Are TB control programmes in South Asia ignoring children with disease? A situational analysis

Shakoor, Sadia; Qamar, Farah Naz; Mir, Fatima; Zaidi, Anita K. M.; Hasan, Rumina

doi:10.1136/archdischild-2013-304816

Cited by 2 publications

(2 citation statements)

References 25 publications

(21 reference statements)

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“…There is a high burden of largely underdiagnosed childhood TB in South Asian countries including, Pakistan [ 11 ]. There is a need for rapid, easy diagnostics for child TB in such settings.…”

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confidence: 99%

Evaluation of Xpert MTB/RIF testing for rapid diagnosis of childhood pulmonary tuberculosis in children by Xpert MTB/RIF testing of stool samples in a low resource setting

et al. 2017

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ObjectiveChildren with tuberculosis (TB) remain underdiagnosed due to difficulty in testing for Mycobacterium tuberculosis (MTB) infection. We evaluated the Xpert MTB/RIF assay for respiratory and stool testing in children for pulmonary TB through a cross-sectional study at tertiary care facilities in Karachi, Pakistan. Fifty children aged 0–15 years screened by a modified Kenneth-Jones (KJ) score were included. Mycobacterial culture of respiratory samples was the microbiological standard against stool Xpert TB results. All positive TB cases were compared against a treatment response standard (TRS).ResultsTwelve study subjects were diagnosed by Xpert TB and nine by MTB culture. Compared with culture [gastric aspirates (GA)/sputum (spm)], stool Xpert TB had a sensitivity of 88.9% (95% CI 50.7–99.4) and a specificity of 95% (95% CI 81.8–99.1). Xpert TB stool versus GA/spm had sensitivity of 81.8% (95% CI 47.8–96.8) and specificity of 94.7% (95% CI 84.6–99.9). We found good agreement (kappa scores of >0.8) between stool Xpert, GA/spm Xpert and GA/spm culture. Stool Xpert PPV and NPV against TRS was 100 and 82.1% respectively. Stool Xpert TB is a relatively easy option for diagnosis for pulmonary childhood TB in a high burden low-resource setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-017-2806-3) contains supplementary material, which is available to authorized users.

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confidence: 99%

Evaluation of Xpert MTB/RIF testing for rapid diagnosis of childhood pulmonary tuberculosis in children by Xpert MTB/RIF testing of stool samples in a low resource setting

et al. 2017

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“… 9 India does not meet the global target for case detection and rates among 10 countries which account for 76% of the gap between case notification rates and estimated incidence. 8 Furthermore, the models for TB incidence rates in children do not take into account specific predisposing factors in Indian children, including high burden of malnutrition, 10 suggesting an overall underestimation of TB cases.…”

Section: Introductionmentioning

confidence: 99%

Incidence of tuberculosis and the influence of surveillance strategy on tuberculosis case-finding and all-cause mortality: a cluster randomised trial in Indian neonates vaccinated with BCG

Jenum

Selvam²,

Jesuraj

et al. 2018

BMJ Open Resp Res

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IntroductionAccurate tuberculosis (TB) incidence and optimal surveillance strategies are pertinent to TB vaccine trial design. Infants are a targeted population for new TB vaccines, but data from India, with the highest global burden of TB cases, is limited.MethodsIn a population-based prospective trial conducted between November 2006 and July 2008, BCG-vaccinated neonates in South India were enrolled and cluster-randomised to active or passive surveillance. We assessed the influence of surveillance strategy on TB incidence, case-finding rates and all-cause mortality. Predefined criteria were used to diagnose TB. All deaths were evaluated using a verbal autopsy.Results4382 children contributed to 8164 person-years (py) of follow-up (loss to follow-up 6.9%); 749 children were admitted for TB evaluation (active surveillance: 641; passive surveillance: 108). The TB incidence was 159.2/100 000 py and the overall case-finding rate was 3.19 per 100 py (95% CI 0.82 to 18.1). Whereas, the case-finding rate for definite TB was similar using active or passive case finding, the case-finding rate for probable TB was 1.92/100 py (95% CI 0.83 to 3.78) with active surveillance, significantly higher than 0.3/100 py (95% CI 0.01 to 1.39, p=0.02) with passive surveillance. Compared to passive surveillance, children with active surveillance had decreased risk of dying (OR 0.68, 95%CI 0.47 to 0.98) which was mostly attributable to reduction of death from pneumonia/respiratory infections (OR 0.34, 95%CI 0.14 to 0.80).ConclusionWe provide reliable estimates of TB incidence in South Indian children <2 years of age. Active surveillance increased the case-finding rates for probable TB and was associated with reduced all-cause mortality.

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Are TB control programmes in South Asia ignoring children with disease? A situational analysis

Cited by 2 publications

References 25 publications

Evaluation of Xpert MTB/RIF testing for rapid diagnosis of childhood pulmonary tuberculosis in children by Xpert MTB/RIF testing of stool samples in a low resource setting

Evaluation of Xpert MTB/RIF testing for rapid diagnosis of childhood pulmonary tuberculosis in children by Xpert MTB/RIF testing of stool samples in a low resource setting

Incidence of tuberculosis and the influence of surveillance strategy on tuberculosis case-finding and all-cause mortality: a cluster randomised trial in Indian neonates vaccinated with BCG

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