Protecting the Future

Even as India grapples with the highest incidence of tuberculosis (TB) in the world and the challenge of dealing with rising incidence of drug-resistant TB, we are confronted with the unsurprising but equally horrifying discovery that the country has the highest number of children infected with the disease. Published in The Lancet, the research shows that the global figure for children with the disease is 25% higher than the World Health Organisation’s (WHO) estimates. And India’s share in this group of 22 countries is the highest. Health rights’ organisations put the figure of children dying due to this painful disease every year between 74,000 and 1,30,000. They are at greater risk of contracting it by infection spread through the air and by living in households with adult TB patients, with malnutrition playing a significant role.

There are many factors that contribute to this grim scenario apart from the fact that it has not received the urgent attention it merits. Diagnosing TB in children is difficult since they do not produce enough sputum for the tests and even when they do, the most affordable tests can diagnose properly only in approximately 30% of cases. The technological tools that have been sharpened for diagnosis in adults do not necessarily work for this section. Thus, under-reporting and delay in seeking treatment is a common phenomenon. Children are also much more susceptible to contracting extra-pulmonary and tubercular meningitis or TB meningitis, which makes diagnosis tougher. The fixed-dose combinations which are considered to be the accepted treatment for children are not easily available and the development of appropriate fixed-dose combination products has been slow, as WHO has noted.