With the highest incidence of tuberculosis and HIV in the world, Swaziland has lacked dedicated resources to tackle the disease burden resulting from TB, which is amplified in children as a result of diagnosis difficulties, limited screening, weakened immune systems and high infection risks. Global health experts from Baylor College of Medicine and Texas Children’s Hospital hope to make a meaningful difference in this fight with the recent opening of a new, state-of-the-art facility dedicated to improving identification, treatment and outcomes of children affected by TB.
“Our goal is zero TB deaths among Swazi children,” said Dr. Anna Mandalakas, associate professor of pediatrics and director of the Global Tuberculosis Program at Texas Children’s Hospital and Baylor College of Medicine. “Childhood Tuberculosis is a leading cause of death and suffering in children, and we believe we can make a significant impact through our work in Swaziland.”
Tuberculous is a disease of the lungs caused by a germ called Mycobacterium tuberculosis that is usually spread in the air by coughing or sneezing. The germ sets up infection that might sit in the body and cause no harm if controlled by the immune system or it could turn into a deadly disease. In general, the development of TB disease following infection in children is higher than in adults (50 percent versus 10 percent); it is more difficult to diagnose TB disease in children as well.
In Swaziland, childhood TB is common, but finding children with disease and treating them remains difficult, Mandalakas said. “Many children under five years of age are exposed to TB in their homes, but people often forget to evaluate these children for disease or give them life-saving medicine to prevent disease even after TB is found in their parents.”
To address this problem, the Global TB team has joined forces with the World Health Organization’s Stop TB Partnership to improve TB case finding among Swazi children. This project has resulted in a 38 percent increase in the detection of TB disease in Swaziland and was recognized as one of three best practice pediatric TB programs sponsored by the WHO initiative.
For every 100,000 people in Swaziland, 1,382 have TB, 15-30 percent of which are children. The large percentage of the Swaziland population in treatment for HIV (31 percent of 18- to 49-year-olds) also contributes to the problem.
“The immune system in a child can be weakened by the presence of HIV and make them vulnerable to TB disease following infection,” said Mandalakas. “Additionally, HIV-uninfected children living with parents who have HIV are much more likely to be exposed to TB. So, it makes sense to combine TB and HIV screening and treatment programs.”
Mandalakas and her team lead the development of the new Baylor Pediatric TB Center of Excellence, which expands on TB services provided at the Baylor College of Medicine – Bristol Myers Squibb Children’s Center of Excellence in Mbabane, part of the Baylor College of Medicine International Pediatrics AIDS Initiative at Texas Children’s Hospital. This initiative has made significant strides in providing HIV/AIDS treatment in the country.
Since opening in 2008, the Baylor Swaziland Center of Excellence has treated more than 1,300 children for TB and tested 65,997 children for TB.
“A large number of children with TB come from families affected by HIV,” said Mandalakas. “Many have one missing parent, leaving the other parent overwhelmed with the HIV burden and responsibility for many other children. This makes diagnosis more challenging because it often requires multiple visits to different facilities.”
The new TB Center offers a TB-specific facility located on the same grounds as the existing HIV center. The TB Center is uniquely designed for children with child-friendly space and advanced laboratory and X-ray equipment that allows doctors to diagnose TB in one day rather than traditional approaches that can take up to six weeks.
This comprehensive, one-stop-shop brings in new resources – both technology and personnel – and provides TB services including screening, specimen collection, testing and treatment.
Additionally, the TB Center will offer training and mentoring for healthcare workers across Swaziland.