14,000 child TB cases go undetected yearly due to diagnostic gap

More than half of paediatric tuberculosis cases go undetected in Kenya every year, indicating a gap in diagnostics.

According to the 2017 TB Prevalence survey in Kenya, out of the possible 22,000 paediatric TB cases only 7,714 were diagnosed, representing 35 per cent of all cases. Out of the detected paediatric cases, 161 children succumbed to the infectious disease.

The survey said that use of microscopy for diagnosis, which is a common method of running TB test in Kenya, misses more than 50 per cent of the cases. Gene X-pert, an innovative method forTB diagnosis is able to detect 78 per cent of cases making it a more reliable and efficient than microscopy. However, the method also presented 22 per cent diagnostics gap. According to the survey, 85,188 overall cases of TB were diagnosed in Kenya during the year.

Detecting TB in children is hard as it presents itself with cough, fever, failure to gain weight or weight loss and reduced playfulness, mimicking common childhood diseases and making it almost impossible to suspect without running recommended tests.

“The biggest challenge in terms of childhood TB is under diagnosis. Estimates have it that about 22,000 children fall sick from TB every year in Kenya. only about 7,000 were diagnosed and put on medication last year, this means that close to 65 per cent of those with TB are not diagnose every year. This is worrying,” said Enock Masini, a TB expert at the WHO.

“This is an area that needs a lot of investment to increase access to modern diagnostic technologies to be able tackle it,” he said.

In 2016, Kenya rolled out improved FDC medicines for treatment of childhood TB nationally and also called for screening of all children with respiratory symptoms seeking care in health facilities for TB. The government also recommended that chest x-rays be done on all persons presumed to have TB and Gene X-Pert be the first diagnostic test for all presumed childhood TB cases.

However, efforts to bridge the diagnostics and treatment gap have not taken off as planned, owing to the knowledge and awareness gap within public health institutions regarding TB and lack of enough diagnostics technology. For instance, the country only has 154 Gene Xpert machines, meaning most facilities lack the crucial technology to detect and arrest the disease.

“Personnel is the other thing that is wanting. How TB is confused with pneumonia means that we need to enhance capacity of health care to be able diagnose. There is an opportunity to combat TB spread in children especially those under five. This is because they get it from adults,” said Masini.

Margaret Mburu, Lab Tech Adviser, CDC Kenya said accurate and timely diagnosis is essential and required in TB control.