According to the Global Tuberculosis Control 2016, WHO, Geneva, last 2016, Philippines is included in the 48 Tuberculosis High Burden Countries, listed under Multiple Drug Resistant TB (normal TB drugs don’t work anymore), ranking 7th in total incidence last 2015 (tbfacts.org). It remains to be among the top 10 causes of death as well in the country.
The government together with WHO West Pacific Asia responded with the program TB Direct Observation Treatment Short Course (TB DOTS) or the National Tuberculosis Control Program which provides the diagnosis and observed treatment plan and medication for a person with TB for 6 months. Updated guidelines are available at doh.gov. Meanwhile TB in children has been included in the program too. Since 2008 treatment was made available to children 15 years old and below.
The problem is making the diagnosis; guidelines are in use but children had been either under or over-diagnosed. “Proportion of children with TB among the notified TB cases ranged from 10% to 40%. This is most likely due to the over-diagnosis since there are no confirmatory test among smear negative TB cases” (Updated PhilPACT 2013-2016). “In 2010-2012, only 12% (87, 936) of the target population (750, 000) under age of 15 were provided with treatment or received preventive therapy.” Two causes were indicated, that compliance was low and implementation was weak in some areas. (Updated PhilPACT 2013-2016). WHO Global report 2015 mentions that among 97,578 new and relapse cases in our country, 12,191 are children. Ending PTB is under SDG health goal 3, as children are recognized as a vulnerable group in need of increased case finding (2009, International TB Meeting).
Being a Christian organization burdened to bring Christ and his compassion to far flung communities neglected (maybe not always intentionally) for various reasons, the number of children and their parents among the Dumagat tribe as well as the other locals with pulmonary tuberculosis alarmed our field nurses as they did their usual house visits. Efforts to collect sputum (phlegm) and bring them by bulk to the municipality are made. Constant health counseling is also carried out to advocate compliance or enrollment to the program. Unfortunately not every pediatric patient had availed free or failed to avail medications for various reasons from the said program, at least as far as we were informed. However, we are aware that NTP is to extend to the pediatric population (NTP 2008), -this became MAP’s leap of faith in Brgy. Umiray. A church in Manila happily responded to the needs of these children in Sitio Singawan and other sitios in Brgy. Umiray and lo, the PTB treatment program for Children begun January 2015. This is a very significant movement made possible by God, because this creates numerous opportunities of not only bringing the good news of salvation but many chances if allowed to do follow-ups and intentional Bible studying.
The most recent PTB screening period was held last March where we gathered all the children with risk factors/symptoms pointing that they may have the disease. 44 got screened (based on recommended guidelines), and 20 of them were found with inactive/active disease and are now receiving treatment. Monthly follow-ups will be carried out. Currently and up to date, DOH regulating and pulling out TB medications from the private sector has been launched.In the near future, we will continue to reinforce and help the LGU in case finding and implementation of NTP among children.
Other Sources: WHO International TB Publications 2016 and Western Pacific, WHO Philippines, tbfacts.org, Manual of Procedures of the National Tuberculosis Control Program DOH, 2014
by Dr. Precious B. Melad, Circulating MD
Dumagat, Ilocano, Tagalog Ministry, Brgy. Umiray, Dingalan Aurora November-March 2017