Doctors Without Borders/Médecins Sans Frontières (MSF) has been collaborating with Sierra Leone’s Ministry of Health through the National Leprosy and Tuberculosis Control Program since 2020, focusing on improving the diagnosis and treatment of tuberculosis (TB) in children. MSF teams operate in Makeni Hospital and in 12 directly observed therapy sites located in clinics across Bombali district.
In 2022, MSF initiated the use of new diagnostic tools for TB in accordance with the recently released guidelines from the World Health Organization. These guidelines include treatment decision algorithms using stool samples for molecular testing or urine samples for children living with HIV. Additionally, MSF teams have established an efficient sample transportation system from the therapy sites to the laboratory at Makeni Hospital for molecular testing.
Diagnosing TB in young children poses unique challenges, as sputum production can be complex, particularly for pulmonary TB. Furthermore, TB in children can manifest outside the lungs, known as extrapulmonary TB, making sample collection and accurate diagnosis even more difficult.
Malnutrition increases TB risk
Malnourished children have compromised immune systems, heightening their susceptibility to TB. Malnutrition is widespread in Sierra Leone, underscoring the importance of recognizing TB symptoms in children.
“I brought my son here because he was not improving,” said Aruna, father of three-year-old Augustine. “He was losing weight, coughing constantly, and sweating profusely at night. I am terrified to see him like this.”
Augustine was diagnosed with TB at Makeni Regional Hospital in Bombali district, supported by MSF. In addition to TB treatment, he is receiving specially formulated therapeutic milk for severe malnutrition. “Since admission, the nurses have been providing him with milk,” Aruna mentioned.
“We had a three-year-old TB patient who, after completing treatment, returned with symptoms,” explained MSF nurse Umu Amara. “Although stool testing was negative for TB, we conducted a urine test due to her HIV status, which confirmed TB.”
Similarly to Augustine, a concerning number of children under five receiving TB treatment are severely malnourished. The MSF team in Bombali district also administers malnutrition treatment as part of the pediatric TB program.
Increased patient treatment
Throughout Bombali district, patients visiting the therapy sites have their treatment progress monitored, prescriptions refilled, and malnourished children provided with therapeutic food like Plumpy’Nut sachets to consume at home. This minimizes the need for frequent consultations, crucial in areas with distant health facilities.
“Given the high number of TB cases in children in Sierra Leone, the National Leprosy and Tuberculosis Control Program requires additional support from the government and donors to expand this successful TB diagnostic and treatment model nationwide,” stated MSF medical coordinator Dr. Kennedy Uadiale.
“By utilizing new tools, offering treatment closer to patients, and providing nutritional assistance at the therapy sites to undernourished children, we have successfully enrolled and treated a significantly higher number of patients,” added MSF medical team leader Jobin Joseph.
Facilitating children’s recovery
Fatmata, diagnosed with TB at Makeni Hospital, faces an extended treatment period of approximately six months, leading to prolonged school absences and potential social isolation due to TB stigma.
In 2023, 2,148 individuals with drug-sensitive TB were enrolled in the TB program in Bombali district. After implementing new diagnostic tools, the number of children under 15 in the program increased substantially from 31 in 2020 to 405 in 2023.
About our work in Sierra Leone
MSF has been active in Sierra Leone since 1986, currently offering medical care in three districts: Bombali, Tonkolili, and Kenema. In Bombali district’s Makeni Regional Hospital, MSF teams assist the Ministry of Health in treating patients with drug-resistant tuberculosis while enhancing the diagnosis and care of individuals with drug-sensitive tuberculosis in primary health care facilities across the district. In Tonkolili district’s Mile 91 and Magburaka town, MSF teams collaborate with the Ministry of Health to provide healthcare for mothers and children. MSF teams in Kenema district completed the construction of a mother and child hospital in Hangha in 2019, delivering comprehensive emergency obstetric and newborn care. Furthermore, MSF offers general healthcare in several Ministry of Health-operated local health centers across Kenema district.
Distributed by APO Group on behalf of Médecins sans frontières (MSF).