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Volume 24, Number 3—March 2018

Prospective Observational Study of Incidence and Preventable Burden of Childhood Tuberculosis, Kenya

Andrew J. BrentComments to Author , Christopher Nyundo, Joyce Langat, Caroline Mulunda, Joshua Wambua, Evasius Bauni, Joyce Sande, Kate Park, Thomas N. Williams, Charles R.J. Newton, Michael Levin, J. Anthony G. Scott, on behalf of the KIDS TB Study Group
Author affiliations: KEMRI–Wellcome Trust Research Programme, Kilifi, Kenya (A.J. Brent, C. Nyundo, J. Langat, C. Mulunda, J. Wambua, E. Bauni, T.N. Williams, C.R.J. Newton, J.A.G. Scott); Oxford University Hospitals NHS Foundation Trust, Oxford, UK (A.J. Brent, K. Park); University of Oxford, Oxford (A.J. Brent, C.R.J. Newton, J.A.G. Scott); Imperial College London, London, UK (A.J. Brent, M. Levin); Aga Khan University, Nairobi, Kenya (J. Sande); London School of Hygiene and Tropical Medicine, London (J.A.G. Scott)

Main Article

Table 3

Incidence of childhood TB derived by applying other published clinical definitions, algorithms, and guidelines, in order of increasing incidence, Kilifi Health and Demographic Surveillance Survey, Kenya, August 2009–July 2011*

Author, year (reference) Outcomes defined No. cases Incidence, cases/100,000 children/y (95% CI)†
WHO, 2006 (27) (a) Strongly suggestive of TB‡ 7 2.9 (1.2–6.0)
Stegen (28) (a) Probable TB 18 7.5 (4.5–11.9)
Nair (29) (a) “TB appears unquestionable” 28 11.7 (7.8–17.0)
WHO, 2006 (27) (b) Requires investigation for TB‡ 33 13.8 (9.5–19.4)
Graham (26) Probable TB 42 17.6 (12.7–23.8)
Hawkridge (30) Probable TB 54 22.6 (17.0–29.5)
Nair (29) (b) TB probable or “unquestionable” 55 23.0 (17.4–30.0)
Stoltz (31) Probable TB 73 30.6 (24.0–38.5)
Jeena (32) Probable TB 107 44.8 (36.7–54.2)
Edwards (33) Criteria for TB treatment 110 46.1 (37.9–55.5)
Ghidey (34) (a) Criteria for TB treatment§ 113 47.3 (39.0–56.9)
WHO, 1983 (35) Probable TB 116 48.6 (40.2–58.3)
Ramachandran (36) Criteria for TB treatment 118 49.4 (40.9–59.2)
Ghidey (34) (b) Criteria for TB treatment§ 130 54.5 (45.4–64.7)
Stegen (28) (b) Probable or possible TB 136 57.0 (47.8–67.4)
Graham (26) Probable or possible TB 145 60.7 (51.3–71.5)
Osborne (37) Probable TB 159 66.6 (56.7–77.8)
Fourie (38) High probability of TB¶ 162 67.9 (57.8–79.2)
Cundall (39) Probable TB 207 86.7 (75.3–99.4)
Kiwanuka (40) Probable TB 219 91.7 (80.0–104.7)

*TB, tuberculosis; WHO, World Health Organization.
†Denominator for incidence calculations is the total person-years observation among children age <15 y (N = 238,746).
‡Results shown separately for (a) children whose clinical features “strongly suggest a diagnosis of TB” according to the guidelines, and (b) using broader criteria that included under “physical signs highly suggestive of TB” all the other “suggestive clinical signs” listed as requiring investigation for TB.
§Results for Ghidey and Habte tool (34) shown using both (a) >3 and (b) >2 signs and symptoms to define a “suggestive symptom complex of TB” (online Technical Appendix Table 1,
¶For the purposes of our analyses, we used “score 2” proposed by Fourie et al (38), which was derived in high TB burden settings in South Africa, Madagascar, and Nicaragua.

Main Article

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Main Article

1The following members of the Kilifi Improving Diagnosis and Surveillance of Childhood TB (KIDS TB) Study Group also contributed to patient recruitment, investigation, and management: Victor Bandika, Jay Berkley, Kath Maitland, Susan Morpeth, Daisy Mugo, Robert Musyimi, Agnes Mutiso, John Paul Odhiambo, Monica Toroitich, and Hemed Twahir.

Prospective data on childhood tuberculosis (TB) incidence and case detection rates (CDRs) are scant, and the preventable burden of childhood TB has not been measured in prospective studies. We investigated 2,042 children (<15 years of age) with suspected TB by using enhanced surveillance and linked hospital, demographic, notification, and verbal autopsy data to estimate the incidence, CDR, risk factors, and preventable burden of TB among children in Kenya. Estimated TB incidence was 53 cases/100,000 children/year locally and 95 cases/100,000 children/year nationally. The estimated CDR was 0.20–0.35. Among children <5 years of age, 49% of cases were attributable to a known household contact with TB. This study provides much needed empiric data on TB CDRs in children to inform national and global incidence estimates. Moreover, our findings indicate that nearly half of TB cases in young children might be prevented by implementing existing guidelines for TB contact tracing and chemoprophylaxis.

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