BACKGROUND AND OBJECTIVES: Chemoprophylaxis is an effective strategy to prevent progression of tuberculosis (TB) in vulnerable children who have had contact with an infectious source of TB. However, many operational gaps prevent implementation of routine chemoprophylaxis in high-burden settings. The TB exposure status and disease spectrum in children diagnosed with culture-confirmed TB are described and missed opportunities for chemoprophylaxis are highlighted. METHODS: All children <13 years of age diagnosed with culture-confirmed TB at a tertiary referral hospital between March 2003 and February 2007 were included. Clinical data were collected from retrospective review of files. TB was classified as pulmonary and extra-pulmonary; disseminated TB included miliary disease and TB meningitis. RESULTS: During the study period, 614 children (327, 53·3% boys, median age 32 months) were diagnosed with culture-confirmed TB. Contact with an infectious adult source case was documented in 333 (54·2%), 237 (71·2%) of whom were <5 years of age, and 24 (7·2%) were HIV-infected and ≥5 years of age. Of those eligible for chemoprophylaxis, missed opportunities were identified in 156/221 (70·6%) children; 127 (81·4%) were <3 years of age, 39 (25%) had disseminated TB and 8 (5·1%) died. The TB source case was the mother or father in 74/156 (47·4%) children. CONCLUSION: Opportunities for initiation of chemoprophylaxis in vulnerable children following TB exposure are often missed. Awareness should be increased among health-care workers and in the community at large regarding the importance of chemoprophylaxis in young and HIV-infected children. Health system strengthening is required to improve delivery of chemoprophylaxis to vulnerable children in close contact with newly diagnosed infectious TB cases.
BACKGROUND AND OBJECTIVES: Chemoprophylaxis is an effective strategy to prevent progression of tuberculosis (TB) in vulnerable children who have had contact with an infectious source of TB. However, many operational gaps prevent implementation of routine chemoprophylaxis in high-burden settings. The TB exposure status and disease spectrum in children diagnosed with culture-confirmed TB are described and missed opportunities for chemoprophylaxis are highlighted. METHODS: All children <13 years of age diagnosed with culture-confirmed TB at a tertiary referral hospital between March 2003 and February 2007 were included. Clinical data were collected from retrospective review of files. TB was classified as pulmonary and extra-pulmonary; disseminated TB included miliary disease and TB meningitis. RESULTS: During the study period, 614 children (327, 53·3% boys, median age 32 months) were diagnosed with culture-confirmed TB. Contact with an infectious adult source case was documented in 333 (54·2%), 237 (71·2%) of whom were <5 years of age, and 24 (7·2%) were HIV-infected and ≥5 years of age. Of those eligible for chemoprophylaxis, missed opportunities were identified in 156/221 (70·6%) children; 127 (81·4%) were <3 years of age, 39 (25%) had disseminated TB and 8 (5·1%) died. The TB source case was the mother or father in 74/156 (47·4%) children. CONCLUSION: Opportunities for initiation of chemoprophylaxis in vulnerable children following TB exposure are often missed. Awareness should be increased among health-care workers and in the community at large regarding the importance of chemoprophylaxis in young and HIV-infectedchildren. Health system strengthening is required to improve delivery of chemoprophylaxis to vulnerable children in close contact with newly diagnosed infectious TB cases.
Authors: E R Maritz; G Montepiedra; L Liu; C D Mitchell; S A Madhi; R Bobat; A Violari; A Ogwu; A C Hesseling; M F Cotton Journal: Int J Tuberc Lung Dis Date: 2016-08 Impact factor: 2.373
Authors: Palwasha Y Khan; Tom A Yates; Muhammad Osman; Robin M Warren; Yuri van der Heijden; Nesri Padayatchi; Edward A Nardell; David Moore; Barun Mathema; Neel Gandhi; Vegard Eldholm; Keertan Dheda; Anneke C Hesseling; Valerie Mizrahi; Roxana Rustomjee; Alexander Pym Journal: Lancet Infect Dis Date: 2018-12-13 Impact factor: 25.071
Authors: Merrin E Rutherford; Rovina Ruslami; Melissa Anselmo; Bachti Alisjahbana; Neti Yulianti; Hedy Sampurno; Reinout van Crevel; Philip C Hill Journal: Bull World Health Organ Date: 2013-09-10 Impact factor: 9.408
Authors: Yesaya K Mwasubila; Issa Sabi; Rogatus Kabyemera; Nyanda E Ntinginya; Reginald Sauve; Benson Kidenya Journal: East Afr Health Res J Date: 2018-04-01