Tuberculosis contact investigation and short-course preventive therapy among young children in Africa
OBJECTIVE: To demonstrate the feasibility and document the effectiveness of household contact investigation and preventive therapy in resource-limited settings.
DESIGN: Children under 5 years living at home with adults with bacteriologically confirmed pulmonary tuberculosis (TB) were screened using questionnaire, clinical examination, tuberculin skin test and chest X-ray. Children free of active TB were offered preventive treatment with a 3-month rifampicin-isoniazid (3RH) or 6-month isoniazid (6H) regimen in Benin. Children were followed-up monthly during treatment, then quarterly over 1 year. Costs of transportation, phone contacts and chest X-rays were covered.
RESULTS: A total of 1965 children were enrolled, of whom 56 (2.8%) had prevalent TB at inclusion. Among the 1909 children free of TB, 1745 (91%) started preventive therapy, 1642 (94%) of whom completed treatment. Mild adverse reactions, mostly gastrointestinal, were reported in 2% of children. One case of incident TB, possibly due to a late TB infection, was reported after completing the 3RH regimen.
CONCLUSION: Contact investigation and preventive therapy were successfully implemented in these resource-limited urban settings in programmatic conditions with few additional resources. The 3RH regimen is a valuable alternative to 6H for preventing TB.
Document Type: Research Article
Affiliations: 1: International Union Against Tuberculosis and Lung Disease, Paris 2: International Union Against Tuberculosis and Lung Disease, Paris, école Nationale de Formation des Techniciens Supérieurs en Santé Publique et en Surveillance Epidémiologique, Université de Parakou, Parakou 3: National Tuberculosis Program, Cotonou, Benin 4: National Tuberculosis Program, Ouagadougou, Burkina Faso 5: National Tuberculosis Program, Yaoundé, Cameroon 6: Complexe pédiatrique, Bangui, Central African Republic 7: Centre Hospitalier Universitaire Necker-Enfants Malades, Paris, France 8: United Nations Childrens' Fund, New York, NY, USA 9: International Union Against Tuberculosis and Lung Disease, Paris, University of Melbourne and Burnet Institute, Melbourne, Australia 10: Département de Santé publique, Canton de Vaud, Lausanne, Switzerland 11: UMI TransVIHMI, Institut de Recherche pour le Développement, Montpellier, France
Publication date: April 1, 2020
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 lung health world-wide.
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