Childhood TB and Stigma: Conversations of resilience in the war against TB

Foward by Farhana Amanullah

TB-related stigma hinders TB elimination efforts. TB is treatable and curable, yet stigma can deter families from seeking care and initiating or continuing treatment. Such stigma has serious health and socio-economic consequences on children, women and families and can eventually lead to delayed diagnosis, neglected followup and non-compliance to treatment.

Young children, although less likely to transmit TB disease, may suffer discrimination within the family, among neighbours, in the playground and at school. Parents may suffer from feelings of guilt and shame for not being able to prevent infection or for ignoring their children’s symptoms and not getting a timely diagnosis. When other household members who are the likely TB source conceal their symptoms because of stigma, they perpetuate an ongoing cycle of transmission and place vulnerable children, who can suffer grave consequences of TB, and other family members at great risk.

Adolescent females are a uniquely vulnerable population in South Asian countries; fear of rejection from potential suitors and their families affects health-seeking behaviour and may lead to death, late disease presentation, complications requiring surgery and devastating TB sequelae despite treatment. Young women with undiagnosed and untreated TB are a further threat to their newborns and young children, who are at a high risk of infection and rapid progression towards severe and fatal forms of TB. Adolescent boys in complex social situations are also susceptible to TB stigma.

The fear of loss of livelihood may prevent individuals from declaring their symptoms Chair, Child and Adolescent TB WG of the Stop TB Partnership – Geneva Senior Consultant, Pediatrics and Director, Pediatric TB programs at The Indus Hospital; Karachi, Pakistan and seeking diagnosis. This may result in months or years of unemployment or even precipitate death, orphaning children and directly impacting families by plunging them into further disease, poverty and undernutrition.

If the WHO End TB strategy is to succeed, all stakeholders and world leaders who join us in the fight against TB need to come together and galvanise the efforts of the GCTA and other civil society warriors. I am proud of all the great work GCTA is doing in the fi eld of stigma, particularly in bringing to light the effects of stigma on children who have TB – an area that has not been explored or understood enough. Stigma is a strong factor preventing diagnosis among the millions of missing people and children with TB. Together, we must remove stigma from the TB narrative.

GCTA. (2018). Childhood TB & Stigma: Conversations of resilience in the war against TB.