Prevalence of Pulmonary Tuberculosis among Presumptive Cases in Rivers State, Nigeria

Abstract

Background: Tuberculosis (TB) is a leading cause of death in children but it is underdiagnosed and underreported in children.
 Objective: To determine the prevalence of pulmonary TB in children among presumptive cases of TB and to compare the diagnostic efficacy of different screening tool for TB in children. 
 Materials and Methods: This study was a descriptive prospective study carried out over one year in nine general health facilities that can provide diagnosis and treatment for tuberculosis in Rivers State, Nigeria. Children aged 0 – 18 years with presumptive TB were explored. They were explored by carrying out a clinical assessment with chest radiograph, sputum or gastric aspirate for AFB microscopy and XpertMTB/RIF screening. Sociodemographic data and results of the screening tests was retrieved from their case records as well as the National Tuberculosis registers. Ethical approval for the study was obtained from the Rivers state Ministry of Health. Those with confirmed pulmonary TB were commenced on anti TB medications and followed up for at least 6months. Obtained data was analysed by SPSS version 20 and expressed as percentages, proportions and frequencies. A test of significance (chi square and t-test) was conducted between proportions and means as appropriate. In all a p value of less than 0.05 was considered significant. 
 Results: Nine hundred and sixty three patients aged 0-18 years had presumptive diagnosis of TB, 394 (40.9%) were males while 569 (59.1%) were females. The commonest presenting symptom was chronic cough which occurred in 735 (76.5%) of the patients. The prevalence of pulmonary TB was 19.1%. Significantly more males (60.9%) than female (39.1%) had confirmed tuberculosis (X2= 37.431, p-value <0.001). Significantly more children (54.3%) from the low socioeconomic class had confirmed pulmonary. Seventy two (39.1%) and 29 (15.8%) of the patients were AFB and XpertMTB/RIF positive respectively. Children aged 0-5 years were neither AFB nor XpertMTB/RIF positive. Of the children with confirmed TB, 98 (53.3%) had suggestive clinical features while 86 (46.7%) had suggestive X-ray features. More than a third (33.2%) of the children aged 0-5 years had their TB confirmed by suggestive X-rays and Clinical features. All the patients with TB were commenced on anti TB medications, 40 (21.7%) were lost to follow up (LTFU), 21 (11.4%) were transferred to other centres while 123 (66.8%) completed the treatment. 
 Conclusion: The prevalence of pulmonary TB among presumptive TB cases in this study was comparable to findings from other studies and clinical diagnosis of Pulmonary TB remains very relevant in its management. Improving the clinical skills of physicians involved in TB care and treatment and the need for community/ facility collaboration to reduce cases of LTFU is advocated.

Multidrug Resistant Tuberculosis in Children in Port Harcourt – A Worrisome Trend

“…Chronic cough was found in 75% of this study and in all patients with Pulmonary TB and this is similar to findings in other studies in children with pulmonary TB [15][16][17]. This cough is initially unproductive but with progressive inflammation and tissue necrosis becomes wet and productive of sputum.…”

“…Individuals from low social class tend to reside in densely populated areas where human traffic and contact is high and this increases TB transmission. However, TB is sometimes also found in person from high social class, so a high index of suspicion is required in all patients presenting with features in keeping with presumptive diagnosis of TB [15].…”

Adherence to Isoniazid Preventive Therapy (IPT) among Children in Close Contact with Adult Pulmonary Tuberculosis (PTB) Patients

“…This study showed that all the social class was represented but more (46.1%) of them belonged to the lower social class. This is typical of findings in other studies as tuberculosis has been described as a disease of poverty [18,22]. These individuals are more likely to live in overcrowded homes and in areas with high population density.…”

“…It was found that over half (58.7%) of the recruited TB contacts were males while 50.8% were children of the TB cases. Though these children were recruited by contact tracing, it is not surprising to find that many studies have shown more males than females as having tuberculosis [18][19][20][21]. That more of the recruited child contacts are children of TB cases emphasizes the need for active contact tracing once an adult case of TB is diagnosed as childhood TB is a reflection of adult TB pool.…”