Identifying children with tuberculosis among household contacts in The Gambia

Our recent study which sought to identify co-prevalent tuberculosis (TB) among child contacts of adults with smear-positive TB in the greater Banjul area of The Gambia show that in our community setting, if contact tracing is restricted to symptom screening and immediate households only, nearly half of all co-prevalent TB disease in child contacts would be missed.

child contacts being screen for TB symptoms

Child being screen for symptoms of TB

The research was conducted by MRC Unit The Gambia (MRCG), within the greater Banjul area in The Gambia, led by Dr Uzochukwu Egere, Clinician and Coordinator of childhood TB Program, Vaccines & Immunity Theme, who is the first author of this publication. Funded by TB Reach Initiative and the MRC Programme Grant of Prof Beate Kampmann the findings were published in International Journal of Tuberculosis and Lung Disease.

In this study, child contacts aged <15 years in the immediate household and compound were prospectively enrolled and evaluated for TB disease using screening questionnaires and the tuberculin skin test (TST). Symptomatic and/or TST-positive (10 mm) contacts were further investigated.

Findings show that of 4042 child contacts who underwent symptom screening and TST, 3339 (82.6%) were diagnosed as TB-exposed but not infected, 639 (15.8%) were latently infected and 64 (1.6%) had co-prevalent TB. Of the 64 TB cases, 50 (78.1%) were from within the immediate household of the index case, and 14 (21.9%) from within the same compound. Of the 27 asymptomatic but TST-positive children diagnosed with TB, 7 were microbiologically confirmed. The median age of the TB cases was 4.4 years (interquartile range 1.9–6.9); 53.1% were aged <5 years. Of the 4042 child contacts, 206 (5%) slept in the same bed as the index case; 28.1% of all TB cases occurred in this group. Symptom screening alone would have detected only 57.8% of the co-prevalent cases.

Dr Uzochukwu Egere, Clinician and Coordinator of childhood TB Program, Vaccines & Immunity Theme

Dr Uzochukwu Egere, Clinician and Coordinator of childhood TB Program, Vaccines & Immunity Theme

Commenting on the research findings, Dr Uzochukwu Egere said, “Children with TB have so often been overlooked in high TB burden settings such as The Gambia due to resource constraints and several operational barriers. Our work has provided a major insight into the actual burden of TB in children in The Gambia and is now guiding a programmatic implementation of contact tracing and isoniazid prophylaxis in the country. It represents an important reference for childhood TB in the sub-region and beyond as well as has contributed critical data towards the current global drive to bring childhood TB to the front burner where it belongs.”

 

 

 
Read more about the study finding on http://www.ingentaconnect.com/contentone/iuatld/ijtld/2017/00000021/00000001/art00010