World TB Day: A Look Back at the MRCG at LSHTM’s Participation at the 49th Union World Conference on Lung Health at The Hague

World Tuberculosis (TB) Day is commemorated on March 24th each year. This year, activities are organised under the global theme “Wanted: Leaders for a TB-free world”. For the MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, it is an opportunity to celebrate our achievements and contributions, and reflect on innovative research strategies to improve the health of affected populations, particularly children, who are more vulnerable to TB.

The Union World Conference on Lung Health is the world’s largest and most comprehensive annual conference on Tuberculosis (TB) and other respiratory diseases, bringing together participants from different countries, leading research institutions, industries, civil societies and health organizations, to present and discuss advances in lung health.

The 2018 conference, held in The Hague, The Netherlands featured a mix of keynote lectures, oral presentations, e-posters and posters, including on Childhood TB research, which has been either neglected or understudied for too long. The conference, themed “Declaring our rights: Social and Political Solutions”, coincided with the end of the Childhood TB Program Grant at the MRC Unit The Gambia at LSHTM, headed by Prof. Beate Kampmann. A large team from the Unit, including clinicians, scientists, students and field workers, attended the conference, and had the opportunity to present our work and share the achievements registered under this program.

The team made 3 oral presentations as follows: High burden of undetected tuberculosis among children with no known contacts in The Gambia by Prof Beate Kampmann, Sheriff Kandeh, and Dr Uzochukwu Egere; Adult to Children Transmission of Tuberculosis within Households in The Gambia by Dr Leopold Tientcheu; and Quality of care among adult pulmonary TB patients in The Gambia, West Africa: a cross-sectional survey by Dr Owolabi Olomuyiwa.

Alhagie Jallow presented an e-poster on The impact of a childhood tuberculosis training program on knowledge among front-line health workers and childhood TB notifications in the provinces of The Gambia. Three posters were also presented, as follows: Enhancing laboratory diagnosis of Mycobacterium tuberculosis in samples from children in The Gambia by Abigail Ayorinde; Mycobacterium tuberculosis complex growth in sputum cultures with and without supplementation of resuscitation promoting factors by Edward Coker; and Use of resuscitation promoting factors to screen for tuberculosis infection in exposed children in The Gambia by Welmoed Van Loon.

Childhood TB represents at least 10% of the global TB burden (~1 million cases). In 2017, an estimated 239,000 children died from TB. Only 23% of an estimated 1.3 million children under 5 years, eligible for preventive therapy in TB households, actually received this proven intervention. Childhood TB diagnosis remains the greatest challenge due to the low bacillary count in children’s samples, and many cases remain undetected.

To bridge this gap in recognition and prevention in The Gambia, the program grant was the first large-scale project to address childhood TB by adopting a community-based approach. The households of over 1000 adult TB index cases were visited. More than 7100 children were screened, and 104 children were diagnosed with active TB, and treated within the NLTP. Children under 5 years of age received isoniazid preventive treatment, and the team demonstrated the feasibility of this approach for the first time in The Gambia. The project has yielded several publications in international peer-reviewed journals, and the diversity of the presentations at the Union meeting continued to showcase the achievement of the program.