By Svetlana Gollands

Statistics are shocking. TB prevalence in Ukraine is much higher than in many other East European countries. Other infections do not account for such a high mortality rate even if put together.

These days every year registers 38-40 thousand of new TB infected and kills 10-11 thousand people. 

No mercy to Children

That means that disease is as a rule diagnosed at an advanced stage when doctors can't do anything. And now another figure sending shivers down your spine: 70% (!) of Ukrainian children aged 14 are infected with agent of the dreadful disease. Doctors can’t always detect TB on time that results in the high risk of TB infection and development with children.

“It is generally harder to diagnose children TB than with adults, for etymological verification of the disease (establishment of the disease nature) is more complicated here, particularly with infants. Their sputum is hard to get and therefore it’s hard to detect the disease agent”, comments Olga Belogortseva, Professor and Chief Scientist of Children’s Respiratory Department at Yanovskiy National Phthisiology and Pulmonology Institute at the Ukrainian Academy of Medical Sciences. “Children diagnostics of early TB symptoms and minor TB forms is not that easy either”.

Annually children TB doctors examine about 200,000 children, the majority of which have latent TB infection. They need rapid medical examination and preventive treatment, for they don’t often reveal developed TB. On the other hand, major part of children with evident TB symptoms have a so-called minor local TB forms which cannot always be revealed using available methods and therefore cannot be timely cured.      

The doctors state that under severe environmental conditions children are particularly vulnerable to the infection as compared with adults. Such is physiology. An adult infected with TB mycobacteria has an annual risk of 0.4% to have TB development.  Alongside with that 40% of infected infants develop TB and children aged 1 to 4 have a risk of the disease development in 23 cases out of 100.

TB is relentless towards children as it quickly aggravates, “eroding” tender pulmonary tissue. Doctors explain it with immaturity of children immune system. Teenagers are especially vulnerable to infection and might not overcome it, for the young organism is “busy” growing and restructuring and can’t keep the immunity sound. Statistics says that every third infected teen-ager who had TB diagnosed for the first time, develop contagious form destructing pulmonary tissue. Looking at the epidemic in the country, one can assume that enjoying all comforts of the XXI century we have come down to extensive poverty and ceaseless wars.

Destructive Diagnosis

Just look at the facts: more children catch heavy TB forms which were widely spread several decades ago during cold and poor war years and revolution. Prosperous 70s and 80s erased from the memories terrible experience of the previous years. Now doctors are totally perplexed.

“TB is undoubtedly a social problem”, states Olga Belogortseva. “Socially vulnerable families are especially exposed to the disease. Ukraine numbers a good many people who can’t afford proper and healthy diet. Low standard of living, lack of vitamins and proteins in food bring down organism’s general resistance including TB resistance.

Threatening enough, but these days the specialists are convinced that anyone can face the disease.

Lethal microparticles released by an infected person can be anywhere – in the transport, supermarket, school, anywhere outside…”

“The present stage of TB epidemic is distinguished by a growing number of people having TB forms resistant (insensitive) to anti-TB medicaments, as well as TB HIV infected”, emphasizes Belogortseva.

Life-saving algorithm

“What should we do to save our children? Which straw should we catch? Shall we await any help from foreign countries? But they are busy solving their own problems now. Shall we hope for the government to suddenly allocate the necessary sums which will be quite enough for all those in need for medical treatment and examination? But the budget of the Health Care Ministry should be 8-10 times larger to meet the goal. Alongside with that, the doctors keep on saying that the earlier they can diagnose the disease, the more chances are left for the children to avoid heavy TB forms”.

“A little patient just over 1 year old staying now in Phthisiology Institute would be sent to lots of doctors. Physicians diagnosed acute respiratory disease although he was whimpering, weakening and having fever”.

“As medicines were helpless, the doctors assumed pneumonia and prescribed treatment. Meanwhile, the child seemed to melt away. Having examined the pneumonogram, phthisiatricians diagnosed specific TB process. The child had his lungs affected and the upper lobar bronchus blocked, which resulted in lung lobe atelectasis. The fight for his recovery will last many months now. Who is to blame? The parents who rejected BCG vaccination after the child’s birth, being overwhelmed with general panic over low-quality vaccines? The doctors who can’t detect the disease using out-of-date equipment? The child’s granny who dotes upon her grandson, but turned out to be a TB carrier without knowing it? Or the environment destroying any infants immunity?

Or still the absence of any solid non-state programs targeted at the epidemic elimination? It’s obvious that we can’t overcome TB pandemic without non-budget funds and assistance of sponsors. Developed countries spend huge sums on childrenTB researches compared with allocations from Ukrainian budget. What do we have? We have only had some minor research projects and TB fighting campaigns held locally and children departments around the country”.

“The Foundation for Development of Ukraine was the first to raise an alarm and undertake the mission to establish the first Ukrainian Medical and Psychological Rehabilitation Center for TB infected children. The Center is being established on the basis of a TB health improvement center that will provide treatment to children as well as health improvement to those who have recovered. It will also ensure psychological support for the patients. However, the practice should be supported by the theory. The Foundation is well aware of it and intends to conduct in-depth researches on the basis of Kharkov Medical Academy of Advanced Studies of Diagnostics of Children TB applying contemporary methods of laboratory diagnostics. It should be noted that researches of children TB have been quite restricted until recently. These years a lot of countries have prioritized development of children TB programs”.

“The Foundation’s initiatives are just well-timed. According to doctors, TB in Ukraine poses a great danger to both national and international security. At the same time WHO demands every country to pay special attention to children TB. Thus, contemporary national record of children’s TB aid provision is needed, for it would grant an equal access for infants and teen-agers to medical service of the best world standards. Our medicine can obviously cope with this task only under the powerful support of non-governmental establishments and organizations”.

For your information.

Human TB is mainly caused by human micobacteria (occasionally by bull and rarely by avian micobacteria), which are quite resistant to environmental influence. TB agents usually penetrate through respiratory apparatus (droplet or air-dust infection) or through gastrointestinal tract and injured skin. The main source of infection is infected people (as a rule those with pulmonary TB, whose sputum contains micobacteria), discharging TB micobacteria as well as TB infected animals, mainly cattle and hens. Infected animals discharge micobacteria with their milk, sputum, excrements and urine. People might get infected through eating meat and eggs, or drinking milk from infected animals and birds. People with constant and profuse discharge of micobacteria are the most dangerous infection carriers. Without following the rules of personal hygiene, a TB infected person like that can infect up to 10-12 people.

The leading role in TB development belongs to unfavorable living conditions and weak resistance of the organism.

Additional Information

Parents should bear in mind that:

Early stages of children’s TB are hard to diagnose, nevertheless alarming symptoms are as follows:
- recurrent increase of the body temperature;
- undue fatigability, weakness;
- bad appetite;
- weight loss;
- sweating;
- continuous cough;
- 

AiF > 34 (627) от 20.08.2008 > Health
http://www.aif.ua/articles/article.aspx?IssueId=432&ArticleId=5998