Multi-drug resistant TB a major threat in children

By Agnes Kyotalengerire

Two-year-old Limuli sits quietly on the verandah, as she watches other toddlers play. She coughs constantly and looks weak and malnourished with no interest whatsoever to join her playmates. According to her mother, Limuli is suffering from multi-drug resistant tuberculosis.

According to Dr. Eric Wobudeya, a paediatrician at Mulago Hospital, multi-drug resistant TB in children is an emerging problem that presents a major threat to the fight against tuberculosis.

Wobudeya says the disease is a form of TB that does not respond to the two most powerful first-line anti-tuberculosis drugs; Rifampicin and Isoniazid.

Diagnosis

Diagnosis of multidrug resistant TB in children is very challenging. It largely depends on a sputum test, yet getting sputum from young children is difficult because they may not understand when asked to cough or spit.


Transmission and cause

Dr. Abel Nkolo, the chief of party, TB CARE I Uganda, says contact with an adult who is coughing and has multi-drug resistant TB, is the commonest way through which children contract multi-drug resistant TB.

Nkolo says children also develop multi-drug resistant TB when they do not adhere to treatment, or are given the wrong dose. “Over time, the germ develops resistance and change the environment,” he explains.


How to tell it is multi-drug resistant TB

Wobudeya says failure to respond to TB treatment in about two months may point to multi-drug resistant TB. Other symptoms include; high fever and continuous coughing.

Prevalence

Wobudeya says very little is known about the magnitude of the problem because multi-drug resistant TB in children is a failry new health condition. However, Saul Akandwanaho, a medical officer in charge multi-drug resistant TB, Mulago Hospital, estimates that out of the 50 children on TB treatment at Mulago Hospital, three have multi-drug resistant TB.

Though three may appear a small number, Inkolo says, this is an indicator that paediatric TB is not being well handled, adding that the number could rise if all Multi-drug resistant TB were tested.#


Treatment

Wobudeya says multi-drug resistant TB drugs for children are available in public health facilities as independent drugs and not combinations.

To ensure adherence, the medicine is only given at the health centre for a period of two years. However, this calls for commitment on the side of the parent or caretaker, Wobudeya affirms.

Usually, injections are administered for the first six months and later, the child is given tablets for about 18 to 24 months. The duration of treatment depends on how soon multi-drug resistant TB germs can no longer be detected in the sputum samples.

This is done through follow-up investigations, where the sputum is checked every month to ensure that the child is responding to treatment, Akandwanaho explains. He, however, says the long treatment period makes management of the disease difficult.


Side-effect of drugs

Aside, the drugs have adverse side-effects, depending on the type of drug used. These range from vomiting, minor abdominal upset, dizziness, joint pains severe reactions, blindness and hearing loss.


Complications

Though children respond well to treatment, unfortunately for those who are not treated, the ultimate complication is death. Aside, Nkolo says multi-drug resistant TB is very destructive; it damages the lungs and the child may end up with scarred lungs and may be malnourished.


Prevention

Akankwasa says children living with multi-drug resistant TB patients are at a higher risk because their immunity is low. The first step in safeguarding children is by treating adults and ensuring they complete their medication.

Children should be isolated from multi-drug resistant TB patients and if contact cannot be avoided, patients with multi-drug resistant TB should wear surgical masks and ensure they sit in an aerated place such as outside the house to avoid TB transmission.