The burden of childhood tuberculosis and the accuracy of community-based surveillance data

Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Stellenbosch, Cape Town, South Africa.
The International Journal of Tuberculosis and Lung Disease (Impact Factor: 2.32). 03/2006; 10(3):259-63.
Source: PubMed


Inadequate surveillance and diagnostic difficulties compromise the quality of epidemiological data on childhood tuberculosis (TB).
To document the incidence of childhood TB and to evaluate the accuracy of community-based surveillance data in a high-burden setting.
This prospective observational study was conducted from February 2003 to October 2004 at five primary health care clinics in Cape Town, South Africa. Comprehensive surveillance was done to ensure that all children <13 years of age treated for TB were included.
During the study period, 443 children (<13 years of age) received anti-tuberculosis treatment, of whom 389 (87.8%) were recorded in the TB treatment register. The TB incidence calculated from the TB treatment register was 441/100,000/year amongst children and 845/100,000/year amongst adults. Fifty-four children treated for TB were not recorded in the TB treatment register, including 21/28 (75%) children with severe disease.
Children <13 years of age contributed 13.7% of the total TB burden, but experienced more than half (52.2%) the TB incidence recorded in adults. Community-based surveillance data excluded the majority of children with severe disease. The accuracy of surveillance data is an important consideration when describing the epidemiology of childhood TB or measuring the success of public health interventions.

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Available from: Ben Marais, Oct 02, 2014
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    • "The marginal improvement in ISTC-adherent care from 5% in 2009 to 28% in 2012 was not associated with an increase in the number of childhood TB cases detected, which remained low, in contrast to our previous finding in adults [7]. Pediatric TB case detection in community settings is rare [14], [15] and although sputum microscopy is the first-step in TB evaluation, pediatric TB is often smear-negative. Therefore, larger improvements in ISTC-adherent care may be needed to identify more smear-positive TB cases and would also maximize the impact of the ongoing scale-up of the Xpert MTB/RIF assay. "
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    ABSTRACT: BackgroundImproving childhood tuberculosis (TB) evaluation and care is a global priority, but data on performance at community health centers in TB endemic regions are sparse.ObjectiveTo describe the current practices and quality of TB evaluation for children with cough ≥2 weeks' duration presenting to community health centers in Uganda.MethodsCross-sectional analysis of children (<15 years) receiving care at five Level IV community health centers in rural Uganda for any reason between 2009–2012. Quality of TB care was assessed using indicators derived from the International Standards of Tuberculosis Care (ISTC).ResultsFrom 2009–2012, 1713 of 187,601 (0.9%, 95% CI: 0.4–1.4%) children presenting to community health centers had cough ≥ 2 weeks' duration. Of those children, only 299 (17.5%, 95% CI: 15.7–19.3%) were referred for sputum microscopy, but 251 (84%, 95% CI: 79.8–88.1%) completed sputum examination if referred. The yield of sputum microscopy was only 3.6% (95% CI: 1.3–5.9%), and only 55.6% (95% CI: 21.2–86.3%) of children with acid-fast bacilli positive sputum were started on treatment. Children under age 5 were less likely to be referred for sputum examination and to receive care in accordance with ISTC. The proportion of children evaluated in accordance with ISTC increased over time (4.6% in 2009 to 27.9% in 2012, p = 0.03), though this did not result in increased case-detection.ConclusionThe quality of TB evaluation was poor for children with cough ≥2 weeks' duration presenting for health care. Referrals for sputum smear microscopy and linkage to TB treatment were key gaps in the TB evaluation process, especially for children under the age of five.
    Full-text · Article · Aug 2014 · PLoS ONE
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    • "In 2012, 81,482 pediatric cases were notified accounting for 7% of all notified TB cases [5]. While the exact burden of childhood TB globally is not known due to diagnostic difficulties, it is estimated that childhood TB constitutes about 10–20% of all TB, in high burden countries [6]–[7]. "
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    ABSTRACT: Diagnosis of pulmonary tuberculosis (PTB) in children is challenging due to difficulties in obtaining good quality sputum specimens as well as the paucibacillary nature of disease. Globally a large proportion of pediatric tuberculosis (TB) cases are diagnosed based only on clinical findings. Xpert MTB/RIF, a highly sensitive and specific rapid tool, offers a promising solution in addressing these challenges. This study presents the results from pediatric groups taking part in a large demonstration study wherein Xpert MTB/RIF testing replaced smear microscopy for all presumptive PTB cases in public health facilities across India.
    Full-text · Article · Aug 2014 · PLoS ONE
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    • "During 2008, an estimated 9.4 million new TB cases were diagnosed, with most cases living in Africa and Asia [33], but no estimates of childhood TB were included. In a prospective community-based survey performed in an area of South Africa, children less than 13 years of age contributed 14% of the total TB disease burden, with an annual incidence of 408/100, 000 [34,35]. More recent estimates suggest that children less than 15 years of age contribute 10-20% of the disease burden in TB-endemic areas [36,37]. "

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