[This entry is co-authored by doctors Elisa López Varela and Alberto García-Basteiro, ISGlobal researchers at the Manhiça International Health Research Centre (Mozambique)]
Shakira is malnourished, has tuberculosis (TB), and is infected with the human immunodeficiency virus (HIV). Today we are starting her treatment, which is expected to last half a year. She will take four pills a day for the next six months, in addition to three other pills to prevent the HIV from crippling her immune system. For an 18-month-old, managing to swallow all these pills is no small feat. Shakira’s grandmother also faces a daunting task: walking to the health centre every week to collect the girl’s medications. At age 70, the grandmother has found herself in the role of the family breadwinner, as her daughter and son-in-law, both stricken with TB and HIV, are too weak to work and depend on her for food, medication and care.
The situation facing Shakira’s family is not unusual in Mozambique, where TB affects more than 140,000 people, more than 60% of whom are also HIV-positive. TB is one of the oldest diseases known to humankind, but in countries like Mozambique it remains one of the deadliest and most widespread ailments. Paired with HIV, its effects are devastating. In fact, TB is the leading cause of death in patients with HIV.
Nelson Mandela once said: “We have known how to cure TB for more than 50 years. What we have lacked is the will and the resources to quickly diagnose people with TB and get them the treatment they need.” Mandela contracted TB in prison and went on to become a tireless activist in the struggle against the disease.
For many years, childhood TB has been a forgotten disease, overlooked as a priority by the countries where it is endemic. Meanwhile, around the world 200 children still die of TB each day, and half a million more contract the disease each year. Many of them never even begin treatment, in part because of the difficulty of diagnosing childhood TB. There is still no fast, reliable diagnostic test to identify TB in children. As a result, many children suffer for months from weight loss, fever and cough before finally succumbing to this curable disease. To make matters worse, TB is perversely associated with a decline in socioeconomic status. It prevents countless families from getting ahead by perpetuating a vicious cycle of disease and poverty. Superstition also plays a role. According to Shakira’s grandmother, some people believe that TB cannot affect children. When a child does contract the disease, it is viewed as a punishment for the family’s failure to properly perform purification rituals. Shakira’s grandmother does not share these beliefs, and fortunately her daughter is beginning to recover. The grandmother smiles when Shakira leaves the hospital because she knows that the girl is on the road to recovery. Like so many Mozambican grandmothers, she is a fighter. Having survived a civil war, she is now witnessing the devastation wrought by TB and HIV on the younger generations.
Eliminating childhood TB will take much more than education and prevention. Research must focus on new diagnostic tests and treatments adapted for infants and children. This will require money (just 30% of the funds needed for TB research and development for the period 2011-2015 are currently available). And it will also require a true political commitment—at both the national and international levels—to ending a disease that affects the poorest, most vulnerable and most forgotten people on the planet.