Control Infection To Prevent TB In Children

At the inaugural lecture of the 42nd Union World Conference on Lung Health, organised by the International Union Against Tuberculosis And Lung Disease (The Union), in October 2011,  Mikkel Vestergaard Frandsen, showed a poignant video clip of a 14 year old girl who had suffered and died of TB in her poor, smoke ridden home in a Kenyan village last year. The video was a telling but true commentary on the polluted and unhygienic environments that exist in most houses of urban slums and villages of the developing world, making them fertile grounds for TB germs, and exposing their children to this life threatening disease. 

Children living in poor circumstances, in very crowded houses with bad ventilation and increased indoor air pollution, due to tobacco and cook stove smoke, become easy targets for the TB bacterium. A congested neighbourhood with poor refuse management and improper drainage only adds to their vulnerability.  Medical experts, as well as community advocates, from across the globe almost unanimously agree that practising basic infection control measures at all levels, including home, community and hospitals, would go a long way in saving our children from unnecessary exposure to TB infections.

Overcrowding in houses with poor ventilation, lack of basic hygiene and proximity to an index adult case, are like an open invitation to the TB bacteria. According to Professor Surya Kant, Head of the Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University, “Usually one TB patient spreads TB to 10-15 other people in a year. But if the patient is living in an overcrowded environment then the spread of TB is more rampant. Children living in urban slums where dwellings house a large number of people in small space can be at higher risk of TB.”

Dr Manoon Leechawengwong, of the Drug-Resistant Tuberculosis Research Fund, Thailand, advises that adults in the family with active TB should practice infection control by wearing masks as long as they continue to cough and must try to stay away from kids in the family.

A large number of rural/urban slum households still use biomass fuels for cooking, and exposure of children to this cook-stove smoke can increase their risk for developing active TB. These fuels should be replaced by other energy options which are not detrimental for one’s health. Second hand smoke arising out of elders smoking cigarettes/bidis is another demon to be watched. Children inhaling this smoke can become easy victims of a host of diseases including TB. Improper ventilation increases the risk as, it not only prevents the smoke from escaping out, but also prevents adequate sunlight from entering the house. Dr Surya Kant mentions that a five minutes exposure to sunlight kills even the drug resistant forms of Mycobacterium tuberculosis bacilli.

Even doctors agree that hospitals are a store house of infections which must be reduced to rein in TB. Proper ventilation of wards to circulate of fresh air and admit enough sunlight is very important. Inefficient disposal of hospital waste and patients’ sputum increase the chances of patients contracting the disease, instead of getting cured. Cough hygiene is very important, especially for those who are AFB sputum positive. They should be counselled to cover their mouth with cotton or mask while talking or coughing. Proper and timely disinfection and management of excreta from known tuberculosis patients is important. Also, spitting on the roads and defecating in the open is very common in India and  helps in the spread of the tuberculosis germs.

In India it is a common practice for children to unnecessarily accompany their parents on hospital visits. All hospitals should be instructed to convey to their patients that whenever they visit the hospital children should not accompany them unless needed – because hospitals are a hot bed of infections.

One of the fallouts of urbanization is construction of flats or apartments which often lack proper ventilation and block sunlight from entering the rooms, thus encouraging the spread of air borne diseases like tuberculosis. City planners, private builders, as well as the housing policy of the government, need to keep these critical issues in mind for construction of residential/official complexes and pay adequate attention to allow for proper air flow and natural light in houses.

Getting to Zero new TB infection in children by 2015 may be like moving a mountain, which requires more than just faith. Challenges are vast and resources are inadequate. It would need the combined efforts of the community, healthcare personnel and supportive government policies to curb the onslaught of TB. As Dr Vijay Kumar Edward of World Vision India, so succinctly sums up, “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 poor of this world huddle together.”

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. Email:, website: 

Published in:
Citizen News Service(CNS), India/Thailand
Spyghana News, Accra, Ghana
G. Krom News, Africa, Thailand


  1. All of us know that there is a pool where TB bacilli can flourish and can cause TB infection in children. We are the ones who together with our knowledge and experience we can eliminate the pool, so that no more infections can occur.

    In the developing and poor countries there are several risk factors which could make the children prone to TB infection could accelerate infection into disease

    Children become prone to infection in overcrowded homes, large number of people in small space can be at higher risk of TB." proximity to an index adult case where ventilation is absent where illumination is poor (no windows, just small doors) no sunlight entering into the house.

    There are factors accelerating infection towards disease:
    - Malnutrition
    - Pollution (cigarette smoke) biomass fuels unhygienic condition, poor hygiene and refuse management and improper drainage
    - Co-existing diseases Viral disease (measles, pertussis, smallpox,etc)
    - Malignancy, diabetes
    - Anaemia,
    - HIV infection.

    The question is, can we do something to change those circumstances caused by poverty, malnutrition and ignorance? The answer is: NO!

    It is not the task of the TB control centers or advocates that will change the sad situation of a poor socio-economic community.

    But what can we do? Detect, treat and cure all infectious cases we encounter in the community, so that no longer they can spread the infectious bacilli to others (children).

    Once the infectious sources are identified and treated, all, each and every earlier mentioned risk factors will become irrelevant.

    The surest way to instantly stop infection is immediate treatment of the infectious source.

    Finally, lest we forget. The TB bacilli contained in sputum droplet nuclei, floating in the air are the very ones that can penetrate the bronchi and bronchioli. While landing on the alveoli the droplet cum bacillus can cause infection when inhaled.

    TB infection is not perse caused by poor disinfection and management of excreta from known tuberculosis patients. Also, spitting on the roads and defecating in the open for sure, are indications of poor hygiene but cannot help in the spread of the tuberculosis germs.

    Dr Muherman Harun, Indonesia

    [Mods note: To join the online dialogue on tuberculosis, send an email to: . Above is a comment to a CNS article published online at: . Comments are welcome. Thanks]

  2. 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

  3. Ventilation is a strong factor to consider in airborne bacteria like tuberculosis. Most modern buildings have anti-bacterial plasma that helps eliminate airborne diseases.