Does Ukrainian Government Ignore Children TB?
Children TB in Ukraine is still a burning problem. According to official statistics, the total number of TB infected teenagers and pre-school children fell down in 2007. But it’s too early for optimistic outlooks as TB aggravates every year endangering life and health of children under four. Taking the problem to the spotlight might contribute to its solution. This concerns in particular improving material and technical facilities of TB treatment establishments, where conditions are far from ideal.
Although, the problem is much less discussed today than, say, 5 or 10 years ago, TB remains an Achilles' heel for Ukraine. No wonder, as TB morbidity peaked in Ukraine in 1998 followed by a gradual recession of the epidemic as well as people’s concerns and care. Meanwhile, the problem remains urgent and dangerous. Experts say the country is still suffering form TB epidemic. The number of people died of TB exceeded 10,000 as of late 2007. TB was detected in 37,000 new people, which is only 4.1% less year on year. So, positive trends are obviously based on a weak ground.
The problem doubles woefully when it comes to children TB. Up to 2,500 children had TB last year. The number of preschool children with firstly diagnosed active TB was 621, and 603 – in teenagers. The figures might not be impressive against the national benchmark at first sight. But experts say the statistics of children TB mortality is deliberately understated, as the given group is under double supervision and responsibility. “Children TB is a critical problem as children are much more vulnerable to TB infection and development. Their physiology makes them the most TB susceptible group”, states Olga Belogortseva, Professor and senior fellow of Children Respiratory Department at Yanovskiy National Institute of Phthisiology and Pulmonology of the Ukrainian Academy of Medical Sciences. A specialist said the annual risk of TB development for an adult infected with mycobacteria (bacillus Kochii) comes up to 0.4%, while the children aged 1 to 4 run the risk of 23%. The biggest concern is that infants are the most unprotected group. Babies under 12 months run a 40% risk of TB contraction. The absolute number of children contracted TB was analyzed by age and gender in 2007 showing TB morbidity in boys and girls under 4 increased significantly.
The rapid spread of infection aggravates the situation a lot. The statistics show every third underage TB-infected child expels TB mycobacteria, i.e. has an open TB form which is of the highest danger to the people around. We should mention that the number of children with lung destructive TB form comes up to 14.3%, the number of teenagers – up to 32.4%. The number of patients with pulmonary destruction exceeds much those expelling TB mycobacteria. According to the experts, this proves that quality of microbiological diagnostics is unacceptably poor in Ukraine. Huge difficulties also arise when it comes to obtaining pathological material, i.e. sputum of infected children. On the one hand, children with a drug-resistant TB have formed a trend already. On the other hand, no information about the number of multi-drug-resistant TB is available.
Ukraine has 186,000 children and teenagers registered with latent TB form, which is a huge problem for any country with any number of population. The lack of the governmental attention and careless parents contribute a lot to TB development. Some people are sure of their child being totally protected and reject vaccination as harmful. The experts point out that this confidence enhances the risk level regardless the family's well-being, social belonging, and way of life. Contraction is not limited to a wet basement or catacombs. For instance, large cities host many TB migrants that can infect a child easily, let alone the risk of infection in kindergartens, schools, public canteens, and city transport. Besides, children TB gets harder to diagnose compared to adults if it is developing into an active form. Children might not show typical symptoms of an active TB form like fever, excessive sweating at night and gradual weight loss. Being the main TB symptom, cough comes too late, unfortunately. Excessive fatigability, irritation. headache, bad appetite, edema of lymph nodes, tachycardia can indicate the early stage of children TB. Infant TB can be diagnosed by detecting abdominal pains, bigger liver, and body temperature rise. However, the symptoms can be typical for other diseases. The only true children TB symptom is a positive Mantoux test – tuberculine susceptibility test – combined with the symptoms listed above. Mandatory chest X-ray can also help detect the disease in case of lung TB. Both Mantoux and X-ray are screening tests obligatory for all citizens. At the same time, only sputum mycobacteria test can help identify a child with an advanced TB form among those infected.
Though, unlike adults, children TB is complicated by correlation of pulmonary and extrapulmonary TB. The figures are far from being bright here. In 2007, the above mentioned correlation was 35% to 65%. According to the statistics, children TB morbidity is made up by 74% of respiratory apparatus TB and 26% of other TB. The latter case primarily comprises osteoarticular TB and peripheral lymph nodes TB. Meanwhile, last year children osteoarticular TB rose by 14%.
Unlike TB in children, lung TB among teens came up to 84% last year, while extrapulmonary TB made 16%. Statistics show that TB incidence among teens exceeds Ukraine's average in 14 administrative areas, and TB incidence in children is above Ukraine's average in 13 oblasts, with the Crimea, Korovograd, Luhansk, Kherson, and Rovno oblasts beating the top of the black ranking. As experts say, cities and rural areas do not differ much in terms of TB incidence among children and teens.
Yet, the level and quantity of treatment and preventive measures differ from region to region. This is a point of special concern about TB among children. The number of children’s TB hospitals has remained unchanged since the previous year. Only Luhansk (100 beds), Kherson (100 beds), and Chernovtsy oblasts (25 beds) run independent inpatient hospitals. Kiev runs an inpatient hospital with 140 beds, with their average occupation coming up to 296 days last year. Kirovograd oblast has established children's TB department which is ready for opening now, while Khmelnitskiy oblast now seeks to separate children's department from the adults' one.
As for children’s health centers, their network comprised 51 establishments at the end of 2007. Apart from insufficient number of TB hospitals and health centers, many regional AIDS centers still lack consulting rooms of children’s TB doctors. According to the statistics, the number of TB patients among HIV infected children has increased recently.
According to Ivan H. Ilnitskiy, Head of Phthisiology Department at Lvov Danilo Galichskiy National Medical University, the above group requires a special focus. He insists that children from TB families, as well as people with showing burdened somatic factors like diabetes, chronic diseases, etc. also need a double care.
But Ukraine needs to improve a range of mistakes first and address a number of issues mostly related to modernization and diversification of material and technical facilities as well as drugs for infected children. No less important is professional postgraduate development of general medical staff (children doctors, family physicians, outpatient specialists) in areas of TB diagnostics, treatment and prevention.
If the TB remains ignored in future, the fallout can be really bad. Ukraine must get over TB epidemic or at least show a positive trend. Otherwise health of the nation is endangered.
By Bohdana Prikhodko