Malawi Mother's TB Journey Highlights Misconceptions, Challenges, and Medical Care

Malawi-Not her real name, Evelyn had a rude awakening when she received the news that her 4-year-old son had been diagnosed with tuberculosis (TB), writes Meclina Chirwa.

Like many others, she had assumed that children were immune to such a disease.

Evelyn was devastated and struggled with how to break the news to her husband, who had always sought help from traditional doctors for various ailments.

Reflecting on what prompted her to take her son to the hospital, Evelyn shared, "I was scared when I noticed my son's persistent cough, especially at night. Despite trying antibiotics at home, his condition didn't improve, and he was becoming increasingly weak. That's when I decided to take him to the hospital, where he was diagnosed with TB."

Diagnosing TB in children can be particularly challenging due to the non-specific symptoms it presents and the lack of sensitive and child-friendly diagnostic tests. It's possible for a child to be infected with TB bacteria without showing active disease.

Evelyn's husband, however, was initially resistant to the idea of seeking medical care at a hospital.

He advised her to visit a traditional doctor instead, as he too was sceptical about the possibility of a child suffering from TB.

Evelyn's experience highlights the misconceptions and lack of awareness that exist around TB in children and the importance of seeking proper medical care for an accurate diagnosis and treatment.

"We both never thought that our son would suffer from TB. However, when I broke the news to my husband, he advised me not to go to the hospital but rather visit a traditional doctor," Evelyn shared, recounting her husband's reaction.

Concerned about her husband's intentions, Evelyn informed the doctor about the situation during her visit to the hospital. The doctor then invited both Evelyn and her husband for counselling.

"When I went to the hospital, I explained everything to the doctor about my husband's refusal to have our son receive medication. The doctor requested my husband's contact information, which I provided. He was called, and we met the doctor the next day for counselling," Evelyn lamented.

After the counselling session, Evelyn and her husband gained a better understanding that TB is curable and can affect anyone, including children.

"I am a living testimony that TB in children is curable. I had doubts, but after the counselling, my husband and I made sure that our son adhered to the prescribed medication," Evelyn said.

Madalitso Chiundira, the district TB officer for Zomba central hospital, provided an overview of how the district has been faring in the fight against pediatric TB.

"Starting with the final half of 2021, the district notified a total of 291 TB cases, out of which 33 were children, representing 11%, while in the final half of 2022, the district notified a total of 362 TB cases, and out of that, 25 were children, representing 7%. You can agree that Zomba district is fairing well in terms of fighting pediatric TB," stated Madalitso Chiundira, the district TB officer for Zomba central hospital.

But what strides has Malawi made in the fight against pediatric TB?

Dr Tisungane Mwenyenkulu, the research, care, and treatment officer at the National TB and Leprosy Elimination program, shared some advancements that have been made, saying, "In the management of pediatric TB, there have been advancements such as the introduction of child-friendly formulations for DR TB and the reduction of the duration of treatment from 18 months to 9 months based on World Health Organization-recommended treatment regimens. Recently, the WHO recommended the use of the stool SOS Xpert Ultra technique for the diagnosis of pediatric pulmonary tuberculosis. This is being piloted in 9 facilities in the country to assess the feasibility and practicality of rolling out the technique nationwide."

TB diagnosis in children has been a challenge not only in Malawi but in many other African countries.

According to Dr Miriam Urasa, the Senior Program Officer for East Central and Southern Africa Health Community, "Child and adolescent TB is often overlooked."

"The symptoms of TB in children are not the typical symptoms that you would see in adults. They may have a poor appetite or a cough, but they are not able to produce sputum, and they may feel tired, which you wouldn't directly associate with TB. On the side of health workers, our suspicion index for TB in children is low. Many have not been sensitized on TB in children," explained Dr Miriam Urasa, the Senior Program Officer for East Central and Southern Africa Health Community.

Meanwhile, on a national level, childhood TB notification has increased by 9%, but there is still a need to improve pediatric TB case findings. In 2021, the childhood target for TB diagnosis and treatment was 2,432; 1,351 cases were achieved, representing 56%.

In 2022, the target was set at 2,551 cases, and 1,473 were achieved, representing 58%.