Paediatric tuberculosis in timor-leste: Opportunities for improving recognition, diagnosis and prevention

Abstract

Introduction/Aim: Timor-Leste has the highest incidence of TB in Southeast Asia but a relatively low rate of paediatric notifications. Bairo Pite Clinic (BPC) in Dili manages more than a fifth of all TB cases in the country. Improved understanding of TB epidemiology in Timor-Leste will inform quality improvement activities focused on recognition, accurate diagnosis and prevention of TB in children. We aimed to describe the epidemiology and diagnostic features of notified paediatric TB cases at BPC and to compare this to national paediatric TB notification rates. Methods: Prospective collection of demographic, clinical and laboratory data for all patients diagnosed with TB at BPC between January 2014 and December 2014 inclusive. Comparison is made with national notification data with respect to paediatric notification rates. Results: In total, 4090 TB cases were notified. Of these, 426 (10%) were children aged <15y. BPC notified 886 cases, of which 110 (12%) were aged <15y. Contact with a known TB case was reported in 43/110 (39%) BPC cases; 15 (14%) were identified through screening household contacts of infectious index cases. Evidence of BCG vaccination was documented in 36/110 (33%). Malnutrition was identified in 39/110 (35%); HIV in 2/110 (2%). Pulmonary TB was diagnosed in 78/110 (71%) BPC cases and 318/426 (75%) paediatric cases nationally. Bacteriological confirmation occurred in 5/78 (6%) pulmonary cases at BPC and 36/318 (11%) cases nationally. In districts other than Dili and Baucau, 29/131 (22%) paediatric pulmonary TB cases were sputum smear positive. Conclusion: Paediatric TB is common in high TB burden settings such as Timor-Leste but is under-recognised. Malnutrition is an important risk factor; HIV co-infection is rare. Opportunities for prevention include improved BCG coverage and implementation of household contact tracing. Consideration should be given to improved specimen collection and strategic use of PCR to improve diagnostic certainty.L6178409362017-08-23 <br />