Yes! We can end TB.” This is the theme of this year’s World TB Day which will be celebrated by the Ministry of Health through the National Leprosy and Tuberculosis Control Programme (NLTCP) with support from international medical organisation Médecins Sans Frontières/Doctors Without Borders (MSF) on 27 March, in Makeni city. The event aims to highlighting the state of tuberculosis care in Sierra Leone in 2024, and to campaign for the use of new innovative tools for diagnosis and treatment as well as better access to quality treatment for all those affected with TB.
The celebration will kick off at 9 a.m. with a march from Lunsar Makeni Highway (Makeni dity clock tower) to the University of Makeni, followed by a town hall meeting. In attendance is expected to be various health and TB organizations, representatives from the Ministry of Health, donor agencies in the country, as well as former patients, community-based organizations and workers, and traditional and political authorities from Bombali district and Makeni city.
In 2022, the World Health Organization reported that more than half of the children and adolescents. with tuberculosis globally miss out on lifesaving TB prevention, diagnosis and care services and over 80 per cent of cases reported globally were in low and middle-income countries, 12 per cent of which were children aged 0 to 14 years. Diagnosing TB in children is particularly challenging, as it can be very difficult for young children to produce sputum (mucus expelled from the respiratory tract) – the traditional way of diagnosing the disease. To address the challenge, in 2021 the World Health Organization (WHO) issued updated guidelines for managing TB in children, including a new algorithms to guide clinicians when diagnosing the disease.
Since 2020, MSF has been collaborating with the NLTCP in the Makeni regional hospital and 12 Direct Observatory (DOT) sites located in primary health centers in Bombali district to provide TB care to patients. In 2022, MSF started the implementation of the newly recommended WHO treatment decision algorithms for paediatrics cases by training MOH staffs to use this tool, collecting stool samples when sputum is not possible and urine samples (TB LAM test) for diagnostic in children. living with HIV. Since the implementation of new diagnostic tools, the number of children under the age of 15 that were diagnosed in the district substantially increased from 75 in 2022 to 405 patients in 2023, with a total of 537 children under the age of 15 being treated for drug sensitive TB (DS-TB) since MSF started its support.
Many of those children were also found to have severe acute malnutrition at the start of their treatment. Undernutrition is one of the primary risk factors for tuberculosis contributing to an estimated 10,000 cases out of the 25,000 TB cases reported in Sierra Leone in 2022. Presently, MSF provides every child diagnosed with TB and simultaneously malnutrition in Bombali district with malnutrition treatment in the form of Ready to Use Therapeutic Food (RUTF) integrated as part of their treatment journey, directly at the DOT sites.
“We cannot treat children for TB without also treating their malnutrition,” says Dr Kennedy Uadiale, MSF medical coordinator. “Outpatient therapeutic feeding programmes should be incorporated into TB treatment across the country.”
In the light of the success of the TB programme in Bombali district, MSF calls on health and development partners across Sierra Leone to implement these new tools and methods to improve the diagnosis and treatment of children with TB. MSF also calls for additional funding for the NLTCP from the Sierra Leone authorities as well as health and development to allow TB diagnosis and treatment of children to be rapidly scaled up and rolled out countrywide.
MSF has been collaborating with the Ministry of Health through the Sierra Leone National Leprosy and Tuberculosis Control Programme (NLTCP) since 2020 to improve access to TB diagnosis and treatment in Bombali district. The project has a dual focus: to treat patients with drug-resistant TB using a decentralised, outpatient model of care, based at Makeni regional hospital; and to treat drug-sensitive TB, with a focus on children under 15 years, at 12 Directly Observed Therapy (DOT) sites located in primary healthcare facilities across the district. Since starting to treat child patients in 2021, 520 children have been enrolled for treatment for both drug-resistant and drug-sensitive TB.
