Prevalence of Tuberculosis in BCG vaccinated children among the TB patients attending the TB clinic at Children’s Emergency Hospital (CEH) Khartoum

Abstract

The current global strategy for control of Tuberculosis, Directly Observed Treatment Short Course (DOTS) focuses primarily on identifying and treating infectious adults. Because children with TB are not usually infectious to others, rarely produce smear positive sputum and pose less risk to the community, they are not always identified and treated. This is a misconception, as children represent the cornerstone of development of any nation and they also represent the next generation for TB spread if untreated. This hospital –based cross sectional (prevalence) study included 357children suffering from Tuberculosis, whether old or new in the age group 0-15 years irrespective of their BCG vaccination status. It was conducted at the TB clinic at Children's Emergency Hospital (CEH) Khartoum over a period of one year from February 2001. The objectives of the study were to determine TB prevalence and clinical features in BCG vaccinated and non BCG vaccinated children among TB patients attending (CEH) TB clinic. It was also intended to elucidate the following factors among the study population including nutritional and socioeconomic status, the index case in the development of tuberculosis, the BCG scar size in relation to the development of TB and the treatment regimens prescribed, the defaulter rate and the treatment outcome. The age of the study population ranged from 2 months to 15 years, with a mean age of 6.8 ±4.2 years. Most patients 88% were from low socioeconomic class. Only 5% of patients had their weight appropriate for their age and sex. History of contact with a tuberculous adult was reported by 53%, parents were index cases in 40.4%. From the study 83% of patients were BCG vaccinated and BCG scar was detected in 67% of vaccinated children. A scar of 5-7mm which is an optimal scar size was detected in 41%. The prevalence of tuberculosis in BCG vaccinated children among the TB patients attending the TB Clinic at (CEH) Khartoum was 83% . The main presenting symptoms were fever, weight loss, cough and sweating occurring in 78.9%, 75.6%, 67.8% and 50.7% respectively. There was no statistical significant difference between vaccinated and non vaccinated patients with regard to the afro mentioned symptoms. Most patients 64% had symptoms for more than 4 weeks. Clinical chest finding were detected in 11.5% and there was no statistical significant difference between vaccinated and non vaccinated patients with regard to chest finding. Radiological changes consistent with TB were detected in 84.3% with no statistical significant differences between those vaccinated and non vaccinated. ESR of more than 100mm/hr was only found in 19% of patients. Most patients were treated by short course chemotherapy and cure was achieved by 7.28%, good response in 83.7% and the defaulter were 5.88%. The commonest pattern of TB in vaccinated and non vaccinated patients was pulmonary TB 75.1% and 59% respectively, while the commonest extrapulmonary type was TB lymphadenitis in vaccinated and non vaccinated patients of 17% and 30% respectively, with no statistical significant difference for both types of tuberculosis.