Tuberculosis: That lumpy neck, hunch back check it out

For many people, Tuberculosis (TB) only infects adults. A cough in a child or a hunch back in a child cannot be suggestive of TB. When it comes to children even if the cough is persistent, it must be that the child’s chest has been exposed to cold or due to asthma.

“There was an 11-year-old boy who had been coughing for over 2 years and had been treated for asthma before she came across us and we gave her a free X-ray voucher to have a chest examination perhaps it was TB,” retorted Mrs Babafunke Olatoye-Ojo, Breakthrough Action Nigeria’s supervisor on TB in charge of Oluyole and Ona-ara LGAs.

Mrs Olatoye-Ojo stated that often, people would have been coughing for a while but TB will be the least of the things they think about until they are encouraged to check to be sure that the cough is not because of TB.

According to her, “the last thing they think about is TB, many have taken different drugs and emaciated and almost dead.

“Some said when they took antibiotics, they seem to get better, but the cough will come back and they again go back to the pharmacy to buy more drugs. So they will treat again and it will seem as if it is gone but it will again reoccur.”

Mrs Olatoye-Ojo stated “ignorance is a big issue, people should just check to rule out TB. In some cases, the major symptom is not cough; it is weight loss, severe fatigue or chest pain. All these symptoms they just attribute to other things but never TB.”

However, at least 7 out of every 10 children with TB experience TB of the lungs, some with TB of the spine, adding, “we see few babies with TB, even children as young as 5 years old.”

Each year, nearly a million children develop TB and 205,000 die of TB-related causes. More than 80% of childhood TB deaths occur in those under the age of 5. Most of these deaths occur because their disease is undiagnosed as children with TB, particularly infants, usually have symptoms that are not specific for the disease.

The TB and leprosy programme’s Monitoring and Evaluation officer at the Oyo State Ministry of Health, Mrs Abimbola Oyebamji, on the sideline of a 3-day media parley by Breakthrough Action Nigeria, stated that in some instance, children with big swelling on their neck that people take for a boil, actually had TB of the lymph node until proven otherwise.

According to her, “If it is ordinary boil, it will be treated and it will go but if it is due to TB, it will not go. When you treat it, it will come out in another place on the neck region. The person may not cough. In some hospitals, they only cut it open. But it will shout out in another place because the lymph node is affected.”

Mrs Oyebamji declared that TB can affect all parts of the body, adding, “for instance a child that is having a spinal cord protrusion, people assume it is a spiritual attack or due to a curse. It is always neglected. People don’t count it to be TB, they just feel that it is something else.”

Professor Regina Oladokun, an infectious disease expert in Children at the UCH, Ibadan, said contrary to many people’s thinking TB also affects children and about 5 per cent of children in admission in the government’s teaching hospital may have tuberculosis.

Some of these children had TB alongside conditions like HIV, kidney and heart problems. Malnourished children, sometimes also have underlying TB.

Oladokun, the Vice-chairman, Child TB steering committee in National Tuberculosis and Leprosy Control Programme (NTBLCP) added, “It may just be that the child is ill; so, it takes somebody who had been trained to recognise TB in a child because it may mimic a lot of other illnesses.”

Professor Oladokun said children with TB develop hunch back when the spine is affected. Spinal TB is a serious form of TB affecting the backbone and its most common presenting complaint is back pain.

The paediatrician, however, said that the signs and symptoms of TB disease in children include cough, feelings of sickness or weakness, lethargy, and/or reduced playfulness; weight loss or failure to thrive; fever; and/or night sweats.

However, she said there is a need for a high suspicion of TB in sick children since these signs and symptoms are also common to many childhood illnesses due to the challenges of confirming TB in children through laboratory tests.

Professor Oladokun, however  said the case of a child with TB is a telltale sign that TB is inside that community because it is the adults that have TB that are giving it to other adults and the children around.

The paediatrician urged mothers to ensure their children get the BCG vaccine as it will protect them against the severe complications of TB. Also, she said, sick children, should be promptly taken to the hospital.