Year : 2021 | Volume
: 13 | Issue : 1 | Page : 1--2
State of the globe: Addressing gender in adolescent tuberculosis
Sunil Kumar Raina
Department of Community Medicine, Dr. RPGMC, Kangra, Himachal Pradesh, India
Dr. Sunil Kumar Raina
Department of Community Medicine, Dr. RPGMC, Tanda, Kangra, Himachal Pradesh
|How to cite this article:|
Raina SK. State of the globe: Addressing gender in adolescent tuberculosis.J Global Infect Dis 2021;13:1-2
|How to cite this URL:|
Raina SK. State of the globe: Addressing gender in adolescent tuberculosis. J Global Infect Dis [serial online] 2021 [cited 2021 Apr 16 ];13:1-2
Available from: https://www.jgid.org/text.asp?2021/13/1/1/310326
May 2014, the World Health Assembly (WHA) resolved to support the new post-2015 Global TB Strategy and its ambitious targets to end the global TB epidemic, with targets to reduce TB deaths by 95% and to cut new cases by 90% between 2015 and 2035. The WHA also set out some interim targets for 2020. The resolution called for a focus on serving populations highly vulnerable to infection and poor health-care access. However, public health policies will need to develop a better understanding of as yet less talked about areas in mitigating the impact of tuberculosis.
One such area could be adolescent TB.
In a recent review by the experts affiliated to the International Union for Tuberculosis and Lung Diseases (The Union), concerns have been raised on the available evidence on clinical and public health perspectives on adolescent tuberculosis. The same report speaks on the lack of sufficient evidence and existence of gaps in knowledge on different aspects of adolescent TB.
Characterized by a substantial increase in the incidence of TB, adolescence, the age group with estimated numbers running into more than a billion worldwide is not only a substantially large but also an important TB-infected population group to deal with. As per the current reports, an estimated 1.8 million adolescents and young adults (10–24 years) worldwide develop TB each year. Apart from the impact of puberty on immunological changes and a broadening of social contacts exposing adolescents to TB, the fact that most of the world's adolescents live in low- and middle-income countries (LMIC) where TB remains common and adolescents make up for almost a quarter of the population are issues that need addressing. As the predominant focus in tuberculosis worldwide continues to evolve around children and adults, this population group has largely remained neglected in the public health policy initiatives. Once this population group grows out of TB vaccination programs planned for pediatric age groups in LMIC, the thrust gets lost. Added to this is the fact that diagnosing TB in adolescents can be more complicated than in adult, more so in the younger adolescents as also once diagnosed, making TB treatment available, accessible and acceptable to young people while ensuring a respectful attitude to them and appreciating their desire for autonomy with an adolescent-specific model of care may not be available across geographies. The health systems will also need to take note of mental health issues, substance abuse, sexual and reproductive health of the adolescents in view of follow-up issues with this group. With drug-resistant TB, a likely fallout of poor adherence, an adherence strategy needs to be a part of the intervention package in adolescent TB.
It is not that efforts have not been mounted to counter this problem. The UN General Assembly in a high-level meeting on TB in 2018 committed to provide care to at least 3.5 million children with TB and 115,000 children with MDR-TB by 2022. The 2020 WHO Global TB Report for the first time included data on MDR-TB in children under 15 years. But the efforts seem to be still insufficient to handle this concern. As per the 2020 WHO Global TB Report, 3400 and 5500 children with MDR-TB were started on second-line treatment in 2018 and 2019, respectively. Translating these numbers into proportions disappoints us as this means that globally, we have only reached 8% of the global target of 115,000 in the first 2 years since the UN high-level meeting on TB.
It is also important to realize that not being a priority group for public health action puts the initiatives on adolescent's tuberculosis in the side stream, a situation that is feared to be worsened by the onset of pandemics like the recent COVID-19 as these further threaten to reverse gains made toward achieving defined targets. COVID-19 is likely to severely impact MDR-TB case detection and care as lockdowns are likely to lead to delays in TB diagnosis and treatment in all age groups and adolescence is no exception to this. The societal disruption in wake of this pandemic leading to increased household exposure and transmission of TB as also a reduced household income, increased poverty, food insecurity, and malnutrition may severely impact vaccinations and health checks across nations with LMIC bearing the heaviest of brunts. An article in the current issue of the Journal of Global Infectious Diseases raises some genuine concerns on our approaches to adolescent TB. It also puts gender into equation by pointing out that adolescent females are more susceptible than males for tuberculosis. This assumes importance in view of the fact that global health initiatives have tended to treat “gender” issues in health more as part of a larger block of women's health and not specific to infectious diseases. The collection and importance of epidemiological data to plan and implement health policies needs to be underpinned to provide more complete insight into the magnitude and nature of sex differences in TB.
|1||WHA approves Post-2015 Global TB Strategy and Targets. Available from: http://www.who.int. [Last accessed on 2021 Feb 07].|
|2||IJTLD,The Union. Available from: http://theunion.org. [Last accessed on 2021 Feb 07].|
|3||COVID-19,The Union. Available from: http://theunion.org. [Last accessed on 2021 Feb 07].|
|4||Thakur S, Chauhan V, Kumar R, Beri G. Adolescent females are more susceptible than males for tuberculosis. J Global Infect Dis 2021;13:3-6.|