Tuberculosis (TB) is one of the respiratory diseases that pose a major risk to children in Kenya. According to the World Health Organisation (WHO), there are 21,000 new childhood TB cases in Kenya but only 7,648 (36 percent) are notified or confirmed.
It is estimated that about a quarter of these infected children usually die, mainly as a result of not being diagnosed and started on treatment in good time. Even among those that get treatment, adherence to the medicine, which lasts for six months can be a challenge for many, leading to high non-completion rates and deaths.
However, changes to the dosage guidelines can go a long way in addressing this problem, thanks to the findings of a study that was recently published in the New England Journal of Medicine.
The study, which was led by researchers from the University College London, found that the treatment duration for the majority of children with non-severe tuberculosis can be shortened from six to four months, reducing the burden on families and healthcare systems around the world.
“Our study showed that treatment for four months using the same standard medicines was as beneficial as a six-month treatment course for children with non-severe TB,” noted the researchers.
Their historic findings have led to a change in the World Health Organisation’s global guidelines for managing the disease in children.
“A shorter treatment for children with non-severe TB allows savings of on average $17 (Sh170) per child, which can be used to improve the screening coverage and to find the missing children with TB,” stated Prof Diana Gibb, the principal investigator of the study from the Medical Research Council (MRC) Clinical Trials at the University College London.
During the study, the research team worked with their counterparts in South Africa, Uganda, Zambia and India to undertake the first research trial aimed at assessing whether children with non-severe TB could be effectively treated with a shorter course of treatment.
The research involved 1,204 children — aged from two months up to 16 years — with non-severe TB, who were divided randomly into two groups and enrolled on either a four- or six-month treatment programme with anti-TB medicines.
Of the enrolled children, 11 percent were living with HIV. All of them were followed for 18 months afterwards, to see whether their treatment had been successful.
The results clearly showed that children who received the shorter treatment course did as well as those on the standard six-month treatment period, regardless of the age group, country or HIV status,
According to the study, an estimated 1.1 million children fall ill with TB globally. And unlike adult patients, most of them (about two thirds) have a non-severe form of the disease.
Yet the treatment duration for children has always been based on past results of research trials conducted among adults, which recommended six months of a combination of daily medicines to effectively tackle the disease.
Aside from health facilities that need to monitor the children closely during this period, this long treatment duration also increases the burden on caregivers as children on TB treatment often stay home from school.
“People think that a child with TB must be very sick yet that’s not true. It is known that two-thirds of children who fall ill with TB every year have non-severe TB and therefore could be treated with shorter treatment,” said Dr Anna Turkova, the first author of the study from the University College London.
“Spending less time on treatment will therefore mean fewer clinic visits, as well as making it easier to complete the full course of medicine. Savings to TB programmes in countries can instead be spent on improving access to screening and diagnostic tests for the disease, which can be poor at lower-level health facilities, as well as on training health care workers.”
Dr Chishala Chabala, another lead investigator of the study from the Zambia University Teaching Hospital, noted that children are often presenting with mild TB disease.
“Therefore, if they are diagnosed on time, they can now be treated with a shorter course. These results are an opportunity to improve treatment of children with TB.”
“For parents, it’s very challenging to manage the pill burden and to motivate kids to complete the full duration of treatment. This short treatment course can make it more manageable,” said Dr Priyanka Anand Kulkarni, a paediatrician involved in the study from the trial site in India.
The evidence from the study was reviewed by the WHO Guidelines Development Group, which recommended that for children and adolescents with non-severe and drug-susceptible TB, a four-month regimen should be used rather than the standard six-month regimen.
Jill Jones, the head of global health strategy at the UK Medical Research Council said: “It’s fantastic to see that the trial results from this study have already been taken up in WHO tuberculosis guidelines.
“TB remains a major health burden for children and so reducing treatment time by two months will have a major impact on the health and wellbeing of children affected by TB.”