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Published on: August 11, 2008
The prevalence of symptoms associated with pulmonary tuberculosis in randomly selected children from a high burden
B J Marais1, C C Obihara, R P Gie
1Department of Paediatrics and Child Health, Centre for TB Research and Education (CENTRE), Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa. bjmarais@sun.ac.za
Insights
Diagnosing childhood tuberculosis is challenging. Common symptoms like cough were not reliable indicators for identifying tuberculosis in children in a high-burden community, with many diagnosed children showing no symptoms.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Childhood tuberculosis diagnosis is difficult, especially in high-burden areas.
- Symptom-based approaches are common but their effectiveness is debated.
- This study investigated symptom prevalence and diagnostic utility in a high-burden community.
Purpose of the Study:
- To determine the frequency of tuberculosis-associated symptoms in children in a high-burden setting.
- To compare symptom prevalence between children with and without tuberculosis.
- To assess the diagnostic value of symptoms for childhood tuberculosis.
Main Methods:
- A cross-sectional, community-based survey involving a random sample of households.
- Symptom questionnaires and tuberculin skin tests (TST) were administered to all children.
- Chest radiographs were obtained based on national guidelines.
Main Results:
- Out of 1415 children, 18 (1.3%) were diagnosed with tuberculosis; 451 (31.9%) were TST positive.
- Weight loss (OR=4.5) and the combination of cough and weight loss (OR=5.4) were significant indicators.
- 50% of children with newly diagnosed tuberculosis reported no symptoms.
Conclusions:
- Symptoms commonly reported by children in this high-burden community had limited ability to distinguish tuberculosis cases.
- Relying solely on symptoms can be misleading for diagnosing childhood tuberculosis.
- Enhanced case definitions and symptom characterization are crucial for improving diagnostic accuracy.
Background:
Diagnosis of childhood tuberculosis is problematic and symptom based diagnostic approaches are often promoted in high burden settings. This study aimed (i) to document the prevalence of symptoms associated with tuberculosis among randomly selected children living in a high burden community, and (ii) to compare the prevalence of these symptoms in children without tuberculosis to those in children with newly diagnosed tuberculosis.
Methods:
A cross sectional, community based survey was performed on a 15% random sample of residential addresses. A symptom based questionnaire and tuberculin skin test (TST) were completed in all children. Chest radiographs were performed according to South African National Tuberculosis Control Program guidelines.
Results:
Results were available in 1415 children of whom 451 (31.9%) were TST positive. Tuberculosis was diagnosed in 18 (1.3%) children. Of the 1397 children without tuberculosis, 253 (26.4%) reported a cough during the preceding 3 months. Comparison of individual symptoms (cough, dyspnoea, chest pain, haemoptysis, anorexia, weight loss, fatigue, fever, night sweats) in children with and without tuberculosis revealed that only weight loss differed significantly (OR = 4.5, 95% CI 1.5 to 12.3), while the combination of cough and weight loss was most significant (OR = 5.4, 95% CI 1.7 to 16.9). Children with newly diagnosed tuberculosis reported no symptoms in 50% of cases.
Conclusion:
Children from this high burden community frequently reported symptoms associated with tuberculosis. These symptoms had limited value to differentiate children diagnosed with tuberculosis from those without tuberculosis. Improved case definitions and symptom characterisation are required when evaluating the diagnostic value of symptoms.
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