Major study to address under-diagnosis of TB among children

A patient and a family member sit on a bed at the National Center for Tuberculosis and Leprosy Control in Phnom Penh, in December 2013. A new research project aims to reduce mortality among children suffering from TB. Heng Chivoan

Yesenia Amaro | The Phnom Penh Post 
Publication date 06 March 2018 | 16:37 ICT

Despite the high prevalence of tuberculosis in Cambodia, fewer than 7,000 childhood cases were reported in 2017, a statistic researchers believe to be an underestimate, and one they hope to correct with a massive new project.

Laurence Borand, with the Pasteur Institute of Cambodia, said the Kingdom is one of seven countries that will take part in a four-year, multi-agency project that will screen about 77,000 children, 12,600 of them in Cambodia. The project seeks to reduce childhood mortality from tuberculosis.

“The outcome of this research project is a simple [and] effective tuberculosis diagnostic approach for children,” Borand wrote in an email.

In Cambodia, 6,757 TB cases in children were reported to the National Center for Tuberculosis and Leprosy Control in 2017, but because of the difficulty in diagnosing the disease among children, Borand said the number might be underestimated.

Mao Tan Eang, director of the National Center, wasn’t able to say exactly how many cases might be going undiagnosed, due to a lack of scientific data, “But for sure there are still some cases undiagnosed,” he said.

The World Health Organization has estimated that there were 1 million new TB cases among children globally in 2016, and of those, 251,000 children died.

“But only 450,000 cases were effectively notified to WHO,” Borand said. “There is an evident lack of diagnosis of tuberculosis in children and consequently, cases are not notified and do not receive the appropriate treatment. More than 96 [percent] of children who died did not receive treatment as they were not diagnosed.”

Tan Eang said that among the cases that are diagnosed in Cambodia, there are “very few” deaths, though he wasn’t able to provide a specific number.

Borand said it’s more difficult to diagnose children with TB for several reasons. For example, interpreting a chest X-ray is challenging, especially among children with co-infections, such as HIV.

“In addition, vulnerable children such as the ones with severe malnutrition and or HIV are more likely to develop TB disease once infected and they have an increased risk of poor outcomes once sick,” he said.

And in countries like Cambodia where TB has been a major public health problem, up to one-fourth of children under 5 years old believed to have died of severe pneumonia could actually have died of TB, Borand said.

“These patients are often not detected with tuberculosis” or are diagnosed too late, he said. “This study will provide better information on this point.”

Tan Eang added this is not the first time his national program is participating in a multi-agency research project, and he hopes the outcome will make a difference.

“We hope similarly that there would be a benefit,” he said, specifically in case-finding and case management.