Tracing contacts of people confirmed to be sick with tuberculosis and making preventive treatment available to those at risk for the disease, could halve current numbers of TB cases among children in resource limited settings, according to researchers reporting a study of patients across a Kenya rural province.
Both of those steps are recommended by the World Health Organization, and were included in Kenya’s national tuberculosis program guidelines at the time of the study, but preventive isoniazid treatment was not available at all at the time the study was conducted, and contact tracing was infrequent. Also commonly missing is a realistic estimate of incidence of tuberculosis among children, of what percentage of those cases are detected, an assessment of the factors creating the greatest risks, and the need for preventive services the authors note.
Researchers followed case detection outcomes stemming from intensified efforts at two rural hospitals in a Kenya health district, with diagnostic testing of all children under 15 years of age with symptoms suggesting tuberculosis if another illness causing the symptoms had not been confirmed, and for all children under five sharing a household with a person confirmed to have pulmonary tuberculosis.
Researchers followed findings from more than 2,000 children with suspected tuberculosis, but also calculated that a significant number of children were never taken to either hospital. Their estimates of 53 cases of tuberculosis per 100,000 children per year locally were conservative, according to their report in the U.S. Centers for Disease Control and Prevention’s Emerging Infectious Diseases Journal, and is relatively low in comparison to other estimates. But the finding that more than half of the cases among children were attributable to a household member confirmed and known to have tuberculosis, indicates the importance of contact tracing and for access to preventive treatment, they wrote.