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Childhood tuberculosis - An emerging health challenge for Bangladesh

1 Department of Paediatrics, Gonoshasthaya Samaj Vittik Medical College and Hospital, Savar, Dhaka, Bangladesh
2 Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia

Date of Submission05-Sep-2022
Date of Acceptance07-Sep-2022
Date of Web Publication28-Sep-2022

Correspondence Address:
Mainul Haque,
Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, 57000 Kuala Lumpur
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aihb.aihb_171_22

How to cite this URL:
Chowdhury K, Haque M. Childhood tuberculosis - An emerging health challenge for Bangladesh. Adv Hum Biol [Epub ahead of print] [cited 2022 Dec 2]. Available from: https://www.aihbonline.com/preprintarticle.asp?id=357311

Mycobacterium tuberculosis (TB) is the paramount basis of death from a single pathogenic microbe globally.[1],[2],[3] TB, one of humankind's oldest infectious diseases, still prevails as the significant cause of mortality. The anti-tubercular vaccine and drug therapies are available for over 90 and 60 years, respectively.[4],[5] While utmost TB diseases occur among the elderly community,[6],[7] children are a particular imminence category because of a higher possibility of quickly acquiring TB infection,[8],[9] with speedy advancement of the disease[10] and high death rate.[11] The World Health Organisation (WHO) reported that in 2020 that 10 million people were infected with TB; among them, 56%, 32% and 12% were men, women and children, respectively.[12] It has been appraised that around 3.5 million children will be infected with TB for a total of 40 million people around the globe in 2022.[13] Other research reported that something like 200,000 children passed away per year worldwide from 2016 to 2019.[14],[15],[16] Another study reported that 80% of these paediatric mortality were below 5 years, and 96% did not access medication.[17],[18] The WHO floated the 'End TB Strategy' in 2015 to minimise equally morbidity and mortality related to TB burden internationally by 2030.[19],[20] Bangladesh remains among the top eight nations, accounting for nearly 67% of the all-encompassing TB burden.[21] Multiple national reports from Bangladesh revealed that paediatric cases under 15 years of TB were below 5% of total cases between 2015 and 2019.[22],[23],[24],[25],[26],[27]

A child becomes infected with TB through respiratory droplets from other adolescent and adult pulmonary TB cases.[28] A significant portion of TB paediatric cases often develop such an infection as they live with adult family members who are sputum smear-positive TB cases.[29] Furthermore, children can acquire TB from their family members who have smear-negative TB disease.[30] The possibility of acquiring infection among children increases close contact, particularly when the mom or principal caregiver had pulmonary TB and it was confirmed radiographically.[31] Moreover, one meta-analysis revealed that children acquire TB infections besides household contacts.[32] Precise figures on children's TB infection are problematic to pick up because of manifold grounds that include underrated detection, difficulties in validating the diagnosis and under-reporting to the accountable public healthcare system.[2],[33] The symptoms, signs and roentgenogram features are less precise among children than adults[34] and are frequently chaotic with other acute respiratory microbial infections.[35] Microbiologic endorsement of the disease is often inadequate because of the paucibacillary nature of childhood TB.[34],[36] Furthermore, microbiological proof is regularly challenging to attain as childhood pulmonary TB cases are hardly ever able to expectorated sputum, and sputum initiation procedures or other sampling methods are expensive and not accessible in real-life in low-income and high-burden countries.[37] In addition, smear microscopy's sensitivity for childhood TB diagnosis remains <15% under the optimal conditions.[38],[39]

Bangladesh is well recognised worldwide for effectively executing the TB control programme.[40],[41],[42] Bangladesh's childhood TB detection rate is persisting at <5% for the past few years.[16] Bangladesh government has formulated and implemented childhood TB management guidelines, and notification of TB cases has been mandatory within the National Tuberculosis Programme.[16] Despite those steps, several obstacles persist, preventing our goal of end TB strategy. Insufficiency of the diagnostic facility, lack of interest in the notification of cases by private practitioners and social disgrace is slowing our progress.[16] Nevertheless, the country has achieved a lot regarding paediatric TB control but still has a long way to go to reach the WHO goal.[43]

TB in children indicates ongoing infection in the community,[44] and they are at the highest risk of progressing, disease-causing significant morbidity and mortality.[45] Despite Bangladesh and other low- and middle-income-countries having limited diagnostic faculties and minimum access to the long-term therapeutic management of TB, it is believed that initiating appropriate strategies at the right time has a favourable outcome.[46],[47] Public healthcare authorities should undertake more initiatives to raise community awareness, involvement of private practitioners and increase service providers' capacity.

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