Spotlight: Zero children dying from tuberculosis by 2015 is possible, if...
Hara Mihalea, PATH
**********************

[Mods note: To join the e-consultation on childhood TB, send an email to:
stop-TB-subscribe@yahoogroups.com . The below CNS article written by Hara
Mihalea, PATH, Thailand, is available online at:
http://www.citizen-news.org/2012/02/0-children-dying-from-tb-by-2015-is.html .
Comments are welcome. Thanks]
**********************

I like to start by sharing a real story which I experienced in one of my visits
in the field last year. I'm sure many of you working in the field have similar
stories to tell. During a monitoring visit for our PPM program I came across a
referral slip made out by a pharmacy staff referring a 36 year old woman to the
DOTS health center.

Looking at the symptoms circled on the slip one could tell that this was
certainly a pulmonary TB case; weight loss, fatigue, chest pain, fever, and
cough with blood. We traced the referral to one of the district health centers
where we found out that the woman had indeed gone for further evaluation, she
was checked, diagnosed, given medication and sent home. We were told by the
health center staff that since the first visit she came back twice, each time
sicker than before, and was again send home, no TB. We decided to visit her at
home where she lived with her husband, her in-laws, two small children and one
baby. We asked the district TB officer to join us so he could be able to
follow-up later on.

When we arrived in her small house we were taken up in her room, she was sitting
on a straw mat on the floor, baby on the breast, glassy eyes, face flushed with
fever. She repeated the same story that the health staff told us. She told us
how disappointed, sad, and scared she felt, she said she was getting worse by
the minute and no one could help her. She said she wanted to go back to the
health center but they didn't have any more money and no transportation. Each
time she coughed she hit on her chest to show us where it hurts. I will never
forget the pain on her face, the shortness of her breath when she tried to tell
us her story. I will never forget the fear I felt for the baby on her breast and
her other two children and thinking that this woman unless treated immediately
will soon die and leave these children orphans. The end of the story is that the
woman did have TB and the last we heard was that the district officer was trying
to get the children tested.

So what went wrong? why did this woman sought care three times and still was
send home with a bag of  antibiotics and vitamins? This is a very common story
and it's happening every day, many times a day around the world, especially in
high TB burden developing countries.

I shared this story with you because I truly believe that once again we might
not be able to reach our goal to Zero the numbers of children dying of TB in our
lifetime, left alone by the year 2015, if we don't take some drastic steps to
address the real problems that are preventing us from doing a good job. We can
have the guidelines and country operational plans for TB in children, we can
have the treatment algorithms however I strongly feel that these will not help
much, especially in limited resource setting where stories such as this are real
unless we start by:

(1) Holding governments accountable for the health and well-being of their
populations, especially the children; health is a right not a luxury and not
only for the few. Advocate governments for resource allocation that will
increase the salaries of the health staff and will motivate them to perform
their tasks in an appropriate manner; health staff in developing countries often
do not get their salary for 3-6 months.

(2) Strengthening the DOTS program. If we had a quality DOTS program the health
staff would have been able to accurately diagnose and successfully treat the mom
in the story.  They would have being able to prevent TB and the needless
suffering in her children.

(3) Integrating TB into the primary health care and sensitizing all health care
providers on TB.  Once sensitized health staff be able to screen children and
moms during immunization sessions, postnatal visits, reproductive health (RH)
visits or other consultations.

(4) Most importantly recognizing the symptoms of TB in children, creating
linkages and partnerships between communities, private providers and TB services

(5) Intensifying case finding and contact tracing when TB is suspected to all
family members, most importantly to children. The majority of the children get
TB from a family member.

(6) TB is a poverty disease, half of the children in the developing countries go
without meals, they are malnutrition which makes them even more vulnerable to
TB. Addressing the nutrition needs is of out-most importance.

(7) TB in a child that is already living with HIV is a double heartbreak and so
much more difficult to diagnose and treat.

I might sound to you pessimistic, I am a little bit because TB is very political
and things are moving very slowly; we cannot afford to move slowly anymore, we
should not allow it. We need to step up and step up very fast. What we should
all see at the end of 2015 is not just the numbers, the statistics showing fewer
deaths, we should see children, happy and smiley faces, children free of TB.
Where there is a will there is a way and collective voices will find the way.

Hara Mihalea CHE, MPH
PATH, Thailand

Online at:
http://www.citizen-news.org/2012/02/0-children-dying-from-tb-by-2015-is.html
**************************************************

[MODS NOTE: Join the e-consultation by sending an email to:
stop-tb-subscribe@yahoogroups.com . The guiding question (Theme 1) of the
time-limited online consultation on childhood tuberculosis (TB) in lead up to
the World TB Day is: "What can be done more (or less of) at the family,
community or your country level to prevent new TB infections in children?"

Have your say before 25th February 2012:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html .
Thanks]
**************************************************

Spotlight: Patients' Charter for TB Care, and childhood TB
Bobby Ramakant - CNS
**********************

[MODS NOTE: Join the e-consultation on childhood TB by sending an email to:
stop-tb-subscribe@yahoogroups.com . The below CNS article is online at:
http://www.citizen-news.org/2012/02/patients-charter-for-tb-care-and.html .
Comments are welcome. Thanks]
**********************

(CNS): Will improving efficiency and efficacy of TB control programmes within
the healthcare facilities help the world meet the 2015 TB-related targets set by
the Millennium Development Goals, the Global Plan to Stop TB, and the country
programmes, or do we need a paradigm shift in the basic principles we do TB
control upon? Experts have repeatedly emphasized that unless we control
adulthood TB, children will continue to get TB. And unless we the change the way
we do TB control, adulthood TB is unlikely to be controlled. The TB programme is
still very medical despite advocacy, investment and the gold standard Patients'
Charter for TB Care - which is sadly not implemented to the extent it should
have been by the countries.

PATIENTS' CHARTER FOR TB CARE
--------------
According to the World Health Organization (WHO),
http://www.who.int/tb/people_and_communities/patients_charter/en/index.html the
Patients' Charter for Tuberculosis (TB) Care, outlines the rights and
responsibilities of people with TB. It empowers people with the disease and
their communities through this knowledge. Initiated and developed by patients
from around the world, the Patients' Charter makes the relationship with
healthcare providers a mutually beneficial one (download the patients' charter
here http://www.who.int/entity/tb/publications/2006/patients_charter.pdf ).

UNLESS WE TREAT ADULT TB, CHILDHOOD TB WILL CONTINUE TO RISE
--------------
In an interview given recently to Shobha Shukla - CNS, Dr Somya Swaminathan, MD
in Paediatric TB, and a Scientist at the National Institute for research in
Tuberculosis (Indian Council of Medical Research - ICMR), said that: "Pediatric
TB is difficult to control, because the infection spreads through the air borne
route, and children get it from adults. So the only way to prevent childhood TB
is to tackle adult TB more seriously. Contact to contact TB testing must be
done. All family members of a TB patient, especially children, should be tested,
and started on chemo-prophylaxis. That way we can reduce the burden of
paediatric TB. The general awareness level about TB is very poor, even amongst
educated people. They do not know how it spreads, how it can be diagnosed and
treated and what they can do to reduce the burden of TB. As it is an air borne
infection, anybody can get it. The most important risk factor in children is
malnutrition, as poor nutrition makes one more susceptible to it. Other social
or environmental causes could be poor housing, overcrowded indoors, indoor air
pollution, passive smoking, and to a much smaller extent HIV infection also, as
in India HIV prevalence is fairly low."

President of Indian Chest Society (North Zone) and Professor and Head,
Department of Pulmonary Medicine, King George's Medical College (now renamed as
CSM Medical University) Dr Surya Kant said: "Another important risk factor is
that we have a large number of adult TB infections that can potentially be
transmitted to children. First and foremost measure that can control childhood
TB is to early diagnose and successfully treat the adult TB. So all adult TB
cases must be treated effectively and priority should be given to those whose
sputum is positive for AFB. If we can intervene in early diagnosing and
successfully treating adult TB then a secondary outcome will be to effectively
control childhood TB."

Dr Surya Kant emphasized: "More effectively we cure the adult TB more
effectively we will prevent the childhood TB. Studies show that children with TB
usually don't infect the adults rather adults with TB infect children. It is
only one way transmission of TB from adults to children."

PATIENTS' CHARTER CAN BE THE GAME-CHANGER
--------------
Unless people who are experiencing the disease (TB) or have successfully
completed the treatment are engaged as EQUAL PARTNERS WITH DIGNITY, we will
continue to see TB control dominated by the medical experts who are undoubtedly
doing a great contribution to TB control, but that's clearly not enough.
Engaging people who know the best can be the game changer. People who have
completed TB treatment are best "community experts" to share with us the
challenges they faced on daily basis when on TB treatment. These are the
challenges which are the potential barriers for many people in benefiting from
existing TB control services and should be addressed by the programme. The
realities of their lives, on day-to-day basis, that continues to put them and
their family members at risk of preventable infections such as TB, needs to be
brought in, to increase the impact of TB programmes. The challenges people face
in getting a proper confirmed TB diagnosis and tolerating the anti-TB treatment,
must be recorded and documented - without which the programme will continue to
miss a very important piece of the puzzle - and is unlikely to reach the ZERO
mark by 2015 in terms of zero new TB infections and deaths.

Unless we implement the Patients' Charter optimally adulthood TB will continue
to challenge us, and so will childhood TB.

As experts said if we can control adulthood TB, childhood TB will automatically
taper off. Implementing the Patients' Charter, empowering communities,
especially those who have completed TB treatment, to get engaged as equal
partners with dignity in TB control, and ensuring the programme addresses the
needs felt by the people can help us reach the unreached TB patients - adults
and children both.

The Citizen News Service (CNS) along with more than 50 partners from around the
world is hosting an e-consultation and conducting key informant interviews on
childhood TB. To have your say, go to:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html

Bobby Ramakant - CNS
Email: bobby@...

Online at:
http://www.citizen-news.org/2012/02/patients-charter-for-tb-care-and.html
**************************************************

[MODS NOTE: Join the e-consultation by sending an email to:
stop-tb-subscribe@yahoogroups.com . The guiding question (Theme 1) of the
time-limited online consultation on childhood tuberculosis (TB) in lead up to
the World TB Day is: "What can be done more (or less of) at the family,
community or your country level to prevent new TB infections in children?"

Have your say before 25th February 2012:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html .
Thanks]
**************************************************

Spotlight: Solving the puzzle: Diagnosing tuberculosis in children
Dr Muherman Harun, Indonesia
******************************

[Mods note: To join the e-consultation on childhood TB, send an email to:
stop-TB-subscribe@yahoogroups.com . The below CNS article is online at:
http://www.citizen-news.org/2012/02/solving-puzzle-diagnosing-tuberculosis.html
. Comments are most welcome. Thanks]
******************************

THE THEME OF THE FIRST WORLD TB DAY 1982 (NOW THIRTY YEARS AGO) REMAINS VALID:
DEFEAT TB! NOW AND FOREVER!

The Citizen News Service (CNS) is conducting an online consultation on childhood
tuberculosis (TB) in lead up to the 2012 World TB Day (To join the
e-consultation on childhood TB, send an email to:
stop-TB-subscribe@yahoogroups.com ). I will like to share our views on the
`essentials' of the diagnosis of TB in Children. The main means of diagnosing TB
in children is undoubtedly, chest X-ray.

1. Children sometimes may have adulthood TB (post primary TB). Diagnosis is
relatively simple.  Symptoms are like in adulthood TB: few weeks cough,
sub-febrile, night sweat, chest pain and sometimes hemoptoe. Every doctor
treating TB can easily recognize TB features on chest X-ray: infiltrates or
patches usually in upper lung fields, sometimes with cavitation. If cavitation
is present, sputum should easily reveal Acid fast bacilli (AFB). This child can
expectorate! Treatment will instantly stop infection and cure the disease.
Without treatment, the child  will die within one or two years.

2. Child may have miliary TB. After witnessing the miliary shadows in the
lung(s) on chest X-ray, even once only, the doctor will remember this X-ray's
characteristic feature. Symptoms: weight loss, loss of energy and activity,
fever, cough.  Without treatment the child may die. Fortunately, this is a rare
development after BCG.

3. Child may have meningitis TB. Symptoms include, longstanding headache,
febrile and drowsiness. Very characteristic/diagnostic signs are neck or back
stiffness. Without treatment the child may die or suffer from sequellae, like
hydrocephalus, blindness, deafness or other neurological defects. This is also
fortunately, a rare development after BCG. Chest X ray may be normal, or miliary
TB may be present.

4. Child may have primary TB. Chest X-ray may show enlarged hilar lymph glands.
The primary TB shows no symptoms. Unfortunately, increased bronchovascular
markings are often overdiagnosed as enlarged hilar lymph glands. Despite
outrageous misjudgment of a number of primary TB cases by our colleagues, we
should also realize that there are how many millions of primary cases that go
unnoticed and get spontaneously cured …..

If occasionally, primary TB is developing progressively, then the disease may
develop into miliary TB or meningitis TB. Fortunately, such developments become
rare after successful BCG vaccination.

In some cases, if body resistance is low, the primary disease will develop into
post primary TB. This condition however, can not be prevented by BCG. But in
this case the diagnosis should be relatively simple. After treatment, sputum AFB
becomes negative and the disease causes no further infection.

WHO ARE THE MAIN KILLERS OF CHILDREN WITH TB?
-----------------------------
The main killers are: miliary TB and/or meningitis TB. They are the rapid
awesome killers. Unabated, they may kill within several weeks. Fortunately, BCG
gives effective protection.

The other is the mass killer: post primary TB, killing the children slow but
sure. Without treatment the child may die within a year or two. These killings
are not prevented by BCG.

IMPORTANT DIAGNOSTIC FACTORS
-----------------------------
- Sputum examination of AFB is most successful if lung/bronchial tissue is
affected or damaged as in post primary TB.  However, in miliary and meningitis
TB, the bacilli are spread through the bloodstream i.e. hematogenic spread,
hence bacilli are usually not detectable in sputum. In primary TB, bacilli are
spread through the lymphatic system (hilar lymph glands) and bloodstream.
Therefore, AFB are usually absent in the sputum. This explains the difficulty to
detect AFB in sputum. We never carried out the gastric lavage for AFB. Such
procedure is too drastic and traumatic for too little yield or impact, if any.

- The tuberculin test in under-fives is particularly useful in the diagnosis of
TB (if BCG was not given) However, the higher the age of the patient, the lesser
diagnostic value the tuberculin test will have. About the usefulness of the
tuberculin test after BCG, there's an old saying which still stands true: "After
BCG, the tuberculin reaction goes, as the wind blows!", in other words, the
tuberculin test is no more a reliable diagnostic tool after BCG vaccination.
There is up till now, no serological or PCR tests for the diagnosis of TB.

- The presence of a house-hold contact who is expectorating TB bacilli, is an
important factor, supporting the diagnosis of TB in children.

- Lymphatic glands caused by TB can usually be seen in the neck. These enlarged
glands may not be painful, and are presented in clusters. If there is
discoloration (livid) and fluctuation or abscesses appear, TB diagnosis becomes
clear and treatment can be given right away. The presence of TB glands in the
neck   becomes very helpful in the diagnosis of pulmonary TB. After only a few
weeks of anti-TB treatment, the swollen lymph glands will soon reduce in size.
This also supports the diagnosis of TB of the lung.

(But there also are lymph glands in the neck of viral origin. If thoroughly
examined, there will be so many small children with enlarged lymph glands in the
neck, which are not TB. These glands are usually not directly visible and will
come and go with the (febrile) condition of the child. This condition does not
need further examination nor treatment. As the child becomes older, the enlarged
glands will disappear spontaneously).

Finally, "How to get to zero new TB infections in children by 2015?" I'd like to
answer this STOP-TB question by emphasizing and reiterating the main and grand
principle: "Focus on the main reservoir, sources of TB bacilli. They are the
ones that cough, spreading the AFB into the air". Find, treat and cure them, no
more and no less. Contact (centrifugal or centripetal) examination could be
carried out on a limited and selective scale.

The important risk factors i.e. "malnutrition, poverty, environmental pollution,
poor housing, overcrowding, indoor air pollution, passive smoking, etc" may not
have an important role to play in an effective TB control program. This was
spectacularly shown from the historic WHO/BMRC/MRCI experiment of Madras in the
fifties.

If we only can persistently treat and diligently cure all of our TB patients who
are infectious, eventually, there will be no more children getting infected!
Hence, chase without delay retrieve any absconders who and wherever they are, at
any cost! Provide patients the fullest treatment with the very best regimen
available, so that the disease be completely cured and forever.

The Theme of the First World TB Day 1982 (now thirty years ago) remains valid:
DEFEAT TB! NOW AND FOREVER!

Dr Muherman Harun
St.Carolus TB Program 1983
Jakarta, Indonesia

Online at:
http://www.citizen-news.org/2012/02/solving-puzzle-diagnosing-tuberculosis.html

Theme 1 Summary: Getting to zero TB infections in children by 2015
Citizen News Service (CNS)
****************************

[MODS NOTE: The summary report has been released today on 26 February 2012, and
is online at:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-summary-getting.html
. Thanks for the support and participation. Theme 2 announcement will go out
tomorrow on 27 February 2012. Looking forward, thanks]
****************************

The SUMMARY REPORT has been released on 26th February 2012 of Theme 1 online
consultation on childhood tuberculosis (TB) in lead up to the World TB Day on:
"Getting to zero new TB infections in children by 2015." The summary report can
be downloaded or read online at:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-summary-getting.html

GUIDING QUESTION of THEME 1 was:
- What can be done more (or less of) at the family, community or your country
level to prevent new TB infections in children?

This e-consultation on childhood TB is being facilitated by the Citizen News
Service (CNS), a partner of the Stop TB Partnership, along with the following
organizations and networks that have endorsed this initiative and joined as
partners:
--------------------
International Union Against Tuberculosis and Lung Disease (The Union)
Irish Forum for Global Health (IFGH)
McGill TB Research Group
Treatment Action Group
International Council of Women living with HIV (ICW) Zimbabwe
Asian Harm Reduction Network (AHRN)
ACTION
TB Alert
International Treatment Preparedness Coalition-India (ITPC-India)
Global Health Strategies
PATH
Cambodian Health Committee (CHC)
L'Association de Lutte Contre la Pauvreté en abrégé (ALCP)
Positive Muslim Group, Myanmar
Life Foundation, Pakistan
The Good Neighbour Nigeria
University of Nairobi, Kenya
Medical Care Development Inputs (MCDI) Kenya
Kenya Consortium to Fight TB, Malaria and AIDS (KECOFATUMA)
Partnership for TB Care and Control, India
Karnataka Health Promotion Trust (KHPT)
National Coalition of PLHIV in India (NCPI+)
PCI India
MAMTA Health Institute for Mother and Child
SNEHA
Institut Pasteur de Madagascar
Institute for Plantation Agricultural And Rural Workers (IPARW)
Advocates for Health International
Rural Youth Advocate for Health and Development in Nigeria (RYAN)
Citizens for Healthy Lucknow (CHL) initiative
Saaksham Foundation
TEST Foundation
PREPARE Foundation
JBS Foundation
Abhinav Bharat Foundation (ABF)
Asha Parivar
Samadhan
National Alliance of People's Movements (NAPM)
PRAYAS Health Group
Indian Society Against Smoking (ISAS)
Citizen News Service (CNS)
----------------

Citizen News Service (CNS)
Email: stopTB@...

Theme II Announcement: Getting to zero TB deaths in children by 2015
Citizen News Service (CNS)
************************

[MODS NOTE: To join the e-consultation, send an email to:
stop-tb-subscribe@yahoogroups.com . The theme II online consultation is open and
GUIDING QUESTION is: "How to correctly diagnose and successfully treat TB in
children in your local settings?" Comments are welcome before 11th March 2012.
Thanks]
************************

Theme II Announcement is online at:
http://www.citizen-news.org/2012/02/theme-ii-e-consultation-getting-to-zero.html
------------------------
The theme II of the time-limited online consultation on childhood tuberculosis
(TB) in lead up to the World TB Day is: "Getting to zero TB deaths in children
by 2015." Have your say before 11th March 2012 - share with us - how to
correctly diagnose and treat TB in children and achieve 'zero TB deaths' in
children by 2015, in your local settings. Your perspectives, opinions and voices
are important for us and we do look forward to them.

GUIDING QUESTION
------------------------
How to correctly diagnose and successfully treat TB in children in your local
settings?

This e-consultation on childhood TB is being facilitated by the Citizen News
Service (CNS), a partner of the Stop TB Partnership, along with many other
organizations and networks that have endorsed this initiative and joined as a
partner (see the list below).

HOW CAN YOU HAVE YOUR SAY?
------------------------
- Join the new Stop-TB eForum by sending an email to:
stop-tb-subscribe@yahoogroups.com and have your say by sending your comments to
stop-tb@yahoogroups.com
- Be a partner of this online consultation - to be a partner organization, send
an email to: bobby@...
- Email us your comments, perspectives and experiences at:
stopTB@...
- Go online at CNS blog: www.citizen-news.org and publish your comments real
time!
- Skype us and we will record your statement (skype id: bobbyramakant ). To
schedule skype appointment, email: bobby@...
- Tweet us! use #tag: #childhoodTB
- Have your say on our CNS Facebook page!
- Call us and record your statement! (+91-98390-73355)

TIMELINE for THEME II
------------------------
Responses to theme II are welcome till 11th March 2012, after which a summary
report of Theme II, will be compiled and released to mark World TB Day.

REFERENCE DOCUMENTS:
------------------------
Call for Action for Childhood TB (launched in Stockholm in March 2011):
http://www.stoptb.org/getinvolved/ctb_cta.asp
Stop TB Strategy: http://www.who.int/entity/tb/strategy/en/
Global Plan to Stop TB: 2011-2015: http://stoptb.org/global/plan/
World TB Day website: http://stoptb.org/events/world_tb_day/2012/
Global Tuberculosis Control Report 2011:
http://www.who.int/tb/publications/global_report/en/
Whole Is Greater Than Sum Of Its Parts: CNS report 2011:
http://www.scribd.com/doc/70768912/Stop-TB-Online-Consultation-Summary-Report-Li\
lle-2011
Tuberculosis and children: Exposing the hidden epidemic - ACTION brief:
http://c1280352.r52.cf0.rackcdn.com/childrens_tb_0811v2.pdf
Theme 1 e-consultation summary report on preventing childhood TB (2012):
http://www.citizen-news.org/2012/02/theme-1-e-consultation-summary-getting.html

PARTNERS
------------------------
International Union Against Tuberculosis and Lung Disease (The Union)
Irish Forum for Global Health (IFGH)
McGill TB Research Group
Treatment Action Group
International Council of Women living with HIV (ICW) Zimbabwe
Asian Harm Reduction Network (AHRN)
ACTION
TB Alert
International Treatment Preparedness Coalition-India (ITPC-India)
Global Health Strategies
PATH
Cambodian Health Committee (CHC)
L'Association de Lutte Contre la Pauvreté en abrégé (ALCP)
Positive Muslim Group, Myanmar
Life Foundation, Pakistan
The Good Neighbour Nigeria
University of Nairobi, Kenya
Medical Care Development Inputs (MCDI) Kenya
Kenya Consortium to Fight TB, Malaria and AIDS (KECOFATUMA)
Partnership for TB Care and Control, India
Karnataka Health Promotion Trust (KHPT)
National Coalition of PLHIV in India (NCPI+)
PCI India
MAMTA Health Institute for Mother and Child
SNEHA
Institut Pasteur de Madagascar
Institute for Plantation Agricultural And Rural Workers (IPARW)
Advocates for Health International
Rural Youth Advocate for Health and Development in Nigeria (RYAN)
Citizens for Healthy Lucknow (CHL) initiative
Saaksham Foundation
TEST Foundation
PREPARE Foundation
JBS Foundation
Abhinav Bharat Foundation (ABF)
Asha Parivar
Samadhan
National Alliance of People's Movements (NAPM)
PRAYAS Health Group
Indian Society Against Smoking (ISAS)
Citizen News Service (CNS)

Looking forward to a meaningful dialogue,

Citizen News Service (CNS)
Email: stopTB@...

Spotlight: Treat Adulthood TB To Prevent Childhood TB
Shobha Shukla, Citizen News Service (CNS)
*************************************

[Mods note: To JOIN the e-consultation on childhood TB, send an email to:
stop-tb-subscribe@yahoogroups.com . The CNS article below is online at:
http://www.citizen-news.org/2012/02/treat-adulthood-tb-to-prevent-childhood.html
. Comments are welcome]
*************************************

AS THE EXPERTS SAY, IF WE CAN CONTROL ADULTHOOD TB, CHILDHOOD TB WILL
AUTOMATICALLY TAPER OFF. PREVENTION OF INFECTION IN CHILDREN DEPENDS UPON
EFFICACY AND COVERAGE OF ADULT TB CONTROL PROGRAMS

(CNS): Children are innocent victims of tuberculosis (which in Hindi is called
Kshaya Rog—a disease which wastes away the body). According to the WHO over
250,000 children fall prey to the disease and 100,000 of them die every year
from TB, for no fault of theirs. They can only blame their infected parents and
elders, who inadvertently pass on the germs of TB to them. Adults infected with
TB become potential transmitters of the disease to children. It is a one way
transmission of the disease from adults to children, as children with TB usually
do not infect the adults.

Doctors, nurses, community activists, and other medical fraternity, all over the
world, label adult TB as the main impediment in achieving zero TB infections in
children. Dr Somya Swaminathan, a Scientist at National Institute for research
in Tuberculosis (ICMR), insists that the only way to prevent TB in children is
to tackle adult TB more seriously. Paediatric TB is difficult to control,
because the infection spreads through the air borne route, and children get it
from adults.
Unless we can diagnose and successfully treat the parent, we will fail to
diagnose and treat the child. The majority of the children get TB disease from a
parent or a close relative. It is not uncommon for small children to be carried
around, and share the same bed, with a parent, grandparent and/or a sibling,
especially in rural and semi urban areas of developing countries. This puts them
to a great risk of infection in case their care giver is infected with the
disease. The longer the exposure, the higher is the risk for infection. So
diagnosis of any adult TB patient, especially mother or care giver, is crucial
for a child's health.

Hara Mihalea of PATH, Thailand, poignantly narrates the story of a 36 years old
woman whom she met during one of her field visits. The woman was referred to the
DOTS health centre, but was sent back home all of the 3 times, when she sought
care, with just a bag of antibiotics and vitamins, and no TB treatment. This
lack of treatment, not only endangered her well being, but also put her
lactating infant and other two children under grave threat of becoming orphans
and/or contracting the disease. Such scary incidents could be occurring in many
parts of the world, especially in high TB burden developing countries.

According to Professor Surya Kant, Head of the Pulmonary Medicine Department,
Chhatrapati Shahuji Maharaj Medical University, "The first and foremost measure
that can control childhood TB is to diagnose early, and treat successfully,
adult TB. We have a large number of adult TB infections that can potentially be
transmitted to children. Hence the more effectively we can cure adult TB, the
better we will be able to prevent childhood TB."

Dr Daisy Dharmaraj, Associate Professor Department of Community Medicine, ACS
Medical College, also agrees that screening the communities for pulmonary TB and
active case findings are crucial to reducing the infection in children.

Claire Crepeau, a Pediatric TB Nurse at McGill University, Canada, wants
everyone to realize the dire need of controlling TB in children as they are the
reservoir of TB for the future, if not treated timely. They should not be
forgotten, especially in screening. So we must strive to manage adult TB
properly if we are to decrease childhood TB and also prevent MDR TB.

Dr Anne Detjun, Technical Consultant, International Union Against Tuberculosis
and Lung Disease (The Union), is apprehensive because a child infected with TB
has a much higher risk of becoming sick with the disease, as compared to an
adult (almost four times higher in case of infants under one year). Moreover the
risk is high, not only of becoming ill, but also of getting very severe forms of
tuberculosis such as TB meningitis and miliary TB. Hence preventive therapy is
very important, especially in children under 5 years of age who are exposed to
cases of infectious TB, so that they never actually contract the disease.

Once an adult is diagnosed with TB then it is the responsibility of the health
centre and of the community to ensure that all the members in the household of
the patient, especially children, are screened for TB and started on chemo
prophylaxis. There has to be intensified case finding and contact tracing, when
TB is suspected, in all family members, most importantly in children. So one
needs to "go back to the basics" of tackling the root cause of the problem— as
soon as someone is identified with TB, immediately do contact tracing and
consider prophylactic treatment in children. Diagnosing and treating TB in
adults, will not only cure them, but also prevent them from becoming carriers of
the disease in children.

Dr Manoon Leechawengwong, from the Drug-Resistant Tuberculosis Research Fund,
Thailand, also agrees that, "To prevent TB in children, adults in the family
with active TB should be diagnosed and treated properly as soon as possible.
They must adhere to the TB medications and strictly follow the doctor's
instruction."

As the experts say, if we can control adulthood TB, childhood TB will
automatically taper off. Prevention of infection in children depends upon
efficacy and coverage of adult TB control programs. Implementing the Patients'
Charter for Tuberculosis Care; empowering communities to get engaged as equal
partners with dignity in TB control; and ensuring that the programme addresses
the need of reaching the unreached TB patients - adults as well as children--
will go a long way in getting to zero new infections. All health professionals
need to partner their efforts to attain this goal with government support. A
callous and uncaring health system will simply add fuel to fire of the epidemic.

In the words of Dr Muherman Harun of Indonesia –"If we only can persistently
treat and diligently cure all of our TB patients who are infectious, eventually,
there will be no more children getting infected! Hence, chase without delay, and
retrieve any absconders who and wherever they are, at any cost! Provide patients
the fullest treatment with the very best regimen available, so that the disease
can be completely cured forever." (CNS)

Shobha Shukla
Citizen News Service - CNS
Email: shobha@...

Online at:
http://www.citizen-news.org/2012/02/treat-adulthood-tb-to-prevent-childhood.html

Spotlight: TB Germs Thrive On Poor Nutrition
Shobha Shukla - CNS
**********************

[Mods note: To JOIN the e-consultation on childhood TB, send an email to:
stop-tb-subscribe@yahoogroups.com . The below CNS article is online at:
http://www.citizen-news.org/2012/02/tb-germs-thrive-on-poor-nutrition.html .
Comments are welcome. Thanks]
**********************

(CNS): TB has been with us since times immemorial. In ancient India it was
called Rajrog or the King's Disease. A benevolent king would dole out gold coins
to the poor, which raised their economic status, leading to improvement in their
nutritional standards. This lead to a decrease in the number of new infections
of TB, and better recovery of those already infected. If he was uncaring towards
his people, the undernourished poor would find it difficult to avoid the curse
of TB and inadvertently become victims of it. So, rightly or wrongly, it was
thought that the king controlled the disease. However, one thing is crystal
clear—it has always been an accepted fact that an undernourished body is an open
invitation to the germs of tuberculosis, as well as other diseases.

Experts agree that TB is a disease of poverty, as poor people are more likely to
be undernourished. This is especially true in  case of children as poor
nourishment weakens their immune system, making them less equipped to fight off
the disease, and thus more vulnerable to it. One activist rightly points out
that right now the general public does not care much about the disease—partly
due to stigma, but more due to poverty. In a world where just trying to survive
for one day is a big challenge for many, talking to them about managing TB may
not make much sense.

     Malnourishment remains an important risk factor to contract TB, especially
in children. Fifty percent of the children in the developing countries go
without meals. According to UNICEF, malnutrition is more common in India than in
Sub-Saharan Africa, with one in every three malnourished children in the world
living in India. In fact, around 46 % of all children below the age of three are
too small for their age, 47 % are underweight and at least 16 % are wasted. Many
of these children are severely malnourished. Hence, addressing their nutrition
needs is of utmost importance. According to Dr Wali, a Consultant Paediatrician
from India, "Improving nutritional status is an extremely important intervention
not only in disease-free population including children but also in patients on
Anti TB Treatment."

Professor Surya Kant, Head of the Pulmonary Medicine Department, Chhatrapati
Shahuji Maharaj Medical University, laments that "Malnutrition is the single
strongest risk factor for childhood or primary TB in India where about 49% of
the children between 0-5 years of age are malnourished.  Tuberculosis occurs as
a result of interaction between Mycobacterium tuberculosis load and the body's
resistance or immunity. Body resistance or immunity is directly related to
nutrition. That is why malnutrition is a very important risk factor in
development of active TB disease in children."

However Dr Surya Kant cautions that TB is no longer a disease of only those
coming from lower socio-economic backgrounds. Life style changes in food habits
are taking a toll of the health of the nation. The fast food culture of modern
urban societies is basically decreasing the body immunity of even well children,
and so nowadays it is not uncommon to find TB targeting the children of affluent
families who are increasingly opting out for fast food.

He says, "Affluent family members of children with TB often ask me--Doctor, I am
from a high socio-economic background and no one in our past seven generations
had TB, how come my child developed TB?. The answer is that probably it is
because of fast food culture. Fast food or junk food, as it is so aptly called,
causes free radical injury and thereby decreases the body's immunity making the
child prone to infections such as TB."

Alberto Colorado rightly stresses on the need to advocate for Children Rights
and Social Protection if we want to have zero deaths and infections related to
Childhood TB. Proper food and good health is the right of all children and not a
luxury for the chosen few. A balanced diet, which is low on fatty, salted and
processed food, is necessary for the health of a child. India (and may be other
countries too) is a paradox where pot bellied children coexist with fat bellied
ones, though of course the former are much larger in numbers.  It is indeed a
pity that despite our phenomenal economic and technological progress, the fight
against malnutrition has not made as much progress, and we still fail to ensure
two square meals for our kids. The country boasted of having 57 billionaires
last year but does not have enough money to feed the impoverished masses. The
Hunger and Malnutrition Report, based on a recent survey conducted across 112
rural districts across nine states of India, found that 42% per cent of the
Indian children were found to be underweight and the growth of almost 60 % was
stunted, a result of inadequate nutrition for the mother during pregnancy and
the child in its early years. These shocking figures prompted our Prime Minister
Mr Manmohan Singh to call malnourishment among the nation's children a "national
shame".

But mere rhetoric will not do. Governments are to be held accountable for the
health and well being of their populations, especially the children. Policy
makers and programme implementers will have to understand the linkages between
education, health, and hygiene, with a view to improve the nutritional status of
our children. TB education should be incorporated into post natal care for
nursing mothers, and care givers of children below 5 years of age.  Maternal and
child health programmes should be comprehensive and should educate mothers about
the importance of exclusive breastfeeding during the first six months for
strengthening the immune system, and about what constitutes a healthy diet. One
of the findings of the above mentioned survey was that malnourished children in
India were rarely hungry; they were merely badly fed on diets consisting largely
of carbohydrates, due to widespread ignorance about nutrition among Indian
parents. Nursing mothers often discard colostrum –the high-protein form of milk
produced just prior to birth—which is again so vital for the baby's health.

Dr Lalji Verma, of India, rightly points out that, "Apart from medicine driven
initiatives, there are many other aspects one needs to consider for prevention
of TB. We all know the importance of healthy and nourishing food, and as long as
we have millions of impoverished children in the world, it may be difficult to
accomplish effective prevention." (CNS)

Shobha Shukla - CNS
Email: shobha@...

Online at:
http://www.citizen-news.org/2012/02/tb-germs-thrive-on-poor-nutrition.html

Spotlight: Tuberculosis Is A Women's Issue Too
Chief K Masimba Biriwasha, CNS
*********************************

[Mods note: To join the e-consultation in lead up to the World TB Day, send an
email to: stop-tb-subscribe@yahoogroups.com . The below CNS article is online
at: http://www.citizen-news.org/2012/03/tuberculosis-is-womens-issue-too.html .
Comments are welcome. Thanks]
*********************************

Today is March 8, and across the world the International Women's Day is being
commemorated. Coincidentally, March is the global tubercolusosis (TB) awareness
month. The disease, which is caused by a mycrobatrium, has a major impact on
women's sexual reproductive health and that of their children. For pregnant
women living in areas with high TB infection rates, there are increased chances
of transmission of TB to a child before, during delivery or after birth. The
disease, especially if associated with HIV, also accounts for a high incidence
of maternal and infant mortality. Unfortunately, there is little to no attention
to women's vulnerability in the current discussion and media blitz of a
resurgent TB internationally, and in particular, sub-Saharan Africa.

In sub-Saharan Africa, TB is threatening to unravel public health developments
gains around increased HIV awareness yet the solutions are not easy,
particularly where they concern the well-being of women.

There is need for huge financial, human, research and technological investments
to fight the problem, but such investments will work only if they radically put
women's health needs at the core.

More importantly is the need to align TB services and sexual reproductive health
services, so that men and women know about the implications of the disease to
their sexual lives and households.

In sub-Saharan Africa, however, there are pervasive systemic factors driving TB
and drug resistance which cannot be ignored in the search of an effective
solution to the problem.

A myriad of social and economic factors, as well as weaknesses in the health
care system, inadequate laboratories combined with high HIV infection rates are
fuelling the resurgence of the TB in the region. Food insecurity, poor
sanitation and overcrowding also contribute to the easy spread of the disease.

According to WHO, although Africa has only 11% of the world's population, it
accounts for more than a quarter of the global TB burden with an estimated 2.4
million TB cases and 540,000 TB deaths annually.

Governments in the region are grappling with inadequate infrastructure and the
increasing threat of drug-resistant strains and co-infection with HIV.

HIV infection increases the likelihood of active TB more than 50-fold. An
estimated one-third of the 24.5 million people living with HIV (PLHIV) in
sub-Saharan Africa also have TB.

For women in the region, the prospect of a growing TB epidemic is harrowing, but
discussion about the disease rarely sheds light nor seeks to address women's
specific needs.

Given the high rates of HIV infection among women in the region – the majority
of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women
– it is clear that they are the largest group at threat to develop active TB,
and more likely drug resistance.

Even with the availability of TB drugs women's socio-economic status and gender
roles including child-bearing and caring puts them at high risk of both HIV and
TB infection.

For many women in the region, the costs required to access health care centers
for TB treatment are usually out of reach due to poverty and undermined
socio-economic positions.

The social stigma associated with a TB diagnosis and its association with HIV
forces both men and women to delay going to get tested for the disease. In some
cases, when men in marital relationships test positive for TB, they are likely
to withhold the information, thereby increasing the likelihood to spread the
disease to both their partner and children.

Moreover, women in the region are largely responsible for the upkeep of the
family, including looking after children, which may also affect consistent
uptake of TB drugs. When a woman is infected with TB, the likelihood of
spreading the disease to young children is very high.

An additional concern for women is that the uptake of TB drugs interferes with
contraceptive use, pregnancy, and fertility.

According to researchers, Rimfampicin, a key component of TB treatment can
reduce the effectiveness of oral contraceptive pills and possibly other hormonal
methods, such as implants, injectables and emergency contraception.

TB in pregnant women not only increases the rate of maternal mortality, but is
also a major factor contributing to the risk of mother-to-child transmission of
the disease.

A study conducted in South Africa revealed mother-to child-transmission of TB in
15% of infants born to a study cohort of pregnant women in which 77% were
HIV-infected. Maternal HIV/TB coinfection also increases the risk of mother-to
child transmission of HIV.

Screening and treatment for TB in pregnant women at antenatal clinics must
therefore be a major public health priority in the region. Information about TB
needs to be an integral component of sexual reproductive health services.

To be precise, women infected with TB need to be empowered so that they can take
control of their own care and lives. (CNS)

Chief K Masimba Biriwasha
Citizen News Service - CNS
Email: masimba@...

(The author, born in Zimbabwe, is a children's writer, poet, playwright,
journalist, social activist and publisher. He has extensively written on health.
His first published book, 'The Dream Of Stones', was awarded the Zimbabwe
National Award for Outstanding Children's Book for 2004)

Online at:
http://www.citizen-news.org/2012/03/tuberculosis-is-womens-issue-too.html

Spotlight: Control Infection To Prevent TB In Children
Shobha Shukla - CNS
************************

[Mods note: To join the online dialogue on TB, send email to:
stop-tb-subscribe@yahoogroups.com . The below CNS article is online at:
http://www.citizen-news.org/2012/03/control-infection-to-prevent-tb-in.html .
Comments are welcome. Thanks]
************************

(CNS): At the inaugural lecture of the 42nd Union World Conference on Lung
Health, organised by the International Union Against Tuberculosis And Lung
Disease (The Union), in October 2011,  Mikkel Vestergaard Frandsen, showed a
poignant video clip of a 14 year old girl who had suffered and died of TB in her
poor, smoke ridden home in a Kenyan village last year. The video was a telling
but true commentary on the polluted and unhygienic environments that exist in
most houses of urban slums and villages of the developing world, making them
fertile grounds for TB germs, and exposing their children to this life
threatening disease.

Children living in poor circumstances, in very crowded houses with bad
ventilation and increased indoor air pollution, due to tobacco and cook stove
smoke, become easy targets for the TB bacterium. A congested neighbourhood with
poor refuse management and improper drainage only adds to their vulnerability. 
Medical experts, as well as community advocates, from across the globe almost
unanimously agree that practising basic infection control measures at all
levels, including home, community and hospitals, would go a long way in saving
our children from unnecessary exposure to TB infections.

Overcrowding in houses with poor ventilation, lack of basic hygiene and
proximity to an index adult case, are like an open invitation to the TB
bacteria. According to Professor Surya Kant, Head of the Pulmonary Medicine
Department, Chhatrapati Shahuji Maharaj Medical University, "Usually one TB
patient spreads TB to 10-15 other people in a year. But if the patient is living
in an overcrowded environment then the spread of TB is more rampant. Children
living in urban slums where dwellings house a large number of people in small
space can be at higher risk of TB."

Dr Manoon Leechawengwong, of the Drug-Resistant Tuberculosis Research Fund,
Thailand, advises that adults in the family with active TB should practice
infection control by wearing masks as long as they continue to cough and must
try to stay away from kids in the family.

A large number of rural/urban slum households still use biomass fuels for
cooking, and exposure of children to this cook-stove smoke can increase their
risk for developing active TB. These fuels should be replaced by other energy
options which are not detrimental for one's health. Second hand smoke arising
out of elders smoking cigarettes/bidis is another demon to be watched. Children
inhaling this smoke can become easy victims of a host of diseases including TB.
Improper ventilation increases the risk as, it not only prevents the smoke from
escaping out, but also prevents adequate sunlight from entering the house. Dr
Surya Kant mentions that a five minutes exposure to sunlight kills even the drug
resistant forms of Mycobacterium tuberculosis bacilli.

Even doctors agree that hospitals are a store house of infections which must be
reduced to rein in TB. Proper ventilation of wards to circulate of fresh air and
admit enough sunlight is very important. Inefficient disposal of hospital waste
and patients' sputum increase the chances of patients contracting the disease,
instead of getting cured. Cough hygiene is very important, especially for those
who are AFB sputum positive. They should be counselled to cover their mouth with
cotton or mask while talking or coughing. Proper and timely disinfection and
management of excreta from known tuberculosis patients is important. Also,
spitting on the roads and defecating in the open is very common in India and 
helps in the spread of the tuberculosis germs.

In India it is a common practice for children to unnecessarily accompany their
parents on hospital visits. All hospitals should be instructed to convey to
their patients that whenever they visit the hospital children should not
accompany them unless needed – because hospitals are a hot bed of infections.

One of the fallouts of urbanization is construction of flats or apartments which
often lack proper ventilation and block sunlight from entering the rooms, thus
encouraging the spread of air borne diseases like tuberculosis. City planners,
private builders, as well as the housing policy of the government, need to keep
these critical issues in mind for construction of residential/official complexes
and pay adequate attention to allow for proper air flow and natural light in
houses.

Getting to Zero new TB infection in children by 2015 may be like moving a
mountain, which requires more than just faith. Challenges are vast and resources
are inadequate. It would need the combined efforts of the community, healthcare
personnel and supportive government policies to curb the onslaught of TB. As Dr
Vijay Kumar Edward of World Vision India, so succinctly sums up, "We should not
be found in a situation where we are pouring all our efforts and funds into
diagnostics, research, treatment and care, while ignoring the silent spread of
TB through fine droplets in closed rooms where the poor of this world huddle
together." (CNS)

Shobha Shukla
Citizen News Service - CNS
Email: shobha@...

Online at:
http://www.citizen-news.org/2012/03/control-infection-to-prevent-tb-in.html

Lives before profits: India issues first compulsory license
Citizen News Service (CNS)
*****************************

[Mods note: To join the online dialogue on TB, send email to:
stop-tb-subscribe@yahoogroups.com. The below article is online at:
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Comments are welcome. Thanks]
*****************************

GROUNDBREAKING MOVE SETS PRECEDENT FOR OVERCOMING DRUG PRICE BARRIERS

In a landmark case, the Indian Patent Office has issued the first-ever
compulsory license in India to a generic drug manufacturer. This effectively
ends German pharmaceutical company Bayer's monopoly in India on the drug
sorafenib tosylate used to treat kidney and liver cancer. The Patent Office
acted on the basis that not only had Bayer failed to price the drug at a level
that made it accessible and affordable, it also was unable to ensure that the
medicine was available in sufficient and sustainable quantities within India.

"We have been following this case closely because newer drugs to treat HIV are
patented in India, and as a result are priced out of reach," said Dr Tido von
Schoen-Angerer, Director of the Médecins Sans Frontières (MSF) Access Campaign.
"But this decision marks a precedent that offers hope: it shows that new drugs
under patent can also be produced by generic makers at a fraction of the price,
while royalties are paid to the patent holder. This compensates patent holders
while at the same time ensuring that competition can bring down prices."

Competition from the generic version will bring the price of the drug in India
down dramatically, from over US$5,500 per month to close to $175 per month – a
price reduction of nearly 97 per cent.

"This decision serves as a warning that when drug companies are price gouging
and limiting availability, there is a consequence: the Patent Office can and
will end monopoly powers to ensure access to important medicines," said Michelle
Childs, Director of Policy/Advocacy at the MSF Access Campaign. "If this
precedent is applied to other drugs and expanded to include exports, it would
have a direct impact on affordability of medicines used by MSF and give a real
boost to accessing the drugs that are critically needed in countries where we
work."

Under the World Trade Organization's TRIPS Agreement which governs trade and
intellectual property rules, compulsory licenses are a legally recognised means
to overcome barriers in accessing affordable medicines. The Indian decision in
fact mirrors similar moves made in other countries, including the US. In
February 2011, the US Patent Office decided not to prevent a "generic" medical
device used for skin grafts from being sold, but rather insisted that its
manufacturer pay royalties to the patent holder.
"Behind this action is the idea that the public has a right to access innovative
health products and they should not be blocked from benefiting from new products
by excessive prices," said Michelle Childs. "If more compulsory licences are
granted in this vein, the answer to the question of how to ensure affordable
access to new medicines could radically shift."

Today's system is one where new medicines are patented, and drug companies
aggressively defend their monopolies, at the expense of patients who can't
afford the high prices charged. Instead, we could move to a more equitable
system where new medicines have multiple producers, who each pay royalties to
the patent holder, helping them not only to recoup their development costs but
ensuring that people in developing countries have access.

This move marks the first time India's patent law has been used to allow generic
production when a drug is unaffordable.

"More generic companies should now come forward to apply for compulsory
licences, including on HIV medicines, if they can't get appropriate voluntary
licences," said Dr Tido von Schoen-Angerer.

The compulsory licence has been granted by India's Controller of Patents (the
highest authority of the Indian Patent Office) to the generic company Natco for
the eight years sorafenib tosylate will remain patented in India (until 2020),
and against the payment of a  royalty rate fixed at 6%. The order of the
compulsory licence can be found online at:
http://www.ipindia.nic.in/ipoNew/compulsory_License_12032012.pdf (CNS)

Citizen News Service - CNS

Online at:
http://www.citizen-news.org/2012/03/people-before-profits-india-issues.html

Spotlight: TB - The ugly face of an innocent childhood
Shobha Shukla - CNS
*******************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . The below CNS article is available online
at: http://www.citizen-news.org/2012/03/tb-ugly-face-of-innocent-childhood.html
. Be welcome to share on social media or websites. Comments are welcome. Thanks]
*******************

LOCATION: a typical urban semi slum area (in as much as the houses are not
makeshift but permanent brick structures) of Lucknow, the capital of Uttar
Pradesh, which boasts of the state of art medical facilities.

PLACE: A brick walled house in a very narrow by lane, carefully protected from
the prying rays of the sun, and just broad enough to let a two wheeler pass
through. There is a small open verandah, leading to two dark, dingy and damp
rooms, with no access to sunlight, and hardly any ventilation. One of the rooms
doubles up as a kitchen, which has a mud stove run on wood fuel. The smoke from
the chulha and from the bidis smoked in the house, linger in the closed
environment for long.

OCCUPANTS: Shiv Prasad, a daily wage earner and  the sole bread winner of the
family, (who is also an ex TB patient) and dutifully follows the patriarchal
tradition of spending a large part of his meagre earnings on drinking liquor and
smoking bidis and thrashing his wife every day; his father; his four
children—three sons and one daughter—aged 14 to 3 years; Ramdulari the charming,
but uneducated, hapless wife, who blames it all on her fate and kismet, waiting
silently for some miracle to happen to blow her misfortunes away.  She has
resigned herself to a life where each day's survival is an ordeal, and where
hope has given way to mute resignation. She no longer resents being beaten/ill
treated by her alcoholic husband every day. Though convinced of the merits of a
small family, she is scared of undergoing tubectomy, but is very sure that she
will not beget another child.

THE GROUND REALITY: Ramdulari has a long tale of woe to narrate and pours out
her heart to my eager ears. This is what she had to say—"My 6 year old third
son, Jugal Kishore, has been diagnosed with pulmonary TB and has been undergoing
free anti tuberculosis treatment (ATT) since the last one month, at a nearby
DOTS centre. I never had any institutional delivery, and like my other kids,
Jugal Kishore too was born at home. It was a normal delivery, but he was under
weight. I could only partly breast feed him, as I was not lactating enough. He
has never been a healthy child, falling sick off and on. When he was 1 month old
he got the BCG vaccination in the hospital, but there was no swelling. So after
9 months an anganwadi (community) worker gave the vaccine a second time. Then
also there was hardly any swelling.

He started coughing when he was two years old, which worsened over a period of
time. The cough would be particularly bad at night, and often make him
breathless. I could do nothing more than massage his back to give him some
relief. We would take him to a government hospital for treatment frequently, but
the medicines did not improve his condition. The doctors would ask us to buy
medicines from outside, which we could not afford. He was eventually diagnosed
with TB in the summer of 2011 on the basis of an X Ray. The doctor prescribed
medicines most of which were to be bought from the private market. We could not
afford that, so treatment was discontinued. Some medicines were given from the
hospital.  After sometime, he was very sick again, so he was admitted in the
hospital for 10 days. Another X-Ray was taken, and he was also given the BCG
vaccine for a third time. Then he was put on ATT about a month ago. Only when I
told the doctors repeatedly that we cannot afford to buy medicines, did they
prescribe free medicines which we now get from the DOTS centre. Doctors have
said that the medication will continue for 6 months.

My husband earns around Rs 100 to Rs 150 ($2 or 3) per day, in which I have to
run a family of seven. There is never enough to eat in the house, let alone milk
or any other nutritive food for the children. We give him plain daal roti to eat
as we cannot afford anything better. Sometimes he complains of headache,
otherwise he is okay. Another X Ray has been taken recently, but we have not got
the report. My husband had TB about 7 years ago. He had taken treatment for 6
months from a government hospital and was cured. But of late he has been
coughing a lot, perhaps because of his smoking. He has not gone to the doctor,
as he feels he has already completed the treatment of TB once, so he will not
have it again.

I do not know anything about TB, or how it is spread. I did not know that we get
free medicine for TB. The doctors did not tell us anything about cough hygiene,
or about cleanliness, or how to protect others from infection. No other member
of the family has been tested for TB, and no doctor has asked us to do so. The
child sleeps with me on the same bed along with my other kids. The cough
increases at night and/or when he cries. When he was admitted in the hospital,
he had improved. Sometimes he complains of headache, but otherwise he is okay.
(When I met the child, he had had a severe bout of cough, and he was coughing
very close to his 3 year old sister). We were not counselled about any infection
control measures at the DOTS centre."

If this is the situation in a metro city, one can well imagine what the
situation would be in rural and remote areas. It may sound politically correct
to cry hoarse in unison that we want a TB Free World by 2015, but merely
chanting slogans are not going to make any difference in the lives of people
like Ramdulari and her kids. One has to see what can be improved in the existing
setup. Only if the much publicised maternal and child health programmes of the
government could reach these unreached populations; only if women could be made
aware and counselled about family planning, exclusive breast feeding and basic
health/hygiene measures; only if the healthcare services were more receptive to
the needs of the common people; only if there was prompt diagnosis of TB and
better contact tracing; only if. . . . The list may seem endless, yet it is
achievable without any extra resources. Only if there is more competency and
accountability in our work, instead of a 'couldn't care less attitude', a lot
can be achieved in the field of controlling TB. (CNS)

Shobha Shukla
Citizen News Service - CNS
Email: shobha@...

Online at:
http://www.citizen-news.org/2012/03/tb-ugly-face-of-innocent-childhood.html

Spotlight: Blaming poverty and malnutrition for TB is no excuse for complacency
Dr Muherman Harun, Indonesia
(Source: Citizen News Service - CNS)
********************************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . The below CNS article is available online
at:
http://www.citizen-news.org/2012/03/blaming-poverty-and-malnutrition-for-tb.html
. Comments are welcome. Thanks]
********************************

All of us know that there is a pool where TB bacilli that can flourish and can
cause TB infection in children. We are the ones who together with our knowledge
and experience aim to eliminate the pool, so that no more infections can occur.

How does infection take place? Infection is caused by a TB patient excreting
Acid Fast Bacilli (AFB) in sputum. While coughing he will disseminate sputum
into the air. The smallest particles called the droplet nuclei will remain
floating and when inhaled, can pass the mouth/nose/bronchi and bronchioli to end
up at the alveoli of the healthy person. The bigger sputum particles will reach
the ground and cannot cause infection (unable to form floating droplet nuclei).

In the developing and poor countries there are several risk factors which could
make the children prone to TB infection and could accelerate infection into
disease  Examples:

Children become prone to infection in over-crowded homes, where large number of
people live in a small space and be at higher risk of TB. In the proximity to an
index adult case, where ventilation and illumination are poor or absent.

In the developing and poor countries there are factors accelerating TB infection
towards TB disease. Examples are malnutrition, pollution (cigarette smoke),
biomass fuels, unhygienic condition, co-existing infectious disease: viral
disease (measles, pertussis, smallpox, HIV etc), anemia, malignancy, diabetes

The question is, can we do something about those circumstances which are
basically caused by poverty, poor nutrition and ignorance?

It is not the task of the TB control centers or advocates to change this sad
situation inherent to a poor socio-economic community.

What can we do? The answer is: Detect, treat and cure all infectious cases we
encounter in the community, so that no longer they can spread the infectious
bacilli to others (children).

Once the infectious sources are identified and treated, all, each and every
earlier mentioned risk factors will become irrelevant. Even under the most
miserable socio-economic conditions where poverty and poor nutrition prevailed,
TB can still be stopped successfully, even on an ambulatory basis as was
reported from Madras.

The Madras study (1966) showed that home-treatment is not less effective than
sanatorium-treatment. That even poor nutritional status and hardships, like
continued working under harsh conditions, do not reduce the success of
treatment. And that the spread of TB is halted as soon as chemotherapy was
started.  This fact was later also shown by Riley R.L. with his experimental
guinea pigs and by Prof Jacques Grosset in his laboratory.

Then Dr Karl Styblo developed the DOTS strategy since the 19-eighties  as the
world's most effective means of controlling the tuberculosis epidemic. And this
was considered to be among the most cost -effective system of all interventions
in fighting sickness and disease in the Third World. Implemented by WHO in 1995,
the DOTS strategy has shown to be successful even in the lesser developing
countries. Let's not blame poverty or poor nutrition for the spread of
tuberculosis.

Instead of waiting for socio-economic situation to improve, let's now
concentrate on stopping the spread of TB.  The surest way to instantly stop
infection is to immediately treat the infectious sources.

Finally, lest we forget. The TB bacilli contained in sputum droplet nuclei,
floating in the air are the very ones that can penetrate the bronchi and
bronchioli. While landing on the alveolus, the droplet cum bacillus can cause
infection when inhaled. The poor and undernourished people are the preferential
targets of TB. Notwithstanding, according to West European records, there were
various kings and many world famous artists, who also were victimized by TB.

Technically speaking, TB infection is not caused by poor disinfection or poor
management of excreta from infectious tuberculosis patients.

Also, spitting on the roads and defecating in the open, are indicative of poor
hygiene but for sure, these acts cannot help in the spread of tuberculosis
germs.

Consequently, bed linen, pillow cases, blankets, handkerchiefs, and personal
clothing from untreated infectious TB patients are contaminated, but not
contagious (observation from the Netherlands before the invention of anti-TB
drugs!).

EPILOGUE: For almost thirty years by now, our service providers in 5 outpost
clinics of Jakarta, used to sit within reach or next to each TB patient. They
(the providers) wear no mask, don't take preventive medicines, daily vitamins or
food supplements. Yet, no one of our workers got the disease. Praise the Lord!

Dr Muherman Harun
St.Carolus TB Program,
Jakarta, Indonesia
Email: muhermanharun@...

Online at:
http://www.citizen-news.org/2012/03/blaming-poverty-and-malnutrition-for-tb.html
********************************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . The above CNS article is available online
at:
http://www.citizen-news.org/2012/03/blaming-poverty-and-malnutrition-for-tb.html
. Comments are welcome. Thanks]
********************************

Spotlight: Children and TB: A Hidden Epidemic
Masimba Biriwasha, CNS, Zimbabwe
*****************************

[Mods note: To join the online dialogue on TB, send an email to:
Stop-TB-subscribe@yahoogroups.com . The below CNS article is online at:
http://www.citizen-news.org/2012/03/children-and-tb-hidden-epidemic.html . Be
welcome to share it on social media and comment, thanks]
*****************************

(CNS): Tuberculosis (TB) among children is rarely discussed. Because children,
more often than not cannot speak for themselves, not much about how they're
affected by the disease ever hits the headlines. This is despite the fact that
TB remains among the top ten killers of children worldwide. In spite of this,
virtually no public or political attention is paid to TB as a children's health
issue. The World Health Organization (WHO) estimates that approximately 176,000
children died, but the consensus among researchers says that actual figures are
higher. In 2009 alone, at least 1 million children became sick with TB.

A report titled "Children and Tuberculosis: Exposing A Hidden Epidemic," states
that TB preys on the most vulnerable children - the orphaned, the malnourished,
those living with HIV - and it causes an almost unimaginable burden to children
and their families.

According to Dr. Jeffrey Starke, a leading TB specialist at Texas Children's
Hospital, childhood TB "is a fundamentally different disease from adult
tuberculosis. Its proper diagnosis, treatment, and prevention require specific
planning and resources. We must consider the unique nature of childhood TB if
we're to successfully eliminate TB anywhere in the world."

"Approximately 9 million people become sick with TB each year.2 At least 10-15
percent of these cases are in children under 15 — but the percentage is probably
much higher, because childhood TB is under-reported," states the report.

Most children have a type of TB classified as sputum smear-negative TB which
makes them less likely to spread the disease to others — but it's still deadly
if left untreated. Because on average children are less contagious than adults,
they've been overlooked by national TB programs.

"While adults most often get TB in their lungs, in children the disease often
spreads to other parts of the body. Children are therefore more likely than
adults to develop severe forms of TB, including TB meningitis. TB meningitis
occurs when the bacteria spread to the central nervous system, including the
brain. The bacteria inflame the tissue that protects the brain, causing it to
swell. TB meningitis is most common in children under two years old, and the
disease is almost always fatal without treatment. TB can attack virtually any
part of a child's body in similar fashion," states the report.

It is more cost effective to prevent disease than it is to treat it. The most
effective way to prevent childhood TB is to stop the disease from spreading in
the wider community.

"Even with the limited tools currently available, better organization of
services and aggressively identifying recently exposed and infected children
would prevent tens of thousands of tuberculosis cases in children every year,"
said Dr. Starke. (CNS)

Chief K.Masimba Biriwasha
Citizen News Service (CNS)
Email: masimba@...

Online at:
http://www.citizen-news.org/2012/03/children-and-tb-hidden-epidemic.html
******************************************

[Mods note: To join the online dialogue on TB, send an email to:
Stop-TB-subscribe@yahoogroups.com . The above CNS article is online at:
http://www.citizen-news.org/2012/03/children-and-tb-hidden-epidemic.html . Be
welcome to share it on social media and comment, thanks]
******************************************

CNS Video: Reality Check on Childhood tuberculosis (part 1)
Citizen News Service (CNS)
*********************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . The CNS Video (see below) is online at:
http://www.citizen-news.org/2012/03/cns-video-reality-check-on-childhood.html .
Thanks]
*********************

Dear Stop-TB members,

The new CNS video documenting voices of families and caretakers of children with
TB, (Hindi and English languages, 12 minutes, Part I) is online now at:
http://www.citizen-news.org/2012/03/cns-video-reality-check-on-childhood.html

Please be welcome to view it, comment and SHARE IT ON SOCIAL MEDIA OR YOUR
WEBSITES in lead up to and during World TB Day.

This video raises key issues such as contact tracing, quality counseling on
infection control, health and treatment literacy, BCG vaccination, risk factors
for TB such as exposure to secondhand smoke, cook stove smoke of biomass fuel,
malnutrition, among others. This is Part 1. The Part 2 is focused on diagnostics
and treatment issues.

Thanks

Bobby Ramakant
Citizen News Service (CNS)
Email: bobby@...
*********************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . The CNS Video is online at:
http://www.citizen-news.org/2012/03/cns-video-reality-check-on-childhood.html .
Thanks]
*********************

Spotlight: A woman's courageous journey through TB treatment
Masimba Biriwasha - CNS
************************

[Mods note: Join the online dialogue on tuberculosis (send an email to:
Stop-TB-subscribe@yahoogroups.com . This CNS article is available online at:
http://www.citizen-news.org/2012/03/womans-courageous-journey-through-tb.html .
Thanks]
************************

"I REMEMBER THERE IS ONE TIME I WAS ADMITTED TO HOSPITAL AND THE
SISTER-IN-CHARGE TOLD THE NURSES NOT TO WASTE THEIR TIME ON ME BECAUSE I WAS
GOOD AS DEAD. THAT GAVE ME STRENGTH TO FIGHT FOR MY LIFE"

(CNS): In 2005, Tariro Jack, 27, fell ill with Tuberculosis (TB) during her
first year at college. She said that she struggled to cope not only with her own
health but also managing people's perceptions. TB is an infectious disease that
spreads through the air. The disease mostly affects young adults in their most
productive years and 95% of TB deaths are in the developing world. Estimated TB
incidence rates are highest in sub-Saharan Africa with over 350 cases per
100,000 population. Among African nations, Zimbabwe is one of those most heavily
affected by TB. The deadly combination of TB and HIV epidemics is igniting a
silent and uncontrollable epidemic of drug resistant TB that will negate
previous national health gains.

"I had TB at 21 in my first year at college and I know people thought that I was
dying; I struggled a lot," Jack said, adding that when she was put on the World
Health Organisation (WHO) -recommended Directly Observed Treatment Shortcourse
(DOTS), matters only got worse as her health further deteriorated.

"My skin was very smooth. When I started taking pills, I developed a rash and my
legs became sore to the extent that I couldn't walk," she said.

"Every time that I took the pills I would feel more sick that before and after,
I used to throw up a lot. I used to go to the toilet frequently because the
pills upset my whole system."

To complicate matters, her doctor at the time told her that she was not
responding well to the medication and recommened that she go and see a
specialist. Other health officials did not help the situation by predicting
Jack's demise.

"I remember there is one time I was admitted to hospital and the
sister-in-charge told the nurses not to waste their time on me because I was
good as dead. That gave me strength to fight for my life," she said.

Due to the close association between TB and HIV, Jack said that she had to
contend with another struggle, that of being suspected to be HIV-positive. TB is
a leading cause of illness and death for people living with HIV - about one in
five of the world's 1.8 million AIDS-related deaths in 2009 was associated with
TB. The majority of people living with HIV and TB are in sub-Saharan Africa. In
spite of this close association, it is not automatic that when one has TB,
they're also HIV positive. Stigma around this association is portent though and
can lead affected to shun seeking medical attention.

"When I had TB, everyone seemed to think I was HIV positive. I went for
countless HIV tests and everytime they came out negative. This was to prove a
point but I later realised I didn't live for people but for myself," Jack said.

"I finally got better as I followed the treatment course until I was fine and I
thank God because people who did not know me at the time cannot in any way tell
that I once had TB."

She said that the negative attitude that she received from some of the health
personnel is still like a fresh scar in her memory.

"To people with TB, whether you're HIV-negative or living with HIV, what you've
to know is that TB is curable. You should just believe in yourself and have a
thick skin because people will always talk but I thank God because He gave me
strength and now I can tell everyone of my experience. TB does not kill. Don't
let anyone lie to you," she said. (CNS)

Chief K.Masimba Biriwasha - CNS
Harare, Zimbabwe
Email: masimba@...

Online at:
http://www.citizen-news.org/2012/03/womans-courageous-journey-through-tb.html

Spotlight: Plan to develop new vaccines could help stop TB in our children's
lifetimes
Dr Lucica Ditiu, Executive Secretary
Stop TB Partnership
************************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . The below blog post by Dr Lucica Ditiu was
first published on Science Speaks. It is available online at: Online at:
http://www.citizen-news.org/2012/03/plan-to-develop-new-vaccines-could-help.html
. Thanks]
************************

The following is a guest blog post by Dr Lucica Ditiu, executive secretary of
the Stop TB Partnership, and was published on the Science Speaks Blog (online
at: http://sciencespeaksblog.org/2012/03/20/blueprint-toward-a-tb-free-future/ )
on occasion of the newly released document "Tuberculosis Vaccines: A Strategic
Blueprint for the Next Decade" (online at:
http://www.stoptb.org/wg/new_vaccines/assets/documents/TB%20Vaccine%20Blueprint%\
202012.pdf ). The new strategy reflects the consensus of members of the TB
vaccine research and development community to develop new vaccines that could
help stop TB in our children's lifetimes.

10 MILLION CHILDREN HAVE BEEN ORPHANED BY THE DEATH OF A PARENT FROM TB
Some 10 million children have been orphaned by the death of a parent from
tuberculosis (TB). That number is shocking, but it does not begin to account for
the children who must quit school to care for sick parents, or go to work to
keep the family fed, or those who catch TB from a parent or another relative, or
those who die from TB without ever accessing proper treatment.

IT IS UNCONSCIONABLE THAT IN THE 21ST CENTURY ANY CHILD SHOULD DIE FROM TB – A
CURABLE ILLNESS
It is unconscionable that in the 21st century any child should die from TB – a
curable illness. This year's World TB Day theme, Stop TB in my lifetime, draws
attention to TB's devastating impact on children and also the vision that
today's youngsters will live to see a world free of TB.

WORLD NEEDS A VACCINE THAT IS SAFE AND EFFECTIVE FOR ALL CHILDREN AND ADULTS
To achieve this goal the world needs a vaccine that is safe and effective for
all children and adults. The new vaccine must go way beyond what the only
existing TB vaccine –BacilleCalmette-Guérin (BCG) – can do. BCG is used broadly
across the world and has considerable value because it protects children against
some forms of severe tuberculosis. But it is not safe for children with HIV, and
it doesn't work against pulmonary tuberculosis – the most common and most
infectious form of the disease – or in protecting adults.

This month, the TB vaccine research field took a leap forward. Members of the TB
vaccine research and development community have come to consensus in a new
document titled Tuberculosis Vaccines: A Strategic Blueprint for the Next Decade
to coordinate and guide their efforts over the next 10 years. This valuable
resource outlines the five key questions that need to be addressed, and provides
a basic framework around which both advocates and researchers can organize and
rally.

The Blueprint appears in a special edition of the journal Tuberculosis and was
produced under the auspices of the Stop TB Partnership's Working Group on New
Vaccines. Co-edited by Dr. Michael Brennan and Dr. Jelle Thole of Aeras and the
Tuberculosis Vaccine Initiative (TBVI) respectively – which are two of the
leading TB vaccine research and development organizations globally – the
Blueprint is a bold and pragmatic scientific plan that highlights how
researchers and advocates can create stronger partnerships to work together to
develop a fully effective TB vaccine.

TB remains grossly overlooked by global decision makers whose support we need to
help drive greater action. According to a report by the Treatment Action Group,
the $78 million TB vaccine investment for 2010 was $302 million short of the
$380 million the Stop TB Partnership indicated as needed in their Global Plan to
Stop TB. We need more doctors, vaccine researchers, and people living with or
affected by TB to raise awareness about the impact of the disease and to demand
support for new tools.

When we think about the desperate need for a TB vaccine, we need to stay focused
on people – the babies, children, women and men who are vulnerable to getting
sick from and dying of TB. Without a new vaccine, TB will continue to wreak
havoc on the lives of millions. It is high time we answered the scientific
questions that remain roadblocks to developing new TB vaccines.

I encourage advocates to use Tuberculosis Vaccines: A Strategic Blueprint for
the Next Decade as a resource to show global leaders that we can, and will,
bring new vaccines to fruition if this effort is prioritized. Researchers and
advocates need to coordinate their efforts. This is the only way we will realize
the vision in the Blueprint.

Over the past decade, tremendous progress has been made toward developing better
TB vaccines. We went from having zero new vaccine candidates to 12 vaccine
candidates in clinical trials globally. With the Blueprint, we will be able to
make even more progress in the decade to come. A global meeting of TB vaccine
researchers and advocates – the Third Global Forum on TB Vaccines – is scheduled
for March 24, 2013 in Cape Town, South Africa. This World TB Day, let's resolve
to make that conference the deadline for each of us to begin to play our part in
increasing local, national and global support for TB vaccine development.

Dr Lucica Ditiu
(The author is the Executive Secretary of the Stop TB Partnership,
www.stoptb.org)

Online at:
http://www.citizen-news.org/2012/03/plan-to-develop-new-vaccines-could-help.html

Spotlight: TB in Children: Why Zimbabwe Must Act Now
Chief Masimba Biriwasha – CNS
*******************************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com. The below CNS article is online at:
http://www.citizen-news.org/2012/03/tb-in-children-why-zimbabwe-must-act.html .
Comments are welcome. Thanks]
*******************************

Harare, Zimbabwe: Tuberculosis (TB) is a major public health problem in Zimbabwe
yet very little is known about the impact of the disease on children. Without a
functional healthcare system and research into paediatric TB, Zimbabwe is likely
to continue losing its children to this hidden public health problem. Among
African nations, Zimbabwe is one of those most heavily affected by TB. The
Global Tuberculosis Control Report from the World Health Organisation (WHO)
ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden.

Zimbabwe had an estimated 71,961 new TB cases in 2007, with an estimated
incidence rate of 539 cases per 100,000 people. While, Zimbabwe has fought TB
fairly successfully since attaining statehood in 1980, in the past few years the
disease has re-emerged as a leading killer, especially among people living with
HIV, who are often not identified through long-established TB tests. Put simply,
the TB control programme has been adversely affected by a lack of adequate
financial, human and material resources.

LITTLE DATA ON CHILDREN WITH TB
As it is, there's very little epidemiological data on the extent of TB among
children in the country. Experts say that child TB is widely under-reported and
can represent as much as 40% of the TB caseload in some TB high burden settings
such as Zimbabwe. Children are at high risk of TB, are prone to disseminated
disease and the diagnosis of paediatric TB may be difficult, since complaints
often are unspecific and contacts may not been known.

To make matters worse, the HIV epidemic has affected TB in children enormously,
as it has adults. It has increased the risk that infants and young children will
be exposed to TB, since many adults with TB-HIV are young parents.

HIV-infected children have a 20-fold risk of developing TB compared to
HIV-uninfected children. It also makes diagnosis and treatment more complicated
and increases the risk of TB-related death about 5-fold.  The HIV epidemic has
also orphaned many children (with or without TB-HIV themselves).

DIAGNOSTIC CHALLENGES
Unfortunately, Zimbabwe's national tuberculosis programme has historically not
given child TB high priority because of diagnostic challenges (e.g., children
under 10 have difficulty producing enough sputum for microscopy and the majority
are smear-negative); children are not a major source of the spread of the
disease; resources are limited; recording and reporting forms did not include
boxes for recording ages 0–4 and 5–14 until 2006.

"Our ability to even assess the magnitude of the problem is severely hampered by
the lack of diagnostics in children. The problem is that diagnostic tools, both
current and in development, do not adequately take into account the special
requirements for assessing children," said Dr Steve Graham, chair of Stop TB's
Child TB Subgroup of the DOTS Expansion Working Group.

Once infected with TB, infants and young children are at greater risk than
adults for developing active TB disease, as well as of having the TB disseminate
throughout the body, including to the brain, where it causes meningitis. This
type of TB is often fatal or leaves the child with major disability.

Many health workers regard the management of a child with suspected TB as
`difficult cases', especially with regard to diagnosis. Children are thought of
as needing specialised care.

Against this background, TB case-finding efforts should target children under 5
years of age living in a household with a sputum-smear positive adult. If the
children are well, they should receive isoniazid preventive treatment (IPT) to
help prevent their developing active TB disease.  If they are not well, TB
treatment should be considered and a clinical examination is recommended.

SUGGESTIONS FOR NATIONAL TUBERCULOSIS PROGRAMMES INCLUDE:
- Establish a dedicated child TB working group that includes National
Tuberculosis Control Programme (NTP) staff and national child TB experts.
- Use the working group to set practical priorities and goals, develop
guidelines, implement activities for child TB, support health workers managing
child TB and raise awareness through advocacy and health education.
- Include the needs of child TB in routine NTP activities, such as training,
drug procurement, strategic plans and recording and reporting.

Chief K.Masimba Biriwasha
Citizen News Service - CNS
Email: masimba@...

*******************************
[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com. The above CNS article is online at:
http://www.citizen-news.org/2012/03/tb-in-children-why-zimbabwe-must-act.html .
Comments are welcome. Thanks] *******************************

CNS Video: Reality Check on Childhood TB (parts 1 and II)
Citizen News Service (CNS)
*********************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . Thanks]
*********************

Dear Stop-TB members,

Both the parts I and II of the CNS video "REALITY CHECK ON CHILDHOOD TB" (37
minutes, Hindi and English) documenting voices of families and caretakers of
children with TB, are now online.

Part I:
http://www.citizen-news.org/2012/03/cns-video-reality-check-on-childhood.html
Part II:
http://www.citizen-news.org/2012/03/cns-video-reality-check-on-childhood_22.html

Please be welcome to view it, comment and SHARE IT ON SOCIAL MEDIA OR YOUR
WEBSITES in lead up to and during World TB Day.

You are most welcome to screen the video at your World TB Day event.

This video raises key issues such as contact tracing, quality counseling on
infection control, health and treatment literacy, BCG vaccination, risk factors
for TB such as exposure to secondhand smoke, cook stove smoke of biomass fuel,
malnutrition, diagnostics and treatment challenges, tubercular empyema in
children, diabetes and TB, TB and HIV co-infection, among others.

Thanks

Bobby Ramakant
Citizen News Service (CNS)
Email: bobby@...
*********************

[Mods note: To join the online dialogue on tuberculosis, send an email to:
Stop-TB-subscribe@yahoogroups.com . Thanks]
*********************

Report: Hearing the unheard voices - saving children from TB
Citizen News Service (CNS)
***********************

Dear friends,

Please be welcome to share the report released on World TB Day, 24 March 2012,
in Lucknow, India and Chiang Mai, Thailand, by CNS summarizing the content from
the online consultation and key informant interviews on childhood TB conducted
by CNS along with support from more than 50 partner organizations and networks
globally.

The Scribd (pdf) version of this report is online at: 
http://www.scribd.com/doc/86723326/Hearing-the-unheard-voices-saving-children-fr\
om-TB

The e-paper version of this report is online at:
http://issuu.com/bobbyramakant-cns/docs/childhood_tb_e-consultation_and_key_info\
rmant_inte

Please share this report with your team members, partners and be welcome to use
it for your advocacy as appropriate. All comments are welcome.

Be welcome to share the links of this report on social media platforms your team
members and partners use.

We will be grateful if this report can be published on your websites as well.

Warm regards

Bobby Ramakant
Citizen News Service (CNS)
Email: bobby@...

**********************************
To join online consultation on tuberculosis, send an email to:
stop-tb-subscribe@yahoogroups.com
**********************************