Health

‘Malnutrition should raise concern about TB in children’

Tuberculosis (TB), an infectious disease, can kill in a few years if not treated. In this interview by SADE OGUNTOLA, Dr. Bolaji Ahmed, a public health physician and the deputy programme manager on TB preventive therapy at Damien Foundation, says that unlike before, the classical looks of individuals with TB have changed.

Why do we have a national TB testing week given that yearly World TB Day is celebrated globally? Of what significance is TB testing?

Tuberculosis is a peculiar disease that for you to place a patient on treatment based on the national TB policy you must have evidence that the patient has the disease. Every patient suspected to have the disease must be tested. Now we notice that there’s a gap in the uptake of TB testing among the community. One of the cardinal points of a patient with TB is cough. But the majority of people in the community are averse to TB testing because many people’s health-seeking behaviour is poor.

Even when they cough, they go to consult the patent medicine vendors or traditional healers. They think of TB last. Sadly, by the time they are thinking of TB, the disease is already causing a lot of damage to their bodies. We need to sensitise the community on the importance of TB testing. It is not to stigmatise them but to ensure that everyone knows that there are facilities for TB tests whenever they have a cough that has lasted for two weeks or more. Both the test and treatment are free.

On a scale of 1 to 10, how do you rate TB testing in Nigeria? Are there challenges to maximizing testing?

I will put it at 4 out of 10 and this is partly because of the challenges with TB testing in the community. The fact is that people don’t even want to come out to take the test. The COVID-19 further worsened the situation. The moment you start talking about coughing, they think that maybe you want to take them to the isolation centre because of COVID-19.

Also, the gold standard for TB testing in Nigeria is conducted by the gene-Xpert machine. Ideally, every local government should have a gene-Xpert machine. Oyo State has less than 15 of such machines to cover its 33 LGAs. It is grossly inadequate. The gene-Xpert machine can detect tuberculosis in less than two hours as against microscopy which will take days. Also, it can tell whether the patient has a drug-resistant tuberculosis or not.

Of course, Nigeria’s poor health-seeking behaviour calls for a lot of concern because it’s affecting the uptake for testing. That is why we need to sensitise the people to create the demand for TB testing. Individuals don’t even know that they can access free TB testing, screening and even treatment in designated private health facilities.

If TB is left untreated, what is the chance of such an individual dying in the next 2 years?

Before the advent of the COVID-19 pandemic, TB was the top killer. Now, it is the second most deadly infectious disease after COVID-19. It is sad that if the infection is not treated it can kill, it may kill maybe in two to 3 years. Of course, it will slowly cause a lot of harm for the patient. Aside from that, someone with TB who is not on treatment can infect about 10 to 15 persons per year. By mere coughing on the bus, workplace, at social gatherings and so on, quite a lot of people could get infected. Both extrapulmonary and pulmonary TB is deadly and they still confer a lot of danger to the community if not treated. We have quite a lot of people that have both types of TB.

Which groups of people are most vulnerable to TB in the community? Is TB also gender sensitive?

TB affects all age groups and gender. But statistics show that adults are more affected than children. Anything that lowers body immunity increases the risk of contracting TB. So, people at a higher risk for contracting TB include children and elderly people, individuals with conditions like HIV and diabetes, prolonged tobacco users, and abusers of steroids.

Indiscriminate use of steroids among women, for example, to get fat reduces their body’s immunity, leaving them exposed to increased risk of TB.

ALSO READ FROM NIGERIAN TRIBUNE

Also, people in poor housing conditions, including poor ventilation, overcrowding and living in slums are particularly at risk of TB. Children with protein-energy malnutrition because of their lowered body immunity are also at risk of contracting TB.

Babies can come down with TB, too?

Yes, of course, babies too can come down with tuberculosis. Their mother can infect them, likewise their caregivers or handlers. We live in an era where children are raised by house-help, crèche minders, and grandmothers. If the caregivers have TB, the child has a very high chance of coming down with TB. We’ve seen it several times and it’s still happening. Well, it’s expected that about 15 per cent of all TB cases that we detect in Nigeria should be from children between the ages of zero and 14 years. From the statistics we have now, cases of TB in children have been hovering between three and four per cent of all the TB-detected cases.

Are there particular professional groups also at a higher risk of TB?

Yes, health workers are particularly at risk of having tuberculosis. As a health worker, you cannot know by just looking at the patient whether the person has TB or not. Due to an improved lifestyle, including better nutrition, the classic picture of how a person with TB looks has changed from that individual that is coughing seriously, thin and almost dying. At the very initial point, you may not even know it. That is why we always train health workers on infection prevention and control practices and also emphasise this.

TB diagnosis in children, how easy is it done?

TB in children calls for a high index of suspicion because we don’t expect the classical signs and symptoms of TB. For instance, don’t expect a child to be coughing blood. The first sign might just be that the child is not thriving despite adequate feeding. Also, when the child is not gaining weight like his peers or suffering from protein-energy malnutrition, it could be a pointer.

One of the very common signs of TB that we see in children is a painless swelling on the neck that looks like a boil. It will require a qualified health practitioner to determine whether it is a boil or an inflamed lymph node. If it is boil, of course, you expect that it will be painful and the temperature around that neck to be higher than that in the environment. Taking a small tissue from the swelling, what is called a biopsy, will help to find out if the swelling is due to TB.

Now, the diagnosis of TB in children is challenging, even with Gene-Xpert. Getting a child to bring out sputum for testing is difficult. Now, thankfully all our gene-Xpert machines have been calibrated to use stool samples to detect TB, especially in children. And of course, clinical diagnosis is based on a chest x-ray. Also, many other high-tech diagnoses are possible.

TB is a deadly disease, so can it be eradicated?

Sure, we can eliminate TB. Eradication is reducing the incidence to zero in the whole world. How do we eliminate TB? First, we have to ensure that our testing capacity increases. All patients having TB or are suspected to have TB need to be tested appropriately. Those confirmed to have TB must also be placed on treatment. Also, all their close contacts need to be investigated. Those that have the symptoms must also be tested and if positive should be treated. Those who have been confirmed to have TB infection because they have been exposed should be placed on what we call TB preventive therapy (TPT). Doing this will break the chain of transmission of TB as a disease. Doing this will certainly put us on the right track to eliminating TB.

Sade Oguntola