• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of archdischArchives of Disease in ChildhoodVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child. Nov 2005; 90(11): 1166–1170.
PMCID: PMC1720178

The prevalence of symptoms associated with pulmonary tuberculosis in randomly selected children from a high burden community

Abstract

Background: Diagnosis of childhood tuberculosis is problematic and symptom based diagnostic approaches are often promoted in high burden settings. This study aimed (i) to document the prevalence of symptoms associated with tuberculosis among randomly selected children living in a high burden community, and (ii) to compare the prevalence of these symptoms in children without tuberculosis to those in children with newly diagnosed tuberculosis.

Methods: A cross sectional, community based survey was performed on a 15% random sample of residential addresses. A symptom based questionnaire and tuberculin skin test (TST) were completed in all children. Chest radiographs were performed according to South African National Tuberculosis Control Program guidelines.

Results: Results were available in 1415 children of whom 451 (31.9%) were TST positive. Tuberculosis was diagnosed in 18 (1.3%) children. Of the 1397 children without tuberculosis, 253 (26.4%) reported a cough during the preceding 3 months. Comparison of individual symptoms (cough, dyspnoea, chest pain, haemoptysis, anorexia, weight loss, fatigue, fever, night sweats) in children with and without tuberculosis revealed that only weight loss differed significantly (OR = 4.5, 95% CI 1.5 to 12.3), while the combination of cough and weight loss was most significant (OR = 5.4, 95% CI 1.7 to 16.9). Children with newly diagnosed tuberculosis reported no symptoms in 50% of cases.

Conclusion: Children from this high burden community frequently reported symptoms associated with tuberculosis. These symptoms had limited value to differentiate children diagnosed with tuberculosis from those without tuberculosis. Improved case definitions and symptom characterisation are required when evaluating the diagnostic value of symptoms.

Full Text

The Full Text of this article is available as a PDF (73K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Donald Peter R. Childhood tuberculosis: out of control? Curr Opin Pulm Med. 2002 May;8(3):178–182. [PubMed]
  • Walls Tony, Shingadia Delane. Global epidemiology of paediatric tuberculosis. J Infect. 2004 Jan;48(1):13–22. [PubMed]
  • Chintu Chifumbe, Mudenda Victor, Lucas Sebastian, Nunn Andrew, Lishimpi Kennedy, Maswahu Daniel, Kasolo Francis, Mwaba Peter, Bhat Ganapati, Terunuma Hiroshi, et al. Lung diseases at necropsy in African children dying from respiratory illnesses: a descriptive necropsy study. Lancet. 2002 Sep 28;360(9338):985–990. [PubMed]
  • Donald Peter R. Childhood tuberculosis: the hidden epidemic. Int J Tuberc Lung Dis. 2004 May;8(5):627–629. [PubMed]
  • Nelson LJ, Wells CD. Global epidemiology of childhood tuberculosis. Int J Tuberc Lung Dis. 2004 May;8(5):636–647. [PubMed]
  • Eamranond P, Jaramillo E. Tuberculosis in children: reassessing the need for improved diagnosis in global control strategies. Int J Tuberc Lung Dis. 2001 Jul;5(7):594–603. [PubMed]
  • Starke JR. Childhood tuberculosis. A diagnostic dilemma. Chest. 1993 Aug;104(2):329–330. [PubMed]
  • Osborne CM. The challenge of diagnosing childhood tuberculosis in a developing country. Arch Dis Child. 1995 Apr;72(4):369–374. [PMC free article] [PubMed]
  • Marais Ben J, Gie Robert P, Schaaf H Simon, Starke Jeff R, Hesseling Anneke C, Donald Peter R, Beyers Nulda. A proposed radiological classification of childhood intra-thoracic tuberculosis. Pediatr Radiol. 2004 Nov;34(11):886–894. [PubMed]
  • Marais BJ, Gie RP, Schaaf HS, Hesseling AC, Obihara CC, Starke JJ, Enarson DA, Donald PR, Beyers N. The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis. 2004 Apr;8(4):392–402. [PubMed]
  • Hesseling AC, Schaaf HS, Gie RP, Starke JR, Beyers N. A critical review of diagnostic approaches used in the diagnosis of childhood tuberculosis. Int J Tuberc Lung Dis. 2002 Dec;6(12):1038–1045. [PubMed]
  • Marais BJ, Gie RP, Schaaf HS, Hesseling AC, Obihara CC, Nelson LJ, Enarson DA, Donald PR, Beyers N. The clinical epidemiology of childhood pulmonary tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis. 2004 Mar;8(3):278–285. [PubMed]
  • Verver Suzanne, Warren Robin M, Munch Zahn, Richardson Madalene, van der Spuy Gian D, Borgdorff Martien W, Behr Marcel A, Beyers Nulda, van Helden Paul D. Proportion of tuberculosis transmission that takes place in households in a high-incidence area. Lancet. 2004 Jan 17;363(9404):212–214. [PubMed]
  • van Rie A, Beyers N, Gie RP, Kunneke M, Zietsman L, Donald PR. Childhood tuberculosis in an urban population in South Africa: burden and risk factor. Arch Dis Child. 1999 May;80(5):433–437. [PMC free article] [PubMed]
  • Shingadia Delane, Novelli Vas. Diagnosis and treatment of tuberculosis in children. Lancet Infect Dis. 2003 Oct;3(10):624–632. [PubMed]
  • Stoltz AP, Donald PR, Strebel PM, Talent JM. Criteria for the notification of childhood tuberculosis in a high-incidence area of the western Cape Province. S Afr Med J. 1990 Apr 21;77(8):385–386. [PubMed]
  • Grimes David A, Schulz Kenneth F. An overview of clinical research: the lay of the land. Lancet. 2002 Jan 5;359(9300):57–61. [PubMed]
  • Schaaf HS, Beyers N, Gie RP, Nel ED, Smuts NA, Scøtt FE, Donald PR, Fourie PB. Respiratory tuberculosis in childhood: the diagnostic value of clinical features and special investigations. Pediatr Infect Dis J. 1995 Mar;14(3):189–194. [PubMed]
  • Salazar GE, Schmitz TL, Cama R, Sheen P, Franchi LM, Centeno G, Valera C, Leyva M, Montenegro-James S, Oberhelman R, et al. Pulmonary tuberculosis in children in a developing country. Pediatrics. 2001 Aug;108(2):448–453. [PubMed]
  • Starke JR, Taylor-Watts KT. Tuberculosis in the pediatric population of Houston, Texas. Pediatrics. 1989 Jul;84(1):28–35. [PubMed]
  • GEDDE-DAHL T. Tuberculous infection in the light of tuberculin matriculation. Am J Hyg. 1952 Sep;56(2):139–214. [PubMed]
  • Delacourt C, Mani TM, Bonnerot V, de Blic J, Sayeg N, Lallemand D, Scheinmann P. Computed tomography with normal chest radiograph in tuberculous infection. Arch Dis Child. 1993 Oct;69(4):430–432. [PMC free article] [PubMed]
  • Schaaf HS, Michaelis IA, Richardson M, Booysen CN, Gie RP, Warren R, van Helden PD, Beyers N. Adult-to-child transmission of tuberculosis: household or community contact? Int J Tuberc Lung Dis. 2003 May;7(5):426–431. [PubMed]
  • Ramchandani Paul, Stein Alan, Evans Jonathan, O'Connor Thomas G. Paternal depression in the postnatal period and child development: a prospective population study. Lancet. 365(9478):2201–2205. [PubMed]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...