Children are dying from tuberculosis, even though it is a disease, which can be prevented and cured. WHO estimates that up to 400.000 children a year die from TB yet children have been largely neglected in TB programmes. The reasons why children have been neglected are because they are not infectious, do not contribute to transmission of the disease and are notoriously hard to diagnose. Signs and symptoms of TB in children are non-specific and easily confused with HIV or malnutrition, which are prevalent conditions in most TB endemic areas and children do not produce sputum, so bacteriological confirmation is extremely difficult. In order to remedy this situation, research into new diagnostic tools for TB is an international research priority and research that can identify the constraints for recognition and proper diagnosis of TB in children is paramount. The overall objective of this project is to improve the means of diagnosing TB in children in settings of endemic tuberculosis and with high prevalence of malnutrition and HIV. We will achieve this by describing the current management of and assessing the constraints for TB diagnosis in children and estimating the burden of undiagnosed TB in hospital and community. We will assess the value of the current TB score chart, an improved TB score chart, which takes HIV status into account, and new immunodiagnostic tests (Quantiferon, IP-10 , and serological tests). The final goal is to develop an action plan for interventions that can improve management of childhood TB at different levels of the health sector. This is a collaborative research project between National Institute of Medical Research, The Regional and District TB coordinators, Tanga, Tanzania, and Centre for International Health, Copenhagen University. Dept of Infectious Diseases and Clinical Research Centre at Hvidovre University Hospital.
The project has described the challenges and constraints of diagnosing childhood TB in a resource limited area with endemic TB and a high prevalence of malnutrition and HIV and has assessed the performance of Quantiferon-TB Gold In-Tube, a paediatric Quantiferon tube (Quantiferon Microtube) and IP-10 for diagnosing active TB in children.
We have confirmed that children in the community with contact to adults with TB are at risk of developing TB. We have confirmed that the lack of diagnostic tools is a major obstacle for reliable diagnosis of TB in children, although lack of awareness of the burden of childhood TB, lack of specific training and appropriate guidelines as well as limited resources and poverty also present challenges for the diagnosis. The Quantiferon TB Gold In-Tube, Quantiferon Microtube and IP-10 tests could not contribute to diagnosis of childhood TB in the study population of young, severely ill TB suspect children. The tests had poor sensitivity and high inconclusive rates in children, whilst the performance in adults was good.