Why the Convention on the Rights of the Child must become a guiding framework for the realization of the rights of children affected by tuberculosis

Abstract

BackgroundUntil recently, paediatric tuberculosis (TB) has been relatively neglected by the broader TB and the maternal and child health communities. Human rights-based approaches to children affected by TB could be powerful; however, awareness and application of such strategies is not widespread.DiscussionWe summarize the current challenges faced by children affected by TB, including: consideration of their family context; the limitations of preventive, diagnostic and treatment options; paucity of paediatric-specific research; failure in implementation of interventions; and stigma. We examine the articles of the Convention on the Rights of the Child (CRC) and relate them to childhood TB. Specifically, we focus on the five core principles of the CRC: children’s inherent right to life and States’ duties towards their survival and development; children’s right to enjoyment of the highest attainable standard of health; non-discrimination; best interests of the child; and respect for the views of the child. We highlight where children’s rights are violated and how a human rights-based approach should be used as a tool to help children affected by TB, particularly in light of the Sustainable Development Goals and their focus on universality and leaving no one behind.SummaryThe article aims to bridge the gap between those providing paediatric TB clinical care and conducting research, and those working in the fields of human rights policy and advocacy to promote a human rights-based approach for children affected by TB based upon the Convention on the Rights of the Child.

Tuberculosis susceptibility and protection in children

“…Appropriately chosen preventive therapy regimes in paediatric contacts of patients with MDR-TB appears to be effective 136. However, contact tracing and preventive therapy are not widely implemented in high tuberculosis-burden countries (Figure 4B) and this is an example of the need for health system strengthening alongside advocacy and human rights approaches to implement such strategies with already proven success 5,137…”

“…To make progress in protecting children against tuberculosis, parallel and multidisciplinary approaches are needed. Poverty remains the most significant risk factor (Figure 4) and therefore universal health coverage, social protection and justice, and poverty alleviation are all part of the solution 5,65,67,158. Furthermore, there are already existing and efficacious interventions: contact tracing, preventive therapy for children under the age of 5; prevention, diagnosis and treatment of paediatric HIV; infection control precautions; and training of front line health workers to improve diagnosis 5.…”

“…Poverty remains the most significant risk factor (Figure 4) and therefore universal health coverage, social protection and justice, and poverty alleviation are all part of the solution 5,65,67,158. Furthermore, there are already existing and efficacious interventions: contact tracing, preventive therapy for children under the age of 5; prevention, diagnosis and treatment of paediatric HIV; infection control precautions; and training of front line health workers to improve diagnosis 5. Alongside implementing what we already know works, the research agenda needs to focus on unravelling the biology behind the glimmers of insight into innate, adaptive and trained immunity, both in susceptible and protected populations, to enable more rational vaccine development and make progress towards zero childhood tuberculosis deaths (Box 1).…”

“…Children and young people represent clinically important populations both with increased susceptibility to tuberculosis, but also key groups in whom to study mechanisms of protection. The precise definition of paediatric tuberculosis is debated: the World Health Organization (WHO) reports tuberculosis data for those less than 15 years old, the UN Convention on the Rights of the Child defines a child as someone less than 18 years old, and adolescence is increasingly considered to be until the age of 24 2,5,6. Here, we broadly refer to those under the age of 18 years old, whilst acknowledging that the burden of adolescent disease is therefore underestimated.…”

Quality matters: Redefining child TB care with an emphasis on quality

“…Many TB programs do not adequately address and prioritize children due to the misconception that children do not significantly contribute to TB transmission as a result of their paucibacillary disease and limited ability to aerosolize and spread bacilli [14], [15], [16]. These erroneous beliefs have long undermined the right to health in this population, driven underestimation of the TB burden in these age groups [2], and repeatedly demonstrated to be false as older children and adolescents can present with adult forms of cavitated pulmonary disease, especially in high burden HIV settings [17,18]. Today, quality in pediatric TB care not only requires scale-up of TB services to reach all children in need but also restructuring of the traditional model to incorporate child-friendly comprehensive TB care delivery in an accessible, timely, safe, effective, efficient and equitable manner [19].…”