By Sharon Atieno
“It started with one child complaining of stomachache, then headache, later the fever rose and we took him to the hospital. He was treated for malaria but the fever did not stop. It forced us to take him to a better hospital where he was found to have typhoid and pneumonia,” narrates Baba Fabian.
“The doctor treated him for three or four days but observed that the fever was not ending. He told me that the next option was to do a scan. He did a scan on his chest and discovered that one of his chests had some form of white cloud. Then he began treatment from there.”
Baba Fabian notes that he has another child who needed to be scanned and upon scanning, it showed the same symptoms though not as defined as in the other case. Both his children have been on TB treatment for the last one month.
Stop TB partnership estimates that in 2019, out of the 140,000 Kenyans estimated to have TB, 18,000 were children.
Speaking during a media for environment, science, health and agriculture (MESHA) and Stop TB briefing, Dr. Felix Mboya, Elizabeth Glasier Paediatric AIDS Foundation –Nairobi noted that 65% of TB in children is missed. “We are only diagnosing 35% in children,” he said.
Dr. Mboya notes that the World Health Organization (WHO) recommends that the proportion of children diagnosed with active TB disease should form at least 10 to 15% of all cases of the adults who are notified. However, in 2019, Kenya managed to diagnose only 9.7%.
He said that with TB testing in Kenya being through a molecular test using geneXpert test, it is difficult to diagnose and confirm TB in children as the very young children often cannot produce sputum for testing.
“Even if we have geneXpert and we have microscopy and we obtain the specimen, then this specimen which we have obtained also have very low quantity of bacteria in that sample,” he explained.
Further, Dr. Mboya adds that despite presence of TB symptoms like lack of appetite and loss of activity among children, one has to know whether there is a history of contact with any adolescent or adult with confirmed presumptive TB or who is on TB treatment within the household.
“In children, the major risk factors are malnutrition and if the child is having some other immunosuppressive condition or using some drugs which reduces immunity or the child has a history of poorly treated previous TB and if the child was not given BCG,” he said.
Dr. Mboya explains that lack of BCG vaccination would expose a child to suffer the severe forms of TB as the BCG which is being given in Kenya only prevents severe forms of TB, most of which are extrapulmonary (outside the lungs) especially TB of the brain, TB of the joints, TB of the bone and TB of the pleura- which are the major ones.
He notes that children under five have higher risk of progression to active TB disease, and especially of developing more severe forms of TB. Because they are small, they develop more pulmonary (lung) TB than extrapulmonary TB, he adds.
To solve the issue of diagnosis, he notes that other tests have been developed including use of stool in geneXpert and TB LAM specifically for those who are HIV positive and those with advanced HIV disease which uses urine specimen.
Further, Dr. Mboya observes that X-rays are a very good screening tool and appeals to county governments to waive them so that children under 14 years can access chest X-rays for free. “You can do geneXpert and it becomes negative, then when you do chest X-ray for the child, you get symptoms resembling TB and that helps you to do clinical radiological diagnosis,” he notes.