It started with the mother; she had been having a persistent cough that was not responding to self medication. Her husband had been buying over the counter drugs in an effort to alleviate the problem to no avail. Her son, Kofi was only four months old and he had the same problem of which they took the same preventive measures. She was diagnosed with TB after some intensive test but she never thought that her child at such a tender age would be having TB. When her son’s condition deteriorated she took him to hospital where she was diagnosed with pneumonia and was admitted for two weeks after which more results showed that he had Tuberculosis. He was only four months old how could that be possible? “Whoever heard of TB in children especially of such tender an age? Had he had his BCG shot?” she wondered. The husband and father to Kofi did not understand when he found out that his son was having TB. He accused his wife of infecting his son because to him he knew that Tuberculosis was a hereditary condition that was passed from mother to son, after all his father and sister in law had both died of Tuberculosis and they were father and sister to his wife respectively. To him his son had been given “ugonjwa ya familia ya bibi” (disease from the wife’s side of the family) and he was erratic about it.
Then there is Britain she is 7 months old but looks like a 3 month old, and is already on anti TB medication. She has TB meningitis. At 4 months of age, Britain was diagnosed with pneumonia and malaria and was effectively admitted at Kenyatta National Hospital, however while in hospital tests showed that she had meningitis which was later confirmed to be tuberculosis. Two weeks after starting TB treatment Britain responded to the drugs and regained consciousness. She had however, to undergo physiotherapy sessions because TB-Meningitis generally affects the central nervous system and she had lost some of her body reflexes. She can now sit on her own though not for long and her neck is no longer flaccid. Britain’s father had previously been treated for tuberculosis.
Meet Kevin he is 13 years old and living with the HIV virus. Kevin has been treated twice for tuberculosis, first in 2001 and most recently in 2010; he has just finished his medication but is still on ARVs. Ever since he was four months Kevin has been battling with recurrent pneumonia and at the time of writing this story he was complaining of chest pains and headache and his mother thought it would be pneumonia because every time he complains of such pains the doctors always prescribe and treat him for pneumonia. Kevin has hydrocephalus (swelling of the brain as a result of cerebral spinal fluid buildup in the central nervous system which causes fontanelle to bulge and the head to become larger than expected) He has besides lost his eyesight and is partially deaf.
Joan is currently an inpatient at Kenyatta National Hospital. She is 15 years old and living with HIV, her parent passed on and is under the care of her relatives. She recently lost her eyesight and suffered partial paralysis which has improved leaving her with the eyesight problem. She is on both anti TB treatment and ARVs. One of her Aunts who is responsible for taking care of her has previously been treated for TB. 2 weeks after starting anti TB treatment Joan complained of persistent headaches and a week later she started staggering, her eyesight got worse and was taken for treatment but when she did not improve she was taken to Kenyatta Hospital where scan results showed her to be having a brain infection but by then she had completely gone blind.
The incidence of Tuberculosis in children has been increasing in recent years with over 250,000 children developing TB while 100,000 dying from TB each year. It is estimated that most of this children are below 15 years of age. A child usually gets TB infection from being exposed to an adult who has tuberculosis. Young children are at high risk of getting because their immune system is less developed. Similarly if a child is infected with HIV, the risk of getting Tuberculosis Meningitis is very high and often results in deafness, blindness paralysis and mental retardation. The diagnosis of tuberculosis in children especially under the age of 10 can be very difficult and most children end up being misdiagnosed thus leading to late treatment and sometimes death. In children diagnosis is largely based on the clinical features of cough, weight loss, fever and history of close contact with an infectious TB patient Though the Kenyan government has scaled up its diagnosis and treatment of tuberculosis with positive results, when it comes to children, it is a challenge that still faces the government.
Whereas TB focus has mainly been on adults, the government now needs to refocus its attention and give technical support and optimal funding to ensure that the issue of pediatric TB is effectively addressed. According to Sr. Jane, the nurse in charge of the TB clinic in Kangemi, the problem of TB treatment is that when it comes to children, health workers tend to ignore the need to diagnose TB and concentrate on other diseases like Malaria and pneumonia. There is also a need to strengthen the government’s community strategy to ensure that children who might be TB infected are not missed out. Parents should also be sensitized on the importance of seeking proper health services as opposed to self medication and treatment and other home remedies, when their children fall sick. Health workers should also be equipped adequately with information and symptoms of the disease to avoid misdiagnosis or late detection of TB which leads to later enrolment on treatment The WHO recently cited that many cases of pediatric Tuberculosis went undiagnosed or were diagnosed incorrectly raising the risk of TB meningitis which has harmful long term effects and high mortality. The government has now embarked on training and sensitization of health workers on effective pediatric tuberculosis diagnosis and has released guidelines to health workers on checking for symptoms of Tuberculosis especially among children born to HIV positive mothers.