Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. e1646-e1652 (doi:10.1542/peds.2007-3138)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Google Scholar
Right arrow Articles by Kruk, A.
Right arrow Articles by Marais, B. J.
PubMed
Right arrow Articles by Kruk, A.
Right arrow Articles by Marais, B. J.
Related Collections
Right arrow Infectious Disease & Immunity

ARTICLE

Symptom-Based Screening of Child Tuberculosis Contacts: Improved Feasibility in Resource-Limited Settings

Alexey Kruk, MD, MSca,b, Robert P. Gie, MD, FCPc, H. Simon Schaaf, MD, MMed, PhDc and Ben J. Marais, MD, FCP, MMed, PhDb,c

a Department of Public Health, Oxford University, Oxford, United Kingdom
b Ukwanda Centre for Rural Health
c Desmond Tutu TB Centre and Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa

OBJECTIVE. National tuberculosis programs in tuberculosis-endemic countries rarely implement active tracing and screening of child tuberculosis contacts, mainly because of resource constraints. We aimed to evaluate the safety and feasibility of applying a simple symptom-based approach to screen child tuberculosis contacts for active disease.

METHODS. We conducted a prospective observational study from January through December 2004 at 3 clinics in Cape Town, South Africa. All of the children <5 years old in household contact with an adult tuberculosis source case were assessed by documenting current symptoms and tuberculin skin test and chest radiograph results.

RESULTS. During the study period, 357 adult tuberculosis cases were identified; 195 cases (54.6%) had sputum smear and/or culture positive results and were in household contact with children aged <5 years. Complete information was available for 252 of 278 children; 176 (69.8%) were asymptomatic at the time of screening. Tuberculosis treatment was administered to 33 (13.1%) of 252; 27 were categorized as radiologically "certain tuberculosis," the majority (n = 22) of which had uncomplicated hilar adenopathy. The negative predictive value of symptom-based screening varied according to the case definition used, with 95.5% including all of the children treated for tuberculosis and 97.1% including only those with radiologically "certain tuberculosis."

CONCLUSIONS. Our findings support current World Health Organization recommendations, demonstrating that symptom-based screening of child tuberculosis contacts should improve feasibility in resource-limited settings and seems to be safe.

Key Words: child • tuberculosis • symptom based • screening

Abbreviations: WHO—World Health Organization • NTP—national tuberculosis program • TST—tuberculin skin test • CXR—chest radiograph

Accepted Dec 3, 2007.