A pilot project to improve the diagnosis and treatment of tuberculosis in children
Since 2014, the Tereska-Foundation supports a project of Doctors Without Borders (MSF) in Tajikistan, which deals with the development and establishment of diagnosis and treatment appropriate for children suffering from tuberculosis and especially multi-drug resistant tuberculosis.
Child appropriate treatment of tuberculosis is a major issue. Children cannot be treated like small adults. They react differently to medical treatments and have different problems to cope with medication, in addition the diagnosis is often more complicated. This was largely disregarded in the past. Now MSF and others intensively try to adapt diagnosis and treatment of tuberculosis to children. It is really important e.g. to keep the dose of the drugs as low as possible because of the severe side effects such as deafness.
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Doctors Without Borders writes: Tuberculosis is a disease to which children are very vulnerable. In regions where TB is endemic - especially in African countries and the countries of the former Soviet Union - the disease is a common cause of death. According to the "Global Tuberculosis Report 2013," the WHO estimated 8.7 million people are infected with TB worldwide. About six percent of those infected are children. Since the diagnosis of TB is very difficult and not well established, these figures are only rough estimates and the actual rate of TB infection among children is probably much higher. For many years the issue of childhood tuberculosis has been neglected. In Tajikistan, - as in many countries of Central Asia - large parts of the population are poor and the state is struggling with major infrastructural problems. The health system is chronically underfunded and even basic care cannot always be provided. One example for this deficit is the high TB rate in the country. Furthermore, resistant TB forms are a major problem. In Tajikistan and other countries of the former Soviet Union these resistant forms make up a very high proportion of all TB infections. Until the start of the project in 2011 by MSF in the Tajik capital Dushanbe children suffering from multidrug-resistant TB remained undiagnosed and untreated.
The work of MSF in Dushanbe is focused on the development of a pediatric pilot project. It is aimed to show that both, improved diagnosis and a child-appropriate treatment of tuberculosis are possible with the currently available means. Within the pediatric TB station a program for the treatment of multidrug-resistant tuberculosis has been established - in this form, the project is unique.
By the innovative nature of MSF´s work, the project aims at identifying options for the child-appropriate treatment of tuberculosis-infected girls and boys: The diagnosis and treatment methods developed in this project thus have impact beyond the borders of Tajikistan and should be applicable in other countries as well.
Retrospect of the activities of MSF in 2014
In 2014, 26 children with resistant TB could be included in the project. In particular, the active search in families in which adults had contracted tuberculosis lead to the identification of six infected children who thus gained access to treatment. MSF treats every infected family member living in the same household, that means also the parents and grandparents, since re-infection can only be prevented if all family members have recovered.
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A New Drug and a New Method
In 2014, MSF diagnosed four children with extremely resistant tuberculosis, which was not sensitive to standard or even replacement medication. As of late, however a new anti-TB drug is available: Bedaquiline. This is the last therapeutic option for some of the patients. In another project in Russia, MSF treat patients successfully with a combination of drugs including Bedaquiline . Final results are expected at the end of 2016
A for Tajikistan new method of obtaining a diagnostic sample was introduced in Dushanbe: The "Gastric lavage method" by which gastric juice of the patient is collected in the morning. The gastric juice in which an increased concentration of bacteria has accumulated overnight, is examined in the laboratory. The method is especially promising for children because collecting sputum is problematic. Sputum induction and production of a child-appropriate pharmaceutical syrup have been tested successfully and will be continued in this project. It is planned that the experience gained in this project is promptly used in another childhood TB project in Uzbekistan.
Cooperation with the Ministry of Health
The cooperation with the Tajik Ministry of Health has been further strengthened and improved. TB treatment protocols were stated in binding agreements, and the psychosocial support of TB-infected children after enduring long hospitalization periods and subsequent stigmatization when returning home was improved after joint discussions. Thus, currently more hospital rooms are converted into playrooms. Children, who are cured and discharged from hospital, receive a certificate of the Ministry of Health, so that they can immediately return to school minimizing the risk of social exclusion. However, this remains a major challenge.
The Ministry of Health in cooperation with MSF conducts training sessions for treatment of TB for doctors from Tajikistan and some neighboring countries- as a result, knowledge is passed on to other doctors in the region.
Facts and figures (January to December 2014)
• 138 children with non-resistant TB were treated
• 22 children with resistant TB were treated
• 4 children with extremely resistant TB were treated
• 9 international and 59 national MSF members work in the project
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Outlook
The new drug Bedaquiline yields hope that both, patients with resistant and extremely drug-resistant tuberculosis, have a better chance on cure. Another new TB drug is Delamanid. Once the drug administration ways have been clarified, MSF wants to use this additional medicine for patients with extremely resistant TB in Dushanbe. Currently, discussions with the pharmaceutical industry and the persons in charge are conducted in Tajikistan.
To reduce the dropout rate of patients with long-lasting therapies, MSF have developed
an accessory book for adult patients. It answers frequently asked questions about TB, includes tips, for example, how to deal with side effects or for a healthy diet and can be used as a therapy diary. If this handbook proves to be a a successful tool, the MSF team in Dushanbe would adapt it for parents of TB-infected children.
Source Doctors Without Borders, as of April 2015
