Zim Underreports Childhood TB Cases

The Elizabeth Glaser Pediatric Aids Foundation says Zimbabwe has been underreporting child TB cases over the years which has seen the country lag behind the benchmarked number.

By Kuda Pembere

Addressing journalists at a media sensitisation meeting, EGPAF Unitaid Catalysing Pediatric Tuberculosis Innovation CaP TB leader Dr Tichaona Nyamundaya said on the back of underreporting of TB cases coupled with difficulties in diagnosing children, Zimbabwe hit below the required percentage of notifications.
“So moving on to Zimbabwe. Zimbabwe is among the top 30 high burden countries. This applies for both TB and HIV. We have a high burden of TB and HIV and also we have a high burden of drug resistance TB. In Zimbabwe, childhood TB has been accounting for 7 to 8 percent of annual notifications for the past eight years. This is against a target of 15 percent. So we are missing half of the children. TB remains as a public health problem for Zimbabwe,” he said.
He also said some TB signs are similar to common childhood illnesses such as high temperatures.
“Number one, we are not diagnosing the children because of the challenges of making the diagnosis and there is also underreporting. Most of the times most of the signs and symptoms are similar to heightened body temperatures. Most of the children with TB are probably misdiagnosed as pneumonia and being managed as malnutrition,” said Dr Nyamundaya.
Dr Nyamundaya also said TB induced mortalities among children and adults have increased over the years.
“Mortality from 2011 to 2015 has been increasing from 35 per 100 000 to 51 per 100 000 in terms of the estimated mortality rates. This is not for children only but for all population. The notification rate has been going down, over the years. But as you can see before 2014 there was a wide gap in the notification rate and the estimated incidence. It is because previously we have been using estimates and we have been overestimating the burden of TB, but the ministry of health did a prevalence survey in 2014 and using the data from the survey we have managed to close the gap,” he added.
Data from the Ministry of Health and Childcare revealed that children on latent TB infection treatment are not completing it due to lengthiness.
“Data from the Ministry shows that children that are put on Isoniazid Preventive Therapy don’t complete the treatment of six months and others also develop possible side effects. We have shorter versions a three month course of Rifampicin that we are going to be implementing in this new project,” Dr Nyamundaya said. “We have also improved diagnosis through a new machine called Gene Expert and this gene expert has different cartridges and now there is new cartridge called Ultra Expert which the ministry of Health has started utilising which is more sensitive. So if you have a test with this cartridge there are high chances of identifying children with TB.”
He said they advise this new treatment course period of three months.
“So in February of 2018, WHO released new guidelines for the management of latent TB infection where we are now recommending shorter duration regimen that is 3 months compared to 6 months of Isoniazid,” said Dr Nyamundaya.

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