Amina*, a resident of Kwale County, was on a business trip in Wajir County when she got a call from her sister that her 10-year-old daughter had fallen ill. Her daughter was coughing, having night sweats, fever and had developed a protruding lymph node swelling on her neck discharging pus. She immediately sent money to her sister to have the girl treated in the nearest private health facility.
“At the private hospital, the doctor diagnosed her with pneumonia and recommended immediate surgery to remove the nodes on her neck. I panicked on hearing this as I had not anticipated the illness to be this serious. I halted the trip and immediately travelled back home,” Amina recalls.
On getting home, she realised that despite her daughter being on pneumonia medication, her situation was worsening by the day. The once playful girl spent most of her time sleeping. Her weight had also reduced drastically. Seeing this, Amina opted for a second opinion, but this time around, in the nearest public hospital, Voi County Referral Hospital.
To her surprise the swelling on her daughter’s neck did not require an operation instead upon examination and tests, she was diagnosed with TB adenitis, a form of pediatric TB that commonly presents itself as an asymmetrical, painless, non-tender lymph node enlargement in the neck area sometimes with or without discharge.
“After a thorough examination involving a chest x-ray and an excision of the swelling, the doctor confirmed to us that my daughter had TB. I was surprised to hear that but at the same time happy to learn that she did not require surgery to get cured,” Amina recounts.
Since the Voi County Referral Hospital was far from their home, they were referred to the nearest dispensary to begin a 6-month course of pediatric TB treatment regimen. This involved daily injections and oral medication under observed therapy by a health care worker.
“At the dispensary, the health officials were very receptive to us. They immediately put my daughter on medication and by the fifth day, the swelling had disappeared. She was also no longer coughing, nor having night sweats or fever and had regained her cheerfulness,” Amina shares.
A team of collaboration made up of the Centre for Health Solutions-Kenya, Tuberculosis Accelerated Response and Care II (TB ARC II) coast region officer, Mr Godano Mamo and the National TB Program Kwale County and Sub-county coordinators did a home follow-up for contact tracing. This involved screening everyone in the household and the neighbours who had close contact with the sick child. It was from this visit that Amina’s other child was found to have presumptive TB symptoms and referred to Voi County Referral hospital for TB testing.
“My happiness was short-lived by the confirmation in the hospital that my other child was ailing from TB but seeing the recovery progress my daughter was making gave me hopes that they would all get cured,” Amina says.
Her second child was also put on medication and just like her sister, she responded well to the medication. The children have now fully recovered and gone back to school.
“I am happy that my children have now fully recovered, and they have been able to go back to school. I am also grateful to the donors as I would not have afforded the treatment for both of them,” Amina says.
Paediatric TB diagnosis confirmation is difficult, however, the clinical diagnosis of TB in children is not as difficult using the approach provided by the World Health Organisation. This includes careful history assessment of TB contact; identification of symptoms suggestive of TB such as persistent cough, weight loss, fever and or night sweats, reduced playfulness, fatigue; and clinical examination which entails growth assessment, chest X-ray interpretation and sputum collection for smear microscopy.
Awareness by health care workers on the above makes identification of pediatric TB uncomplicated. Initial diagnosis of this TB is not only beneficial in preventing progression of the disease leading to death but also averts the spreading of the disease to others as was the case in Amina’s household.
TB ARC II with funding from USAID is working with the National TB Program by capacity building health care workers to conduct appropriate pediatric TB diagnosis and treatment. This is by conducting weekly free online extension for community healthcare outcomes (Project ECHO) an innovative telementoring program designed to create virtual communities of learners by bringing together healthcare providers and subject matter experts using video conference technology, brief lecture presentations, and case-based learning, fostering an all learn, all teach approach on pediatric TB, frequent continuous medical education on pediatric TB at the facility level, and through the development of paediatric TB algorithms, guidelines, job aids and information, education and communication materials targeted to health care workers.