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Number Needed to Screen for Tuberculosis Disease Among Children: A Systematic Review

Katherine O Robsky1, Lelia H Chaisson2, Fahd Naufal3

  • 1Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.

Pediatrics
|March 29, 2023
PubMed

Insights

Improving pediatric tuberculosis (TB) detection is crucial. Screening children in healthcare settings, particularly outpatient, offers the best opportunity for active case finding (ACF) and reducing childhood TB burden.

Area of Science:

  • Pediatric infectious diseases
  • Public health
  • Epidemiology

Background:

  • Pediatric tuberculosis (TB) detection requires improvement to reduce child morbidity and mortality.
  • Active case finding (ACF) strategies are essential for identifying children with TB.

Approach:

  • A systematic review was conducted to estimate the number of children needed to screen (NNS) for TB detection.
  • Searched 4 databases (PubMed, Embase, Scopus, Cochrane Library) from Nov 2010 to Feb 2020.
  • Included 31 studies on TB ACF in children (<15 years) using symptom-based screening, clinical indicators, chest x-ray, and Xpert.

Key Points:

  • Symptom-based screening was most common (NNS: 257).
  • Lower NNS observed in inpatient (216) and outpatient (67) settings compared to community (1117) and school (464) settings.
  • Risk of bias was low across included studies.

Conclusions:

  • Screening children in healthcare settings presents an opportunity for increased TB detection.
  • Pediatric TB case finding interventions should integrate evidence-based practices and local context.
  • Heterogeneity in screening methods and populations necessitates careful interpretation of findings.
Abstract

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