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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 5

Estimated annual caseload and incidence of childhood TB after adjustment for the case detection rate, Kilifi Health and Demographic Surveillance Survey, August 2009–July 2011*

TB classification Age group, y No. cases Adjusted incidence, cases/100,000 children/y (95% CI)
Confirmed TB
0–4 20 22 (9–46)
5–9 17 22 (8–47)
10–14 6 9 (1–29)
18 (10–30)
Confirmed or highly probable TB
0–4 86 96 (65–137)
5–9 31 39 (20–71)
10–14 9 13 (3–36)
53 (38–71)
All TB 0–4 131 146 (107–196)
5–9 60 76 (47–116)
10–14 14 20 (7–48)
Total 205 86 (67–109)

*To generate the most conservative estimates of community childhood TB incidence, we used the highest case detection rate estimate of 0.35 derived from hospital-based mortality surveillance. TB, tuberculosis.

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.

Page created: February 15, 2018
Page updated: February 15, 2018
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