Abstract
BackgroundThe study was conducted at a high TB-HIV burden primary health community clinic in Cape Town, South Africa. We describe the management of children under five years of age in household contact with a smear and/or culture-positive adult TB case.MethodsThis study was a record review of routinely-collected programme data.ResultsA total of 1094 adult TB case folders were reviewed. From all identified contacts, 149 children should have received IPT based on local guidelines; in only 2/149 IPT was initiated. Management of child contacts of sputum smear and/or culture-positive compared to sputum-negative TB patients were similar.ConclusionsIPT delivery to children remains an operational challenge, especially in high TB-HIV burden communities. A tool to improve IPT management and targeting sputum smear and/or culture-positive TB child contacts may overcome some of these challenges and should be developed and piloted in such settings.
Highlights
The study was conducted at a high TB-HIV burden primary health community clinic in Cape Town, South Africa
The risk of developing TB in children can be substantially reduced by administration of Isoniazid Preventive Therapy (IPT) in those infected with Mycobacterium tuberculosis (M.tb)[3,4]
Active contact tracing through home visits by clinic personnel is not routinely recommended by the South Africa National TB Programme (SANTP); rather, guidelines recommend that children under five years of age who are in close contact with an adult TB case, should be identified, invited to the clinic for TB screening and initiate IPT once active TB disease is excluded
Summary
The study was conducted at a high TB-HIV burden primary health community clinic in Cape Town, South Africa. South Africa has an estimated tuberculosis (TB) incidence rate ranking first in the world and has one of the highest reported childhood TB rates [1,2]. The estimated incidence of childhood TB in the Western Cape Province of South Africa was 620/100 000/year in 2007 [unpublished data, Western Cape Department of Health]. The risk of developing TB in children can be substantially reduced by administration of Isoniazid Preventive Therapy (IPT) in those infected with Mycobacterium tuberculosis (M.tb)[3,4]. Children in high TB-burden settings are frequently exposed to cases with infectious TB at home, leading to infection with M.tb at a young age. The risk of developing TB is the highest in children under five years of age [5,6,7]. Based on the high risk of disease progression and efficacy of post-exposure prophylaxis, IPT is recommended by the World
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