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Ethical issues surrounding childhood tuberculosis
P Hummel1, N Ahamed2, F Amanullah3
1Department of Philosophy, Edgecliffe, The Scores, St Andrews, UK.
Insights
Childhood tuberculosis (TB) presents severe ethical challenges in diagnosis, treatment, and research. Addressing these requires improved reporting, equitable care, and systematic inclusion of children in TB research agendas.
Area of Science:
- Pediatrics
- Public Health
- Bioethics
Background:
- Childhood tuberculosis (TB) affects over a million children annually, with significant mortality.
- Ethical considerations in pediatric TB are underexplored, with limited management strategies.
- Existing ethical challenges are amplified in children compared to adult TB cases.
Purpose of the Study:
- To identify and analyze the ethical challenges associated with childhood tuberculosis.
- To propose actionable suggestions for addressing these ethical issues.
- To inform research agendas and policies aligned with the WHO End TB Strategy.
Main Methods:
- Literature review and ethical analysis of childhood TB.
- Identification of ethical challenges in susceptibility, diagnosis, reporting, service provision, treatment, and psychosocial support.
- Formulation of recommendations for policy and research.
Main Results:
- Ethical challenges in childhood TB are clustered around susceptibility, diagnosis, reporting, service provision, treatment, psychosocial support, and R&D neglect.
- These issues are often interconnected and mutually reinforcing.
- There is a duty to provide care and interventions to children with TB, irrespective of their transmission impact.
Conclusions:
- Improving diagnosis and reporting is crucial for effective research and policy development in childhood TB.
- Children with TB require comprehensive care, including psychosocial support and equitable inclusion in research.
- Addressing ethical neglect in pediatric TB research and development is essential.
Abstract:
Each year, at least one million children become ill with tuberculosis (TB) and more than 253 000 died of TB in 2016. The ethical issues surrounding childhood TB remain underexplored, and established or proposed management strategies are scarce. In this paper, we identify ethical challenges that are raised by childhood TB. Some of them are familiar from TB in other populations but arise with increased severity in children. We discuss interconnected and mutually reinforcing difficulties clustered around the topics of susceptibility, diagnosis, reporting, service provision, treatment, psychological and social support, and research and development (R&D) neglect. We formulate suggestions on how to address these ethical issues. For developing sound research agendas and policies based on the WHO End TB Strategy, it is essential that diagnosis and reporting improve. There is a duty to care for and provide available interventions to children with TB even if they are not a major source of transmission, and therefore no major impact on public health is expected. Treatment should be accompanied by counselling, health education, psychological and material support to TB-affected children and their families. Children need to be included equitably and more systematically into the TB research agenda.
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