ATLANTA, Ga – Modeling suggests that tuberculosis is responsible for 6 to 15 percent of all maternal mortality.
But real data remains elusive. While evidence indicates greater risks for women during pregnancy of progressing from tuberculosis infection to illness, national TB reporting in highly affected countries does not include information on whether patients are pregnant or have recently given birth. And while 30 percent of annual TB cases globally occur in women, in southern Africa where HIV fuels tuberculosis epidemics, as many women get sick as men, Dr. Surbhi Modi from the Centers for Disease Control and Prevention noted at a session here on Thursday.
Measuring the impact of tuberculosis on infants and children presents another set of challenges, said Modi, since only a few countries have age-specific reporting. And because children don’t transmit tuberculosis to others, and diagnosing the disease among them remains challenging with currently available tools, childhood TB has received little public health priority. Still she said, an estimated 210,000 childhood deaths from TB are hidden, and may be reported as pneumonia, HIV or malnutrition deaths. An autopsy study conducted in Zambia, she noted, found 18 percent of deaths in children under 5 years old were caused by tuberculosis. “Pneumonia is the leading cause of death in this age group, but TB could be the underlying cause or a comorbidity,” said Modi. Scale up of the pneumococcal vaccine might help to “unmask” tuberculosis, she said.
“TB needs to be more visible on the maternal and child health agenda,” is how Anne Detjen from UNICEF put it in another presentation examining ways to integrate tuberculosis care into health services.Stigma associated with both HIV and tuberculosis, inflexible funding streams, and a laser focus pneumonia and malnutrition, all are challenges to accomplishing greater integration, though. Overburdened primary care systems operating in isolation from National TB programs, and the increasing work load of community health workers, also complicate attention to the impact of tuberculosis, she said.
And, a member of the audience from Kenya said, his country and others that fail to recognize community health workers as integral members of health care systems who need to be paid and supported are ignoring an answer in those who are best situated to work at the community level to educate their peers about TB in children, to help identify active TB cases, and to connect them with health care services.