Patients' Charter for TB Care, and childhood TB

By Bobby Ramakant, CNS
February 22, 2012
The author serves as Director (Policy and Programmes), Citizen News Service (CNS) and is a World Health Organization (WHO) Director-General’s WNTD Awardee 2008. Email: bobby@citizen-news.org, website: www.citizen-news.org

(CNS): Will improving efficiency and efficacy of TB control programmes within the healthcare facilities help the world meet the 2015 TB-related targets set by the Millennium Development Goals, the Global Plan to Stop TB, and the country programmes, or do we need a paradigm shift in the basic principles we do TB control upon? Experts have repeatedly emphasized that unless we control adulthood TB, children will continue to get TB. And unless we the change the way we do TB control, adulthood TB is unlikely to be controlled. The TB programme is still very medical despite advocacy, investment and the gold standard Patients' Charter for TB Care - which is sadly not implemented to the extent it should have been by the countries.

PATIENTS' CHARTER FOR TB CARE
According to the World Health Organization (WHO), the Patients' Charter for Tuberculosis (TB) Care, outlines the rights and responsibilities of people with TB. It empowers people with the disease and their communities through this knowledge. Initiated and developed by patients from around the world, the Patients' Charter makes the relationship with healthcare providers a mutually beneficial one.

UNLESS WE TREAT ADULT TB, CHILDHOOD TB WILL CONTINUE TO RISE
In an interview given recently to Shobha Shukla - CNS, Dr Somya Swaminathan, MD in Paediatric TB, and a Scientist at the National Institute for research in Tuberculosis (Indian Council of Medical Research - ICMR), said that: "Pediatric TB is difficult to control, because the infection spreads through the air borne route, and children get it from adults. So the only way to prevent childhood TB is to tackle adult TB more seriously. Contact to contact TB testing must be done. All family members of a TB patient, especially children, should be tested, and started on chemo-prophylaxis. That way we can reduce the burden of paediatric TB. The general awareness level about TB is very poor, even amongst educated people. They do not know how it spreads, how it can be diagnosed and treated and what they can do to reduce the burden of TB. As it is an air borne infection, anybody can get it. The most important risk factor in children is malnutrition, as poor nutrition makes one more susceptible to it. Other social or environmental causes could be poor housing, overcrowded indoors, indoor air pollution, passive smoking, and to a much smaller extent HIV infection also, as in India HIV prevalence is fairly low.”

President of Indian Chest Society (North Zone) and Professor and Head, Department of Pulmonary Medicine, King George's Medical College (now renamed as CSM Medical University) Dr Surya Kant said: "Another important risk factor is that we have a large number of adult TB infections that can potentially be transmitted to children. First and foremost measure that can control childhood TB is to early diagnose and successfully treat the adult TB. So all adult TB cases must be treated effectively and priority should be given to those whose sputum is positive for AFB. If we can intervene in early diagnosing and successfully treating adult TB then a secondary outcome will be to effectively control childhood TB."

Dr Surya Kant emphasized: "More effectively we cure the adult TB more effectively we will prevent the childhood TB. Studies show that children with TB usually don’t infect the adults rather adults with TB infect children. It is only one way transmission of TB from adults to children."

PATIENTS' CHARTER CAN BE THE GAME-CHANGER
Unless people who are experiencing the disease (TB) or have successfully completed the treatment are engaged as EQUAL PARTNERS WITH DIGNITY, we will continue to see TB control dominated by the medical experts who are undoubtedly doing a great contribution to TB control, but that's clearly not enough. Engaging people who know the best can be the game changer. People who have completed TB treatment are best "community experts" to share with us the challenges they faced on daily basis when on TB treatment. These are the challenges which are the potential barriers for many people in benefiting from existing TB control services and should be addressed by the programme. The realities of their lives, on day-to-day basis, that continues to put them and their family members at risk of preventable infections such as TB, needs to be brought in, to increase the impact of TB programmes. The challenges people face in getting a proper confirmed TB diagnosis and tolerating the anti-TB treatment, must be recorded and documented - without which the programme will continue to miss a very important piece of the puzzle - and is unlikely to reach the ZERO mark by 2015 in terms of zero new TB infections and deaths.

Unless we implement the Patients' Charter optimally adulthood TB will continue to challenge us, and so will childhood TB.

As experts said if we can control adulthood TB, childhood TB will automatically taper off. Implementing the Patients' Charter, empowering communities, especially those who have completed TB treatment, to get engaged as equal partners with dignity in TB control, and ensuring the programme addresses the needs felt by the people can help us reach the unreached TB patients - adults and children both.

The Citizen News Service (CNS) along with more than 50 partners from around the world is hosting an e-consultation and conducting key informant interviews on childhood TB. To have your say, go to: www.citizen-news.org

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Posted on: February 22, 2012 07:46 PM IST