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July 8, Kathmandu. In the last week of March, a 9-year-old girl was admitted to Kanti Children’s Hospital. After the child developed symptoms such as fever, occasional fainting, and flatulence, the parents took the child to four private hospitals, but none of them confirmed the disease. Finally, he suspected that he might have tuberculosis and took medicine.
The girl’s health became serious due to the on-and-off medication. Dr. Jagat Jivan, a pediatric respiratory and critical care specialist, went to Jimiel. He suspected that the girl had tuberculosis and recommended a test. After a few days of examination, it was confirmed that he had tuberculosis.
“His condition was very serious. The tuberculosis had affected various organs. I had to be treated in the intensive care unit for three weeks,” said Ghimire.
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Dr. Raju, a 40-year-old female senior chest specialist and critical care specialist, went to Pangani. Based on the symptoms, she was tested for TB and received the same report three days later.
He also lives with a 10-year-old son who has not shown any symptoms. But the doctor recommended that the child be examined as well. “Through X-ray examination, a scar was found on the chest,” the doctor said. Pangani told Habar Online, “During the examination, it was confirmed that the son also had tuberculosis from his mother.”
According to the National Tuberculosis Control Center, the incidence of tuberculosis infection among children is on the rise. In the 2077/2078 fiscal year, 1,892 people under the age of 14 were diagnosed with tuberculosis infection. In 2078/79, there were 3,000,293 new cases of infection, and in 2079/80, there were 2,000,995 new cases of infection.
According to the National Tuberculosis Prevalence Survey conducted by the World Health Organization in 2076, there are 69,000 new tuberculosis patients in Nepal every year. At least 10% of them may be children under the age of 14. In other words, it is estimated that about 6,900 children may have tuberculosis every year if identified at the community level.
But with only about 3,000 children being treated, doctors say it can be assumed that more than half will not want treatment.
Do you have tuberculosis?
According to doctors, tuberculosis is likely to spread among children for two reasons. The risk of transmission is high between a pregnant mother’s first child and another child of a family member. Children spend a lot of time in school. The disease can also be spread by consuming food and water from another friend’s infected person.
Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis. People infected with this bacterium can spread the virus to other people through small particles released when they cough and sneeze.
According to doctors, about 10% of adults cough or clear their respiratory system when such bacteria enter. In 80% of people, it exists in the lungs or some parts of the body in a dormant state and does not immediately cause tuberculosis. In this way, dormant bacteria can cause tuberculosis infection during chronic illness or when immunity is reduced.
10% of people have TB with infection of the lungs and other organs. This means that 80% of those infected will also have a lung infection.
According to the prevalence survey, 69,000 new tuberculosis patients are diagnosed each year. Including old tuberculosis patients, the estimated number of tuberculosis patients is 117,000.
Children at risk
According to doctors, there are problems with the identification of TB in children. For one thing, there is a lack of awareness that even children can be infected with TB, so no attempts are made to detect the disease. Since the symptoms of TB in children are similar to those of other diseases, it is not easy to identify the disease.
If an adult has TB, symptoms include cough, blood in sputum, chest pain, weight loss, weakness, fever, and night sweats. If you suspect you have TB, you can easily get a stool test.
In children, fever and weight loss are prominent, similar to symptoms of other diseases. They are not easy to test because they cannot extract the toxins. Testing is done by drinking water on an empty stomach based on symptoms, and this test is only available in limited health facilities.
“Because there are fewer bacteria in the body, reports won’t come back positive in some cases, which makes it a challenge to identify the disease,” Dr. Ghimire said.
Children under the age of 5 are at greater risk of contracting tuberculosis. According to doctors, children under the age of 5 have not yet fully developed lungs and their immunity is weaker.
Due to low immunity, tuberculosis bacteria spread very quickly. In children, it can cause not only lung infections but also infections of various other organs.
Due to a weak immune system, the lungs alone cannot contain the bacteria. Hence, the infection quickly spreads to other organs,” said Dr. Raju Pangani. Apart from the lungs, TB infection can also occur in the spine, kidneys, heart, brain, intestines, etc.
Dr. Gemmiller said some children have two or more organs affected by TB bacteria, which can make the health condition serious. If the bacteria spreads, some children may even die.
“The infection can spread to different parts of the child, not just one site. TB is very serious,” Dr. Ghimire said. “Such patients should be treated in an intensive care unit. In some cases, the spread of the infection can even lead to death.”
How is tuberculosis spread among children?
According to doctors, TB is likely to spread among children for two reasons. Pregnant mothers and family members are at high risk of transmission. Children spend a lot of time in school. The disease can spread even if another friend consumes food and water from an infected person.
The government has implemented the five-year strategic plan for Nepal’s TB-free campaign (2078/79 to 2082/83) and has just started reaching out to communities and identifying people infected with TB.
According to doctors, one infected person has the ability to infect more than a dozen healthy people within a year.
“In recent days, the number of TB patients has also increased due to the development of TB detection technology,” said Dr. Pangani. “The increase in the number of children with TB shows that TB is not under control even among adults in the community.”
Government enters the community
TB is curable if the medicine is taken regularly. According to government data, 6,209 DOTS (Dots) centres distribute TB medicines free of charge.
Similarly, TB patients can get free treatment from DR Centre No. 23, DR Sub-Centre No. 82 and 6 DR Hostels. The government has also arranged free insurance and nutritional subsidies for DR patients.
However, prevention adds an extra challenge when patients do not take their medication regularly. According to officials, 30,000 infected people are still yet to receive treatment. Official statistics show that even those who come for treatment stop taking their medication. According to doctors, when infected people stop taking TB drugs, drug resistance develops in their bodies.
Normal TB patients should take the drug for at least 6 to 9 months, while DR patients should take it regularly for at least a year to 18 months or more. Moreover, their infection is severe and complicated. “After taking the drug for a month, the patient feels healed. If left in the middle, the drug will have adverse reactions. “In this way, DR patients are more contagious, so the infection will spread more widely in the community,” Pangani said.
Tuberculosis ranks seventh among the top ten causes of death in Nepal. The 2074/75 prevalence survey estimated that 17,000 people would die from tuberculosis.
Nepal has been receiving institutionalized TB treatment for more than eight years. During this time, various models have been used for prevention. Sometimes treatment (DOT) was done under the direct supervision of health workers, and sometimes it was done through the development of a Stop TB Strategy. But the same could not be done for TB prevention.
“An estimated 70,000 new TB cases are reported every year, but 42% of them remain undiagnosed,” said Prajwar Shrestha, head of the National Tuberculosis Control Centre. He believes that TB patients are not identified due to poverty, illiteracy, discrimination against TB patients, lack of access to health services and the tendency of those who have access to society to not visit health facilities.
Experts say the government’s policy of identifying TB patients has failed as it has adopted a reactive model where only patients who come to health facilities are tested.
Experts in the field said the TB situation in Nepal is becoming critical as the proactive identification model of TB patients in villages is not being implemented.
The government has implemented the five-year strategic plan for the TB-free Nepal campaign (2078/79 to 2082/83) and has just started reaching out to the community and identifying people infected with TB. According to the National Tuberculosis Control Centre, a programme to find TB patients through an active model has been implemented at the community level in 25 cities this fiscal year.
The centre plans to make the programme available at all 753 local levels by 2083. It will detect the true extent of TB, bring patients under treatment and “break the chain of infection”, Shrestha said. But at this rate, it will be impossible to eliminate TB by 2035.
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