Ann. Pak. Inst. Med. Sci. 2010; 6(1): 50-54
Objective: To determine the frequency of known risk factors in confirmed cases of tuberculosis in children.
Study Design: Cross sectional study
Methodology: Children between 2 and 144 months with confirmed tuberculosis were enrolled in the study from outpatient and inpatient departments. Detailed information was taken regarding, history of contact, history of measles or whooping cough, house hold size, people sleeping in a room, socioeconomic and education status of parents, history of steroid use and urban & rural dwelling. Patients were examined for BCG scar and nutritional status.
Place and Duration: It was done at the Children Hospital Pakistan Institute of Medical Sciences, Islamabad from August 2006 to May 2007.
Materials and Methods: Children between 2 and 144 months with confirmed tuberculosis were enrolled in the study from outpatient and inpatient departments. Detailed information was taken regarding, history of contact, history of measles or whooping cough, house hold size, people sleeping in a room, socioeconomic and education status of parents, history of steroid use and urban & rural dwelling. Patients were examined for BCG scar and nutritional status.
Results: A total of 200 patients were evaluated. The mean age was 80 months, 160 (80%) patients had history of contact with TB case and 129 (69.5%) had no BCG scar. Illiteracy was found in 133 (66.5%) mothers and 73 (36.5%) fathers. One hundred and twenty three (61.5%) patients were residents of rural area and 102 (51.0%) belonged to poor background (income < Rs. 3000/month). One hundred three (51.5%) patients belonged to families where 5 or more people live in one room. Only 1% of patients belong to such families where 2 persons live in one room. One hundred (50%) children had grade III malnutrition, 48 (24.0%) had grade II malnutrition while 30 (15.0%) had grade I malnutrition. Out of total 200 cases, 27 (13.5%) had history of long term use of steroids, 86 (43.0%) had history of measles in near past while there was no history of whooping cough in any of patients.
Conclusion: Adult with TB disease spread TB to children. Family education especially the maternal education and vaccination with BCG are the two most important factors in preventing tuberculosis in children. Malnutrition, measles and steroid therapy are three important risk factors for development of tuberculosis in children.
Keywords: Risk factors, tuberculosis, children
Introduction
Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide1. Accurate global burden of childhood TB epidemic is scarce2,3, but of the estimated 8.3 million new cases of TB reported globally in 2000, 11% were children.3- 5 However, the prevalence of TB varies greatly between countries and 75% of all diseased children reside in 22 high burden countries2,5, Pakistan being one of the high burden countries for TB. In Pakistan approximately 5.7 million people suffer from TB6, with 260000 new cases occurring every year.7 The exact proportion of children with TB in Pakistan is unknown8. Overall the estimated proportion of children with TB is 3 to 13% of all TB cases.9, 10 Only 5-10% of all infected children will acquire the disease.8, 10
Majority of these infected children 80-90% will however add to the pool of people from whom future adult cases of TB will arise.8, 10
The basic cause of infection and disease caused by Mycobacterium tuberculosis and the ways of diagnosis and management of TB are the same for children and adults.11 TB is mainly spread via tiny aerosol droplets produced almost by an infectious source case. 5 Although children and adults are at equal risk to develop TB infection when exposed to a person with infectious TB, the children are substantially at greater risk for developing TB diseases especially miliary TB and tuberculosis meningitis.11
Factors that determine the risk of TB infection are more or less the same for children and adults.12 The risk of infection following exposure depends on the severity of infectiousness of the source case together with the proximity and duration of contact5. The risk of progress to disease following primary infection is highest in very young children (less than 2 years).13, 14 The risk is lowest in immune competent children aged 3-10 years but increases again if children develop primary infection after 10 years of age.13, 14 Other important risk factors are; use of immunosuppressive drugs15, lack of BCG vaccination16,17, severe malnutrition17, overcrowding18 and measles.1
Since TB is a very common disease in Pakistan and children represent a large proportion of the pool from which cases will arise in the future. Moreover, there are limited data on the risk of infection in child population in developing countries, so knowledge about the risk of TB in children is of prime importance to evaluate the transmission of the infection in the community and to adapt TB control activities.
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