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Tuberculosis: The Special Needs of Children

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Abstract

Mycobacteriumtuberculosis infects one-third of the world’s population and is a leading cause of morbidity and mortality, particularly in poorer countries and underresourced communities where tuberculosis (TB) is endemic. Although childhood TB is largely preventable, children living in these areas are extremely vulnerable to the development of disease as a result of the interplay of environmental, social, and medical/health systems factors. TB disease is the end result of a progression from exposure to an infectious case, to infection and subsequent development of symptoms. Young and immune-suppressed children progress more rapidly and develop more severe forms of disease.

The health care needs of children in TB-endemic areas are being neglected both by the global community and by the local governments. In order to prevent TB, children require adequate nutrition, hygienic living spaces, access to education, and health care. These basic needs are largely unmet in countries where governments are unstable, and where resources are limited or inequitably distributed. In addition, children require strong health systems, where infectious adults are identified and promptly treated, and where child contacts of such adults are administered timely prophylactic therapy. Vertical transmission of HIV needs to be eliminated and HIV infection appropriately treated. A safe and effective vaccine should be a global research priority.

Children with TB disease need to be diagnosed accurately and treated speedily in order to prevent serious complications. The diagnosis of TB remains elusive in most high-burden countries due to the poor performance of the available tools and the lack of adequate laboratory services. It is imperative that novel rapid diagnostics are evaluated for use in the pediatric population. In addition to diagnostics, therapeutic options are also limited in children, especially those suffering from drug-resistant TB. Drug doses are mostly not evidence based, but extrapolated from adult clinical trials, and drug formulations are not tailored for children. This impacts adherence and eventual treatment outcomes. There has been very little research into new anti-TB drugs until recent years, mostly due to the lack of profitability of conducting therapeutic trials in poorer nations.

If international and local commitment to improving the situation of children in underprivileged areas is not undertaken, children will continue to suffer unnecessary morbidity and mortality from preventable diseases such as TB.

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Notes

  1. 1.

    Food insecurity can be defined as the lack of “access to food, adequate in quantity and quality, to fulfill all nutritional requirements for all household members throughout the year” (Jonsson and Toole 1991).

Abbreviations

ART:

Antiretroviral Therapy

BCG:

Bacille Calmette-Guerin

BPD:

Bronchopulmonary Dysplasia

CF:

Cystic Fibrosis

CNS:

Central Nervous System

CXR:

Chest Radiograph

DOTS:

Directly Observed Therapy Short Course

HAART:

Highly Active Antiretroviral Therapy

HIV:

Human Immune-Deficiency Virus

IGRA:

Interferon Gamma Release Assays

INH:

Isoniazid

IPT:

Isoniazid Preventive Therapy

MDR TB:

Multidrug-Resistant Tuberculosis

MTB:

Mycobacteriumtuberculosis

PCR:

Polymerase Chain Reaction

PMTCT:

Prevention of Mother-to-Child Transmission of HIV

RTHC:

Road-to-Health Card

TB:

Tuberculosis

TNF:

Tumor Necrosis Factor

TST:

Tuberculin Skin Test

WHO:

World Health Organization

XDR:

Extensively Drug Resistant

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Authors and Affiliations

  1. Desmond Tutu Tuberculosis Centre, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Stellenbosch, 19063, 7505, Tygerberg, South Africa

    Elisabetta Walters MD & Robert P. Gie MD

  2. Health Systems Trust, 808, 4000, Durban, South Africa

    Elizabeth Lutge MD, Ph.D.

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  1. Elisabetta Walters MD
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  2. Elizabeth Lutge MD, Ph.D.
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  3. Robert P. Gie MD
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  1. Chapel Hill, University of North Carolina, 410 Berryhill, Chapel Hill, 27599-7575, North Carolina, USA

    David Hollar

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© 2012 Springer Science+Business Media New York

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Walters, E., Lutge, E., Gie, R. (2012). Tuberculosis: The Special Needs of Children. In: Hollar, D. (eds) Handbook of Children with Special Health Care Needs. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2335-5_10

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  • DOI: https://doi.org/10.1007/978-1-4614-2335-5_10

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-2334-8

  • Online ISBN: 978-1-4614-2335-5

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