The daily consumption of 20 pills over a 14-24 month treatment period is an overwhelming challenge for anyone, especially children diagnosed with multidrug-resistant tuberculosis (MDR-TB). These young patients, some as young as 15, face the daunting task of ingesting up to 14,000 pills along with enduring painful daily injections throughout their treatment.
This immense medication burden, combined with the stigma often associated with tuberculosis, can significantly affect a child’s psychological well-being. Ntoetse Makhupane, a psychologist at Botšabelo MDR-TB Hospital, highlighted the struggles teenagers face during treatment. She noted that the stigma associated with tuberculosis often leads to school dropouts as children fear discrimination from their peers.
“The fear of diagnosis and the treatment itself can be overwhelming for these young people,” Makhupane said. “They feel like their lives have been put on hold, which can have a devastating effect on their mental health.”
Makhupane also pointed out that the treatment’s side effects vary among patients. “Some may experience no side effects, while others may struggle with severe ones such as nausea and vomiting,” she explained. “This fear of side effects can cause anxiety and even depression in some patients.”
To tackle these challenges, the hospital has implemented a mental health assessment process to monitor the emotional well-being of patients. “We conduct regular check-ins with our patients to ensure they are coping with the treatment and to provide support where needed,” Makhupane said.
“We don’t just send patients home and forget about them,” Makhupane emphasized. “We have community supporters in the villages who help patients adjust to life after discharge and continue their medication.”
Continuous assessments are conducted to ensure that patients maintain their mental health and adhere to treatment. This process is enhanced by educating patients and communities about MDR-TB. “Understanding the disease helps patients cope better and boosts their psychological resilience,” Makhupane said.
“Education about MDR-TB is critical not only for patients but also for their communities,” Makhupane explained. “It makes contact tracing and testing much easier as people are more willing to come forward and get tested when they understand the disease and the importance of early detection.”
This comprehensive approach helps ensure patients receive necessary care and treatment while also preventing further spread of the disease. Makhupane stressed the importance of community involvement in combating MDR-TB: “It is only through working together and sharing knowledge that we can truly overcome this disease.”
Dr. Mikanda, a specialist in treating MDR-TB, confirmed that clinical trials have identified new drug regimens that are effective and safer for adolescents and children. “The endTB regimens are a significant breakthrough,” he said. “They can shorten treatment time by up to two-thirds while maintaining similar efficacy and safety to conventional treatments. This will have a massive impact on patients, particularly adolescents who are at risk of dropping out of treatment due to side effects or lengthy treatment periods.”
He added that these new regimens also include a pediatric formulation, which is good news for children. “The new regimen lasts for 9 months without injections, whereas the previous one was 18-24 months with painful injections for 6-9 months. This means the adolescents and children will not suffer psychologically because the treatment is tolerable, less toxic, shorter, and injections-free,” Dr. Mikanda said. He also noted that taking too many pills can cause other problems such as kidney failure and hypertension.
The World Health Organization (WHO) highlights that impoverished communities can provide an ideal environment for the airborne transmission of tuberculosis. “Poverty is a powerful determinant of tuberculosis. Crowded and poorly ventilated living and working environments often associated with poverty constitute direct risk factors for tuberculosis transmission.”
Undernutrition is another significant risk factor for developing active disease. Poverty is also associated with poor general health knowledge and a lack of empowerment to act on health knowledge, leading to exposure to several tuberculosis risk factors such as HIV, smoking, and alcohol abuse.
“The required social, economic, and public health policies include those that improve environment and living conditions in prisons and other congregate settings, pursue overarching poverty reduction strategies, expand social protection, reduce food insecurity, improve living and working conditions, and promote healthy diets and lifestyles including the reduction of smoking and harmful use of alcohol and drugs,” the World Health Organization advised.
