by Shobha Shukla, CNS)
    ***********************************

    ReplyDelete
  21. Dear all,
    my take is that governments should establish mandatory vaccination to new born infants and subsequent screening of family members every year.

    ReplyDelete
  22. (सिटिज़न न्यूज़ सर्विस के राहुल कुमार द्विवेदी ने डा. अभिषेक वर्मा, वरिष्ठ बाल रोग विशेषज्ञ से बच्चों मे टीबी पर बात की - वो प्रस्तुत हैं)
    (Rahul Kumar Dwivedi from Citizen News Service (CNS) had interviewed Dr. Abhishek Varma on Childhood TB - below are the responses in Hindi. We are translating and soon English version will be published too)

    जांच के लिये एक्स-रे कराते हैं। पीसीआर कराते हैं और बहुत सारे टेस्ट कराते हैं जिससे कन्फर्म हो जाता है कि बच्चे को टीबी हुई है या नही कन्फर्म करने से पहले कोई एटीटी नही देना चाहिये।
    बड़े बच्चे हैं जैसे 5 साल से अधिक उम्र के बच्चे हैं जिनमे सेकंडरी-टीबी होता है उसमें एक्स-रे से पता चलता है साथ-साथ उसमें कफ भी मिल जाता है जिसकी जांच की जा सकती है। बच्चा देखने से लगता है कि इसमें टीबी है, तो उसमें डायग्नोस करना थोड़ा आसान होता है और डायग्नोस कन्फर्म करने के लिये सारे टेस्ट कराने पड़ते हैं। हम यही चाहते है कि जब किसी बच्चे को एटीटी (एंटी ट्युबरक्लोसिस ड्रग) शुरू किया जाय तो पहले निश्चित रूप से कन्फर्म कर लिया जाए कि बच्चे को टीबी है या नही क्योंकि यह दवाई एक दो दिन के लिये नही चलती है और सारी दवाईयां टाक्सीक्विक होती हैं तो बगैर कन्फर्मेशन के दवा की बरबादी और पैसे की बरबादी है और साइक्लॉजिकल प्रॉबलम भी होती है परिवार में किसी बच्चे को टीबी हो गई ये सारी चीजें परिवार को ओवरलोड करती हैं तो बेहतर यही होगा कि पहले कन्फर्म कर लिया जाए।
    जांच में प्राब्लम वही आती है जैसे । एडल्ट में प्रजेंट करता है वैसे बच्चों में प्रजेंट नही करता है दोनों में प्रजेंटेशन अलग होता है बच्चों में कफ बिल्कुल नही होता है तब भी टीबी हो सकता है अगर वेट गेन नही कर रहा है तब भी मान सकते हैं टीबी हो सकता है समस्या यह है कि इसमें बड़ों जैसा प्रेजेंटेशन नही होता है। 5 साल के नीचे वाले बच्चों में स्पुटम से भी डायगनोस नही होता है इसलिये थोड़ी दिक्कत होती है तो नई जो विधाएं आ गई हैं जैसे पीसीआर है और बहुत सारे टेस्ट हैं टीबी के, तो इन सब को करना पड़ता है तो उससे कन्फर्म हो जाता है। कोई प्राब्लम नही आती है लेकिन यह थोड़े महंगे होते हैं।

    डा.अभिषेक वर्मा
    वरिष्ठ बाल रोग विशेषज्ञ
    डा.राम मनोहर लोहिया संयुक्त चिकित्सालय, लखनऊ

    ReplyDelete
  23. (सिटिज़न न्यूज़ सर्विस के नदीम सलमानी ने 4 वर्षीय टीबी रोगी और उनके अभिभावकों से बात की - वो प्रस्तुत हैं)
    (Nadeem Salmani from Citizen News Service (CNS) had interviewed parents of a 4 years old child with TB - below are the responses in Hindi. We are translating and soon English version will be published too)
    ******************************
    14 वर्षीये टीबी रोगी बच्ची का नाम- ज्योति
    पिता का नाम - मनोहर लोधी
    पता- हुसड़िया गांव, गोमती नगर, लखनऊ

    1- आस पास के लोग बच्ची से दूर नही भागते हैं। असल में यह घर पर ही रहती है कहीं बाहर जाती ही नही है।
    2- दूसरे लोग अपने बच्चों को बच्ची के साथ खेलने से मना नही करते हैं।
    3- परिवार में इससे पहले किसी को भी टीबी की बीमारी नही थी।
    4- घर में कोई भी धूम्रपान नही करता है।
    5- इसके अलावा घर में किसी भी अन्य सदस्य को कोई भी बीमारी नही है।
    6- बच्ची के जीवन के पहले 6 महीने तक माँ का दूध पिलाया और साथ-साथ पानी व बोतल का दूध भी पिलाया था।
    7- खाना गैस चूल्हे पर बनाती हूँ।
    8- दवा का कोई साइड इफेक्ट नही है अब फायदा लग रहा है।
    9- पहले चिड़चिड़ापन था लेकिन जबसे दवा खाती है तब से ठीक है ज्यादा हंसती मुस्कुराती नही है और न ही किसी से बात करती है।
    10- बीसीजी का टीका लगवाया था।
    11- टीबी क्यों हुआ इस बारे में कोई जानकारी नही है।
    12- घर में साफसफाई के बारे में डाक्टर ने बताया था और खाने में हरी सब्जी बताई थी और मसालेदार चीजों को खाने से परहेज बताया था। चावल वगैरह बन्द है बस रोटी दाल और मूंग की दाल, इसके अलावा ताकत वाली चीजे़ देने को कहा था।
    13- परिवार के अन्य बच्चों का कोई भी परीक्षण नही कराया, वह सब ठीक हैं।
    14- डाट्स सेंटर पर 6 महीने इलाज कराने को कहा है।

    ReplyDelete
  24. (सिटिज़न न्यूज़ सर्विस के शोभा शुक्ला जी ने 14 वर्षीय टीबी रोगी और उनके अभिभावकों से बात की - वो प्रस्तुत हैं)
    (Ms Shobha Shukla from Citizen News Service (CNS) had interviewed parents of a 14 years old child with TB - below are the responses in Hindi. We are translating and soon English version will be published too)

    14 वर्षीये टीबी रोगी बच्चे का नाम: आकाश
    वजन: इलाज से पहले 25 किग्रा0 इलाज के बाद 30 किग्रा0
    उम्र: 14 वर्ष

    1- एक साल पहले खांसी आती थी तो गैर सरकारी चिकित्सक का इलाज किया दवा देते थे। फिर एक्स रे कराया तो पता चला कि टीबी की शुरूआत हो चुकी है। फिर सरकारी अस्पताल में दिखाया तो वहां बलगम जांच कराई तो टीबी का पता चला तो वहीं इलाज शुरू किया।
    2- डाट्स सेंटर से मुफ्त में इलाज हो रहा है।
    3- इलाज कराते हुए 5 महीने हो गये हैं 6 महीने का कोर्स चिकित्सक ने बताया था।
    4- दवा हफ्ते में एक दिन लेने जाना पड़ता है दवा को कोई पैसा नही लेते है।
    5- एक दिन छोड़कर दवा खानी होती है कई प्रकार की दवाएं होती हैं।
    6- परिवार के अन्य सदस्यों की जांच के बारे में डॉक्टर ने कुछ नही बताया। परिवार में किसी और को कोई बीमारी नही है।
    7- दवा खाने से कोई समस्या नही होती है दवा का कोई साइड इफेक्ट नही है।
    8- पहले से अब खाने की खुराक बढ़ी है। ठण्डी चीजें, मिर्चा, खटाई, तेल आदि खाने को मना किया है। अब खांसी बिल्कुल नही आती है।
    9- पहले 9 महीने इलाज के लिये बोले थे लेकिन अब 6 महीने ही इलाज के लिये बोला है।
    10- पिता जी शराब, सिगरेट और बीड़ी का सेवन करते हैं।
    11- परिवार में किसी और को टीबी नही है।
    12- बच्चों को कोई भी टीका नहीं लगा है न इस बच्चे को और न ही घर में किसी और बच्चे को।
    13- टीबी क्यों हुआ है इस के बारे में कुछ पता नही है।
    14- पहले खाना नही खाते थे बस बाहर से बिस्किट, नमकीन आदि खा लेते थे।
    15- दूध नही पिलाते हैं। डॉक्टर ने मना किया है। दही और घी भी मना किया है।
    16- कभी कभी गर्म करके दूध पिला देते है।
    17- घर में साफ सफाई ठीक से रखते हैं।

    ReplyDelete
  25. (सिटिज़न न्यूज़ सर्विस के शोभा शुक्ला जी ने 4 वर्षीय टीबी रोगी और उनके अभिभावकों से बात की - वो प्रस्तुत हैं)
    (Ms Shobha Shukla from Citizen News Service (CNS) had interviewed parents of a 4 years old child with TB - below are the responses in Hindi. We are translating and soon English version will be published too)
    **********************************
    6 वर्षीये टीबी रोगी बच्चे का नाम: जुगल किशोर
    उम्र: 6 साल

    1- यह जबसे पैदा हुआ है तब से बीमार ही रहता है। बचपन से ही कमजोर है।
    2- 2 साल की आयु से खांसी आ रही है। बचपन से लोहिया सरकारी अस्पताल का इलाज चल रहा है।
    3- ज्येठ के महीने में एक्स-रे कराया था तो टीबी का पता चला। तो चिकित्सक ने मेडिकल कालेज में दिखाने को कहा। और बाहर की दवाएं लेने को कहा। तो पैसे न होने के कारण इलाज नही कर सके। वहीं से जो दवा मिली वो ले ली। बाकी दवा नही ली।
    4- फिर अब दोबारा एक्स-रे कराया तो डाक्टर ने भर्ती कराने को कहा तो लोहिया अस्पताल में भर्ती कराया। 10 दिन भर्ती रहा फिर उसके बाद से दवा दूसरे तीसरे दिन लेने जाना होता था।
    5- अब दवा डाट्स सेंटर से लेते है। 6 महीने तक दवा खिलाने को कहा है।
    6- दवा खाने से पहले कभी-कभी सर में दर्द होने लगता है। बाकी कोई समस्या नही है।
    7- खाना में दाल, रोटी, सब्जी देते है। पैसे की कमी की वजह से दूध नही दे पा रहे है।
    8- घर में पिता जी को टीबी की बीमारी थी, काफी पहले 6 महीने सरकारी अस्पताल का इलाज कर चुकें हैं, लेकिन खांसी अभी भी आती है।
    9- पिता जी धूम्रपान करते हैं। बाकी घर में कोई और बीमार नही है।
    10- पिता के शराबी होने के कारण घर की आर्थिक स्थिति काफी खराब है।
    11- डाक्टर ने साफ सफाई के बारे में कुछ नही कहा।
    12- डाक्टर ने घर के किसी अन्य सदस्य की जांच के लिये नही कहा।
    13- अब डाट्स सेंटर से दवा लाते है।
    14- अब फिर से एक्स रे कराया है तो अभी रिपोर्ट नही मिली है एक्स रे मुफ्त में किया है लोहिया अस्पताल में।
    15- 1 महीने से ज्यादा का समय हो चुका है डाट्स सेंटर का इलाज चलते हुए।
    16- खांसी अभी भी आती है रात मे अधिक खांसी आती है। जब भर्ती कराया था तो खांसी ठीक हो गई थी।

    ReplyDelete
  26. *********************
    Dr Anoop Misra
    Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC)
    Director, Diabetes and Metabolic Diseases, Diabetes Foundation (India) (DFI)
    Email: anoopmisra@gmail.com
    (submitted by email)
    *********************

    There is a strong correlation between diabetes and tuberculosis at all ages and childhood is no exception. Indeed, association is more likely since often immunity is not fully developed in children. Children suffering from diabetes are more prone to develop any infection, and also tuberculosis.

    Tuberculosis may present with atypical symptoms and signs. In those suffering from both, sometimes there is delay in diagnosis since children may not be able to accurately pinpoint their problems/symptoms of tuberculosis.

    Children with high blood sugar, in fact, have mixed symptoms of high sugar and tuberculosis, which could be confusing. Tuberculosis is more likely to be widespread in those with uncontrolled diabetes.

    Any child with diabetes, any prolonged fever, weight loss or cough should lead to suspicion of tuberculosis. Threshold of suspicion for tuberculosis is lower in these patients.

    If diabetes is well controlled, and the nutrition of child is good, chances of developing tuberculosis are low. Any child with diabetes should be kept away from any patient with infectious tuberculosis (not all patients with tuberculosis are infectious), and also from any patient with cough in general.

    *********************
    Dr Anoop Misra
    Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC)
    Director, Diabetes and Metabolic Diseases, Diabetes Foundation (India) (DFI)
    Email: anoopmisra@gmail.com
    (submitted by email)

    ReplyDelete
  27. Dr AG Unnikrishnan
    Professor, Department of Endocrinology
    Amrita Institute of Medical Sciences (AIMS)
    Cochin, India
    ********************

    There is no direct connection between TB and diabetes in Children. However, people with diabetes, especially uncontrolled diabetes, are prone to infections, particularly tuberculosis. For optimal treatment of tuberculosis, diabetes needs to be controlled.

    ********************
    Dr AG Unnikrishnan
    Professor, Department of Endocrinology
    Amrita Institute of Medical Sciences (AIMS)
    Cochin, India
    ********************

    ReplyDelete
  28. Tb, treatment in child is very challenging particularly when we consider formulations and dosages.In this area less has been done and more research and participation is required.

    Thank you ,

    Warm regards.

    Dr Tobias Kichari
    Kenya

    ReplyDelete
  29. New drug regimens and better, more accurate diagnostic methods are urgently needed to control tuberculosis. However, mathematical modelling studies show that tuberculosis can only be fully eliminated with the help of new vaccines.
    Currently there is only one vaccine against tuberculosis available worldwide: Bacille Calmette-Guérin (BCG). This vaccine, used since 1921, can protect children from severe forms of tuberculosis. However, BCG has little to no efficacy in preventing lung TB, the most common and most infectious form of tuberculosis, and its protection seems to fade during adolescence. Moreover, there are serious safety concerns regarding the use of BCG in HIV infected newborns.
    More effective, safe vaccines to improve or replace BCG are urgently needed as tuberculosis keeps taking its toll.
    Chris Dye, Bethesda 2010:
    In order to eliminate TB by 2050 we need to reduce incidence by 16% per year. If we keep following current trajectory, hardly anything happens. The global plan could accomplish a 6% decrease, but not the needed 16%.





    This figure shows the impact of vaccination in a mathematical model. The black line above shows that the incidence of tuberculosis would remain similar over the next 40 years: around 200 cases per 100,000 inhabitants.

    If children were vaccinated at birth (neonatal vaccination) with a new efficacious vaccine which were to replace BCG (= pre-exposure vaccine), the reduction would be substantial but far from enough to eliminate tuberculosis by 2050 (red line, 2nd from above).

    The massive use of post-exposure vaccines (blue line, 3rd from above) would generate a more important reduction in the number of cases but still not enough to eliminate tuberculosis by 2050. Post-exposure vaccines are vaccines which prevent latently infected persons or carriers from developing disease and spreading tuberculosis.

    Massive use of pre-exposure vaccines (green line, 4th from above) would have a very important effect. Pre-exposure vaccines must be administered before exposure to tuberculosis. Both boost and replacement vaccines belong to this category. Boosting vaccines are administered to persons who have received an earlier BCG or its replacement vaccine.

    Massive use of both pre- and post-exposure vaccines would have the biggest impact (violet line, 5th from above). During the latest world vaccine symposium on tuberculosis vaccines in Tallinn , the scientific community confirmed the results of this model and claimed again that massive use of both pre- and post-exposure vaccines is needed to eliminate tuberculosis.

    This analysis enabled the ‘working group on economics and target product profiles of Stop TB partnership working group on TB vaccines’ to conclude that the world should develop at least 8 vaccines to satisfy worldwide mass vaccination with pre- and post-exposure vaccines .

    For more elaborate explanation: http://www.pnas.org/content/106/33/13980.full
    Vaccines – generally accepted as and proven to be both a very efficient and cost-effective way of preventing infectious diseases – can make the difference.
    Improved diagnostics and more efficient drug therapies are needed now, they would save tens of millions of lives. However, we also need to look at the future, different types of new vaccines could prevent infection altogether, block existing latent infections from developing into active disease and will also be especially crucial in combating multidrug-resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB), forms of TB that are expensive and extremely difficult or virtually impossible to treat.

    sent by Jojanneke

    ReplyDelete
  30. We need to have school based programs.In kenya all school age going children go to school.When we go to primary and high school to talk about the symptoms of TB then it will be easy to diagnose all the suspects
    Programmes like the one in South Africa of connecting a popular game like football with advocacy in schools is a good way to involve children by 'kicking TB out"
    Regards
    peter ngola

    ReplyDelete
  31. Right now, we have five children with TB AND THEY ARE RECEIVING SOME TREATMENT NOW.
    ACTWID board members led by Wendi Losha

    ReplyDelete
  32. Professor (Dr) Surya Kant
    Head, Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University (CSMMU) – erstwhile King George’s Medical College (KGMC)
    &
    President, Indian Chest Society (North Zone)
    *******************************

    Tuberculosis is a disease known to exist since thousands of years in the age of ‘Vedas’ and was known as ‘Kshay (decay) rog (disease)’. TB is characterized by prolonged fever, weakness and decay of the body. Treatment as prescribed in Ayurveda comprise of fresh air, good nutrition and good nursing care. And till 1994, treatment of TB remained the same as described in Ayurveda in the form of Sanotoria treatment. Basic component of sanitoria treatment remained the same: fresh air, good nutrition and good nursing care.

    Nearly half of Indian population and one-third of world’s population are infected with Mycobacterium tuberculosis, (and TB disease is roughly 2% in our Indian population) which I recently described in a publication as ‘Micro-terrorist’ because it is the only single causative organism in flora and fauna that has largest number of hosts. Although Robert Koch identified Mycobacterium tuberculosis in 1882 still despite over 130 years had passed by we are failing to control TB. This is why I describe it as micro-terrorist.

    *******************************
    Professor (Dr) Surya Kant
    Head, Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University (CSMMU) – erstwhile King George’s Medical College (KGMC)
    &
    President, Indian Chest Society (North Zone)
    *******************************

    ReplyDelete
  33. *******************************
    Professor (Dr) Surya Kant
    Head, Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University (CSMMU) – erstwhile King George’s Medical College (KGMC)
    &
    President, Indian Chest Society (North Zone)
    *******************************

    DIAGNOSIS
    The main challenge in early diagnosis of TB is the poor awareness regarding TB in the society. We have to educate the society about TB and health and use range of mass media campaigns including print media, electronic media among others more effectively.

    We should also prepare some documents to effectively communicate how to prevent common diseases in the society. Regular school based check-up should also be done. Also we should remember that a child with conditions such as lymph-node TB will not even be symptomatic. Parents too are likely to ignore such conditions. That is why we need frequent school-based health check-up camps for early detection and health education. And schools should not be given certificates recognizing their school if they are not fulfilling the promise of regular health checkup of their students by doctors. This should be one of the policies for early detection of diseases such as TB.

    Diagnosis of TB is difficult and is a dilemma most of the times. Because on one hand any shadow in the child’s chest x-ray is considered as pulmonary TB which is not true. Sometimes parents ask me that there is a family member who has active TB disease and what is the risk of their child getting the infection. The natural outcome in such a situation is that there are 90 per cent chances that this child will remain healthy. Only 10 per cent of such children may develop active TB disease. So this message should also be spread that there is 10 per cent lifetime risk of developing active TB disease if a child is exposed to TB bacilli. This is true for children negative for HIV. In children living with HIV the risk might be up to 50 times higher and such children also have a 10 per cent per year risk of developing active TB disease.

    We need new rapid effective diagnostic tools especially for extra-pulmonary TB. Diagnostic tools such as PCR, Gene Xpert, are the possible future of diagnosing childhood TB and genetic based tools should be used in India although they are costly affair. More hospitals and laboratories should have such molecular based diagnostic tools so that any physician can refer patients whenever in dilemma.

    In children living with HIV, TB treatment should be started first and within 2-4 weeks of starting anti-TB treatment, if there is indication of starting antiretroviral therapy (ART) then it can also be initiated according to the guidelines of the National AIDS Control Organization (NACO).

    *******************************
    Professor (Dr) Surya Kant
    Head, Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University (CSMMU) – erstwhile King George’s Medical College (KGMC)
    &
    President, Indian Chest Society (North Zone)
    *******************************

    ReplyDelete
  34. *******************************
    Professor (Dr) Surya Kant
    Head, Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University (CSMMU) – erstwhile King George’s Medical College (KGMC)
    &
    President, Indian Chest Society (North Zone)
    *******************************

    Anti-TB drug resistance in children is a very major issue. I wrote an article published in an International Journal that MDR-TB is an iatrogenic problem. Most of the times we are responsible for creating multidrug-resistance in the society – the doctors are responsible. If we (the doctors) are not educating the patients then how can we blame the patients that they have defaulted from the treatment? It is basically the effective motivation provided by the doctor, which will increase compliance and adherence to the treatment. Patients don’t know the consequences of defaulting from the treatment. It is we – the doctors’ community – that has to educate the patient and regularly motivate the patient. This is a digital era of communication and we must note the mobile number or email address of the patient if any. One social worker must be employed in the hospital and private clinics to follow with the patients and make sure that they don’t default from their treatment. If at all the patient defaults then strict disciplinary action must be taken and government of India should give some provision that if somebody is defaulting even in spite instruction of the doctor, and despite pursuance of the social worker he should be punished. Because such a person is not only having a disease but he is spreading disease in the society also. So he is basically a culprit. If he is creating new 10-15 cases in a year, then he should be considered as a culprit. And accordingly he should be given the punishment. This is the only way we can control drug resistant TB by increasing more compliance and adherence to the treatment. We have to educate the patients about the consequences of defaulting from the treatment.

    In the near future I can foresee if we continue with the same trends and practices of treating tuberculosis at the government and private health facility level, in the near future we will see lot of extensively drug-resistant TB (XDR-TB).

    *******************************
    Professor (Dr) Surya Kant
    Head, Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University (CSMMU) – erstwhile King George’s Medical College (KGMC)
    &
    President, Indian Chest Society (North Zone)
    *******************************

    ReplyDelete
  35. *******************************
    Professor (Dr) Surya Kant
    Head, Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University (CSMMU) – erstwhile King George’s Medical College (KGMC)
    &
    President, Indian Chest Society (North Zone)
    *******************************

    TREATMENT
    Dosing schedule in the children is another aspect to look after. Often children are in a hurry in the morning to take their medicines on empty stomach, especially school going children. What we have tried in our hospital and saw it work is to give the missed morning dose in the night after three hours of dinner. Because after three hours of dinner stomach is empty, so practically it is the same situation as in the morning when stomach is empty.

    For children we need syrup based formulations. Usually children like the syrups and syrup based formulations of vanilla, chocolate and other flavours should be prepared so that children can like the taste and find it easier to comply.

    We cannot control TB if we aren’t able to control diabetes. Usually in children we find type-1 diabetes that is the insulin dependent diabetes. In India we do require more child friendly insulin preparations because children often tend to avoid the injections. Diabetes researchers must think on how to get rid of these injections.

    When malnourished children with TB begin anti-TB treatment within two weeks or so their appetite increases and they need proper nutrition. After completion of anti-TB treatment, the malnourished child if given proper nutrition as per appetite can become well nourished. Usually I avoid giving costly commercially available nutritional supplements and recommend green leafy vegetables, pulses, carbohydrates, jaggery which is a rich source of Iron, or other locally available diet that is possible in family’s circumstances.

    To reach to zero new TB infections, zero TB deaths by 2015, lot of work has to be done especially in successfully treating drug-resistant cases. Much more needs to be done to early diagnose and successfully treat TB in people living with HIV, or drug-resistant strains. On war footing level proper training of healthcare providers must be done so that they can early diagnose and successfully treat these cases of TB. If we can cut down the TB transmission by treating TB successfully, TB control will become a reality.

    *******************************
    Professor (Dr) Surya Kant
    Head, Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University (CSMMU) – erstwhile King George’s Medical College (KGMC)
    &
    President, Indian Chest Society (North Zone)
    *******************************

    ReplyDelete
  36. A high index of suscipion of TB in a child is key to early diagnosis
    of childhood TB. Less than that then the TB diagnosis is difficult!

    I have found the triad of ; History of contact with an adult with TB,
    Positive mantoux test and Chest X Ray changes. The challenge is when
    there seems to be no history of contact with TB patient at household
    level, Mantoux test is quit expensive and requires at least two visits
    and the intepretation of the Tuberculin Skin Test is tricky in an
    immunisuppressed (where majority lay!) child and chest x ray
    interpretation comes with experience.

    Successful treatment requires adequate patient preparation for
    treatment and ongoing support counseling for both the patient and the familiy. But ofcourse there must be regular drug supply which is not
    the case for the 22 high TB burden Countries.

    Dr Charles Namisi, Uganda
    Email: charlespcn@gmail.com

    ReplyDelete
  37. Viva india for achieving such great thing (POLIO ERADICATION) it is not easy to succeed such a great challenge.I wish other countries can do the some, we need more Activists for this achievment.

    thanks

    fred zambia
    TALC

    Fred Mwansa

    ReplyDelete
  38. Dear Stop TB Partners

    I fully endorse Blessina`s comments. Unlike the hype and aggressive advertising created for the polio TB just remains in the realm of meetings seminars and symposiums. I attended recently an open Symposium on Social Determinants of Tuberculosis at LSHTM which was followed by a 2 day meeting of Laboratory researcher Economist and so many other eminent persons( I did not attend this exclusive meeting). This 2 day meeting is supposed to form a high level Commission to lay down a policy frame work for devising ways t
    o direct cash transfers to nutritional support and even toiletries. Examples were cited of the impact of these special efforts. Coming from India I was surprised that the enlightened speakers are totally unaware of the food security under public distribution scheme in India which guarantees assured food grains to each BPL family.

    I have also experienced how Global Fund has not made the impact it was supposed to make even after few Rounds. There is too much stress on training and capacity building. Of whom is my question?

    Now there is talk of bringing childhood TB to zero by 15. How? please consider to resolve the issue of access versus availability. I come from a remote village in the lower Himalayas and I see that people from that reason have to walk miles and miles to the nearest diagnostic facility if there is one or the personnel are present.

    To tackle the monster of TB we have to think of ground realities and not theoretical solutions as the case is today. Create partnership and trust civil society to be a part owner of the programme. Create penetrative awareness at local level and enable to demand services very near to people.

    Tilak S Chauhan
    F-216 Vaishali Garden Apts
    Nagarjuna nagar Tarnaka
    Secunderabad - 500017

    Landline: 27179781
    Mob: 9849107449

    Email: tilak_chauhan@hotmail.com

    ReplyDelete
  39. (Rahul Kumar Dwivedi from Citizen News Service (CNS) had interviewed Dr. Abhishek Varma on Childhood TB - below are the responses in English translated by Ms Shobha Shukla)

    Children normally get primary complex. In primary TB there are very few symptoms. If the child complains of loss of appetite, is underweight/not gaining weight, does not interact with friends but loves to remain solitary, then we investigate, as chances of primary complex or tuberculosis are high in them. Proper investigations are very important. Many doctors diagnose primary TB if there is Hilar Shadow in the lungs. But in 99% cases, Hilar shadows may appear different from TB, and even if Hilar lymph nodes are enlarged it may not be TB. It could be something other than TB. Unless there are other symptoms of appetite loss, weight loss, we should not give TB medicines for primary complex. But some doctors are doing this. ATT should not be started unless TB is confirmed on the basis of various tests done like X Ray, PCR (polymerase chain reaction) test. It is very important that confirmed diagnosis be done before starting treatment as the treatment will last for at least 6 months and drugs are toxic. So if treatment is started without confirmation it is a waste of money, drugs and creates psychological problems too. TB in one child affects the entire family. Proper investigation is very important.
    There are problems in diagnosis as presentation of the disease in children is different from that in adults. Even if the child is not gaining weight, even if there is no cough, it could be TB. In children below 5 years of age, there is very little sputum formed, so we cannot diagnose through sputum examination. But there are newer tests like PCR which are better, but they are costly.

    Dr. Abhishek Varma
    Senior Consultant Pediatric
    Dr. Ram Manohar Lohiya Combined Hospital, Lucknow

    ReplyDelete
  40. (Rahul Kumar Dwivedi from Citizen News Service (CNS) had interviewed parents of a 6 years old child with TB - below are the responses in English translated by Shobha Shukla)
    *********************************
    Patient Name- Jugalkishor
    Father Name- Shivprasad
    Mother Name- Ram Dulaari

    Testimony of the parent of a 6 years old child who was diagnosed with pulmonary TB about a month ago (in January 2012)

    My son was born at home and was a weakling at the time of birth. He has been coughing for the past 4 years. The cough would be so bad and persistent at times that he would become breathless. I have been taking him for treatment to government hospital, since long. But the medicines were not helping. Once the doctor took an X –Ray and then asked me to buy medicines from outside, but I could not afford this. He was diagnosed with TB in the summer of 2011. The doctor gave some medicines, and asked us to buy the rest from the market. We are too poor for this and so treatment was discontinued. The child was again admitted one month back in the hospital for ten days, and then finally the doctor referred us to the DOTS centre from where we are now getting free medicines. The treatment will continue for 6 months. The boy’s father, a daily wage earner, who is an avid bidi smoke, had TB 7 years ago and he completed the 6 months treatment. He has again started coughing. No other member of the family has been advised to get tested for TB. We were not told anything at the DOTS centre or by the doctor about infection control measures. We cook on wood fuel stove. I could not exclusively breast feed my son as I did not lactate enough.

    ReplyDelete
  41. Citizen News Service - CNS06 March, 2012

    Dear Partner,

    This is a typical rural family. The father was the first to get TB, then this three years old child on the left. The second child from left is now showing sighs of TB but we tried to get sputum from cough but every time he instinctively swallows it. The clinical officer says gastric aspirate give every poor results because of the food particles, gastric juice etc. There is report that the third child is also unwell and we are planning to visit and screen.

    We have to treat all the adults, trace all defaulters and screen all contacts not ones or twice but within three months of treatment.

    - PETER NGOLA -

    Photo: http://www.facebook.com/photo.php?fbid=356323267745027&set=a.356323081078379.89222.138949669482389&type=1&theater

    ReplyDelete
  42. (Rahul Kumar Dwivedi from Citizen News Service (CNS) had interviewed parents of a 14 years old child with TB - below are the responses in English translated by Shobha Shukla)
    *********************************
    Patient Name- Akash
    Father Name- Ramkhilawan
    Mother Name- Rama

    Testimony of parents of 14 years old Akash, studying in class 4

    I have three children—two sons and one daughter. Akash is the youngest. He was sick with fever and cough for the past 1 year. We initially showed him to 3 or 4 doctors in the private sector spending around 5000 rupees a month on his treatment—each injection alone would cost 100. There would be momentary relief, but no lasting improvement. Then 5 months ago we showed him in a government Hospital where he was diagnosed with pulmonary TB. So it took around 6 months for correct diagnosis. Treatment at the govt hospital is free. I do not have to buy medicines from outside, but get them from DOTS centre. We go there every Friday to get the medicines for one week, which we give him at night on alternate days. He has already completed 5 months of treatment—so there is just one more month to go. The doctor has told to give him a diet of green vegetables, daal, roti, but no milk or curd. We were also told to maintain cleanliness and not let him share his food with others. Nobody else in the family has TB. No other member in the family has been tested for TB—the doctor did not ask for it. Akash’s father and his elder brother eat tobacco and are habitual bidi smokers. We use a cook stove in the house. None of my children have been vaccinated against any disease. I have breastfed all my children. I have no idea how TB can be prevented. Since he has started eating TB medicines, he has become very short tempered. But his overall condition has improved. His weight has also increased by 5 kg.

    ReplyDelete
  43. Overcrowding poverty malnutrition ill ventilated rooms and less immunity are all accepted but is it really possible to get down to "0"? When there is NO awareness of air borne transmission of TB in the masses, community , elders and the mothers?

    Why cant we go forward with generating greater conscious support for awareness about the ease of air borne transmissibility of TB?

    We do need to zero down on the diagnostic criteria of pediatric TB as well

    Thanks
    Dr Shanta Ghatak
    Email: drshantaghatak@gmail.com

    ReplyDelete
  44. Dear members of stop-TB eForum of CNS,
    i would like to convey my sincere thanks to all your efforts in the fight against TB in relation to HIV/AIDS. I foresee a big challenge in achieving the "Getting to Zero" new infection slogan/mission, but nothing is impossible with joint efforts. My request to stakeholders is to try and have integrated health services for PLWHAs as it can increase the service seeking behavior among people affected and infected with HIV/AIDS. More to that organizations implementing HIV/AIDS related activities should make TB awareness program an integral part of their activities instead of waiting for a separate grant in order to create awareness on TB among communities!

    Thank you once again, and let's keep the ball rolling.

    Margaret Namaganda, Uganda
    Email: margaretnamaganda@yahoo.com

    ReplyDelete
  45. competence and accountability not only to the system , but also to our conscience must be there ....in order to really effectively control TB

    Dr Shanta Ghatak, India
    Email: drshantaghatak@gmail.com

    ReplyDelete
  46. We can do a lot , friend , I believe

    We need that motivation and clarity of actions

    Why can't we think of starting in smaller pockets where TB is more and work towards curative and preventive services with judicious monitoring and supervision? If we can begin in 1 place in 1 community with a focus on adults, children and antenatal mothers - can't we really achieve a positive result? Instead of reaching out to the entire TB world at a single go , can't we just start DOING this achievable target within our own small reach?

    But then accessing proper funding sources for such projects is an issue. Only through national schemes this is UNACHIEVABLE. Dynamics are such that instead of stopping TB our efforts would be stopped because :

    1) Non motivated officers through which existing schemes are to be accepted, their poor understanding of services and continuous harping that statistical data for such pockets are showing a growing trend of successfully treated and cured cases so HOW can we think of such interventions in such areas?

    2) Superfluous community mobilisations wielding to the governmental norms with properly documented previous justifications showing apparent success

    3) Lack of transparency in NUMBERS reported so that assisting for better governance in order to help the patients looks unconvincing .

    Reality really bites !!

    Wish to deliver......quality TB support ......anytime ..... holding hands and holding breath ...we need to start countdown ?

    Dr Shanta Ghatak, India
    Email: drshantaghatak@gmail.com

    ReplyDelete
  47. I also enjoy reading the comments, but notice that a lot of people should stay on topic to try and add value to the original blog post.

    ReplyDelete