WHO roadmap to end TB in children focuses for 1st time on pregnant, post-partum women affected by disease

Maternal, pregnancy, birth & infant outcomes should be included in dedicated safety studies for all new TB drugs & vaccines: WHO

By Seema Prasad
Published: Wednesday 15 November 2023
Photo: iStock_

It is important to make periodic assessments to estimate the burden of maternal tuberculosis and develop targeted interventions, the World Health Organization said in its revised 2023 roadmap toward ending tuberculosis among children and adolescents.

The United Nations health agency highlighted that data on pregnant and post-partum women affected by the disease are not collected and reported as part of routine surveillance by national TB programmes.

Therefore, the burden and characteristics of TB in this vulnerable population and their infants remain largely unknown, the report highlighted.

WHO also stressed on the need to include maternal, pregnancy, birth and infant outcomes in dedicated safety studies for all new TB drugs (for both drug-sensitive and drug-resistant-TB) and vaccines before the completion of phase III trials. This, the global body said, will facilitate their inclusion in regulatory submissions.

“Rigorous operational research and collection of data in global registries will enable the systematic and rapid detection of uncommon adverse maternal, pregnancy and birth outcomes, including birth defects,” the report added.

In September 2023, at the second United Nations High-Level Meeting on the fight against TB, commitments were redefined with a 2027 timeline.

About 90 per cent of people living with TB should be diagnosed and treated by 2027, the authors of the report noted. “This translates to providing life-saving treatment for up to 45 million people between 2023 and 2027, including up to 4.5 million children and up to 1.5 million people with drug-resistant tuberculosis.”

The roadmap tells countries to provide 90 per cent of people at high risk of developing TB with access to preventive treatment by 2027. “This translates to providing preventive treatment to 30 million household contacts of people with TB, including children,” the report added.

Moreover, the roadmap is an update to the 2013 and 2018 goals outlined. The previous target to provide treatment to 3.5 million children and young adolescents was not achieved as only 71 per cent of the target was met.

When progress between 2018 and 2022 was evaluated, it was revealed that only 19 per cent of the target to provide treatment for 115,000 children and young adolescents with multidrug-resistant tuberculosis (MDR-TB) and rifampicin-resistant TB (RR-TB) was met.

This is equivalent to four in five children and young adolescents with MDR / RR-TB in the past five years not getting access to treatment.

Of the 1.3 million TB deaths in 2022, 214,000 TB deaths were of children 14 years old and below, according to the report. As much as 96 per cent of deaths occurred in children who did not access TB treatment, the findings showed.

“It is unacceptable that hundreds and thousands of children and adolescents worldwide still do not have access to life-saving TB prevention, treatment and care,” said Dr Tereza Kasaeva, Director of WHO’s Global TB Programme.

“The new Roadmap lays the groundwork for much-needed actions over the next five years, building on commitments made by world leaders at the 2023 UN High-Level Meeting on TB, to close gaps in access to care and safeguard the rights of children and adolescents,” Kasaeva added.

The roadmap included 10 key priorities that require work:

  • Increase funding for TB prevention and care, including for children and adolescents 
  • Foster (sub-)national leadership, multisectoral accountability and collaborative activities 
  • Implement social protection programs for children, adolescents, and families affected by TB
  • Sustain advocacy on TB in children and adolescents at all levels
  • Build and sustain local capacity to prevent and manage TB
  • Plan, implement and scale up interventions for TB prevention
  • Increase access to optimal TB care for children and adolescents
  • Strengthen implementation of integrated, people-, family- and community-centered strategies as part of PHC
  • Improve data collection, reporting, and use
  • Support TB R&D and innovation focused on children, adolescents, pregnant and postpartum women

The report highlighted progress on the targets set during the 2018 UN High-Level Meeting on TB for children and identified the several gaps.

Of the 3.5 million children who were supposed to be treated between 2018–2022, 2.5 million (71 per cent) were treated in 2018–2022, it noted. Of the MDR / RR-TB treatment intended to be delivered to 115,000 children in 2018–2022, only 21,600 (19 per cent) were treated in 2018–2022, it added. Of the four million household contacts aged less than five years between 2018–2022, 2.2 million (55 per cent) were treated in 2018–2022, the data showed.

Of the 10.6 million people with TB among all ages in 2022, 1.25 million children 14 years and below developed TB in 2022, and 47 per cent were below five years of age.

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