High caseload of childhood tuberculosis in hospitals on Java Island, Indonesia: a cross sectional study.

Trisasi Lestari,Anna-Karin Hurtig,Adi Utarini,Ari Probandari

doi:10.1186/1471-2458-11-784

Abstract

BackgroundChildhood tuberculosis (TB) has been neglected in the fight against TB. Despite implementation of Directly Observed Treatment Shortcourse (DOTS) program in public and private hospitals in Indonesia since 2000, the burden of childhood TB in hospitals was largely unknown. The goals of this study were to document the caseload and types of childhood TB in the 0-4 and 5-14 year age groups diagnosed in DOTS hospitals on Java Island, Indonesia.MethodsCross-sectional study of TB cases recorded in inpatient and outpatient registers of 32 hospitals. Cases were analyzed by hospital characteristics, age groups, and types of TB. The number of cases reported in the outpatient unit was compared with that recorded in the TB register.ResultsOf 5,877 TB cases in the inpatient unit and 15,694 in the outpatient unit, 11% (648) and 27% (4,173) respectively were children. Most of the childhood TB cases were under five years old (56% and 53% in the inpatient and outpatient clinics respectively). The proportion of smear positive TB was twice as high in the inpatient compared to the outpatient units (15.6% vs 8.1%). Extra-pulmonary TB accounted for 15% and 6% of TB cases in inpatient and outpatient clinics respectively. Among children recorded in hospitals only 1.6% were reported to the National TB Program.ConclusionIn response to the high caseload and gross under-reporting of childhood TB cases, the National TB Program should give higher priority for childhood TB case management in designated DOTS hospitals. In addition, an international guidance on childhood TB recording and reporting and improved diagnostics and standardized classification is required

Highlights

Childhood tuberculosis (TB) has been neglected in the fight against TB
Similar to other high burden countries, Indonesia faces challenges in capturing childhood TB cases to be treated under the National TB Program (NTP)
The goals of this study were to document the caseload and types of childhood TB in the 0-4 and 5-14 year age groups diagnosed in Directly Observed Treatment Shortcourse (DOTS) hospitals on Java Island, Indonesia

Summary

Introduction

Childhood tuberculosis (TB) has been neglected in the fight against TB. Despite implementation of Directly Observed Treatment Shortcourse (DOTS) program in public and private hospitals in Indonesia since 2000, the burden of childhood TB in hospitals was largely unknown. Childhood tuberculosis (TB) has been neglected in the global efforts to control TB, [1,2] because it is considered to be rarely contagious and difficult to diagnose. The WHO estimated that 11% of all new TB cases diagnosed in 2000 were children [5]. Similar to other high burden countries, Indonesia faces challenges in capturing childhood TB cases to be treated under the National TB Program (NTP). The scoring chart comprises history of contact with a smear sputum positive case, positive tuberculin skin test (TST), weight, fever, cough, lymph enlargement, bone and joint enlargements, and suggestive chest X-ray [10]. The sensitivity and specificity of the Indonesian scoring chart have not been validated and the cost for TST test is still high and only available at hospitals and chest clinics

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