Katherine Floyd from the World Health Organization (WHO) kicked off an all-day symposium on TB and women and children at the Lille, France meeting of the International Union against Tuberculosis and Lung Disease by summarizing WHO’s latest global TB report with an eye to looking at women and children.
There are significant data challenges to evaluating the TB impact on women and children. Fifty percent of smear-negative TB cases and extra pulmonary cases are not disaggregated by sex, and only 60 percent of notified cases in children can be identified through routine reporting. From reporting countries – 35 percent of cases among women are smear-positive and 42 percent are smear-negative or extra pulmonary. Overall, 38 percent of global case notifications are among women, and a higher percentage of TB cases in the Africa region are among women even though a number of key countries in Africa are not reporting data by sex. TB case notification rates among children in Africa are also higher, although there is speculation that TB in kids often is under-reported.
The WHO estimates about 10 percent of all cases of tuberculosis are among children. There were an estimated 3.2 million new TB cases among women in 2010 and about half a million TB deaths among women worldwide, including at least 200,000 deaths among women co-infected with HIV.
Robert Gie, a pediatrician from South Africa, documented the high numbers of severe cases of tuberculosis among infants with mothers with active TB disease. He showed cases of numerous, very sick infants with severe lung disease with mothers with smear positive tuberculosis—a number of which had gone undetected. T B rates are very high in women of child-bearing age in South Africa. If a mom dies from TB, the infant is at very high risk of death, from TB as well as from other causes. Gie did characterize antiretroviral therapy as the biggest advance in the treatment of children co-infected with HIV and tuberculosis, but argued that we are not doing enough for pregnant women and their babies to prevent, diagnose and treat TB. He documented the very high prevalence of active tuberculosis among pregnant women in South Africa and called for a fourth “I” – intensified case finding to detect TB in pregnant women. Eleven percent of pregnant women attending an antenatal clinic in Soweto, South Africa, were diagnosed with active TB. Gie also highlighted the need to integrate TB treatment with maternal and child health services.