Experts call for early TB interventions after new data shows it causes stunting in children

Health experts have long known that suffering from tuberculosis during childhood has the potential to compromise and reduce the functionality of lungs later in life.  

Now, a child health investigation tracking risk factors for respiratory disease and other infections in young children at Drakenstein in the Western Cape has revealed new facts about paediatric TB.

The latest findings from the Drakenstein Child Health Study, a multiyear research project following about 1,000 mothers and their children from birth to adolescence, reveal that not only does TB shrink the size of growing lungs, but also stunts the growth of children. 

University of Cape Town (UCT) and Boston University researchers found that five-year-old or younger children who developed paediatric TB were more likely to wheeze, have poor lung function, and reduced height and weight for their age, even after accounting for pre-existing respiratory and growth conditions.  

The study is the first to show post-TB paediatric growth impairment and an association between TB and wheezing after the infection. 

Prof Heather Zar, chair of the department of paediatrics and child health at UCT and one of the authors, said the findings highlight the importance of strengthening preventive interventions against TB in children “to prevent long term impairment in health and the need to diagnose and treat disease early”. 

She said the study leverages a unique opportunity to observe the enrolled children.

“Given the large burden of childhood TB in low-and-middle-income countries, these results are crucial in delineating the burden and morbidity associated with TB illness, and in strengthening preventive interventions,” she said. 

The WHO estimated in 2018 that 27,000 children developed TB in South Africa. Childhood TB remains underreported though, with a case detection rate of 65%, leaving a third of affected children in the country undiagnosed or unreported. 

For the study Zar and international researchers from Boston University and the University of Western Australia followed a cohort of 1,068 children from birth to the age of nine.  

Lead author Leonardo Martinez, an assistant professor of epidemiology at Boston University, said the findings “suggest that prevention of TB in the first few years of life may have substantial long-term health benefits, in particular to lung health, through childhood”. 

The study, which appears in American Journal of Respiratory and Critical Care Medicine comes as the WHO calls for “increased investments and accelerated global action to end TB”. 

“Although there is an effective treatment for TB in children, there is concern that the impact may be long-lasting and there could be long-term morbidity even after treatment and recovery,” said Martinez. 

He said several developments were crucial to ensure children received adequate preventive care, including new vaccines, increased screening and access to treatments. 

“Most children in high-burden settings are not identified by health services before they progress to tuberculosis disease. They are found typically because they have presented with TB symptoms and need to be treated.” 

However, researchers noted a “huge momentum in the field to work together to find new scientific discoveries that are directly relevant to those at risk of TB or have the disease”.

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