An Evaluation of Childhood Tuberculosis Program in Chegutu District, Zimbabwe, 2020: A Descriptive Cross-Sectional Study

Background Childhood tuberculosis (TB) is a major global public health concern contributing to significant child morbidity and mortality. A records review of the TB notification for Chegutu District Health Information System 2 (DHIS2) showed a low childhood TB case detection rate. For 2018 and 2019, childhood TB notifications were 4% and 7% respectively against the national 12% case detection rate. We evaluated the performance of the childhood TB program in Chegutu. Methods We conducted a descriptive cross-sectional study. Sixty-six health workers (HW) participated in the study. Interviewer-administered questionnaires and checklists were used to collect data on reasons for low TB case detection, HW childhood TB knowledge, program inputs, processes and outputs. Strengths, Weaknesses, Opportunities and Threats analysis was used to assess the childhood TB processes. We analyzed the data using Epi Info 7TM to generate frequencies, proportions and means. A Likert scale was used to assess health worker knowledge. Results The majority 51/66(77%) of HW were nurses and 51/66(67%) of respondents were females. Reasons for the low childhood TB case detection were lack of HW confidence in collecting gastric aspirates 55/66(83%) and HW’s negative attitudes towards gastric aspirate collection 23/66(35%). HW 24/66 (37%) had a fair childhood TB notification knowledge. The district had only one functional X-ray machine for 34 health facilities. Only 6/18 motorcycles were functional with inadequate fuel supply. No desk guide for the management of TB in children for HW (2018) was available in 34 health facilities. Ethambutol 400mg was out of stock and adult 800mg tablets were used. Funds allocated for motor vehicle and motorcycles service ($1612USD/year) were inadequate. The district failed to perform planned quarterly TB review meetings, contact tracing and childhood TB training due to funding and COVID-19 lockdown restrictions. Conclusion The childhood TB program failed to meet its targets due to inadequate inputs and suboptimal HW childhood TB knowledge. Case detection and notification can be improved through on-job training, mentorship, support and supervision and adequate resources.

The Diagnostic Value of Urinary Secretory Antigen Target of 6 kDa in Childhood Pulmonary Tuberculosis

Introduction. Childhood tuberculosis (TB) is difficult to diagnosed and is based together on clinical and microbiology examinations. Since in children signs and symptoms of TB are not typical and sputum is difficult to be obtained, Mycobacterium tuberculosis (Mtb) antigen detection could be considered as a non invasive method for early detection of childhood TB. ESAT-6 is a low molecular weight specific protein that plays an important role in Mtb virulence. Aim. To determine the diagnostic value of urinary ESAT-6 for the diagnosis of childhood tuberculosis. Methodology.This was a cross-sectional study, with consecutive sampling collection . in children aging between 0-14 years suspected for pulmonary TB based on the clinical presence of :cough lasting more than 2 weeks, fever without clear ethiology, loss of body weight or poor weight gain, fatigue, malaise with positive history of contact with sputum smear from adult TB patients. Diagnosis of pulmonary TB was based on clinical presentation plus tuberculin positive skin test, chest x-ray, AFB staining and/or sputum culture. Subjects who met the inclusion criteria but unconfirmed by clinical and microbiological were considered as control (non-TB group). Urinary ESAT-6 level was analyzed by using ELISA. Cut off value and AUC was determined using ROC Statistical Analysis (SPSS 20.0). Sensitivity and specificity was measured from 2x2 crosstable. Result. Between the 61 studied children with suspected TB, 46/61 (75%) were finally diagnosed with TB, with 34/46 (74%) microbiologically confirmed cases either by sputum microscopy 31/34 (91%) or culture 3/34 (9%), whereas 15/61 (25%) subjects were not-confirmed cases (non-TB group). The mean value of urinary ESAT-6 level was higher in TB than non-TB group, Mean (SD) [4.855(6.714)] ng/mLvs [1.503(0.946)] ng/mL; p=<0.001(Mann-Whitney test). At ROC curve analysis ,the cut off value of urinary ESAT-6 in subjects TB confirmed both with clinical plus microbiology evaluation as reference standard was 1,91 ng/mL, with sensitivity 72% and specificity 67%. While the cut off value of ESAT-6 in TB subjects confirmed group only by clinical signs was 2.45 ng/mL, with sensitivity 65% and specificity 67%. Conclusion. For TB Diagnosis in Children, Urinary ESAT-6 urine could be considered of value when utilized in addition to microbiological tests and clinical examination.

Epidemiology, clinical features and outcomes of incident tuberculosis in children in Canada in 2013–2016: results of a national surveillance study

PurposeChildhood tuberculosis disease is difficult to diagnose and manage and is an under-recognised cause of morbidity and mortality. Reported data from Canada do not focus on childhood tuberculosis or capture key epidemiologic, clinical and microbiologic details. The purpose of this study was to assess demographics, presentation and clinical features of childhood tuberculosis in Canada.MethodsWe conducted prospective surveillance from 2013 to 2016 of over 2700 paediatricians plus vertical tuberculosis programmes for incident tuberculosis disease in children younger than 15 years in Canada using the Canadian Paediatric Surveillance Program (CPSP).ResultsIn total, 200 cases are included in this study. Tuberculosis was intrathoracic in 183 patients of whom 86% had exclusively intrathoracic involvement. Central nervous system tuberculosis occurred in 16 cases (8%). Fifty-one per cent of cases were hospitalised and 11 (5.5%) admitted to an intensive care unit. Adverse drug reactions were reported in 9% of cases. The source case, most often a first-degree relative, was known in 73% of cases. Fifty-eight per cent of reported cases were Canadian-born Indigenous children. Estimated study rates of reported cases (per 100 000 children per year) were 1.2 overall, 8.6 for all Indigenous children and 54.3 for Inuit children.ConclusionChildhood tuberculosis may cause significant morbidity and resource utilisation. Key geographies and groups have very high incidence rates. Elimination of childhood tuberculosis in Canada will require well-resourced community-based efforts that focus on these highest risk groups.

Childhood Tuberculosis: An Under Prioritized Disease in Nepal

Globally, childhood tuberculosis constitutes up to 10% of overall tuberculosis cases. In Nepal, childhood tuberculosis has remained around 5.5% of overall tuberculosis cases and has remained stagnant over the years. Moreover, our health system is focused on adult tuberculosis. Childhood tuberculosis has recently got its attention both at the national and international levels. National Tuberculosis Program has been a successful program; however, more has to be done to track childhood tuberculosis progress. In this viewpoint, we discuss current initiatives taken by the government and the way forward for case detection and management of childhood tuberculosis in Nepal.