Yield of facility-based verbal screening amongst household contacts of patients with multi-drug resistant tuberculosis in Pakistan

Abstract

BackgroundHousehold contacts of multidrug-resistant tuberculosis (MDR-TB) patients are at a high risk of getting infected with TB/MDR-TB, therefore symptomatic or vulnerable individuals should be screened and treated early.MethodsA cross-sectional study was conducted among household contacts of MDR-TB patients in three high-burden TB sites in Pakistan from July 2013 to June 2014. MDR-TB index patients were asked to provide a list of all members of their household and were asked whether any of them had TB symptoms such as productive cough, fever, weight loss and night sweat (“facility-based verbal screening”). Symptomatic contacts were defined as presumptive TB cases and were invited for investigations at the facility. Those who did not come were paid a home-visit. Confirmed TB/MDR-TB patients were registered in the nearest treatment facility.ResultsOf 209 MDR-TB index patients, 1467 household contacts were identified and screened, 95 of them children < 5 years. Of these 172 (12%) were symptomatic. Most common symptoms were cough 157 (91%) and fever 107 (62%). 58 (34%) presumptive TB contacts were not investigated. Of total contacts, 56 (3.8%) were diagnosed with TB, among them 54(96%) with MDR-TB and 2(4%) with drug-susceptible-TB. The number needed to screen (NNS) to identify a new MDR-TB case among adult household contacts was 27 and among presumptive adult and pediatric TB contacts was three. All 56 confirmed patients were registered for treatment.ConclusionScreening household contacts of MDR-TB index cases may be considered a feasible and high yield option, in high-burden, low-resource settings within Pakistan. The number of presumptive TB contacts required to screen to identify a new MDR-TB case was unusually low, indicating an effective strategy that could easily be scaled-up. The screening and management of vulnerable adults and children living with patients having TB of any form is a major priority in the combined efforts to end TB.

Multi Drug Resistance: A Continuous Challenge by a Century Old Mycobacterium Tuberculosis

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“…Among them, 95 were children under five years of age. Out of these, a total of 56 (3.8%) were diagnosed with Tuberculosis, while the vast majority (96%; 54) were MDR-TB cases, and only two cases (4%) had drug-susceptible Tuberculosis (14).…”

Burden of drug-resistant pulmonary tuberculosis in Pakistani children: A cross-sectional study

“…It was seen that 378 of 1463 contacts (26%) were children aged 0-15. Of these, 11 children were symptomatic for TB, were tested, and 4 cases of TB were diagnosed from these children, all of which were MDR 10 . This study highly reinforces the impact of household TB contact on the development of MDR-TB in children, which has also been highlighted in our study.…”