Diagnosis of childhood tuberculosis in Malawi: an audit of hospital practice


Weismuller, MM; Graham, SM; Claessens, NJM; Meijnen, S; Salaniponi, FM; Harries, AD; (2002) Diagnosis of childhood tuberculosis in Malawi: an audit of hospital practice. The international journal of tuberculosis and lung disease, 6 (5). pp. 432-8. ISSN 1027-3719

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Abstract

SETTING: All 44 non-private hospitals in Malawi that register and treat children with tuberculosis (TB). OBJECTIVE: To determine 1) clinical features and diagnostic practices in children registered with TB, and 2) the use of the WHO score chart in diagnosis. DESIGN: A cross-sectional study of all children aged 14 years or below in hospital receiving anti-tuberculosis treatment, using reviews of treatment cards, case files and chest X-rays and performing a clinical assessment. RESULTS: There were 150 children, 98 with pulmonary TB (PTB) and 52 with extra-pulmonary TB (EPTB). The median duration of illness was 8 weeks. Most patients had fever, no response to anti-malarial treatment and antibiotics, and 40% had a family history of TB. Nearly 45% had weight for age <60%. Diagnosis was mainly based on clinical features and radiography, with less than 10% having tuberculin skin tests or HIV serology, and very few having other sophisticated investigations. A WHO diagnostic score chart was used in 13 (9%) patients by hospital staff. An independent assessment by the study team found that 61% of patients had a score of 7 or more; this was higher in EPTB than PTB patients. CONCLUSION: Diagnostic practices in children with TB in Malawi are poor, and improvements should be made.

Item Type: Article
Keywords: Adolescent, Age Factors, Antitubercular Agents, Child, Child, Preschool, Cross-Sectional Studies, Female, Hospitals, Humans, Infant, Malawi, Male, Medical Audit, Physician's Practice Patterns, Tuberculosis, Adolescent, Age Factors, Antitubercular Agents, therapeutic use, Child, Child, Preschool, Cross-Sectional Studies, Female, Hospitals, statistics & numerical data, Humans, Infant, Malawi, epidemiology, Male, Medical Audit, organization & administration, statistics & numerical data, Physician's Practice Patterns, organization & administration, statistics & numerical data, Tuberculosis, diagnosis, drug therapy, epidemiology
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 12019919
Web of Science ID: 175197800011
URI: http://researchonline.lshtm.ac.uk/id/eprint/8898

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