Integration of childhood TB into guidelines for the management of acute malnutrition in high burden countries

Abstract

T uberculosis (TB) is a major public health challenge, now surpassing human immunodeficiency virus (HIV) infection as a leading cause of death from infectious disease globally. With one million estimated cases, children aged <15 years accounted for approximately 10% of the 10.4 million incident TB cases in 2015, and 210 000 children died. 1 However, only 39% of child TB cases were reported, highlighting significant underdiagnosis and under-reporting of childhood TB. 1 Despite increased awareness within the TB community and the launch of a Roadmap for Childhood Tuberculosis in 2013, 2 there is a significant policy-practice gap in implementing guidelines, capacity building at the country level, and decentralization and integration of TB services into broader child health programs to better reach children where they access the health care system. 3 This means targeting programs and services at the community and primary health care level, and health care providers caring for those at high risk for TB. It also means actively engaging key stakeholders in child health and survival, including the nutrition sector. 4,5 TUBERCULOSIS AND MALNUTRITIONApproximately 45% of deaths in children aged <5 years are attributable to undernutrition, 6 which may be acute or chronic, and categorized as moderate or severe. Children with undernutrition are at increased risk of death from infectious diseases and, conversely, severe infectious diseases in early childhood can affect nutritional status. 6 Undernutrition increases the risk of TB and TB can cause or worsen undernutrition. 7 One study estimated that 26% of overall TB cases in 22 high-burden countries are attributable to undernutrition. 8 Data on TB prevalence among acutely malnourished children vary widely: 2-24% of acutely malnourished children in high TB burden settings have been diagnosed with TB. 9-13 The wide range observed between studies can be partly attributed to the use of varying screening strategies and access to TB diagnostics, as well as varying clinical capacity for childhood TB diagnosis and treatment among hospitalized children. Even at referral hospitals, access to diagnostic tests may be limited, 14 highlighting the need for improved access to services across all levels of the health care system, including appropriate referral pathways. These data also highlight the role of TB as a comorbidity among children with acute malnutrition, emphasizing the need to routinely screen for TB and manage those at risk of TB appropriately. Asking about contacts with persons with TB is included as part of the initial history for children with severe malnutrition, as outlined in the 1999 World Health Organization (WHO) manual on the management of severe malnutrition. 15 In the WHO 2013 update on the management of severe acute malnutrition (SAM), TB screening is mentioned in the context of HIV infection. 16 We performed a review of the guidelines on acute malnutrition from high TB burden countries to identify whether and how TB is integrated within nutrition guidelines. METHODS...

Evaluating the integration of tuberculosis screening and contact investigation in tuberculosis clinics in Ethiopia: A mixed method study

“…This is contributing to the missed TB cases [28]. Identification of presumptive TB in children largely depends on contact history with infectious TB cases, recurrent and repeated pneumonia, and failure to respond to the standard therapeutic therapy [29][30][31]. Those in contact with undiagnosed chronic coughers in the neighborhood or school should be considered to find all TB cases in children.…”

CD8+ T Cells Prevent Lethality from Neonatal Murine Roseolovirus Infection

“…Neutralizing IgM antibodies toward HHV6 develop during acute exantham subitum (15). Virus-specific CD4 + and CD8 + T-cells are present in adults without HHV6 viremia, presumably due to prior exposure to the virus (16, 17). However, the relative importance of these cell types during acute HHV6 infection or reactivation is unclear.…”

Immunological Aspects of Diagnosis and Management of Childhood Tuberculosis

“… Conditions that modify TB disease and standard diagnosis tools Age Children under three years are at the highest risk for rapid progression to active TB, they have a paucibacillary condition, non sputum. 2 , 3 , 25 , 27 , 28 , 30 , 32 , 39–41 , 48–50 , 56–63 . Nutrition Malnourished children have high TB burden.…”