Tracing TB to Save Children’s Lives in Southwest Uganda

Follow a dirt path through banana plantations in the village of Kigando—in the Ntungamo District southwest Uganda—and you will arrive at the home of Zephania Kabatangare, 38, where he lives with his wife, Kelia Adrine, also 38, and their seven children. Constructed according to tradition, the mud and wattle house keeps out the weather, but offers poor ventilation, which can enhance the spread of airborne diseases like tuberculosis (TB).

The couple and three of their children were recently discovered as having TB and received treatment thanks to contact tracing by health workers from nearby Kitwe Health Centre IV who had been trained by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) under the Catalyzing Pediatric TB Innovations (CaP TB) project.

The first link in the chain was Zephania, who was coughing blood, accompanied by chest pain, night sweats, and fever. Zephania is living with HIV, and TB is the most common HIV coinfection. He defaulted on his HIV treatment in 2019 and found himself severely ill by the second quarter of 2020. In April, he finally decided to seek care at Kitwe Health Centre IV.

Once Zephania received treatment, health workers requested that they come to his home to test the rest of his family. Zephania was hesitant. He confided that he worried about his wife’s disapproval upon discovering his TB status. Through counseling, Zephania finally agreed that they visit his home. All were tested. Kelia and three of the seven children tested positive for TB.

“To me, when the health workers came to test and started our children on treatment, it meant that I would be relieved and my family members are helped—because the children are now healthy and taking their drugs,”says Zephania.

“I now feel relieved because we are all taking our drugs and feeling stronger,” says Kelia. “I have also trained the elder brothers to always guide and remind the children to take their drugs.” This is the third year in a row that the family has dealt with cases of TB. To find out why the Kabatangare family has had recurrent TB and to find and treat other cases, health workers started tracing and testing people whom the family comes in contact with—their friends, neighbors, and other people in the village.

Prosper Taremwa, the TB focal person at Kitwe Health Center IV, says that the health workers at the facility have also remained in close contact with the family to ensure that the children are taking their drugs and assessing whether they are adhering to treatment.

He says that while adults have also been traced and treated, staff is making a deliberate effort to targeted and identifying children because children cannot seek medical care on their own. According to the World Health Organization, one million children worldwide develop TB each year, with 230,000 of them dying from this curable disease.

CaP TB focuses on reaching undiagnosed children by incorporating TB screening into services for HIV, nutrition, and maternal and child health. This has helped health workers reach out to the communities in tracing for the cases and following up on those who are already enrolled in care. Through CAP TB, 427 additional cases of TB were diagnosed and treated in Ntungamo District during fiscal year 2019 than during the previous fiscal year. High impact and proven interventions, along with access and availability of Genexpert machines for diagnosis and the involvement of private care facilities has contributed to this success.

Unitaid  is a global health agency engaged in finding innovative solutions to prevent, diagnose and treat diseases more quickly, cheaply and effectively, in low- and middle-income countries. Our work includes funding initiatives to address major diseases such as HIV/AIDS, malaria and tuberculosis, as well as HIV co-infections and co-morbidities such as cervical cancer and hepatitis C, and cross-cutting areas, such as fever management.