Establishing Centers of Excellence (CoE) for Childhood TB in Kunda-Nqob’ iTB (KN-TB) districts is a new approach that is expected to improve childhood TB case finding. Health workers from Gweru and Gwanda Provincial Hospitals and Mwenezi District Hospital were recently capacitated to ensure that the three KN-TB provinces have sites where mentorship and clinical attachments for childhood TB will be conducted.
The training included a day practical session at an existing CoE for childhood TB, Mpilo Hospital in Bulawayo. The visit leveraged on the centre which was established during the USAID supported Challenge TB (2015-2019). At Mpilo Hospital, the clinicians, pharmacists, laboratory technicians and environmental officers were taken through practical demonstrations including gastric lavage, stool SOS method and Mantoux at the paediatric and nutrition wards as well as the reference laboratory.
Globally, TB in children remains a situation of public health concern. Similar to global and regional patterns, the proportion of child TB cases among total notified cases per given year remain lower than the expected targets. Many children with TB are being missed. In 2021, only 5% of all notified TB cases were children between 0-14 years, much lower than global achievements of between 10-12% annually.
KN-TB Chief of Party, Dr Ronald Ncube highlights that childhood TB poses a challenge to deal with mainly because of difficulties in reaching diagnosis.
“Sometimes, children do not show specific signs and symptoms suggestive of TB, but rather present with overlapping symptoms of other common childhood illnesses,” Dr Ncube says.
“Getting a specimen for TB testing is more difficult in a child, who is likely to swallow their sputum. If one does get a specimen, sometimes the result may come back negative, not because they don’t have TB, but because of how TB typically presents in a child, whose immune system is not yet well developed.”
Dr Ncube notes that although sputum is the best specimen for testing for TB, other specimens such as gastric washings and stool can be used in children under the age of 5 years. Use of stool specimen was adopted initially as a pilot in a few districts, with current efforts to scale up its uptake at all levels.
“The rationale is that younger children tend to swallow rather than expectorate their sputum, with swallowed TB bacteria ending up in the gastro-intestinal tract (gut) including stool. Its benefit include the fact that stool has some reasonable and acceptable WHO-approved diagnostic accuracy (sensitivity and specificity) in children; it is easy to collect without special clinical expertise needed; and the stool sample can now be processed using a simple one-step (SOS) method and tested using the same GeneXpert platform, just like sputum.”
Apart from diagnostic challenges in children as described, there are efforts with funding from USAID through KN-TB project to train more healthcare workers and establish CoEs for prevention, diagnosis, treatment and care of children with TB.
USAID, through the Tuberculosis Local Organization Network (TB-LON) funding mechanism is supporting a national TB-HIV response in Zimbabwe in 8 districts across three provinces – Masvingo, Matebeleland South and Midlands selected on account of high disease burden, poor TB treatment outcomes and a concentration of artisanal small-scale miners (ASMs), an important and often neglected risk group for silicosis and TB.
