Tuberculosis is not a disease of the past, since more than 5,000 people -- including at least 200 children -- die of TB every day. Young children under 5 years of age are particularly susceptible if they are exposed to TB, due to their age and other risks factors, such as the immunodeficiency caused by HIV infection or severe malnutrition.
As per international guidelines, young or HIV-infected children in contact with an adult with TB should be offered preventive treatment that can reduce the risk of their developing TB disease. However, in many limited-resource settings, this protocol is not followed and, unfortunately, children who do not receive proper diagnosis and preventive therapy often develop TB disease within one or two years -- or at any later stage -- after exposure. This is precisely why the burden of TB in children must be addressed.
To build public awareness and offer a plan of action, in 2013 a group of seven partner organizations worked together to produce a new "Roadmap for Childhood Tuberculosis" with leadership from the Stop TB Partnership's Childhood TB Subgroup, the global umbrella that advocates for all TB-related topics.
Although there are well-developed systems for managing TB in adults, children most frequently receive health care from clinics providing maternal and child services, so their awareness and understanding of TB, as well as their participation, are critical to success. The partners were therefore very pleased that The United Nations Children's Fund (UNICEF) joined their campaign, which, in addition to the Stop TB Parternship, also involved the World Health Organization (WHO), the International Union Against Tuberculosis and Lung Disease (The Union), Treatment Action Group (TAG), the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Agency for International Development (USAID).
The next challenge will be to see that the 10 steps for addressing childhood TB outlined in the roadmap are implemented.
"We managed to go beyond the TB community by including maternal and child health organizations, and this will facilitate the scale up of better coordinated services for children," said Dr. Anne Detjen, a technical consultant based at The Union North America Office, who served on the roadmap writing team.
Among the steps are very practical suggestions, including the need to:
"The roadmap is more like an advocacy document than a policy statement," said Detjen. "There are lots of policies. We want to see this happening on the ground, so our goal was to set out very clear steps."
- Adapt the roadmap to country needs
- Develop child-friendly TB diagnostic tools, especially at peripheral levels of the health care systems
- Train the human resources involved at each level, from the laboratory worker to senior management
- Scale up services for efficiency and effectiveness.
"Any child who dies from TB is one child too many," said Dr Mario Raviglione, Director, Global Tuberculosis Programme at WHO in commenting on the importance of this campaign. "TB is preventable and treatable, and WHO is working towards translating this roadmap to action in countries to stop children dying."
Like other public health problems, a successful roll-out of the Roadmap is also linked to addressing other broad challenges, including the need to improve coordination among the many local, regional and international players involved in TB control; and avoid the duplication of efforts and wasted resources.
Coordinating the development of the roadmap took skillful project management and careful consensus building, especially since childhood TB can only be effectively addressed with greater collaboration of partners and players beyond the standard TB network, including the maternal and child health community.
As a business development officer at The Union's International Management Development Programme, I had a pleasure of teaching project management concepts at a number of international public health workshops, and one of the key concepts I share is that project plans should focus on prediction and prevention, not reaction and recognition.
The partners who developed the Roadmap have successfully demonstrated this principle with their proactive plan to move the world toward a future with zero childhood deaths from TB. Although there are many challenges ahead, remaining stuck in 'reaction and recognition' will inevitably lead to the unacceptable outcome that thousands of children continue to die from TB.