Professor Regina Oladokun is the Vice Chair of the National Tuberculosis Programme’s Child TB Steering Committee and the President of the Nigerian Society for Paediatric Infectious Diseases. In this interview with SADE OGUNTOLA, she discusses the value of early childhood TB diagnosis and treatment as well as the uniqueness of the disease in children.

WhAT does the nationwide tuberculosis (TB) testing week of 2024 which kicked off this Monday mean?

The national TB testing week is an initiative of the National TB Programme, which started last year. The aim is to help find missing cases of TB in children and, at the end of the day, increase the number of reported cases. Thus, setting aside time to declare that we are screening to detect more cases of TB in children is a commendable move. Last year, it yielded very good fruits. This year’s nationwide general TB testing week for both adults and children fell on March 24, the World TB Day. Children are usually included in the general testing week, but there is a tendency to leave the children behind. Children’s Day, which falls in May, provides an opportunity to highlight the needs of children and has helped bring attention to numerous children who were previously unknown to have TB.

What is the current state of child TB in Nigeria?

The World Health Organisation expects that up to 15 percent of TB cases detected should be in children. Unfortunately, the number being reported in Nigeria is low, showing that we are still missing many children with TB. When an adult starts to lose weight and cough up blood, you can tell right away. Therefore, TB detection is high. However, children may not cough up blood. It requires a qualified individual to even recognise that a child might have tuberculosis. In order to fill in the gaps in our report on the detection of tuberculosis cases in children, this testing week is crucial.

Why are children at risk of TB, considering that many people presume TB to be a disease of adults?

TB does not affect only adults. Children and adolescents also come down with TB. Healthcare workers have been trained to detect TB in not only adults but also children. TB in children in any community is evidence that TB is moving around in that community. Adults are the ones that usually have the TB and pass it on to the children. In essence, it is not that children do not have TB, but transmission is mainly by adults. TB manifests in children in a different way than in adults. Thus, TB in children is frequently overlooked.

During National TB Testing Week, more emphasis is placed on finding and testing children who are at a higher risk of developing TB. Every child on the street is not pulled aside to check for TB. No, as a result of cost, efforts need to be concentrated on those who are more likely to come down with TB. They include children who are not growing well (malnutrition) or have HIV. Not growing well, and TB goes very well together. Children who have presented in the health facility for whatever reason need to be checked to be sure they do not have TB since the disease can manifest in different ways.

Other groups of children who are at risk of contracting TB are those who live in overcrowded and poorly ventilated homes, IDP camps, etc. Additionally, children are more likely to contract TB if an adult member of the family has the disease and is exhibiting symptoms such as coughing, weight loss, and night sweats.

What causes tuberculosis in children, and how does it manifest?

Mycobacterium tuberculosis is the germ that causes TB, and it can infect both adults and children. However, the manifestation of the TB germ is a bit different in adults compared to children. One of the main symptoms of TB is coughing because it affects mainly the lungs. When an adult with TB coughs, thousands of TB germs are released into the atmosphere. For many hours, the germs may linger in the air. As a result, there is a chance that someone who is in that crowded, poorly ventilated area could contract TB. In such a household, the children are far more in danger than the adults.

Why are children more at risk of contracting TB than adults?

It has to do with the immune system, which is not as mature as in adults. Additionally, children become significantly more susceptible to contracting TB if they have other health issues such as measles, HIV, and other diseases. Children’s TB has frequently been misdiagnosed as other illnesses, including typhoid and malaria. The major symptom of TB is coughing, which has been present for two weeks or more. Even with cough syrup and other remedies, this cough does not go away. That is what suggests that a cough should be checked to know whether it is TB.

Are there other symptoms that babies or children with TB present with?

Aside from the key one, which is prolonged coughing, the body can be hot, with or without sweating a lot at night. When children are ill with TB, they start losing weight. For adults, they frequently spit up blood when they cough. This is because the lungs are greatly impacted by the illness. TB in young children affects the lungs differently, and they may not cough up blood. There is a significant distinction between how TB affects adults and children. Healthcare workers are trained to have a high index of suspicion to identify a child with TB.

For some reason, sometimes people do not want to volunteer their illness when they are coughing up blood. However, the matter is not helped by hiding it. Those around that individual, whether in the same household or workplace, are put at risk. If someone has any symptom suggesting TB, such as prolonged coughing or weight loss, regardless of age, they should present at the nearest health facility. The government has provided free testing and even treatment. TB is very curable.

Is TB more deadly in children than in adults?

A simple yes-or-no response to that question is challenging. Both adults and children may present late. If a person is diagnosed early and begins taking the TB medication within a week or two, there will be a lot of improvement. Very young children may have a poor outcome, especially if they are detected late. That is part of the reason for the child TB testing week.

Again, for emphasis, the symptoms of active TB in children may include prolonged fever, cough, weight loss or poor growth, swollen glands in the neck area, and others, depending on whether other organs have become involved. Unfortunately, some of these symptoms mimic those of other diseases. It is occasionally thought in the community to be malaria or even typhoid fever.

If  TB is limited to the lungs, it is referred to as pulmonary tuberculosis. Pulmonary TB manifests with coughing, along with the other symptoms mentioned earlier. However, TB can also affect other parts of the body. It can impact the brain’s outer layer, leading to meningitis; it can also cause pericardial effusion in the heart; and it can develop TB within the abdomen. It may also impact the backbone, leading to a hunchback. When the lymph nodes are involved, they enlarge and show as lumps in the child’s neck. As a result of these many manifestations of extrapulmonary TB in children, it may require a skilled person to diagnose the TB in young tuberculosis.

But what are the treatment options for TB in children?

In Nigeria, treatment for TB is free. For children, the TB medications come in tablet form and with different fruit flavours. You just put it in water, and it will disperse. Additionally, it is easy for the child to tolerate the medicine and recover quickly. The TB bacillus is very stubborn; therefore, it needs to be treated for up to 6 months to make sure the body is completely cleared of it.

For TB prevention in children, ensuring every child takes the BCG vaccine at birth is important. It will stop the infection’s main consequences, such as heart infection, even if the child is exposed to tuberculosis later in life. There is also a place for giving prevention treatment if a child is exposed to someone with TB but does not show the full symptoms of the disease.

How is a child’s TB diagnosis made?

A TB diagnosis starts with identifying the symptoms and signs. Then further diagnosis requires assistance from lab tests. A chest x-ray is very useful. The doctor will check it and see whether it suggests TB or not. The government has also made it free of charge.

Sputum tests are also done to confirm a case of TB. Adults easily produce sputum, but younger children cannot produce sputum easily. Currently, the stool of the child is sent to the laboratory for a molecular test (GeneXpert), which detects the nucleic acid of the TB bacilli. When other parts of the body, like the covering of the brain or the backbone, are affected, the same molecular test can be carried out on a fluid sample from the affected part of the body to see if it is TB.

What should parents do if they suspect that their children have been exposed to someone with TB or that they have TB?

A screening is necessary to ensure that their children are free of tuberculosis. There is a treatment for tuberculosis. Therefore, the adult who has TB should request to have his contacts checked to determine whether they also have the disease. Individuals who have been diagnosed with tuberculosis (TB) or who exhibit symptoms, such as weight loss and a cough that lasts longer than two weeks, should get checked to make sure they do not have TB. If it turns out to be tuberculosis, they should kindly ask that other adults and children living in their home be tested. They can also be given drugs that will prevent them from having TB. This is also applicable to a child with a persistent cough who is losing weight.