Pediatric tuberculosis in Punjab

Pakistan ranks 5th globally in TB, a disease that is 100% preventable and curable. Pediatric TB con­trol is facing challenges, worldwide an estimated 1 million children become ill with TB, and about 600 children die each day. World Health Organi­zation (WHO) estimates “as many as 1 in 10 TB cases globally are children, but the number could be even higher because many children are simply under-diagnosed”. The emergence of pediatric TB as a significant concern demands immediate at­tention and comprehensive strategies. This arti­cle probes into the alarming situation of pediatric TB in Punjab and proposes potential solutions to tackle this growing public health challenge.


Pakistan’s fight against tuberculosis is not new, but the revelation of pediatric TB’s increasing in­cidence presents a new dimension. Children rep­resent a substantial 10-15% of total TB cases in the country, an estimated 57,000 children, (rang­ing from 51,000 to 63,000), with around 27,232 cases in Punjab. Even more distressing is the fact that children below 5 years of age are particular­ly vulnerable, constituting 8-20% of TB-related deaths. The battle against pediatric TB demands a collective effort from all stakeholders. The gov­ernment’s commitment to healthcare, coupled with community support, can bridge gaps and save countless young lives.


The reasons behind the surge in pediatric TB cases are multi-layered. Missed diagnosis, de­layed treatment, and underreporting are signifi­cant challenges. Primary healthcare providers often overlook TB due to its non-specific symp­toms, leading to missed diagnoses and contrib­uting to the disease’s spread. Additionally, the conventional diagnostic tools in the private sec­tor (which makes up to 60% of services) prove inadequate for accurately identifying TB in chil­dren, further exacerbating the situation in the community. Poverty, overcrowding, and malnu­trition are also contributing risk factors. Children from marginalized communities in rural areas are at higher risk due to limited access to quality healthcare and nutritious food. This vicious cycle perpetuates the vulnerability of children to TB.


Addressing the pediatric TB crisis necessitates a multi-pronged approach involving the govern­ment, healthcare providers, and communities. Here are some potential solutions:

1. Enhancing Healthcare Provider Capac­ity: Training and orientation sessions for health­care providers at both private and government facilities are crucial. Empowering them with knowledge about early diagnosis and treatment of childhood TB can significantly improve case identification.

2. Strengthening Diagnostic Algorithms: Collaborative efforts between the National TB Program (NTP) and organizations like the Paki­stan Pediatric Association (PPA) have resulted in diagnostic algorithms. Expanding the use of these tools, such as the PPA scoring chart, can aid in more accurate diagnoses.

3. Public Awareness Campaigns: Launch­ing Childhood TB-specific, comprehensive pub­lic awareness campaigns can educate parents, caregivers, and communities about the signs and symptoms of pediatric TB. This will encour­age early reporting and diagnosis.

4. Integration of Technology: Leveraging technology for TB diagnosis and monitoring can streamline healthcare processes. Digital plat­forms could be used to track patients’ treatment adherence and provide timely support.

5. Inclusion of the Private Sector: The pri­vate healthcare sector should be actively engaged in reporting and accountability efforts. Collaboration between the public and private sectors can amplify the impact of pediatric TB control initiatives.

6. Tuberculosis Preventive Therapy (TPT): Maximizing TPT usage in children under 5 years, in close contact with bacteriologically-positive TB patients, can substantially reduce the risk of infection.

7. Intensified Case Finding (ICF): Imple­menting ICF strategies to identify missing child­hood TB cases within the healthcare system is crucial. Early detection and treatment can pre­vent further transmission.

The journey towards eradicating pediatric TB is daunting, but it is also an opportunity to ensure a healthier future for Punjab’s children. By com­bining knowledge, innovation, and compassion, the province can move from the shadows of this silent threat into the light of better healthcare for its youngest generation. Parents’ trust in TB healthcare services and their psychosocial and economic support from the government will contribute remarkably towards the success of pediatric TB control efforts. As the saying goes, “A society’s greatness is measured by how it treats its weakest members.” It’s time to translate this sentiment into action and protect our children.

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