India not only has the highest burden of paediatric tuberculosis but also records the maximum gap between children who require preventive therapy and those who actually receive it, according to a report released at the 71st World Health Assembly — the decision-making body of World Health Organization (WHO).
The report, released by international voluntary scientific organisation The Union, shows that only 1.84 per cent of children, aged up to 14, in India receive preventive TB treatment.
Preventive therapy is given to those who do not have active TB, but live in contact of infected TB patients and are prone to the bacterial infection. In India, a six-month regimen is provided under Revised National Tuberculosis Control Programme (RNTCP) as preventive therapy.
The Union report, however, finds that of projected 3.6 lakh Indian children in need of preventive therapy, only 6,637 (1.84 per cent) were given the therapy in 2016.
The gap in access to preventive therapy in India is the largest globally, followed by Democratic Republic of Congo where of 75,000 children exposed to TB, only 4,725 are receiving preventive treatment.
“Most TB-related deaths in children occur in young children who have not been diagnosed or treated, representing a missed opportunity for prevention. The burden of multi drug-resistant TB (MDR-TB) in children is still largely unknown, but it is estimated that less than 10 per cent of all children with MDR-TB are detected and treated,” the report said.
According to the WHO, only 13 per cent of children eligible to be treated with isoniazid, as preventive therapy, receive it globally.
Dr Soumya Swaminathan, deputy director general at the WHO, said at present less than 10 per cent children receive preventive therapy in India. “We have to reach out to children under five, that is still missing. The household contacts are at highest risk.”
Current preventive therapy involves primary screening. A child at risk of contracting TB is put on six-month regimen for preventive therapy.
“Mumbai slums have so many people who share a single room, specially migrant workers. We need to first do contact tracing and then expand to latent TB population,” Swaminathan added.
Data analysed in 20 countries showed that India recorded 1.2 lakh children, the maximum, who contracted TB in 2016, followed by China at 53,000 and Philippines at 37,000 children aged up to 14.
“This is a human rights issue if children do not get treatment at right time,” said Dr Paula Fujiwara, scientific director at The Union. She added the bacteria is less likely to come up in sputum samples or in x-ray because children develop less lung lesions making diagnosis difficult.
“There are four gaps we are looking at, in prevention, research, diagnosis and treatment. The findings of gap in preventive therapy for paediatric TB are new for us. The hidden epidemic has to be dealt with at primary health care. The most vulnerable are children with co-infection of TB, HIV and malnourishment,” said Dr Vidhya Ganesh, deputy director (Program division) at UNICEF in New York.
Speaking on sidelines of the 71st World Health Assembly, Health Minister J P Nadda said, “The goal to eliminate TB by 2025 is achievable. We have already created a system for screening and treatment. Active surveillance is on. There are now 1,100 plus GeneXperts machines available and nutrition schemes have already been launched.”