Pediatric tuberculosis in India: Justice and human rights

Abstract

Tuberculosis (TB) is the deadliest infectious disease across the world, with the greatest burden occurring in India. Pregnant women and children are especially vulnerable to adverse effects from infection, and they tend to have diminished ability to protect themselves. Malnutrition, HIV, and other causes of immune suppression such as exposure to air pollution make one more prone to serious illness or death from TB infection. Risk factors are influenced by maternal education, access to health care, poverty, nutrition, healthcare stigma, and sanitation, among others. Current literature is heavily clinical, lacking focus on upstream factors, with a skew toward secondary and tertiary prevention strategies (i.e., case finding and treatment), and less emphasis on primary prevention (e.g., wealth equity and environmental regulation). Given concerns with extremely drug resistant TB and because infectious diseases can permeate National borders, public health nurses, and other healthcare professionals must educate themselves and advocate on behalf of vulnerable populations such as children in India. Improved sanitation, air quality monitoring, women's education, and increased access to health care are cost‐effective and evidence‐based strategies to address pediatric TB in India, a challenge which is grounded in human rights and justice.

Tuberculosis epidemic in India – a systematic review

“…The vast geographic area and biological diversity of India have resulted in a number of epidemics that have harmed public health and caused catastrophic costs, such as TB, which accounts for a sizable portion of TB cases worldwide. 11,34,45 Similar to this, the Seasonal Waves of Respiratory Disorders study discovered strong correlations between seasonal variation and a high prevalence of TB, with symptoms worsening slightly in the summer and exacerbating in the autumn as a result of climatic variations in various parts of India. 46 Similarly, research has revealed that atmospheric temperature is an important factor and has a significant association with the progression of TB during the summer and monsoon seasons (Fig.…”

“…30,57 When a pregnant TB patient cannot adequately protect, medications like isoniazid prophylaxis (3-6 months) or the Bacillus Calmette-Guerin (BCG) vaccine are administered to protect the neonates or newborns. 11,57,58 Factors mentioned in Fig. 3 are the primary causes of an increase in risk factors among children and pregnant women, all of which contribute to the spread of TB.…”

“…3 are the primary causes of an increase in risk factors among children and pregnant women, all of which contribute to the spread of TB. 11,57,58 In addition to gender differences in TB prevalence, mortality rates increased dramatically with age, being 17 times higher in children under 15 years and more than twice as common in adults 60 and older than in those between the ages of 15 and 59. 1,3,4,[10][11][12]20,28,38,41,43,46,59 Furthermore, the COVID-19 reaction-induced lockdown has resulted in poverty and economic hardship, worsening food shortages and making it more difficult to provide various TB services such as prevention, surveillance, and treatment to the vulnerable segment.…”

“…11,57,58 In addition to gender differences in TB prevalence, mortality rates increased dramatically with age, being 17 times higher in children under 15 years and more than twice as common in adults 60 and older than in those between the ages of 15 and 59. 1,3,4,[10][11][12]20,28,38,41,43,46,59 Furthermore, the COVID-19 reaction-induced lockdown has resulted in poverty and economic hardship, worsening food shortages and making it more difficult to provide various TB services such as prevention, surveillance, and treatment to the vulnerable segment. 13,22,31,44,60 Children with TB had significant implications or problems during the COVID epidemic, such as requiring more mechanical breathing, being hospitalized for longer periods of time, and having poorer outcomes.…”

“…7,9,10 In the same vein TB is commonly prevalent in 0-9-year-old children in India, consisting 0.11 million pediatric cases especially among those who have immunological weaknesses. [11][12][13][14][15] The COVID-19 pandemic, on the other hand, has occasionally hampered the access to essential healthcare services, resulting in an increase in the incidence of various community-borne diseases, mortality, and morbidity. 1,2 Fig.…”