Rates of tuberculosis in Mongolian school-aged children are up to five times higher than previous estimations by the World Health Organization (WHO), according to new findings from Mongolia’s first clinical study of tuberculosis in children.
Preliminary results show there are 1,479 active cases of tuberculosis (TB) in 100,000 school-aged children, putting it in line with South Africa, where the TB epidemic is the country’s number one cause of death.
The study, by the Mongolian Health Initiative in conjunction with the Harvard T.H. Chan School of Public Health in the United States, also found that 10 percent of school-aged children had latent (inactive) TB.
Mongolian Health Initiative (MHI) research fellow Dr. T.Mendsaikhan, who was on the study team, said the early results were alarming.
“The results of our study show it’s very high- much higher than the predictions by the World Health Organization, which predicted 500 to 1,000 cases in 100,000,” Dr. T.Mendsaikhan said.
“The cases of latent TB were at 10 percent, and previous figures showed it was only two percent, so there’s been a huge increase in latent TB in children.
“This shows that we have to take more action on TB.”
The study’s other results revealed that passive smoking increased the TB rate in children by a worrying 22 percent. And the risk of contracting the disease is four times higher when there is a TB-infected person living in the household.
A 2015 study revealed that Mongolia is the fourth highest tuberculosis-burden country in the Western Pacific Region. It is the sixth leading cause of death amongst the population and the first leading cause of death from communicable diseases.
TB is an infectious disease caused by the Mycobacterium tuberculosis which is spread by airborne transmission from person to person. It spreads when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes or spits.
In latent TB, which is usually acquired in childhood, people still have the TB infection, but the bacteria remains in the body in an inactive state and causes no symptoms. While it is not contagious, latent TB can turn into active TB, so treatment is important.
Despite wide access to TB drugs, people still die from TB. In Mongolia, even though babies are vaccinated within 24 hours of being born, the disease is being spread in later life due to more cases of drug-resistant TB, symptoms being ignored and incorrect diagnosis of the disease.
The next stage of the trial by MHI is determining if vitamin D can reduce the prevalence of latent TB in school-aged children.
More than 8,000 students aged six to 13 years from 15 schools in six districts of Ulaanbaatar are taking part in the trial, which will conclude by 2019. The students take a vitamin D gel tablet once a week.
International studies have shown that vitamin D pills are proving effective when the body cannot produce enough of the vitamin from radiation by the sun. The low-cost pill has been used in countries to prevent tuberculosis with some promising results.
Dr. T.Mendsaikhan, who works as a pediatrician at a private clinic, SOS Medica Mongolia, said many Mongolians suffer from vitamin D deficiency as a result of the dark winter months and not enough sunlight, along with a lack of vitamin D rich food.
“Vitamin D tablets are becoming more popular in Mongolia and are readily available at pharmacies. Children should be taking these especially in the winter months,” she said.
Vitamin D is also found in oily fish, cow liver, eggs, yeast and some dairy products.
In 2016, Mongolia began fortifying some brands of milk with vitamin D in an effort to combat deficiencies from inadequate sun exposure and poor vitamin D dietary intake.
Dr. T.Mendsaikhan also warned of the dangers of ignoring latent TB.
“In Mongolia, people with latent TB don’t take medicine but they should be,” she said.
“The medicine is available but it’s not being prescribed. There needs to be a health directive or policy that says people with latent TB must take medicine to suppress the bacteria. At the moment, that’s not happening, it’s being ignored.”
In Mongolia, 74 percent of overall TB cases are among poorer people living below the poverty line, according to WHO.
Dr. T.Mendsaikhan said one of the most important messages is spreading the word to parents about the risks of TB.
“We encourage parents to keep their children’s immune system strong and healthy with good sleep and diet,’’ she said.
“The other message is that tuberculosis can still affect anyone, whether your child is at a school in the ger district or at one of the best private international schools.”
While Mongolia has one of the largest numbers of TB cases in the world, the impact of the disease on children has not been widely acknowledged. But Dr. T.Mendsaikhan said that attitude is slowly changing.
“Tuberculosis in children is becoming a more popular issue right now due to our study and other studies,” she said.
“A lot of TB cases in children are not being diagnosed and treated properly and that’s something that has to change.”