•Mrs Kulu Jafaru with her TB positive child
By Abujah Racheal
The critical stages of development in infancy and childhood require an optimal intake of nutrients for healthy growth.
Children with tuberculosis (TB) need extra energy and nutrients because of the increased demand from both growth and the illness.
Nutritionists say childhood TB remains a pressing public health concern in Nigeria, where its prevalence is exacerbated by conditions such as malnutrition.
The intersection of these two diseases amplifies the complexity of addressing TB in young children.
During the critical periods of infancy and childhood, optimal nutrient intake is essential for sustaining rapid growth and development.
However, malnutrition not only compromises this growth trajectory but also significantly increases the vulnerability of children to TB infection.
Mrs Kulu Jafaru, 37 years old, and resident of Gwagwalada, a suburb of the Federal Capital Territory (FCT), witnessed her three year-old daughter struggle to breathe.
“My daughter’s small frame was consumed by relentless coughing fits, leading to a diagnosis of tuberculosis after months of futile attempts and hospital visits,” she narrated.
Jafaru expressed astonishment when doctors at the Kwali General Hospital revealed her daughter’s malnourished state.
She recounted the challenges she faced as a widow, struggling to provide a balanced diet for her daughter due to limited access to fresh produce, resulting in a diet predominantly comprising starchy foods and sugary drinks.
The deficiency in nutrition compromised her daughter’s immune system, heightening susceptibility to ailments like tuberculosis, as explained by the doctors.
She said as her daughter commenced TB treatment, health workers at the Kwali General Hospital educated her on the significance of a balanced diet.
She said that they guided her in incorporating protein, vitamins, and minerals into her daughter’s meals, along with information on accessing affordable, nutritious foods within their community.
As her daughter’s health gradually improved, she observed a positive transformation in her overall well-being, with reduced coughing fits and increased vitality for play.
Initially, she said, “the medication provided showed limited effectiveness, but with the combination of appropriate medical care and a nutritious diet, her daughter is now on the path to recovery.”
Mrs Angela Ameh, 47 years old, a resident of Ushafa community in Bwari Area Council, FCT, said in addition to battling severe malnutrition, her daughter was diagnosed with spinal and intra-thoracic lymph node TB.
This is an extremely rare and dangerous variant of the disease. It commonly affects children.
Ameh said her daughter completed treatment for extensively drug-resistant TB, signifying her recovery from an extended period of immobility.
“My daughter’s health has notably improved, and she is now pain-free. Watching her take her first steps in three years brought me immense happiness as a mother.
“It’s difficult to convey the hardships we endured and the overwhelming emotions I experienced witnessing my daughter walk again.
“Today, she not only walks but also engages in running and playing with other children. Her medical team assures us that she will continue to thrive and develop normally,” she narrated.
The intersection of malnutrition and childhood tuberculosis in Nigeria reflects a stark reality endured by many families.
According to data obtained from the National Childhood TB Steering Committee (NCTSC), there are improvements in overall TB notification with the country having its highest TB notification of 285,561 in 2022.
However, childhood TB there remains a critical gap in Nigeria’s TB programme.
In 2022, there was an estimated 58,000 childhood TB cases in Nigeria. However, the country notified only 20,411 representing 35 per cent of the estimated childhood TB cases for the same year.
Similarly, the proportion of notified childhood TB cases among overall TB notification was seven per cent in 2022 which experts say is a far cry from the WHO recommended benchmark of 12 per cent.
This suggests significant under-diagnosis and possibly under-reporting of childhood TB in the country.
Recently the United States Agency for International Development ranked Nigeria as the second-highest nation with malnutrition globally.
Ms Anne Patterson, USAID Mission Director, said this during a Trade Fair in Abuja, citing a Food Consumption and Micronutrients Survey.
She said the survey showed a rise in severe acute malnutrition among Nigerian children from seven per cent to twelve per cent over five years.
She called for actions to reverse the trend, with only 2.8 per cent of affected children receiving ready-to-use therapeutic foods.
According to the 2023 Global Report on Food Crises (GRFC) indicates a growing number of individuals facing severe food insecurity, requiring immediate assistance.
This trend is evident in the country, where soaring living costs have pushed millions into acute hunger.
Daily, Nigerians grapple with food scarcity amidst various challenges like insecurity, malnutrition, and infections.
Nigeria, previously listed in the top 10 crisis-affected countries in the 2022 GRFC Report, now sees its citizens struggling to maintain a balanced diet.
Reports from Good Health Weekly reveal that families prioritise energy giving food over nutritional needs.
Doctors Without Borders (MSF) says it welcomes the World Health Organisation’s (WHO) ‘Roadmap towards ending TB in Children and Adolescents’ released on Nov. 14.
MSF urged all countries with high TB burdens to prioritise adoption, implementation, and scale-up of the WHO’s consolidated guidelines on the management of tuberculosis.
According to Dr Shehu Labaran, Director and National Coordinator, National TB and Leprosy Control Programme (NTBLCP), malnutrition exerts a multifaceted impact on tuberculosis prevention, treatment, and the management of these dual burdens.
Labaran said that malnutrition weakens the immune system, rendering individuals more susceptible to TB infection.
“In children, inadequate nutrient intake hampers the development of a robust immune response, making them particularly vulnerable to TB transmission.
“Furthermore, malnutrition complicates TB treatment outcomes. Children with TB require increased energy and nutrients to support both their growth and combat the disease.
“However, malnourished children often struggle to meet these heightened nutritional demands due to decreased appetite and limited stomach capacity,” he said.
Similarly, Prof. Umar Lawal, a professor of paediatric infectious disease and Chairman, NCTSC, said managing the dual burdens of malnutrition and TB presents unique challenges.
Lawal, said that health facilities in resource-constrained countries such as Nigeria often face difficulties in effectively diagnosing and treating both conditions simultaneously.
He said that limited access to nutritious food, diagnostic tools, and specialized healthcare services further exacerbate the complexities of managing malnutrition and TB in tandem.
He noted that addressing these challenges requires a comprehensive approach that integrates nutrition-sensitive TB care into existing healthcare systems.
“This entails implementing strategies to improve nutritional support for TB patients, enhancing access to diagnostic and treatment services, and strengthening collaboration between nutrition and TB programmes.
“Only through concerted efforts can we effectively mitigate the impact of malnutrition on TB prevention, treatment, and management, particularly among vulnerable populations in countries like ours,” he said.
Dr Anyaike Chukwuma, Director, Public Health, Federal Ministry of Health and Social Welfare, re-echoed the urgent need for collaboration among stakeholders to address the alarming gap in the detection and treatment of TB.
“Despite recording the highest TB notification in 2022, childhood TB cases remain significantly under-diagnosed and under-reported, contributing to the nation’s high under-5 mortality rate.
“To tackle this issue, the ministry established the NCTSC to give advice on effective control strategies,” he said.
Chukwuma stressed the importance of sustained commitment and collaboration for timely detection and treatment, highlighting efforts from government agencies, healthcare providers, NGOs, and the private sector.
“These efforts include integrating TB care with Reproductive, Maternal, Newborn, Child, Adolescent Health, and Nutrition (RMNCAH+N) services and implementing innovative, people-centered approaches,” he said.
He underscored the significance of finding missing children with TB through integrated services aligned with national health sector priorities.
Stakeholders say by integrating TB care with broader health services, implementing innovative approaches, and prioritising early detection and treatment, Nigeria can make significant strides in reducing the burden of childhood TB and malnutrition.
Investing more in the health and well-being of Nigeria’s children is not only a moral imperative but also a critical step towards achieving broader health, education, and economic development goals for the nation. (NANFeatures)
