Measles, malnutrition possible reasons for tuberculosis in children —Study

Lack of vaccination has led to millions of deaths previously worldwide due to diseases like measles, tuberculosis, poliomyelitis, diphtheria, tetanus, pneumonia, and diarrhoea. Now, experts suggest that malnutrition and measles are important risk factors for the development of tuberculosis in children.

Experts, in the study, said although children and adults are at equal risk of developing TB infection when exposed to a person with infectious TB, children are substantially at greater risk for developing TB diseases, mainly because of malnutrition, measles and steroid therapy.

The study to determine the frequency of known risk factors in confirmed cases of tuberculosis in children, however, reported that family education, especially the mother’s educational level and vaccination with BCG are the two most important factors in preventing tuberculosis in children. It was in the Annals of Pakistan Institute of Medical Sciences.

Children between 2 months and 12 years with confirmed tuberculosis were enrolled in the study from outpatient and inpatient departments of the Children’s Hospital at the Pakistan Institute of Medical Sciences, Islamabad from August 2006 to May 2007.

Detailed information was taken regarding, history of contact, history of measles or whooping cough, household size, people sleeping in a room, socioeconomic and education status of parents, history of steroid use and urban & rural dwelling. Patients were examined for BCG scar and nutritional status.

Dr Bolaji Ahmed, a public health physician and the deputy programme manager on TB preventive therapy at Damien Foundation, in a reaction, said children with protein-energy malnutrition because of their lowered body immunity are at a higher risk of contracting TB.

According to him, “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. Measles, too, can accelerate the progression from TB infection to active TB disease. People can have TB infection, but they will not necessarily become sick with TB disease.

“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.”

Dr Ahmed said that it’s expected that about 15 per cent of all TB cases that are detected 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,” he added.

Conversely, Dr Ahmed said TB in children calls for a high index of suspicion because often they do exhibit the classical signs and symptoms of TB.

According to him, “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.”

For the study, 200 patients were evaluated for risk factors of tuberculosis; 160 (80%) patients had a history of contact with TB case and 129 (69.5%) had no BCG scar. Illiteracy was found in 133 (66.5%) mothers and 73 (36.5%) fathers. One hundred and 23 (61.5%) patients were residents of rural areas and 102 (51.0%) belonged to poor backgrounds.

One hundred three (51.5%) patients belonged to families where 5 or more people lived in one room. Only 1% of patients belong to such families where 2 persons live in one room. One hundred (50%) children had grade III malnutrition, 48 (24.0%) had grade II malnutrition and 30 (15.0%) had grade I malnutrition, demonstrating a correlation between malnutrition and development of TB.

Out of a total of 200 cases, 27 (13.5%) had a history of long-term use of steroids, 86 (43.0%) had a history of measles in the near past and there was no history of whooping cough in any of the patients.

The majority of the children in this study also had TB before two years of age as well but they were undiagnosed in the community and a history of contact with an adult TB patient is the commonest risk factor for TB in children.

Data from the study also highlighted that maternal education is more important than paternal education in preventing TB in children. The second is that more is the education of parents, the lesser the chances of acquiring TB in their children.

With a higher education level, the parents are more likely to understand the importance of screening their children for possible infection with M. tuberculosis so that prophylaxis can be given before the disease occurs.

Moreover, educated parents give anti-tuberculosis drugs regularly and complete the course on time. Thus their children recover completely without any complication of tuberculosis.

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