Diagnosis and management of childhood tuberculosis in public health clinics in a rural area in the Philippines: Results from a community surveillance

Abstract

Background. Childhood tuberculosis (TB) remains a significant health problem worldwide despite the increase on its emphasis in national health programs. Objective. This study aimed to describe how TB in children is identified and managed in a routine TB program in a rural setting in a high-burden country. Methods. This is a prospective, community-based surveillance study in public rural clinics in the Philippines. Observations on case finding and management of TB in children as well as contact tracing in an existing TB program are described. Results. Out of 266 children with presumptive TB, 41 (15.4%) were cases of TB, 15 (5.6%) had latent TB infection (LTBI), 81 (30.5%) had TB exposure, and 129 (48.5%) had no TB. There were 37 (90%) TB cases who were clinically diagnosed. Ninety-three per cent (93%) of children with TB disease were cured or completed treatment. Among 25 children targeted for isoniazid preventive therapy (IPT) for LTBI and TB exposure, only 12 (52%) completed the recommended 6 months of IPT. Only 40 (43%) children aged 0 to 4 years exposed to smear-positive TB cases were screened. Conclusion. Barriers in the diagnosis, low IPT completion and problems in contact tracing may hinder successful implementation of TB programs for children.