Raffaella Colombatti


Background and Objectives: The World Health Organization End tuberculosis (TB) Strategy, approved in 2014, aims at a 90% reduction in TB deaths and an 80% reduction in TB incidence rate by 2030. One of the suggested interventions is the systematic screening of people with suspected TB, belonging to specific risk groups. The Hospital Raoul Follereau (HRF) in Bissau, Guinea-Bissau, is the National Reference Hospital for Tuberculosis and Lung Disease of the country. We performed an active case-finding program among pediatric age family members and cohabitants of admitted adult TB patients, from January to December 2013.

Methods: Newly admitted adult patients with a diagnosis of TB were invited to bring their family members or cohabitants in childhood age for clinical evaluation in a dedicated outpatient setting within the hospital compound. All the children brought to our attention underwent medical examination and chest x-ray. In children with clinical and/or radiologic finding consistent with pulmonary TB a sputum-smear was requested.

Results: All admitted adult patients accepted to bring their children cohabitants. In total, 287 children were examined in 2013. Forty-four patients (15%) were diagnosed with TB. The number needed to screen (NNS) to detect one case of TB was 7. 35 patients (80%) had pulmonary TB; 2 of them were sputum smear-positive. No adjunctive personnel cost was necessary for the intervention.

Conclusions: children with TB represent a large proportion of the pool of undetected TB. A simple TB active case-finding program targeted to high risk groups like children households of severely ill admitted patients with TB can successfully be implemented in a country with limited resources.


Tuberculosis, Child, Diagnosis, Case finding, Bissau

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Submitted: 2017-07-10 22:24:01
Published: 2017-10-15 00:00:00
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World Helath Organization. Global Tuberculosis Report 2016. http://apps.who.int/iris/bitstream/10665/250441/1/9789241565394-eng.pdf?ua=1. Last accessed June 14th 2017

Kirigia JM, Muthuri RD. Productivity losses associated with tuberculosis deaths in the World Health Organization African region. Infect Dis Poverty. 2016;5(1):43 URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888542/pdf/40249_2016_Article_138.pdf

Barter DM, Agboola SO, Murray MB, Bärnighausen T. Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa--a systematic review. BMC Public Health. 2012;12:980. URL: https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-980

Rabna P, Ramos J, Ponce G, Sanca L, Mané M, Armada A, Machado D, Vieira F, Gomes VF, Martins E, Colombatti R, Riccardi F, Perdigão J, Sotero J, Portugal I, Couto I, Atouguia J, Rodrigues A, Viveiros M. Direct Detection by the Xpert MTB/RIF Assay and Characterization of Multi and Poly Drug-Resistant Tuberculosis in Guinea-Bissau, West Africa. PLoS One. 2015;10(5):e0127536.

URL: http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0127536&type=printable

United Nation General Assembly. Transforming our world: the 2030 Agenda for Sustainable Development Resolution A/70/L.1. http://www.un.org/ga/search/view_doc.asp?symbol=A /RES/70/1&Lang=E. Last accessed June 14th 2017

Azman AS, Golub JE, Dowdy DW. How much is tuberculosis screening worth? Estimating the value of active case finding for tuberculosis in South Africa, China, and India. BMC Med. 2014;12:216. URL: https://bmcmedicine.biomedcentral.com/track/pdf/10.1186/s12916-014-0216-0?site=bmcmedicine.biomedcentral.com

Van't Hoog AH1, Onozaki I, Lonnroth K. Choosing algorithms for TB screening: a modelling study to compare yield, predictive value and diagnostic burden. BMC Infect Dis. 2014;14:532. URL: https://bmcinfectdis.biomedcentral.com/track/pdf/10.1186/1471-2334-14-532?site=bmcinfectdis.biomedcentral.com

Seddon JA, Jenkins HE, Liu L, Cohen T, Black RE, Vos T, Becerra MC, Graham SM, Sismanidis C, Dodd PJ. Counting children with tuberculosis: why numbers matter. Int J Tuberc Lung Dis. 2015;19 Suppl 1:9-16. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708268/pdf/nihms748754.pdf

Starke JR. Improving tuberculosis care for children in high-burden settings. Pediatrics. 2014;134(4):655-7

World Health Organization. Roadmap for childhood tuberculosis: towards zero deaths. 2013. http://apps.who.int/iris/bitstream/10665/89506/1/9789241506137_eng.pdf?ua=1&ua=1. Last accessed on June 14th 2017

Central Intelligence Agency. The World Factbook. Guinea Bissau. 2016. https://www.cia.gov/library/publications/the-world-factbook/geos/pu.html. Last accessed on June 14th 2017

Colombatti R, Penazzato M, Bassani F, Vieira CS, Lourenço AA, Vieira F, Teso S, Giaquinto C, Riccardi F. Malaria prevention reduces in-hospital mortality among severely ill tuberculosis patients: a three-step intervention in Bissau, Guinea-Bissau. BMC Infect Dis. 2011;11:57. URL: https://bmcinfectdis.biomedcentral.com/track/pdf/10.1186/1471-2334-11-57?site=bmcinfectdis.biomedcentral.com

Colombatti R, Vieira CS, Bassani F, Cristofoli R, Coin A, Bertinato L, Riccardi F. Contamination of drinking water sources during the rainy season in an urban post-conflict community in Guinea Bissau: implications for sanitation priority. Afr J Med Med Sci. 2009;38(2):155-61

Colombatti R, Coin A, Bestagini P, Vieira CS, Schiavon L, Ambrosini V, Bertinato L, Zancan L, Riccardi F. A short-term intervention for the treatment of severe malnutrition in a post-conflict country: results of a survey in Guinea Bissau. Public Health Nutr. 2008;11(12):1357-64. URL: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/E607EB92A5FB993105B14C517C065A4E/S1368980008003297a.pdf/shortterm_intervention_for_the_treatment_of_severe_malnutrition_in_a_postconflict_country_results_of_a_survey_in_guinea_bissau.pdf

Vieira F, Sanha MS, Riccardi F, Colombatti R. Short term advantages of a public-private partnership for tuberculosis in Guinea bissau: reduction of mortality and increased diagnostic capacity. Mediterr J Hematol Infect Dis. 2014;6(1):e2014049. URL: http://www.mjhid.org/article/view/2014.049

Ministério da Saúde Pública Programa Nacional de Luta contra a Tuberculose. Manual de Tratamento. Bissau, Guinea Bissau. 2010. http://www.nationalplanningcycles.org/sites/default/files/country_docs/Guinea-Bissau/pndsii_2008-2017_gb.pdf. Last Accessed on June 14th 2017

Blok L, Sahu S, Creswell J, Alba S, Stevens R, Bakker MI. Comparative meta-analysis of tuberculosis contact investigation interventions in eleven high burden countries. PLoS One. 2015 Mar 26;10(3):e0119822. URL: http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0119822&type=printable

Lala SG, Little KM, Tshabangu N, Moore DP, Msandiwa R, van der Watt M, Chaisson RE, Martinson NA. Integrated Source Case Investigation for Tuberculosis (TB) and HIV in the Caregivers and Household Contacts of Hospitalised Young Children Diagnosed with TB in South Africa: An Observational Study. PLoS One. 2015;10(9):e0137518. URL: http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0137518&type=printable

Puryear S, Seropola G, Ho-Foster A, Arscott-Mills T, Mazhani L, Firth J, Goldfarb DM, Ncube R, Bisson GP, Steenhoff AP. Yield of contact tracing from pediatric tuberculosis index cases in Gaborone, Botswana. Int J Tuberc Lung Dis. 2013;17(8):1049-55. URL: http://docserver.ingentaconnect.com/deliver/connect/iuatld/10273719/v17n8/s11.pdf?expires=1499718800&id=91027656&titleid=3764&accname=Guest+User&checksum=A107FB786876E2DD517979835F95D6C6

Kwan CK, Ernst JD. HIV and tuberculosis: a deadly human syndemic. Clin Microbiol Rev. 2011;24(2):351-76. URL: http://cmr.asm.org/content/24/2/351.full.pdf+html

Morrison J, Pai M, Hopewell PC. Tuberculosis and latent tuberculosis infection in close contacts of people with pulmonary tuberculosis in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2008;8(6):359-68. URL: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(08)70071-9/fulltext

Karki B, Kittel G, Bolokon I Jr, Duke T. Active Community-Based Case Finding for Tuberculosis With Limited Resources. Asia Pac J Public Health. 2017;29(1):17-27. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349312/pdf/10.1177_1010539516683497.pdf

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