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Published on: April 5, 2017
Two methods for setting child-focused tuberculosis care targets
C M Yuen1, H E Jenkins2, R Chang3
1Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA ; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Tuberculosis (TB) programs can estimate child contacts needing care using two new methods. These methods utilize available data to set targets for evaluating and treating children exposed to TB.
Area of Science:
- Public Health
- Epidemiology
- Global Health
Background:
- Tuberculosis (TB) programs require accurate estimates of child contacts needing care for effective resource allocation.
- Household contact investigations are crucial for controlling TB transmission.
Purpose of the Study:
- To develop and validate methods for estimating the annual number of child contacts (aged 0-14 years) requiring TB evaluation and treatment.
- To provide tools for TB programs to set programmatic targets for child contact management.
Main Methods:
- Developed two distinct methods for estimating child contacts requiring TB care.
- Method 1: Utilizes local data and simple formulas for estimation.
- Method 2: Employs a linear regression model using Demographic and Health Survey and World Bank data, combined with TB case notifications and risk estimates.
Main Results:
- Method 1 application in Malawi estimated ~21,000 child contacts annually needing evaluation and ~1900 TB diagnoses.
- Globally, Method 2 estimated over 2.4 million children under 5 and 5 million aged 5-14 live with adult TB patients.
- Projected TB cases among these child contacts: ~239,000 (<5 years) and ~419,000 (5-14 years), with millions more infected.
Conclusions:
- Available data can be effectively used to establish programmatic targets for TB evaluation and treatment in child contacts.
- The developed methods offer feasible approaches to improve care for children exposed to TB.
Objective:
To allocate resources for household contact investigations, tuberculosis (TB) programs need estimates of the numbers of child contacts requiring care.
Design:
We developed two methods to estimate annual numbers of child contacts aged 0-14 years requiring evaluation and treatment. Method 1 combines local data using simple formulas. Using publicly available data, Method 2 uses a linear regression model based on Demographic and Health Survey and World Bank data to estimate the number of children per household, then combines these results with case notifications and risk estimates of disease and infection.
Results:
Applying Method 1 to data from Malawi indicated that every year ~21 000 child contacts require evaluation and ~1900 should be diagnosed with TB. Applying Method 2 to all countries suggested that, globally, 2.41 million (95% uncertainty interval [UI] 2.36-2.46) children aged <5 years, and 5.07 million (95%UI 4.81-5.34) children aged 5-14 years live in households of adult patients with known TB. Of these, 239 014 (95%UI 118 649-478581) and 419 816 (95%UI 140600-1 268805), respectively, will have TB. An additional 848 453 (95%UI 705838-1 017551) and 2660 885 (95%UI 2080517-3 413 189), respectively, will be infected.
Conclusion:
It is feasible to use available data to set programmatic evaluation and treatment targets to improve care for child contacts of patients with TB.
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