“My child was given injections at a local hospital for fever, cold and pneumonia. But dry cough of the child wasn’t cured even within two months of treatment. Then, many suggested me to take my child to Shyamoli TB Clinic for investigation.” told Hasina of Bikrampur at the chamber of the physician of National TB Control Program taking her one and a half year old child in the lap. The physician on duty of the clinic mentioned that though the age of this child is one and a half year but the weight is only 7 kg. Hasina became pale when physician informed that the child is infected with TB detected by X-ray. She got nervous learning this and asked questions to the physician on how to deal with this child, where to go for treatment, how much will the treatment costs her etc.

Dr. Ruhul Amin, Head of the Department, Child (lung) Pulmonary, Dhaka Shishu Hospital, informed that 1 to 2 months children can also be infected with TB. Children are contaminated with TB by any infected family member or fellow being. Chief of the Nutrition Program of International Center for Diarrhoeal Diseases and Research (ICDDRB), Dr. Tahmid Ahmed said many educated persons don’t know that children can be infected with TB. He opined that `Children are less affected by TB’, such views among us are reducing attention from children. As per information of the countrywide implemented National TB Control Program, 1625 children with TB were detected in 2005. This number was 4179 in 2006. But in 2006, the total number of detected TB patients was 45,186. Accordingly, the number of detected children with TB appears to be too low or brought less in number under detection program, commented the officials of National Program.

But the experts say, living with poverty and in densely populated areas influence TB infection. If BCG vaccines are not given to the children, if their parents are drug addicted or feeding milk of TB infected cows also creates risks of TB infection to the children. Children are at risks of TB infection from that aspect too. National TB control Program has been implementing by twenty eight NGOs including BRAC. BRAC also supervises activities of other NGOs in this regard. BRAC has been implementing its programs in different areas including 283 upazilas, municipalities in 42 districts, 5 cities, 22 medical college hospitals and 41 prisons.

Dr. Akramul Islam, Coordinator, Health Program of BRAC mentioned that it is necessary to pay attention to the fact whether the number of TB affected children in the country is really small or they are brought less under detection program. Children are also treated besides adults at DOTS (Direct Observation Treatment System) centers operated by BRAC and others under National TB Control Program. He informed that DOTS centers have been initiated at Dhaka Shishu Hospital and Mother & Child Institute at Matuail with the assistance of BRAC. More DOTS centers will be established in other areas of the country on the experiences of these two centers.

Shahida Akter Sultana, In charge of the Child and Mother Institute DOTS center stressed on dissemination of the message that children are also infected with TB. Sabana Siddiqua, Program Organizer of Dhaka Shishu Hospital DOTS center mentioned that the patients are referred to the nearest DOTS centers while discharging the admitted TB patients from Shishu Hospital. Patients complete their courses of drugs from their nearby DOTS centers.

Detection of TB among children is difficult. TB among adults could be easily detected by perforated lungs, plural fluid and X-ray. But in most cases those symptoms remain absent in children. Children cannot give their sputum and x-ray cannot always confirm detection of TB. Sometimes child specialists diagnose TB from its symptoms. Dr. Vikarun Nesa Begum, Junior Consultant of National TB Control Project at Shyamoli, urged the government to appoint child specialists at every upazila health complex for the detection of TB among children. Dr. Vikharun Nesa stressed on the proper treatment of children though it is delayed for one week to start. Wrong treatment can be devastating to the children. Dr Asif Muztaba Mahmud, Associate Professor of National Institute of Chest Diseases and Hospital at Mohakhali mentioned that nowadays children with TB are found rarely. But no study was conducted on the fact why children with TB are so rarely identified. He emphasized on providing training of early detection of TB among children to the specialist physicians and of medication and other relevant issued to the field level workers.

A children-focused initiative
ICDDRB is going to start a pilot project on detecting TB among children at Madhupur upazila under greater Mymensingh district. Fifty thousand children of age group 0 to 14 in four among twelve unions of this upazila will be included in this two year project. ICDDRB will be implementing this project by the award money of `Development
Market-place Award’ received from World Bank. ICDBRB expects that a scenario of TB in rural children will be revealed on completion of this project.

Under this project, children will be referred to upzila health complex for examination if answers of two among the questions whether the child has been coughing for two weeks or more or suffering from fever for more than seven days or is playing normally with other children nor any other member of the family is infected with TB, are yes.

What parents should do
Parents are getting their children admitted to ICDDRB with the complications of diarrhoea. During the course of treatment for diarrhoea children are given other treatments including nutrition. At that time TB is detected among them. Parents are getting their children admitted to hospital with diarrhoea and pneumonia. Dr.Tahmid opined such awareness is still poor that the parents are getting their children admitted to hospital for the treatment of TB. Dr. Tahmid also mentioned, parents should be aware by themselves and take their children to specialists for consultation if their child suffers from fever for more than two weeks; if usual medication doesn’t cure the child from coughing; if glands are swelling like rope nodes, if weight falls, if weight doesn’t gain and if fever comes at night. Dr. Vikharun Nesa mentioned if mother is infected with TB she should be careful about her child including keeping her mouth covered well with clothing or her face should be turned to other side while breast feeding.

A separate chapter for children has been added to the National TB Control Manual in the last year. This chapter includes child nutrition, age specific doses of drugs etc. There is poor publicity about children in the TB control program. As such people involved with this program have felt necessity of wider campaign in this regard.

29 August 2007
Translated by: Md. Mahbubul Ashraf