Authors: Marais, B.J.¹; Obihara, C.C.¹; Warren, R.M.²; Schaaf, H.S.¹; Gie, R.P.¹; Donald, P.R.¹

Source: The International Journal of Tuberculosis and Lung Disease, Volume 9, Number 12, December 2005 , pp. 1305-1313(9)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

The burden of childhood tuberculosis (TB) reflects recent transmission within a community and the level of TB control achieved within the adult (maintenance host) population. Children contribute little to the maintenance of the TB epidemic, but they may suffer severe TB-related morbidity and mortality. This review describes the main determinants of the burden of childhood TB within a particular community.

Basic infectious disease principles identify the community, and not the individual, as the central entity that sustains an epidemic. The prevalence of TB is determined by the community's exposure to Mycobacterium tuberculosis, and their vulnerability to developing disease following exposure. The main variables that influence both exposure and vulnerability are discussed. Multiple variables are linked to poverty, and it is their cumulative effect, rather than the exact degree of poverty, that seems most important.

Diligent contact tracing and the use of preventive chemotherapy will reduce the TB-related suffering of children. The burden of childhood TB, however, is a reflection of our ability to control the epidemic; this remains the ultimate challenge. Current efforts to control the TB epidemic aim to reduce transmission by treating sputum smear-positive adults, while very little emphasis is placed on reducing the vulnerability of high-burden communities. Successful control of the epidemic is the most effective way to reduce the burden of childhood TB, but this will require a holistic approach that acknowledges the importance of sustainable poverty alleviation.

Keywords: childhood tuberculosis; burden; prevalence; exposure; vulnerability

Document Type: Review article

Affiliations: 1: Center for TB Research and Education and the Department of Paediatrics and Child Health, Tygerberg Children's Hospital and the Faculty of Health Sciences, Tygerberg, South Africa 2: Medical Research Council (MRC) Centre for Molecular and Cellular Biology, Department of Medical Biochemistry, Stellenbosch University, Tygerberg, South Africa

Publication date: 2005-12-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

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