Tuberculosis spread in children

 Tuberculosis spread in children

Experts in this field say that the tuberculosis situation in Nepal is becoming dire because the active model of identifying tuberculosis patients in villages cannot be implemented.

A 9-year-old girl was admitted to Kanti Children's Hospital. The parents had taken the child to four private hospitals after experiencing fever, occasional fainting, and flatulence, but the disease was not diagnosed. In the end, he suspected that he might have tuberculosis and administered medicine.

The health condition of the girl became serious as she sometimes took and stopped taking medicine. Child respiratory and intensive care specialist Dr. Jagatjivan went to Ghimire. He suspected that the girl had tuberculosis and suggested to be tested. After a few days of testing, it was confirmed that he had tuberculosis.

He came in a very serious condition. Tuberculosis had already affected various organs. Ghimire said, "He had to be treated in the ICU for three weeks."

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A 40-year-old female senior chest specialist and intensive care specialist Dr. Raju went to Pangeni. Tuberculosis was tested based on the symptoms, and the same report came back three days later.

A 10-year-old son was also living with him, and he did not show any symptoms. But the doctor suggested to examine the child as well. "Looking through the X-ray, a scar was seen on the chest" Dr. Pangeni told Online Khabar, "During the check-up, it was confirmed that the son had also contracted tuberculosis from the mother."

According to the National Tuberculosis Control Center, tuberculosis infection among children is increasing. In the financial year 2077/78, tuberculosis infection was confirmed in 1,892 people under 14 years of age. In 2078/79, 3 thousand 293 and 2 thousand 995 new infections were added in 2079/80.

According to the National Tuberculosis Prevalence Survey conducted by the World Health Organization in 2076, 69,000 new tuberculosis patients are added every year in Nepal. At least 10 percent of them may be children under 14 years of age. In other words, if it is identified at the community level, it is estimated that around 6,900 children may have tuberculosis per year.

But since only around 3,000 have come under the scope of treatment, doctors say that it can be assumed that more than half of the children are averse to treatment.

What is tuberculosis?

According to doctors, tuberculosis is likely to be transmitted in children for two reasons. The risk of transmission is high from birth to pregnant mother and from family members. Children spend a lot of time in school. The disease can also be transmitted by eating the food and water of an infected person by another friend

Tuberculosis is an infectious disease caused by bacteria called Mycobacterium tuberculosis. The possibility of transmission to others is high even from small particles released when a person affected by this bacteria coughs and sneezes.

According to doctors, about 10 percent of adults cough or clear the respiratory system when such bacteria enter. In 80 percent of people, it lies dormant in the lungs or in some part of the body, and does not immediately cause tuberculosis. In this way, dormant bacteria can cause tuberculosis infection during chronic illness or when immunity is reduced.

10 percent of people have tuberculosis due to infection of lungs and other organs. In this way, 80 percent of those who are infected also get an infection in the lungs.

According to the prevalence survey, 69,000 new patients are added every year, and it is estimated that there are 117,000 tuberculosis patients including the old ones.

Children at risk

According to doctors, there is a problem in identifying tuberculosis in children. On the one hand, there is a lack of awareness that even children can be infected with tuberculosis, so there is no attempt to detect the disease. Because the symptoms of tuberculosis in children are similar to those of other diseases, it is not easy to identify the disease.

If an adult person gets tuberculosis, the symptoms of cough, blood in the sputum, chest pain, weight loss, weakness, fever and night sweats are seen. If there is a suspicion of tuberculosis, it can be easily tested by swab.

In children, the problem of fever and weight loss is prominent, which is similar to the symptoms of other diseases. They cannot be easily tested because they cannot extract the toxins. Based on the symptoms, the test is done by taking water from the empty stomach, which is only available in limited health institutions.

"Because there are less bacteria in the body, in some cases the report does not appear positive, which makes it a challenge to identify the disease", said Dr. Ghimire says.

Children under 5 years of age are more at risk of tuberculosis. According to doctors, the lungs of children under 5 years of age are not well developed and their immune system is not developed.

Because the immunity is low, the germs of tuberculosis infect quickly. In children, it causes infection not only in the lungs but also in various other organs.

Because the immune system is weak, the lungs alone cannot contain the bacteria. Because of this, the infection spreads quickly to other organs," said Dr. Raju Pangeni said. In addition to the lungs, tuberculosis infection can occur in the spine, kidneys, heart, brain, intestines, etc.

Dr. According to Ghimire, in some children, two or more organs are affected by tuberculosis bacteria, which can make the health condition serious. Some children may even die if the bacteria spread.

"The infection spreads to different parts of the child, not just one. Tuberculosis which is very severe.

Ghimire said, "Such patients should be treated in the ICU." In some cases, the spread of infection even leads to death.

How is tuberculosis transmitted in children?

According to doctors, tuberculosis is likely to be transmitted in children for two reasons. There is a high risk of transmission from one birth from the pregnant mother and the other from a member of the household. Children spend a lot of time in school. Even if another friend eats the food and water of an infected person, the disease can be transmitted.

The government, which has implemented the five-year strategic plan (2078/79 to 2082/83) for the Tuberculosis-free Nepal Campaign, has also started going to the community and identifying TB-infected people.

According to doctors, one infected person has the ability to infect more than ten healthy people in a year.

"In recent days, the number of tuberculosis patients is also increasing due to the development of technology to detect tuberculosis." Pangeni says, "The increase in the number of children with tuberculosis shows that tuberculosis is not under control even among adults in the community."

The government is going to the community

Tuberculosis can be cured if you take medicine regularly. According to government data, 6,209 DOTS (Dots) centers distribute free tuberculosis drugs.

Similarly, TB patients get free treatment from DR Center 23, DR Sub-Center 82 and 6 DR Hostels. The government has also arranged free insurance for DR patients with nutritional allowance.

However, when the patient does not take the medicine regularly, an additional challenge has been added to the prevention. According to officials, 30,000 infected people have not been treated yet. Official statistics show that even those who came for treatment stopped taking the medicine. According to doctors, drug resistance develops in the infected person's body when they stop taking tuberculosis medicine.

A normal TB patient should take the drug for at least 6 to 9 months, while DRs should take it regularly for at least a year to 18 months or more. Also, their infection is serious and complicated. After taking the medicine for a month, the patient feels as if he is cured. If you leave it in the middle, the medicine will react badly. Pangeni says, 'In this way, patients with DR are more contagious, and the infection spreads more in the community.'

Among the 10 leading causes of death in Nepal, tuberculosis ranks seventh. The prevalence survey of 2074/75 has estimated that 17 thousand will die due to tuberculosis.

It has been more than 8 decades since tuberculosis was treated institutionally in Nepal. During this period, various models were used for prevention. Sometimes treatment (DOTs) under the direct supervision of health workers was done, and sometimes it was done by making a stop TB strategy. But the prevention and cure of tuberculosis could not be done.

"It is estimated that 70,000 new tuberculosis patients will be added every year, but we have not been able to identify 42 percent of them," said the head of the National Tuberculosis Control Center. Prajwal Shrestha said. He argues 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 the society not to go to health institutions.

Experts say that the government's policy to identify tuberculosis patients has failed. The government has worked in a passive model, i.e. only patients who have come to health institutions have been tested.

Experts in this field say that the tuberculosis situation in Nepal is becoming dire because the active model of identifying tuberculosis patients in villages cannot be implemented.

The government, which has implemented the five-year strategic plan (2078/79 to 2082/83) for the Tuberculosis-Free Nepal campaign, has just started going to the community and identifying those infected with TB. According to the National Tuberculosis Control Center, in this financial year, a program has been put in place to search for tuberculosis patients through an active model at the community level in 25 municipalities. Before this, tuberculosis patients were searched in 125 high-risk municipalities.

The center plans to deliver this program to all 753 local levels by 2083. It will detect the true condition of tuberculosis, bring the patients to the treatment and 'break the chain' of infection. Shrestha says. But at this rate, it is not possible to eliminate tuberculosis by 2035.