Author:
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López-Varela, Elisa; Augusto, Orvalho; Gondo, Kizito; García-Basteiro, Alberto L.; Fraile, Oscar; Ira, Tasmiya; Ribo Aristizabal, Jose Luis; Bulo, Helder; Muñoz Gutiérrez, José; Aponte, John J.; Macete, Eusébio; Sacarlal, Jahit; Alonso, Pedro
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Abstract:
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BACKGROUND: Tuberculosis (TB) contributes significantly to child
morbidity and mortality. This study aimed to estimate the
minimum community-based incidence rate of TB among children
<3 years of age in Southern Mozambique. METHODS: Between
October 2011 and October 2012, in the Manhica District Health
and Demographic Surveillance System, we enrolled prospectively
all presumptive TB cases younger than 3 years of age through
passive and active case finding. Participants included all
children who were either symptomatic or were close contacts of a
notified adult smear-positive pulmonary TB. Children were
clinically evaluated at baseline and follow-up visits.
Investigation for TB disease included chest radiography, HIV and
tuberculin skin testing as well as gastric aspirate and induced
sputum sampling, which were processed for smear, culture and
mycobacterial molecular identification. RESULTS: During the
study period, 13,764 children <3 years contributed to a total
of 9575 person-year. Out of the 789 presumptive TB cases
enrolled, 13 had TB culture confirmation and 32 were probable TB
cases. The minimum community-based incidence rate of TB
(confirmed plus probable cases) was 470 of 100,000 person-year
(95% confidence interval: 343-629 of 100,000). HIV co-infection
was present in 44% of the TB cases. CONCLUSION: These data
highlight the huge burden of pediatric TB. This study provides
one of the first prospective population-based incidence data of
childhood tuberculosis and adds valuable information to the
global effort of producing better estimates, a critical step to
inform public health policy. |