One in every 20 children, who were diagnosed with tuberculosis (TB) at Mumbai’s private hospitals between September 2014 and April 2016, had drug-resistant forms of the infection, revealed data by Private Provider Interface Agency (PPIA), which operates under the supervision of the BMC. Under the PPIA initiative, 1,826 paediatric cases were reported by 116 doctors during the period.
PPIA was launched in August 2014, under the civic body’s Mumbai Mission for TB control, to increase the notifications of TB cases from private hospitals. Around 50% of the city’s population seeks first-hand medical help at private hospitals.
“Two years ago, we did not have diagnostic GeneXpert to analyse drug resistance in TB cases. But some doctors are using GeneXperts liberally, which has given us this data,” said a PPAI official.
GeneXpert is a molecular test, which diagnoses TB by detecting the presence of TB bacteria, as well as tests the bacterium DNA for drug resistance. While this is preliminary data, doctors said the number of children with drug-resistant TB could be higher after data from the government-run hospitals is also taken into account.
Dr Daksha Shah, BMC’s TB officer, told HT it will take time to release data on drug-resistant cases in children. However, an official from the state’s TB control office said 2,159 cases of children with TB were reported in Mumbai in 2015. But the BMC is yet to study how many of these were drug resistant, the officer said.
“Until two months ago, we did not separately capture the portion of paediatric drug-resistant TB in our routine reporting mechanism. Now that it has been instituted, we will have more data about drug-resistant infections in children,” the official added.
A study published in the scientific journal Lancet, last month, found that 2 million children across the world were infected with multidrug-resistant TB.
Dr Vikas Oswal, chest physician, Vikas Nursing Home in Govandi, said diagnosing TB in children is a huge challenge. “While adults can spit out their sputum for a confirmatory test, many children can’t. In most cases, confirming that if child has TB itself is a challenge, then how does one test for its drug-resistant forms,” he said.
Experts said they have to resort to invasive methods such as bronchoscopy, to collect sputum sample from children so that they can use advanced diagnostics techniques such as GeneXpert to check the drug-resistance patterns.
Another challenge in treating children with TB is no drug formulations are available that are specially manufactured for children, said doctors. “We either have to crush the drugs that are meant for adults or dissolve them in water. There is an urgent need of formulations meant specifically for children,” said Shah.