Rise in Paediatric Tuberculosis Cases in India

In recent years, India has witnessed rise in paediatric tuberculosis (TB) cases. The number of notified cases among children aged up to 14 years increased by 38 per cent from 2020 to 2024. This surge has raised alarms among health experts and policymakers. Key factors contributing to this rise include malnutrition, the impact of the Covid-19 pandemic, and an increase in drug-resistant TB.

Definition of Paediatric Tuberculosis

Paediatric tuberculosis refers to TB cases reported in children under the age of 14. According to the World Health Organization (WHO), this demographic accounts for a notable percentage of India’s overall TB burden, estimated at 10 to 12 per cent. The rising case numbers reflect both actual increases and potential underreporting issues.

Statistics and Trends

From 102,090 cases in 2020, the number rose to 141,182 in 2024. The India TB Report 2024 indicates that 5 to 7 per cent of all notified cases under the National TB Elimination Programme (NTEP) are children. This is lower than the expected 12 per cent, suggesting diagnostic challenges and underreporting.

Diagnostic Challenges

Diagnosing paediatric TB poses unique difficulties. Children often present with non-specific symptoms and may have extrapulmonary TB, affecting organs other than the lungs. Sputum sample collection is particularly challenging in children, leading to delays in diagnosis.

Factors Contributing to Increased Cases

Several factors contribute to the rise in paediatric TB cases. High rates of malnutrition weaken children’s immune systems. Additionally, the Covid-19 pandemic has exacerbated the situation. Steroid treatments during the pandemic may have reactivated latent TB infections in children.

Drug-Resistant Tuberculosis

The incidence of multidrug-resistant TB (MDR-TB) and extremely drug-resistant TB (XDR-TB) among children is a growing concern. These forms of TB require more complex and prolonged treatment regimens. The treatment duration can extend from 18 to 24 months or longer, often involving toxic and expensive second-line drugs.

Government Initiatives

The Government of India aims to eliminate TB by 2025, five years ahead of the Sustainable Development Goals (SDG) target of 2030. Initiatives include expanding BCG vaccination at birth and enhancing TB screening across all age groups. The government is also focusing on improving diagnostic capabilities and providing child-friendly treatment formulations.

Implementation Gaps

Despite the existence of guidelines for paediatric TB, gaps in implementation persist. Many healthcare professionals lack training in diagnosing and treating TB in children. Access to diagnostic facilities remains a challenge, particularly for private practitioners.

Future Directions

To address the rising incidence of paediatric TB, there is a need for enhanced training for healthcare workers. Increased awareness and access to appropriate diagnostic methods, such as gastric aspiration, are crucial.

Questions for UPSC:

1. Discuss the impact of malnutrition on the prevalence of tuberculosis in children.
2. Critically examine the role of the Covid-19 pandemic in the rise of drug-resistant tuberculosis.
3. What are the challenges in diagnosing tuberculosis in children? Explain with suitable examples.
4. Comment on the effectiveness of government initiatives aimed at eliminating tuberculosis in India by 2025.

Answer Hints:

1. Discuss the impact of malnutrition on the prevalence of tuberculosis in children.

1. Malnutrition weakens the immune system, making children more susceptible to infections, including TB.
2. In India, high rates of malnutrition correlate with increased TB cases among children.
3. Malnourished children are less able to fight off latent TB infections, leading to active disease.
4. Malnutrition can complicate TB treatment and recovery, prolonging illness duration.
5. Addressing malnutrition is essential for effective TB control and prevention strategies.

2. Critically examine the role of the Covid-19 pandemic in the rise of drug-resistant tuberculosis.

1. The pandemic disrupted healthcare services, leading to delays in TB diagnosis and treatment.
2. Increased use of steroids during Covid-19 may have reactivated latent TB infections in vulnerable children.
3. Reduced access to healthcare facilities hindered timely treatment, contributing to drug resistance.
4. Lockdowns and social distancing measures limited TB screening and preventive measures.
5. Overall, the pandemic exacerbated existing health issues, leading to a rise in drug-resistant TB cases.

3. What are the challenges in diagnosing tuberculosis in children? Explain with suitable examples.

1. Children often present with non-specific symptoms, complicating accurate diagnosis.
2. Sputum sample collection is difficult; alternative methods like gastric aspiration are underutilized.
3. Extrapulmonary TB is common in children, making it harder to identify the disease early.
4. Healthcare providers may lack training and awareness of pediatric TB diagnostic protocols.
5. Underreporting and diagnostic delays lead to increased morbidity and mortality in children.

4. Comment on the effectiveness of government initiatives aimed at eliminating tuberculosis in India by 2025.

1. The government has set an ambitious target to eliminate TB five years ahead of the SDG goal.
2. Initiatives like expanding BCG vaccination and enhancing TB screening are positive steps.
3. However, implementation gaps and lack of training for healthcare workers hinder effectiveness.
4. Access to diagnostic facilities remains a challenge, especially for private practitioners.
5. Continuous monitoring and adaptation of strategies are necessary to achieve the elimination goal.