TB cases in children are on the rise

Chennai: The introduction of new techniques, 500 CBNAAT machines for TB diagnosis, GeneXpert, new drugs such as Bedaquilline and expansion of diagnostic facilities to 628 laboratories in the country notwithstanding, tuberculosis has led to 4.8 lakh deaths in India this year. 

The Revised National Tuberculosis Control Programme (RNTCP) promised improved TB surveillance strategy and effective strategies to reach TB patients, but the Annual TB Report 2017 released recently shows a rise in the number of cases among children.

Though the proportion of children among new TB patients was six percent in 2016, it has seen a surge this year, with late diagnosis being the prime cause. In spite of specialised devices and techniques being employed in diagnosing paediatric tuberculosis, diagnosis in children is the main problem as per the annual status report of RNTCP.

Pulmonologists and paediatricians mention about the absence of appropriate samples and decentralised capacity to get appropriate samples to test for TB as a challenge in TB detection in children.  

“There are non-specific symptoms for the detection of TB in children, which makes diagnosis a bit difficult. We have to rely on chest X-ray mostly as other invasive techniques such as Gastric Lavage and GeneXpert are difficult to perform on small children for sample collection,” says Dr Murugan, a senior pulmonologist.

Doctors from The Government Hospital for Thoracic Medicine at Tambaram Sanatorium said that the method of diagnosis varies in children from adults as the diagnosis is carried out in adults by sputum detection AFB but as children are not capable of producing sputum, it is not possible.

“Children cannot be diagnosed with TB through the sputum technique as they swallow it generally. We have to carry out invasive techniques to detect TB by extracting acid from the stomach through a tube. As it is a complicated technique, this cannot be performed on children mostly. This owes to the high rate of late detection of TB, mostly when it gets worse,” says Dr V Ranjith, a senior paediatrician.

When contacted, State TB officials said, “TB Control programme has expanded the scope of using CBNAAT for paediatric TB diagnosis and has been made available at all government centres. We hope that it will improve TB case detection in children”.

Control programme: Patients uninformed of financial grants 
The Union Health Ministry grants financial aid to TB patients under the Revised National TB Control Programme (RNTCP), but patients remain unaware of such benefits. 

It is not only the patients but also the medicos providing healthcare facilities for TB patients who seem to be ignorant of the fact that TB patients are given such benefits along with free TB treatment.

As per RNTCP, a financial grant of Rs 1,000 is provided monthly for a period of two years to the patients suffering from multi drug-resistant TB. And TB in-patients below poverty line are provided this grant through State Tuberculosis Centers by Union Health Ministry. But most of the TB patients in the city are ignorant of these facts and are not given any such benefit.

Following the Union government's declaration to make Aadhaar card mandatory for the beneficiaries of the programme, the issue came into light as patients were asked to enrol in Aadhaar.

Doctors at government hospitals, members of various doctors’ associations, pulmonologists and thoracic medicine doctors at government hospitals in the city do not have the information and hence denied the patients the financial benefits given under RNTCP.

G.Ram, who underwent treatment for TB at Government Hospital for Thoracic Medicine said, “I have not received any communication from the hospital that any kind of monetary help will be given. I underwent treatment for around nine months, and have remained an outpatient for a long period, but only free treatment and food was given at the hospital, no money was received by me.

Agreeing with Ram, V.Manoj, relative of a TB patient at the hospital, said, “My father has been admitted in the hospital for around seven months now, but we have not availed cash under any government scheme. Hospital has provided with food and treatment, but cash was never transferred to our bank accounts”.

Officials at District TB office seeking anonymity, said that the money was sent directly to the bank accounts of patients by the Union Ministry and denied their involvement in handling the monetary grants.

Aadhaar compulsory for RNTCP?
The recent notification on RNTCP says that an eligible individual can avail the benefit of financial grant needs to possess Aadhaar card for easy identification and for easy record of beneficiaries of the scheme.As per the officials, Aadhaar linking would ensure proper record of beneficiaries, and was therefore, mandatory. The government's notification mandates enrollment for Aadhaar lastly by August 31, 2017 to avail the benefits.

However, officials at the State TB office said, "Aadhaar is not mandatory as many patients don't possess Aadhaar cards. We are giving away the financial money by direct transfer of money to their accounts Aadhaar is just an added document that is accepted if patients possess it.”