Embracing the tuberculosis community awareness, screening and treatment

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OPINION

By Gertrude Abbo

Every 24^th day of March, Uganda joins the rest of the world to celebrate World TB Day. Under this year’s theme; “Yes! We Can End TB: Commit, Invest, deliver”, Investment in community awareness about TB is crucial in ensuring we end TB by 2030. 

During the months of March and September every year, the Ministry of Health, Local Governments, and Partners steer the implementation of CAST+ (Community Awareness, Screening, and Treatment) as a mechanism to raise awareness, find cases, and strengthen the health system for community level health interventions. In Uganda, 16 of every 100 cases of TB are children aged below 14 years.

Additionally, the 2024TB CAST campaign identified a rise in TB patients among school aged children with the west Nile region and parts of the north central region being the most affected. Out of 7 schools reached in the west Nile region, a total of 27 pupils were identified to have TB, while in the north central region, 1 pupil had multi-drug resistant TB, and many other schools reported more than 5 pupils with TB.

Finding TB in children often signals that there is an infectious adult nearby who may still be undiagnosed and spreading the disease. This therefore calls for early identification through raising awareness and screening at a community level to curb the spread of this deadly infectious disease.

The TB CAST campaign goes a long way in ensuring every child is reached through its integrated approach of extending health services holistically to the community including schools and other institutions.

Uganda launched the TB CAST campaign in 2022 intending to enhance early detection, raise awareness, and encourage proactive health-seeking behaviours among young learners and their communities. To date, the programme has implemented 5 rounds of the CAST TB campaign during the months of March and September with promising results.

This bi-annual approach has enhanced the early identification of persons ill with TB and raised awareness of the disease among young learners. With the next campaign happening in March 2025 this year, joint collaboration among health officials, educators, parents, and students is called for.

Stakeholder engagement and participation during the upcoming school activities including extending the awareness and screening to additional schools will go a long way in curbing the spread of TB in schools and therefore breaking the chain of transmission. Awareness activities in schools may include school activities such as debates, edutainment, and talks about the risk factors and signs and symptoms of TB. By embracing this initiative, we can create a healthier learning environment and take a significant step towards eliminating TB among children in Uganda.

Tuberculosis (TB) remains a highly infectious yet curable and preventable disease that mostly affects the lungs. According to the US Centers for Disease Control (CDC), the most common signs and symptoms of TB are a severe cough that lasts more than 3 weeks, spitting of blood, and chest pain.  It is also a disease in adults, but people of any age may have it. Thus children, especially those between 1 and 4 years of age, are not protected. Dr Matshidiso Moeti, the World Health Organization Regional Director for Africa, reports that ‘Any child living in a setting where there are people with infectious TB can become ill with TB, even if they are vaccinated.’

Why Focus on School-Aged Children? Schools are one of the major TB prone areas due to the nature of the setting. School-aged children easily mix and share many items such as cups, plates and bedding. Congestion is a pre-disposing risk factor for TB in schools, therefore facilitating transmission from one person to another.

By targeting school-aged children, the TB CAST campaign seeks to; Improve TB awareness among students and teachers, facilitate early detection through routine screening programs in schools, reduce stigma and misinformation surrounding TB and encourage families to seek timely medical intervention for suspected TB cases.

Childhood TB in Uganda presents unique challenges, including underreporting, diagnostic difficulties, and high mortality rates (death rates) among hospitalized children. Addressing these issues requires a multifaceted approach, encompassing improved diagnostic capabilities, robust contact investigation, preventive therapy, and targeted public health interventions. All these approaches are embedded within Uganda's Community Awareness, Screening, Testing, Prevention, and Treatment (CAST) TB campaign launched by the Ministry of Health under the National TB and Leprosy program.

The TB CAST campaign is built on three fundamental pillars: that is; Community awareness, screening and early detection and treatment and support. Through awareness, health workers and educators engage students through interactive sessions, posters, and drama performances highlighting TB symptoms, prevention, and treatment.

The regular screening and early detection pillar helps identify children showing TB symptoms and facilitates early intervention in the schools while the treatment and support pillar helps identified cases receive appropriate treatment and support to ensure complete recovery while minimizing transmission.

Teachers and parents play a vital role in ensuring the campaign’s success. Schools are encouraged to integrate TB education into the health curriculum, establish peer-led TB awareness clubs, and foster a stigma-free environment where affected students receive the necessary support. Health authorities also urge parents to remain vigilant and seek medical help if their child exhibits prolonged cough, night sweats, weight loss, or fatigue.

The integration of CAST TB activities in schools is crucial, considering that children are a vulnerable group to TB infection. By incorporating TB awareness, screening, and prevention strategies within the educational system, Uganda will reduce the burden of TB among school-aged children and foster a healthier future generation thus facilitating meeting the 2030 goal of ending TB. The writer is a field epidemiology fellow at the Uganda Public Health Fellowship Program and hosted at the National Tuberculosis and Leprosy Division, Ministry of Health.

The writer is a field epidemiology fellow at the Uganda Public Health Fellowship Program and hosted at the National Tuberculosis and Leprosy Division, Ministry of Health