Tuberculosis in the Children of Ukraine: the Epidemiological Situation and Areas of Improvement of Antituberculosis Care

Abstract

Introduction. The main thrust of the global tuberculosis response for decades has been focused on tuberculosis (TB) in adults. However, this approach has failed to achieve the expected results in TB control. Therefore, WHO has changed the paradigm of TB control with a focus on childhood TB. Objective. To investigate the epidemiological situation of childhood tuberculosis in Ukraine in dynamics, to define the main factors of negative changes, and to define the directions for improvement of antituberculosis care. Materials and Methods. Epidemiological, clinical, statistical. Results. The epidemiological situation in Ukraine remains difficult. Over the past 10 years, the relapse rate of TB in adults has increased significantly, from 13.6% to 23.0%, and the number of patients with drug-resistant (DR) TB (in children by 11.0% in 2020). The volume of professional examination of children for TB decreased significantly, which led to an increase in the structure of the disease of severe forms requiring surgical treatment, and a significant under-recognition of patients and individuals with latent TB infection. Etiological verification of the diagnosis in children is very difficult. Practically 50.0% of unhealthy inpatients, even with very scrupulous examination, fail to detect MBT by any method (in Ukraine this figure reaches 70.0%). Conclusions. In spite of positive dynamics of morbidity and mortality, WHO estimations show significant underdiagnosis of TB patients in Ukraine. The relapse rate in adults and DR-TB patients of all age groups is increasing; the percentage of children under 14 years old in the age structure is increasing. Early detection of TB infection in children is extremely important for TB control in the country, which requires free access of the child population to systematic screening for TB with the Mantoux test and a new skin test with highly specific TB biomarkers (ESAT-6, CFP-10). Modern methods of molecular-genetic diagnostics of TB are quickly and efficiently implemented in NIFP, treatment of children with DR-TB with new anti-TB drugs was started. For the first time in Ukraine, the Center of surgical treatment of children with tuberculosis of the respiratory organs was established at the Institute. Keywords. TB in children, epidemiological indicators, dynamics of morbidity, drug-resistant TB, improvement of anti-TB care.