Better reporting may lead to advances in managing TB in children

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While this is double the estimate of childhood TB deaths compared to last year's WHO report, the Desmond Tutu TB Centre (DTTC) at Stellenbosch University says it's positive in that at least more cases are being reflected. Many childhood tuberculosis cases simply went unreported before.

"In the past, cases have been widely under-estimated. To see these numbers is a huge advance. Although it sounds negative, you need to know something to do something about it," says Anneke Hesseling, the director of the Paediatric TB Research programme at the DTTC in the university's Department of Paediatrics and Child Health.

"The higher number means hopefully there will be more action while children who have TB will be prioritized and given the attention they deserve."

In South Africa, children make up 10% of all TB cases. Almost 40 000 cases of childhood TB were reported in South Africa in 2013, although Hesseling estimates that there are probably many more. "There's a huge burden of tuberculosis among children in South Africa. The cases that aren't reported are often babies or children who may have died or tend to have severe forms of TB, such as TB meningitis."

Despite the high statistics, particularly in South Africa, she believes there is hope for the better diagnosis and treatment of childhood TB. "Tools to better diagnose and treat TB are being developed, and children are now able to access treatment that they were unable to before," Hesseling earlier told a special seminar series on tuberculosis in children, hosted by the Department of Paediatrics and Child Health at Stellenbosch University.

South Africa is also one of a few countries at the forefront of crucial studies to develop safer, child-friendly TB medication and to shorten the duration of treatment from its current six months to four months.

Multi-drug Resistant (MDR) TB is also being tackled, but Professor Simon Schaaf, childhood MDR TB specialist at the DTTC, says MDR TB remains a crisis. "We need new and faster diagnosis and shorter courses of drugs without injectables, which can lead to hearing loss in children."

Prevention is also essential. TB frequently spills over into children from adults. Hesseling says there is a great need to spread the awareness of prevention therapy in the form of the drug, isoniazid, which can prevent TB in children at risk of being infected by family or household members.

Retiring experts

The 'Day of Excellence' set of seminars focused on children with TB in honour of the work of DTTC director, Professor Nulda Beyers and senior specialist and Professor in the Department of Paediatrics and Child Health, Professor Robert Gie. They are retiring from their current positions after championing the cause of the prevention and treatment of TB, particularly in children, over several decades.

"Together with Stellenbosch University colleagues such as Simon Schaaf and Peter Donald, they worked tirelessly at establishing childhood TB as an agenda item internationally. They put it on the map at a time when there was a complete disregard for TB in children," says Hesseling.

Professor Beyers has been internationally recognised for her exceptional work in TB and has been ranked by Thomson Reuters as one of the top 10 most influential TB researchers in the world. She achieved a Gold award from the South African Medical Research Council last Thursday. The award is given to scientists 'who have had a monumental impact on health science in South Africa'. Professor Beyers was also a National Runner-Up in the Department of Science and Technology's 2015 Women in Science Awards.

Under her guidance as director of the DTTC, the centre has grown from small beginnings into having a staff complement of over 400.

Professor Gie was key in establishing WHO international health guidelines for the treatment of childhood TB. Both Professors Beyers and Gie have been recognised as Distinguished Professors by Stellenbosch University.