Cape Town - Experts from across the globe have placed their thinking caps together and have revealed a critical gap in the understanding of the risks of tuberculosis (TB) in children.
The groundbreaking study was done by researchers from the University of Cape Town (UCT)’s Department of Paediatrics and Child Health, Boston University School of Public Health (BUSPH) and the University of São Paulo.
The outcome revealed there was a high risk of TB infection and disease in children up to 10-years-old who lived in communities where the sickness was common.
Their findings were published in The Lancet Child & Adolescent Health.
The study states that Paediatric tuberculosis leads to more than 200 000 deaths annually.
They investigated the incidence of Mycobacterium tuberculosis infection and tuberculosis disease in the first decade of life in the Drakenstein Child Health Study (DCHS), a South African cohort in a community with high tuberculosis and HIV incidence.
They said an estimated 1.2 million children develop TB, and 200 000 kids die from TB worldwide each year, but the risk of developing infection and disease throughout childhood remains under-studied.
They added the majority of studies on the paediatric burden of TB are informed by data from patients in healthcare settings, rather than people in real-world, community settings.
Co-senior author Professor Heather Zar, principal investigator of the Drakenstein Child Health Study and chair of the Department of Paediatrics and Child Health at UCT.
Professor Zar is also the director of SAMRC, South African Medical Research Council Unit on Child & Adolescent Health and said their findings would help pave the way forward in treating TB in children.
“Despite reasonable nutrition and almost no children living with HIV, there was an extraordinarily high, concerning rate of TB infection and disease in this cohort.
“Many children with TB disease were diagnosed when they presented with acute pneumonia, suggesting that in areas of high TB prevalence, children with pneumonia should be investigated for TB.”
According to the study, the team observed and followed a birth cohort of 1 137 pregnant women and their 1 143 children enrolled in the Drakenstein Child Health Study and living near Cape Town between 2012 and 2023.
The Drakenstein Child Health Study (DCHS) is a multi-year birth cohort study following 1 000 mother child pairs to investigate the epidemiology, aetiology and risk factors for childhood lower respiratory illness and the impact on child health, including the development of chronic respiratory disease.
Children were tested for TB infection and disease at age six months, 12 months, and then a year later for those who produced negative test results.
This included if they developed lower respiratory tract infection.
In this way, the team found that by eight years old, children’s risk of developing TB infection was a substantial 36%.
They said new cases of TB disease were highest during the first year of life, and even though the risk decreased as children grew older, one in 10 children afflicted by the disease by age 10 was an alarming find.
Dr Leonardo Martinez, assistant professor of epidemiology at BUSPH and study co-senior author, said these results were striking and showed that children in these communities in South Africa are at extraordinarily high risk.
“Perhaps 1 000 to 2 000 South African children are at greater risk of TB than their young counterparts in the United States. It’s clearly an urgent health problem with both short and long-term impacts on these children and their families,” he explained.
They also found that despite the disease and infection being treatable, many few accessed the care.
They added that the World Health Organization has pledged by 2030 to reduce TB incidence by 80% and TB deaths by 90%, and to ease the financial burden among individuals and families dealing with this illness.
“Much work still needs to be done to tackle the paediatric TB epidemic in South Africa and other high-burden countries, said Martinez.
“If we are to reduce paediatric TB globally, a multi-sectoral approach is needed that brings together researchers, policymakers, healthcare workers, funders, and advocates to find comprehensive solutions.”