My daughter's battle with Tuberculosis

Mercy Muya was slowly fading away as doctors remained perturbed by her symptoms. Only a mother's last ditch effort and a brilliant doctor's brainwave saved the situation. 

Symptoms of tuberculosis (TB) in children are difficult to detect and that is what would have killed my one and half year old daughter, Mercy Muya. I am a mother of four and I live with my family in a small manyatta in Kakuma within Turkana County. I have a little  food business at the shopping centre and many times I would bring Mercy along with me. Because spitting on the dusty ground is very common among my Turkana community, I highly suspect that Mercy may have acquired the TB bacteria from the dust. Mercy's illness was abrupt but the symptoms were slow and gradual. Heath volunteer workers in the nearby Kakuma mission hospital have been educating women especially mothers on how to identify TB symptoms but Mercy didn't have any of the symptoms. She was just dull and fatigued most of the time. The usually playful girl was asleep most of the time. For a week, I thought that she was just teething. I however realised that her health was deteriorating. I took her to the Kakuma Mission Hospital where she was admitted immediately. Several laboratory tests were carried out but none was positive. Regrettably, there is no paediatrician in the hospital. The poor child was weakening by the day and by the third day after admission she couldn't even breastfeed. She was wheezing hard and had started getting seizures.

The medics suggested treating possible illnesses. First they prescribed anti-malarial treatment, then pneumonia and when these seemed to be making her worse, they put her on a respiratory inhaler in attempts to treat asthma. All this time, I was looking on helplessly and praying that at least one test would turn positive so that the doctors would get something to work with because as it were, she was getting worse.

After a week, the child's eyes started rolling and I was so scared I would lose her. I asked my husband, who was out looking for pastures to come home to figure out a plan for action. We decided to take Mercy to Kitale General Hospital. Mercy had several convulsions in the seven hour journey and though a paediatrician came in to attend to her immediately, she was so motionless that I thought I had lost her. I explained to him what we had gone through and he quickly requested for a chest x-ray and other laboratory tests as we were ushered to the wards.

Moments later, he explained to us that the child had tuberculosis. However because of the delay in diagnosing the illness most of Mercy's lungs had been destroyed by TB. Mercy was immediately started on treatment which lasted for six months. The doctor said that her situation wouldn't have been this dire if we hadn't spent precious time taking the wrong treatment. We were admitted for another two weeks for monitoring. My daughter is back to her normal playful self only after one month of the TB treatment. She has another five months to go but so far she's the cheery girl she has always been. Whenever I imagine what would have happened to my daughter had I not risked going to Kitale, I shudder in fear. I am also glad that my NHIF card covered Mercy's treatment otherwise the admission and treatment would have been very expensive for us. I hope this does not happen to any other baby especially those who may not afford even the travel expenses in search of a second opinion.

CHILDHOOD TUBERCULOSIS

Tuberculosis is a serious infectious bacterial disease that mainly affects the lungs. Children especially below the age of two years tend to suffer disseminated forms of TB meningitis, millary or disseminated TB among others. Pulmonary TB – TB of the lungs is the most common form of TB in children.

Common symptoms • Persistent cough that is not responding to regular treatment, • Fever • Reduced playfulness, • Weight loss

TB symptoms imitate other childhood illnesses and may not be easily diagnosed if the clinician does not have a high index of suspicion. Many children are diagnosed late and may die. Dr Kathure Immaculate of the National TB Program in Kenya notes that because children are unable to express themselves verbally, clinicians and caregivers can easily dismiss symptoms such as coughing or night sweat as ordinary conditions occurring among growing children. Dr Kathure explains that a clinician relies mostly on the high index of suspicion to request for a TB test. While these symptoms may not occur in a child, the doctor adds that it is very important for the parent to be vigilant and request for a TB test if it is suspected.

She advises clinicians to take a thorough history when attending to a sick child. This includes a history of • Contact between the sick child and persons with TB or any chronic cough. • Persons at home such as parents, nannies or visitors. • Contact with persons outside the home such as neighbours, school bus drivers or conductors and teachers who may have cough is important.

You can prevent TB spread by.... • Early diagnosis and treatment for all suspected cases of TB. TB treatment is given freely in all government hospitals and the country now has child friendly TB medicines that are easy to give and have a pleasant taste for the children. • Screening all children in contact with TB. Those found not to have TB are given medicine to prevent TB if below 5 years of age. • Ensuring good cough etiquette by covering mouths when coughing. • Supporting TB patients to ensure they complete treatment as advised by the doctor. • Improving ventilation in environment by keeping windows open. This includes passenger service vehicles. • Ensuring that persons living with HIV receive TB preventive treatment from the hospital. Parents should ensure that the child completes all their medication for the entire period even if they feel better. This will prevent the child from death or development of drug resistant TB.