CNS: Biggest threat to citizens lurks within our borders
Bobby Ramakant - CNS
*************************

Online at:
http://www.citizen-news.org/2012/01/biggest-threat-to-citizens-lurks-within.html

(CNS): Newspapers in India today feature a news (
http://timesofindia.indiatimes.com/india/Nuclear-weapons-only-for-strategic-dete\
rrence-Army-chief/articleshow/11502906.cms )prominently where the Army Chief has
said that nuclear weapons are not for war-fighting (because it will finish the
world) but have a deterrent value. Also the news highlights that Pakistan has
slightly more nuclear warheads than India - further fueling the ongoing arms
race in the Indian sub-continent. Firstly, we believe that the nuclear weapons
have zero deterrent value. If nuclear weapons had a deterrent value then nuclear
powers would not have been attacked by countries that have no nuclear weapon,
and nuclear powers would not have to lose a war. Secondly, where should India
invest a significant portion of its budget - in strengthening military/ army or
systems that help fight the 'enemies' that are real threat to its citizens on
daily basis?

Which is the biggest killer of our citizens in India? And what is the biggest
threat to us Indians? Is it the enemy across the border or is it the conditions
in which our people live on day-to-day basis that puts them at risk of premature
death? Should not this decide where the public money is invested in so that our
citizens are healthy, safe and secure?  Non-communicable diseases (NCDs) account
for about two-third of deaths, and lead conditions include heart diseases,
stroke, diabetes, cancer, among others.

According to a news published in The Times of India
(http://timesofindia.indiatimes.com/india/Superpower-230-million-Indians-go-hung\
ry-daily/articleshow/11494502.cms ), 21% of India's population is
undernourished, nearly 44% under-5 children are underweight and 7% of them are
dying before they reach five years. India is firmly established among the
world's most hunger-ridden countries (Source: International Food Policy Research
Institute - IFPRI which combines the above three indicators to give us a Global
Hunger Index (GHI) according to which India is 67th among the worst 80 countries
in terms of malnourishment.)

In India, diarrhoea continues to be a significant cause of mortality. Childhood
pneumonia is the biggest cause of death for under-five children. How can one
justify when our people are dying of preventable, and even worse, curable,
causes such as pneumonia, diarrhoea, tuberculosis, or hunger?

The above-mentioned news further adds: the proportion of hungry in the
population has actually gone up. Today India has 213 million hungry and
malnourished people by GHI estimates although the UN agency Food and Agriculture
Organization (FAO) puts the figure at around 230 million. The National Family
and Health Survey (NFHS), last carried out in 2004-05, had shown that 23% of
married men, 52% of married women and a chilling 72% of infants were anemic - a
sure sign that a shockingly large number of families were caught in a downward
spiral of slow starvation (Source: TOI news).

Where is the biggest threat to majority of our citizens - across the borders or
within our country? Should we invest huge amounts of money in weapons and
military or should we strengthen our health systems?

Citizens have to seriously ponder of the utility (or futility) of investing
significant amounts of limited public money India has in nuclear weapons and
other arms and ammunition. Where should our money (public money) be invested? In
bombs or in providing basic human amenities to every citizen? Should not
governments provide social security to every citizen instead of so-called false
sense of security that comes from nuclear weapons and other forms of weapons?

Time for citizens to think rationally and make a choice.

Bobby Ramakant - CNS

Online at:
http://www.citizen-news.org/2012/01/biggest-threat-to-citizens-lurks-within.html

Childhood Tuberculosis: Act before it is too late
SHOBHA SHUKLA – CNS
**********************
ONLINE AT:
http://www.citizen-news.org/2012/02/tuberculosis-in-children-act-before-it.html

(Based on an interview given to CNS by Dr Soumya Swaminathan, at Chennai ART
Symposium, 2012)

(CNS): A significant proportion - about 15% to 20% - of all tuberculosis (TB)
occurs in children in India, where paediatric TB is a serious, but
under-recognized and neglected public health problem. "The reason is that,
unlike in adults, children get forms of TB that are not infectious. Therefore
less public health priority and importance is given to it. TB spreads through
the air borne route. So children get it from adults through cough etc. The most
important risk factors in children are malnutrition, poverty,  environmental
pollution, poor housing, overcrowding, indoor air pollution, passive smoking,
and to a much smaller extent HIV infection also" said Dr Soumya Swaminathan,
National Institute for Research in Tuberculosis, Chennai.

Dr Swaminathan was speaking to Citizen News Service (CNS) at the recently
concluded Chennai ART Symposium (CART 2012). She has been working at the
National Institute for Research in Tuberculosis, Chennai since 1992. She has
been involved with clinical trials for new TB regimens, both for adults and
children, has focused on HIV infected adults and children, especially its
interaction with TB.

According to Dr Swaminathan, the two main challenges in dealing with childhood
TB are by way of diagnosis and treatment. Timely and correct diagnosis is a
challenge due to two reasons:
(i) young children cannot produce sputum whose examination is the cornerstone of
TB diagnosis and
(ii) TB in children is pauci-bacilliary: there is more of tissue damage, but
less of bacteria. Hence it is more difficult to isolate and examine those
bacteria. Another reason is the shortage of laboratory facilities in India to do
TB cultures. Many states still do not have reference labs for this purpose. So,
diagnosis has to rely on clinical evidence and X- Rays which can often lead to a
lot of confusion. So now work is being done on diagnostic criteria which will be
very well laid out and can be followed internationally by researchers as well as
clinicians.

The symptoms of the common form of TB of lungs (pulmonary TB), are fever and
cough, which overlap with the symptoms of many other common infections in
children - viral, bacterial and upper respiratory tract infections, asthma and
wheezing. So there is often confusion in the mind of the parent as well as the
doctor as to what type of fever and cough it is. Most often, parents bring the
child to the doctor for repeated and persistent fever/ cough, or if the child is
not gaining weight and not having a good appetite. The other common form of TB
in children is the lymph node TB, in which case there may be an enlarged
swelling in the neck or the armpit. Then there are serious forms of TB like TB
meningitis, in young children specially. They may just be lethargic and have low
grade fever, followed by headache and vomiting. But there is a lot of overlap
with symptoms of other diseases.

Treatment depends upon correct diagnosis, so once correct diagnosis is made,
half the challenge is over. As TB can very often mimic pneumonia,
bacterial/viral infections, it is very important to follow a correct procedure
for diagnosis. Once TB is suspected we need to do a chest X- Ray, and wherever
possible try to make a bacteriological diagnosis—either by obtaining sputum in
case of an older child, or by obtaining respiratory secretions in younger ones
like a gastric lavage or induced sputum. If the X- Ray is suggestive of TB, then
one should give a course of antibiotics, and watch the child for about 10 to 14
days. Most of the other bacterial infections, including pneumonia, will improve
in this time. If the child still does not improve, only then can one consider TB
as a likely diagnosis. Many doctors skip this step. They may, find a lesion in
the X- Ray and start TB treatment. This is responsible for a lot of misdiagnosis
and may also be dangerous for the child in the long.

There are treatment adherence and compliance problems in children with TB,
especially because of the long duration of treatment (6 to 9 months) and also
because they have to depend on others to take the drugs. They may refuse to take
medicine or spit it out. Even in older children and adolescents, we can get
issues of noncompliance, especially if we do not have child friendly
formulations—the taste may be bad or the pills too big to swallow. It depends a
lot on the parents and caregivers, to ensure that treatment is completed.
Unfortunately we have very few quality assured child friendly formulations. So,
very often one ends up using adult formulations with reduced dosage. The Revised
National TB Control Program now has pediatric boxes which are made keeping in
mind different age and weight bands in children. Luckily, side effects in TB
drugs for children are very less as compared to those in adults.

Childhood TB is difficult to control, because the infection is air borne, and
the only way to prevent is to tackle adult TB more seriously. All family members
of a TB patient, especially children, should be tested, and started on
chemoprophylaxis. This way the burden of pediatric TB can be reduced. There are
social and economic issues too, as most of the TB affected children come from
poor socio economic background.

As for HIV-TB co infection in children, it is not too much in terms of overall
population prevalence, but for the HIV infected child, TB is a huge problem, and
very often difficult to diagnose. HIV- TB co infected children have very bad
outcomes, if they are not properly diagnosed and treated in a good centre. In
HIV positive children infected with TB, the challenges are bigger, because many
of them are orphans, living either with grandparents or extended families or
living in orphanages. Treatment compliance in these children is much worse, as
there is no dedicated caregiver, and children are left to themselves to take
their medicine.

Children are innocent victims of the TB epidemic. They have to deal with the
disease as well as the stigma associated with it. 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 can they do to reduce the
burden of TB. As it is an air borne infection, anybody can get it, but poor
nutrition makes one more susceptible to it. We must incorporate nutrition and
education program in the primary health care system, as primary care is very
critical for overall health of the child. We also need to use community
volunteers, social mobilization, and self-help groups to motivate patients to
complete TB treatment and not leave it in between.

As someone has rightly said - Many things can wait, but a child cannot. To her
we cannot say tomorrow, for her name is today. (CNS)

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J
Fellow of National Press Foundation (NPF) USA. She has worked earlier with State
Planning Institute, UP and taught physics at India's prestigious Loreto Convent.
She also co-authored a book (translated in three languages) "Voices from the
field on childhood pneumonia" and a report on Hepatitis C and HIV treatment
access issues in 2011. Email: shobha@..., website:
http://www.citizen-news.org)

ONLINE AT:
http://www.citizen-news.org/2012/02/tuberculosis-in-children-act-before-it.html

How to Get To Zero childhood TB infections and deaths by 2015?
Citizen News Service (CNS)
******************************

[Mods note: HAVE YOUR SAY by joining the online consultation. Send an email to:
stop-tb-subscribe@yahoogroups.com . Online at:
http://www.citizen-news.org/2012/02/online-consultation-how-to-get-to-zero.html
]
******************************

The Citizen News Service (CNS, www.citizen-news.org), a partner of the Stop TB
Partnership, is facilitating a time-limited online consultation in lead up to
the World TB Day, on issues around childhood TB.

This online consultation will be around two themes:
THEME 1: How to 'get to zero new TB infections' in children by 2015?
THEME 2: How to correctly diagnose and treat TB in children and achieve 'zero TB
deaths' in children by 2015?

We will like you to speak your world and share your experiences of addressing TB
in children in your local contexts.

HOW CAN YOU HAVE YOUR SAY?
- Join the new Stop-TB eForum by sending an email to:
stop-tb-subscribe@yahoogroups.com and have your say!
- Be a PARTNER of this online consultation - to be a partner organization, send
an email to: bobby@...
- Email us your comments, perspectives and experiences at:
stopTB@...
- Go online at CNS blog: www.citizen-news.org and publish your comments real
time!
- Skype us and we will record your statement (skype id: bobbyramakant ). To
schedule skype appointment, email: bobby@...
- Tweet us! use #tag: #childhoodTB
- Have your say on our CNS Facebook page!
- Call us and record your statement! (+91-98390-73355)

TIMELINE
The online consultation is open for five weeks (Monday, 13th February to
Saturday, 17th March 2012), after which a summary report will be published by
CNS and released on World TB Day, 24th March 2012.

REFERENCE DOCUMENTS:
Call for Action for Childhood TB launched in Stockholm in March 2011:
http://www.stoptb.org/getinvolved/ctb_cta.asp
Stop TB Strategy: http://www.who.int/entity/tb/strategy/en/
Global Plan to Stop TB: 2011-2015: http://stoptb.org/global/plan/ World TB Day
website: http://stoptb.org/events/world_tb_day/2012/
Global Tuberculosis Control Report 2011:
http://www.who.int/tb/publications/global_report/en/
Whole Is Greater Than Sum Of Its Parts: CNS report 2011:
http://www.scribd.com/doc/70768912/Stop-TB-Online-Consultation-Summary-Report-Li\
lle-2011

Looking forward to a meaningful dialogue,

Citizen News Service (CNS): www.citizen-news.org
Email: stopTB@...

Theme 1 (e-consultation): Getting to zero new TB infections in children by 2015
Citizen News Service (CNS) and partners
*******************************************

[Mods note: To sign up for the e-consultation, send an email to:
stop-tb-subscribe@yahoogroups.com . The Theme 1 announcement is online at:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html .
Thanks]
*******************************************

The theme 1 of the time-limited online consultation on childhood tuberculosis
(TB) in lead up to the World TB Day is: "Getting to zero new TB infections in
children by 2015."

Have your say before 25th February 2012 - share with us what should be done more
(or less of) to prevent new TB infections in children in your local settings.
Your perspectives, opinions, voices are important for us and we do look forward
to them.

GUIDING QUESTION
---------
- What can be done more (or less of) at the family, community or your country
level to prevent new TB infections in children?

This e-consultation on childhood TB is being facilitated by the Citizen News
Service (CNS), a partner of the Stop TB Partnership, along with many other
organizations and networks that have endorsed this initiative and joined as a
partner (see the list below).

HOW CAN YOU HAVE YOUR SAY?
---------
- Join the new Stop-TB eForum by sending an email to:
stop-tb-subscribe@yahoogroups.com and have your say by sending your comments to
stop-tb@yahoogroups.com
- Be a partner of this online consultation - to be a partner organization, send
an email to: bobby@...
- Email us your comments, perspectives and experiences at:
stopTB@...
- Go online at CNS blog: www.citizen-news.org and publish your comments real
time!
- Skype us and we will record your statement (skype id: bobbyramakant ). To
schedule skype appointment, email: bobby@...
- Tweet us! use #tag: #childhoodTB
- Have your say on our CNS Facebook page!
- Call us and record your statement! (+91-98390-73355)

TIMELINE for THEME 1
---------
Responses to theme 1 are welcome till 25th February 2012, after which a summary
report of Theme 1, will be compiled and released to mark World TB Day.

REFERENCE DOCUMENTS:
---------
- Call for Action for Childhood TB launched in Stockholm in March 2011:
http://www.stoptb.org/getinvolved/ctb_cta.asp
- Stop TB Strategy: http://www.who.int/entity/tb/strategy/en/
- Global Plan to Stop TB: 2011-2015: http://stoptb.org/global/plan/ World TB Day
website: http://stoptb.org/events/world_tb_day/2012/
- Global Tuberculosis Control Report 2011:
http://www.who.int/tb/publications/global_report/en/
- Whole Is Greater Than Sum Of Its Parts: CNS report 2011:
http://www.scribd.com/doc/70768912/Stop-TB-Online-Consultation-Summary-Report-Li\
lle-2011
- Tuberculosis and children: Exposing the hidden epidemic - ACTION brief
http://c1280352.r52.cf0.rackcdn.com/childrens_tb_0811v2.pdf

PARTNERS
---------
McGill TB Research Group
Treatment Action Group
Asian Harm Reduction Network (AHRN)
PATH
Cambodian Health Committee (CHC)
Positive Muslim Group, Myanmar
Life Foundation, Pakistan
The Good Neighbour Nigeria
TB Alert
University of Nairobi, Kenya
Medical Care Development Inputs (MCDI) Kenya
Kenya Consortium to Fight TB, Malaria and AIDS (KECOFATUMA)
Partnership for TB Care and Control, India
PCI India
MAMTA
SNEHA
Institut Pasteur de Madagascar
Institute for Plantation Agricultural And Rural Workers (IPARW)
Rural Youth Advocate for Health and Development in Nigeria (RYAN)
Citizens for Healthy Lucknow (CHL) initiative
Abhinav Bharat Foundation (ABF)
Asha Parivar
Samadhan
National Alliance of People's Movements (NAPM)
PRAYAS Health Group
Indian Society Against Smoking (ISAS)

Looking forward to a meaningful dialogue,

Citizen News Service (CNS)
Email: stopTB@...

POST YOUR COMMENT online at:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html

Spotlight: Zero children dying from tuberculosis by 2015 is possible, if...
Hara Mihalea, PATH
**********************

[Mods note: To join the e-consultation on childhood TB, send an email to:
stop-TB-subscribe@yahoogroups.com . The below CNS article written by Hara
Mihalea, PATH, Thailand, is available online at:
http://www.citizen-news.org/2012/02/0-children-dying-from-tb-by-2015-is.html .
Comments are welcome. Thanks]
**********************

I like to start by sharing a real story which I experienced in one of my visits
in the field last year. I'm sure many of you working in the field have similar
stories to tell. During a monitoring visit for our PPM program I came across a
referral slip made out by a pharmacy staff referring a 36 year old woman to the
DOTS health center.

Looking at the symptoms circled on the slip one could tell that this was
certainly a pulmonary TB case; weight loss, fatigue, chest pain, fever, and
cough with blood. We traced the referral to one of the district health centers
where we found out that the woman had indeed gone for further evaluation, she
was checked, diagnosed, given medication and sent home. We were told by the
health center staff that since the first visit she came back twice, each time
sicker than before, and was again send home, no TB. We decided to visit her at
home where she lived with her husband, her in-laws, two small children and one
baby. We asked the district TB officer to join us so he could be able to
follow-up later on.

When we arrived in her small house we were taken up in her room, she was sitting
on a straw mat on the floor, baby on the breast, glassy eyes, face flushed with
fever. She repeated the same story that the health staff told us. She told us
how disappointed, sad, and scared she felt, she said she was getting worse by
the minute and no one could help her. She said she wanted to go back to the
health center but they didn't have any more money and no transportation. Each
time she coughed she hit on her chest to show us where it hurts. I will never
forget the pain on her face, the shortness of her breath when she tried to tell
us her story. I will never forget the fear I felt for the baby on her breast and
her other two children and thinking that this woman unless treated immediately
will soon die and leave these children orphans. The end of the story is that the
woman did have TB and the last we heard was that the district officer was trying
to get the children tested.

So what went wrong? why did this woman sought care three times and still was
send home with a bag of  antibiotics and vitamins? This is a very common story
and it's happening every day, many times a day around the world, especially in
high TB burden developing countries.

I shared this story with you because I truly believe that once again we might
not be able to reach our goal to Zero the numbers of children dying of TB in our
lifetime, left alone by the year 2015, if we don't take some drastic steps to
address the real problems that are preventing us from doing a good job. We can
have the guidelines and country operational plans for TB in children, we can
have the treatment algorithms however I strongly feel that these will not help
much, especially in limited resource setting where stories such as this are real
unless we start by:

(1) Holding governments accountable for the health and well-being of their
populations, especially the children; health is a right not a luxury and not
only for the few. Advocate governments for resource allocation that will
increase the salaries of the health staff and will motivate them to perform
their tasks in an appropriate manner; health staff in developing countries often
do not get their salary for 3-6 months.

(2) Strengthening the DOTS program. If we had a quality DOTS program the health
staff would have been able to accurately diagnose and successfully treat the mom
in the story.  They would have being able to prevent TB and the needless
suffering in her children.

(3) Integrating TB into the primary health care and sensitizing all health care
providers on TB.  Once sensitized health staff be able to screen children and
moms during immunization sessions, postnatal visits, reproductive health (RH)
visits or other consultations.

(4) Most importantly recognizing the symptoms of TB in children, creating
linkages and partnerships between communities, private providers and TB services

(5) Intensifying case finding and contact tracing when TB is suspected to all
family members, most importantly to children. The majority of the children get
TB from a family member.

(6) TB is a poverty disease, half of the children in the developing countries go
without meals, they are malnutrition which makes them even more vulnerable to
TB. Addressing the nutrition needs is of out-most importance.

(7) TB in a child that is already living with HIV is a double heartbreak and so
much more difficult to diagnose and treat.

I might sound to you pessimistic, I am a little bit because TB is very political
and things are moving very slowly; we cannot afford to move slowly anymore, we
should not allow it. We need to step up and step up very fast. What we should
all see at the end of 2015 is not just the numbers, the statistics showing fewer
deaths, we should see children, happy and smiley faces, children free of TB.
Where there is a will there is a way and collective voices will find the way.

Hara Mihalea CHE, MPH
PATH, Thailand

Online at:
http://www.citizen-news.org/2012/02/0-children-dying-from-tb-by-2015-is.html
**************************************************

[MODS NOTE: Join the e-consultation by sending an email to:
stop-tb-subscribe@yahoogroups.com . The guiding question (Theme 1) of the
time-limited online consultation on childhood tuberculosis (TB) in lead up to
the World TB Day is: "What can be done more (or less of) at the family,
community or your country level to prevent new TB infections in children?"

Have your say before 25th February 2012:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html .
Thanks]
**************************************************

Spotlight: Patients' Charter for TB Care, and childhood TB
Bobby Ramakant - CNS
**********************

[MODS NOTE: Join the e-consultation on childhood TB by sending an email to:
stop-tb-subscribe@yahoogroups.com . The below CNS article is online at:
http://www.citizen-news.org/2012/02/patients-charter-for-tb-care-and.html .
Comments are welcome. Thanks]
**********************

(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),
http://www.who.int/tb/people_and_communities/patients_charter/en/index.html 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 (download the patients' charter
here http://www.who.int/entity/tb/publications/2006/patients_charter.pdf ).

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:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html

Bobby Ramakant - CNS
Email: bobby@...

Online at:
http://www.citizen-news.org/2012/02/patients-charter-for-tb-care-and.html
**************************************************

[MODS NOTE: Join the e-consultation by sending an email to:
stop-tb-subscribe@yahoogroups.com . The guiding question (Theme 1) of the
time-limited online consultation on childhood tuberculosis (TB) in lead up to
the World TB Day is: "What can be done more (or less of) at the family,
community or your country level to prevent new TB infections in children?"

Have your say before 25th February 2012:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-how-to-get-to.html .
Thanks]
**************************************************

Spotlight: Solving the puzzle: Diagnosing tuberculosis in children
Dr Muherman Harun, Indonesia
******************************

[Mods note: To join the e-consultation on childhood TB, send an email to:
stop-TB-subscribe@yahoogroups.com . The below CNS article is online at:
http://www.citizen-news.org/2012/02/solving-puzzle-diagnosing-tuberculosis.html
. Comments are most welcome. Thanks]
******************************

THE THEME OF THE FIRST WORLD TB DAY 1982 (NOW THIRTY YEARS AGO) REMAINS VALID:
DEFEAT TB! NOW AND FOREVER!

The Citizen News Service (CNS) is conducting an online consultation on childhood
tuberculosis (TB) in lead up to the 2012 World TB Day (To join the
e-consultation on childhood TB, send an email to:
stop-TB-subscribe@yahoogroups.com ). I will like to share our views on the
`essentials' of the diagnosis of TB in Children. The main means of diagnosing TB
in children is undoubtedly, chest X-ray.

1. Children sometimes may have adulthood TB (post primary TB). Diagnosis is
relatively simple.  Symptoms are like in adulthood TB: few weeks cough,
sub-febrile, night sweat, chest pain and sometimes hemoptoe. Every doctor
treating TB can easily recognize TB features on chest X-ray: infiltrates or
patches usually in upper lung fields, sometimes with cavitation. If cavitation
is present, sputum should easily reveal Acid fast bacilli (AFB). This child can
expectorate! Treatment will instantly stop infection and cure the disease.
Without treatment, the child  will die within one or two years.

2. Child may have miliary TB. After witnessing the miliary shadows in the
lung(s) on chest X-ray, even once only, the doctor will remember this X-ray's
characteristic feature. Symptoms: weight loss, loss of energy and activity,
fever, cough.  Without treatment the child may die. Fortunately, this is a rare
development after BCG.

3. Child may have meningitis TB. Symptoms include, longstanding headache,
febrile and drowsiness. Very characteristic/diagnostic signs are neck or back
stiffness. Without treatment the child may die or suffer from sequellae, like
hydrocephalus, blindness, deafness or other neurological defects. This is also
fortunately, a rare development after BCG. Chest X ray may be normal, or miliary
TB may be present.

4. Child may have primary TB. Chest X-ray may show enlarged hilar lymph glands.
The primary TB shows no symptoms. Unfortunately, increased bronchovascular
markings are often overdiagnosed as enlarged hilar lymph glands. Despite
outrageous misjudgment of a number of primary TB cases by our colleagues, we
should also realize that there are how many millions of primary cases that go
unnoticed and get spontaneously cured …..

If occasionally, primary TB is developing progressively, then the disease may
develop into miliary TB or meningitis TB. Fortunately, such developments become
rare after successful BCG vaccination.

In some cases, if body resistance is low, the primary disease will develop into
post primary TB. This condition however, can not be prevented by BCG. But in
this case the diagnosis should be relatively simple. After treatment, sputum AFB
becomes negative and the disease causes no further infection.

WHO ARE THE MAIN KILLERS OF CHILDREN WITH TB?
-----------------------------
The main killers are: miliary TB and/or meningitis TB. They are the rapid
awesome killers. Unabated, they may kill within several weeks. Fortunately, BCG
gives effective protection.

The other is the mass killer: post primary TB, killing the children slow but
sure. Without treatment the child may die within a year or two. These killings
are not prevented by BCG.

IMPORTANT DIAGNOSTIC FACTORS
-----------------------------
- Sputum examination of AFB is most successful if lung/bronchial tissue is
affected or damaged as in post primary TB.  However, in miliary and meningitis
TB, the bacilli are spread through the bloodstream i.e. hematogenic spread,
hence bacilli are usually not detectable in sputum. In primary TB, bacilli are
spread through the lymphatic system (hilar lymph glands) and bloodstream.
Therefore, AFB are usually absent in the sputum. This explains the difficulty to
detect AFB in sputum. We never carried out the gastric lavage for AFB. Such
procedure is too drastic and traumatic for too little yield or impact, if any.

- The tuberculin test in under-fives is particularly useful in the diagnosis of
TB (if BCG was not given) However, the higher the age of the patient, the lesser
diagnostic value the tuberculin test will have. About the usefulness of the
tuberculin test after BCG, there's an old saying which still stands true: "After
BCG, the tuberculin reaction goes, as the wind blows!", in other words, the
tuberculin test is no more a reliable diagnostic tool after BCG vaccination.
There is up till now, no serological or PCR tests for the diagnosis of TB.

- The presence of a house-hold contact who is expectorating TB bacilli, is an
important factor, supporting the diagnosis of TB in children.

- Lymphatic glands caused by TB can usually be seen in the neck. These enlarged
glands may not be painful, and are presented in clusters. If there is
discoloration (livid) and fluctuation or abscesses appear, TB diagnosis becomes
clear and treatment can be given right away. The presence of TB glands in the
neck   becomes very helpful in the diagnosis of pulmonary TB. After only a few
weeks of anti-TB treatment, the swollen lymph glands will soon reduce in size.
This also supports the diagnosis of TB of the lung.

(But there also are lymph glands in the neck of viral origin. If thoroughly
examined, there will be so many small children with enlarged lymph glands in the
neck, which are not TB. These glands are usually not directly visible and will
come and go with the (febrile) condition of the child. This condition does not
need further examination nor treatment. As the child becomes older, the enlarged
glands will disappear spontaneously).

Finally, "How to get to zero new TB infections in children by 2015?" I'd like to
answer this STOP-TB question by emphasizing and reiterating the main and grand
principle: "Focus on the main reservoir, sources of TB bacilli. They are the
ones that cough, spreading the AFB into the air". Find, treat and cure them, no
more and no less. Contact (centrifugal or centripetal) examination could be
carried out on a limited and selective scale.

The important risk factors i.e. "malnutrition, poverty, environmental pollution,
poor housing, overcrowding, indoor air pollution, passive smoking, etc" may not
have an important role to play in an effective TB control program. This was
spectacularly shown from the historic WHO/BMRC/MRCI experiment of Madras in the
fifties.

If we only can persistently treat and diligently cure all of our TB patients who
are infectious, eventually, there will be no more children getting infected!
Hence, chase without delay retrieve any absconders who and wherever they are, at
any cost! Provide patients the fullest treatment with the very best regimen
available, so that the disease be completely cured and forever.

The Theme of the First World TB Day 1982 (now thirty years ago) remains valid:
DEFEAT TB! NOW AND FOREVER!

Dr Muherman Harun
St.Carolus TB Program 1983
Jakarta, Indonesia

Online at:
http://www.citizen-news.org/2012/02/solving-puzzle-diagnosing-tuberculosis.html

Theme 1 Summary: Getting to zero TB infections in children by 2015
Citizen News Service (CNS)
****************************

[MODS NOTE: The summary report has been released today on 26 February 2012, and
is online at:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-summary-getting.html
. Thanks for the support and participation. Theme 2 announcement will go out
tomorrow on 27 February 2012. Looking forward, thanks]
****************************

The SUMMARY REPORT has been released on 26th February 2012 of Theme 1 online
consultation on childhood tuberculosis (TB) in lead up to the World TB Day on:
"Getting to zero new TB infections in children by 2015." The summary report can
be downloaded or read online at:
http://www.citizen-news.org/2012/02/theme-1-e-consultation-summary-getting.html

GUIDING QUESTION of THEME 1 was:
- What can be done more (or less of) at the family, community or your country
level to prevent new TB infections in children?

This e-consultation on childhood TB is being facilitated by the Citizen News
Service (CNS), a partner of the Stop TB Partnership, along with the following
organizations and networks that have endorsed this initiative and joined as
partners:
--------------------
International Union Against Tuberculosis and Lung Disease (The Union)
Irish Forum for Global Health (IFGH)
McGill TB Research Group
Treatment Action Group
International Council of Women living with HIV (ICW) Zimbabwe
Asian Harm Reduction Network (AHRN)
ACTION
TB Alert
International Treatment Preparedness Coalition-India (ITPC-India)
Global Health Strategies
PATH
Cambodian Health Committee (CHC)
L'Association de Lutte Contre la Pauvreté en abrégé (ALCP)
Positive Muslim Group, Myanmar
Life Foundation, Pakistan
The Good Neighbour Nigeria
University of Nairobi, Kenya
Medical Care Development Inputs (MCDI) Kenya
Kenya Consortium to Fight TB, Malaria and AIDS (KECOFATUMA)
Partnership for TB Care and Control, India
Karnataka Health Promotion Trust (KHPT)
National Coalition of PLHIV in India (NCPI+)
PCI India
MAMTA Health Institute for Mother and Child
SNEHA
Institut Pasteur de Madagascar
Institute for Plantation Agricultural And Rural Workers (IPARW)
Advocates for Health International
Rural Youth Advocate for Health and Development in Nigeria (RYAN)
Citizens for Healthy Lucknow (CHL) initiative
Saaksham Foundation
TEST Foundation
PREPARE Foundation
JBS Foundation
Abhinav Bharat Foundation (ABF)
Asha Parivar
Samadhan
National Alliance of People's Movements (NAPM)
PRAYAS Health Group
Indian Society Against Smoking (ISAS)
Citizen News Service (CNS)
----------------

Citizen News Service (CNS)
Email: stopTB@...

Theme II Announcement: Getting to zero TB deaths in children by 2015
Citizen News Service (CNS)
************************

[MODS NOTE: To join the e-consultation, send an email to:
stop-tb-subscribe@yahoogroups.com . The theme II online consultation is open and
GUIDING QUESTION is: "How to correctly diagnose and successfully treat TB in
children in your local settings?" Comments are welcome before 11th March 2012.
Thanks]
************************

Theme II Announcement is online at:
http://www.citizen-news.org/2012/02/theme-ii-e-consultation-getting-to-zero.html
------------------------
The theme II of the time-limited online consultation on childhood tuberculosis
(TB) in lead up to the World TB Day is: "Getting to zero TB deaths in children
by 2015." Have your say before 11th March 2012 - share with us - how to
correctly diagnose and treat TB in children and achieve 'zero TB deaths' in
children by 2015, in your local settings. Your perspectives, opinions and voices
are important for us and we do look forward to them.

GUIDING QUESTION
------------------------
How to correctly diagnose and successfully treat TB in children in your local
settings?

This e-consultation on childhood TB is being facilitated by the Citizen News
Service (CNS), a partner of the Stop TB Partnership, along with many other
organizations and networks that have endorsed this initiative and joined as a
partner (see the list below).

HOW CAN YOU HAVE YOUR SAY?
------------------------
- Join the new Stop-TB eForum by sending an email to:
stop-tb-subscribe@yahoogroups.com and have your say by sending your comments to
stop-tb@yahoogroups.com
- Be a partner of this online consultation - to be a partner organization, send
an email to: bobby@...
- Email us your comments, perspectives and experiences at:
stopTB@...
- Go online at CNS blog: www.citizen-news.org and publish your comments real
time!
- Skype us and we will record your statement (skype id: bobbyramakant ). To
schedule skype appointment, email: bobby@...
- Tweet us! use #tag: #childhoodTB
- Have your say on our CNS Facebook page!
- Call us and record your statement! (+91-98390-73355)

TIMELINE for THEME II
------------------------
Responses to theme II are welcome till 11th March 2012, after which a summary
report of Theme II, will be compiled and released to mark World TB Day.

REFERENCE DOCUMENTS:
------------------------
Call for Action for Childhood TB (launched in Stockholm in March 2011):
http://www.stoptb.org/getinvolved/ctb_cta.asp
Stop TB Strategy: http://www.who.int/entity/tb/strategy/en/
Global Plan to Stop TB: 2011-2015: http://stoptb.org/global/plan/
World TB Day website: http://stoptb.org/events/world_tb_day/2012/
Global Tuberculosis Control Report 2011:
http://www.who.int/tb/publications/global_report/en/
Whole Is Greater Than Sum Of Its Parts: CNS report 2011:
http://www.scribd.com/doc/70768912/Stop-TB-Online-Consultation-Summary-Report-Li\
lle-2011
Tuberculosis and children: Exposing the hidden epidemic - ACTION brief:
http://c1280352.r52.cf0.rackcdn.com/childrens_tb_0811v2.pdf
Theme 1 e-consultation summary report on preventing childhood TB (2012):
http://www.citizen-news.org/2012/02/theme-1-e-consultation-summary-getting.html

PARTNERS
------------------------
International Union Against Tuberculosis and Lung Disease (The Union)
Irish Forum for Global Health (IFGH)
McGill TB Research Group
Treatment Action Group
International Council of Women living with HIV (ICW) Zimbabwe
Asian Harm Reduction Network (AHRN)
ACTION
TB Alert
International Treatment Preparedness Coalition-India (ITPC-India)
Global Health Strategies
PATH
Cambodian Health Committee (CHC)
L'Association de Lutte Contre la Pauvreté en abrégé (ALCP)
Positive Muslim Group, Myanmar
Life Foundation, Pakistan
The Good Neighbour Nigeria
University of Nairobi, Kenya
Medical Care Development Inputs (MCDI) Kenya
Kenya Consortium to Fight TB, Malaria and AIDS (KECOFATUMA)
Partnership for TB Care and Control, India
Karnataka Health Promotion Trust (KHPT)
National Coalition of PLHIV in India (NCPI+)
PCI India
MAMTA Health Institute for Mother and Child
SNEHA
Institut Pasteur de Madagascar
Institute for Plantation Agricultural And Rural Workers (IPARW)
Advocates for Health International
Rural Youth Advocate for Health and Development in Nigeria (RYAN)
Citizens for Healthy Lucknow (CHL) initiative
Saaksham Foundation
TEST Foundation
PREPARE Foundation
JBS Foundation
Abhinav Bharat Foundation (ABF)
Asha Parivar
Samadhan
National Alliance of People's Movements (NAPM)
PRAYAS Health Group
Indian Society Against Smoking (ISAS)
Citizen News Service (CNS)

Looking forward to a meaningful dialogue,

Citizen News Service (CNS)
Email: stopTB@...