21 March 2012

Tuberculosis (TB) often goes undiagnosed in children from birth to 15 years old because they
lack access to health services - or because the health workers who care for them are unprepared
to recognize the signs and symptoms of TB in this age group. With better training and
harmonization of the different programmes that provide health services for children, serious
illness and death from TB could be prevented in thousands of children every year, the World
Health Organization (WHO) and Stop TB Partnership said today.
"We have made progress on TB: death rates are down 40% overall compared to 1990 and
millions of lives have been saved," said Dr Mario Raviglione, Director of the WHO Stop TB
Department. "But unfortunately, to a large extent, children have been left behind, and childhood
TB remains a hidden epidemic in most countries. It is time to act and address it everywhere".
Most families who are vulnerable to TB live in poverty and know little about the disease and
how to obtain care for it. All too often, when an adult is diagnosed with TB, no attempt is made
to find out whether children in the household also have the disease. This is a crucial step, since
most children catch TB from a parent or relative. Any child living with a TB patient and that has
an unexplained fever and failure to thrive may have the disease and should be evaluated by a
health worker for TB. Those who are not ill with TB should be protected against the disease
through preventive therapy with the drug isoniazid. Those who are ill should receive treatment.
"Two hundred children die from TB every day. Yet it costs less than 3 cents a day to provide
therapy that will prevent children from becoming ill with TB and 50 cents a day to provide
treatment that will cure the disease," said Dr Lucica Ditiu, Executive Secretary of the Stop TB
Partnership. "But before we can give prevention or treatment we have to find the children at risk
of TB, and this will only happen if governments, civil society and the private sector work
together. From now on let us agree: It is unconscionable to let a single child die of TB."
Another problem is that TB can be hard to diagnose. While high-income countries now use
sophisticated childhood molecular tests to detect TB, most developing countries still use a
method developed 130 years ago. The patient must cough up a sample of sputum, which is then
checked under the microscope for the bacteria that cause TB. Young children generally are
unable to produce a sample. Even if a child with active TB succeeds in providing a sample, it
often contains no detectable bacteria.
Recent studies have shown, however, that when health programmes do start looking for children
with TB, they find far more cases than expected. In Karachi, Pakistan, in 2011, researchers
trained community members in the Korangi and Bin Qasim Towns to use an electronic score
card on a mobile phone to find people who needed a TB test and then accompany them to the
hospital or clinic. One result was a 600% increase in detection of pulmonary TB among children.
Another recent study in Bangladesh found that the number of children found to have TB more
than trebled when workers at 18 community health centres received special training on childhood TB. WHO and the Stop TB Partnership point to three key actions needed to improve TB care and prevent TB deaths in children, which are outlined in a No more crying, no more dying; Towards zero (, today.
* Examine all children who have been exposed to TB through someone living in their household.
If they are very ill or living with HIV, treat them for TB immediately if they have typical
signs and symptoms - even if a definitive diagnosis unavailable.
* Provide preventive treatment with the drug isoniazid to all children who are at risk for TB but
are not ill with the disease.
* Train all health workers who care for pregnant women, babies and children to check patients
for TB risk, signs and symptoms and refer them for TB preventive therapy or TB treatment as
TB most commonly affects the lungs, but it also can affect other parts of the body. Infants and
young children are at special risk of having severe, often fatal forms of TB, such as TB
meningitis, which can leave them blind, deaf, paralysed or mentally disabled. Children are just as
vulnerable as adults to developing - or becoming infected with - drug-resistant forms of TB that
require a lengthy, costly treatment with often severe side effects.
At least half a million babies and children become ill with TB each year and as many as 70 000
are estimated to die of the disease. Children under 3 years of age and those with severe
malnutrition or compromised immune systems are at greatest risk for developing TB.
Judith Ann

On Behalf Of The Stop TB Partnership



Department of Applied Mathematics and Theoretical Physics∗ Electronic Address: [email protected] fundamental issue in evolutionary biology is the emergence of multicellular or-ganisms from unicellular individuals. The accompanying differentiation from motiletotipotent unicellular organisms to multicellular organisms having cells specializedinto reproductive (germ) and veget

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