Unmasking the Hidden Epidemic: The Clock is Ticking!

结核病(TB)是主要原因of severe illness and death in young children worldwide. On this World TB Day, Dr Jacquie Narotso Oliwa details the challenges still remaining before the global eradication of childhood TB can be achieved. For more information on childhood tuberculosis, please explorePneumonia’sthematic series由本·马莱(Ben Marais)编辑。

结核病(TB)是主要原因of debilitating illness and death in children globally. However, it is often described as a hidden epidemic because the true burden of this disease in children remains unknown. This dearth of knowledge can be attributed to the many challenges faced by healthcare professionals in confirming a diagnosis of paediatric TB.

诊断挑战

结核病模仿了许多其他常见的儿童疾病,包括肺炎,营养不良和艾滋病毒,因此在儿童中严重诊断和治疗不足。这是幼儿特别关注的,因为他们携带最高风险由于结核病而死亡。最近的学习suggest that as many as one in ten children hospitalised in TB endemic countries with severe pneumonia may also have TB. Overworked clinicians in busy, usually poorly resourced facilities may often miss these cases.

There is no accurate test for paediatric TB, which often is mistaken for HIV, pneumonia, etc.
©Ronstik / Getty Images / Istock

由于不可靠的测试方法,诊断也很复杂。为了测试结核病,临床医生测试了患者痰液中肺炎的样品,以引起肺部的细菌。但是,儿童倾向于吞咽痰,几乎无法获得确认诊断所需的样品。因此,许多患有结核病的儿童仍未诊断和未经治疗,并且常常死于既可以治愈又可预防的古老疾病。

While there are many challenges to identifying all TB cases in a community, it is particularly unfortunate when children who present clear signs and symptoms of TB are not appropriately assessed to make a diagnosis. Although limited availability and accuracy of diagnostic tests present challenges, this should not be a barrier, as many children with TB can be diagnosed and treated using clinical assessment alone.

We recently observed this phenomenon in astudy在住院的肯尼亚儿童中。这些孩子中几乎有60%的症状和症状暗示结核病。但是,尽管有测试可用,但其中许多儿童从未适当研究结核病,而不到三分之一的孩子最终被诊断为结核病。临床医生似乎缺乏对儿童结核病的高度怀疑,这与肯尼亚这样的高负担国家都存在。该国已经看到了政府和其他合作伙伴为提供基于证据的准则,培训和新技术来支持结核病的案例检测的巨大努力。然而,仍然存在重大的政策差距,尤其是有关儿科护理的问题。

向前进

On World TB Day, let us work together to conquer this disease.

While global efforts to eradicate TB have seen an estimated 63 million lives saved since the year 2000, many high burden countries are lagging behind, especially in the detection of TB in young children. A real concern is that the COVID-19 pandemic is reversing recent gains due to reduced case detection of TB and poorer treatment outcomes compared to pre-COVID years. Patients are staying away from health facilities, and those on treatment are unable to get the necessary support to ensure they complete it.

The clock is ticking towards 2030, the year by which global leaders committed toend TB。我们所有人都需要暂停并反思这个世界结核日,我们是否确实实现了结核病目标。每个人都需要成为公众,政策制定者,政府,资助者,研究人员,卫生工作者,民间社会以及患者本身的解决方案的一部分。对COVID-19大流行的反应的努力,投资,政治意愿和快速成就令人印象深刻,尤其是疫苗的快速发展。通过确保不会错过像孩子这样的脆弱人群,可以同样复制这些努力,以终止我们一生中隐藏的结核病流行的迫切需求。

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