TB, a possible cause of malnutrition in children? —Experts

Aisha Hammed, 4 year-old, suffers from malnutrition so severe that she looked like a two-year-old. Unlike her senior sister, her growth just stopped after her third birthday. The loss of weight was so noticeable that her mother was forced to take her to the hospital.

“The loss of weight was so pronounced though she eats so  I had to complain at the hospital that something was wrong with her,” stated. Mrs Aminat Hammed. “The doctor after running several tests said she had tuberculosis.”

Little Aisha is among the thousands of children that are diagnosed daily to have childhood Tuberculosis in Nigeria. Nigeria currently ranks second in the world for the highest number of children with tuberculosis (TB).

The Minister of State for Health, Dr Olorunnimbe Mamora during the 2021 ministerial press briefing to commemorate this year’s World TB Day, in Abuja, said every hour, 50 Nigerians develop active TB, with 10 out of them being children.

Tuberculosis, an airborne disease, is a leading cause of death in young children and from available evidence, malnutrition could be a predictor of tuberculosis disease and is associated with worse outcomes.

Children become malnourished if they are unable to take in enough or utilise fully the food they eat, due to illnesses such as diarrhoea or other longstanding illnesses, such as measles, HIV and tuberculosis.

“There is a need for a high index of suspicion for TB when you have a child that fails to thrive; such a child may not even have a cough. And of course, in such children there could be weight loss,” said Dr Olatunbosun Fadeyi, medical Coordinator, Global fund PPM grant Programme Manager, Damien Foundation Belgium.

Feeling generally unwell with loss of appetite, apathy and fatigue are common symptoms of childhood tuberculosis. Occasionally, in a small number of such children, without proper treatment, the infection progresses, causing fever, irritability, a persistent cough, weakness, heavy and fast breathing, night sweats, weight loss, and poor growth.

Dr Fadeyi declared that “There may be nonspecific symptoms such as weight loss and fever. The diagnosis tools that we have is less sensitive for childhood TB, thereby making childhood TB diagnosis pretty more difficult when compared to adults. So the tendency that the health worker may misdiagnose a child with TB is very high.”

He, however, declared that lower socioeconomic status, history of contact with an adult TB case source, overcrowding, absence of cross ventilation, ingestion of unpasteurised milk and severe malnutrition makes children vulnerable to TB infection.

According to him, parents need to step up the level of hygiene to protect children from contracting TB and anybody in the family coughing should ensure they go to the hospital, diagnose the cough and treat it promptly. This will reduce the chances of a child getting infected with TB.

Programme Manager, Oyo State TB and Leprosy Control Programme, Dr Johnson Babalola, said both adults and children could have TB infection when exposed to the germ (Mycobacterium tuberculosis) that causes it, and eventually without treatment may progress to becoming TB disease.

He said children with TB infection, however, easily develop TB disease if they are malnourished or have intestinal worms.

Dr Babalola declared :“Children are predisposed to having TB because of their lower level of immunity. Malnutrition will further reduce their immunity, making them more susceptible to developing the disease if they have the infection.”

In addition, he said “the nutrition that will be beneficial to the body will be taken up by worms and that also can also lead to malnutrition.”

Dr Babalola, however, said that preventive treatment is always offered to ensure children that might be exposed to adults with TB do not contract the infection.

Moreover, Dr Samuel Akingbesote, a public health expert, with the Institute of Human Virology Nigeria (IHVN) declared that there is a two-way link between TB and malnutrition. TB makes malnutrition worse, and malnutrition makes TB worse.

He added, “in most facilities where we work on TB, we look for children with malnutrition so that we can identify TB cases.  About 5% of the TB patients in the pediatric group are also malnourished.”

Screening children with malnutrition for TB can be an effective mechanism to increase the accurate identification of TB in children. Malnutrition is estimated to contribute to 26 per cent of incident TB globally.

What is more, Oyo State Coordinator of the Civil Society Scaling-up Nutrition in Nigeria (CS-SUNN), Mr Olusegun Adio, good nutrition in children is central to the prevention and treatment of many diseases, including TB.

He stated that malnourished tuberculosis patients have delayed recovery and higher mortality rates than well-nourished patients.

According to Mr Adio, “we need government’s intervention on ensuring nutritional support for quicker recovery for any child that is beingw treated for TB. Children with severe malnutrition and TB are 40 per cent more likely to die than children with severe malnutrition and without TB.”

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