Prospective cohort study of the feasibility and yield of household child tuberculosis contact screening in Uganda

Abstract

Setting: Screening and isoniazid preventive therapy (IPT) of child contacts of tuberculosis (TB) patients is poorly implemented in resource-limited countries, in part due to difficulties in TB diagnosis in children. Objective: To assess the feasibility and yield of hospital-based screening and IPT in Uganda, and to evaluate the utility of symptom-based screening. DESIGN: Household child (age ,5 years) contacts of adults with pulmonary TB were assessed for TB or latent tuberculous infection (LTBI). Children classified as ‘LTBI’ or ‘uninfected’ were prescribed IPT and followed for 9 months. Screening algorithms based on combinations of symptoms associated with TB were constructed post hoc, and their performance evaluated against a radiological-based reference standard. Results: Of 281 contacts (median age 33 months), 44 (15.7%) started anti-tuberculosis treatment and 234 (83.3%) received IPT, 80.3% of whom completed a 6month course. After adjustment for age and human immunodeficiency virus status, cough (aOR 4.10, 95%CI 1.39–12.11) and reduced playfulness (aOR 7.79, 95%CI 2.12–25.18) were associated with radiological TB. Screening based on cough or reduced playfulness had a sensitivity of 81.8% and a negative predictive value of 97.6%. Conclusion: Hospital-based screening appears to be feasible, and confirms the potential utility of symptom based screening to select children for IPT and those for further investigations