Prevalence of Pulmonary Tuberculosis among Presumptive Cases in Rivers State, Nigeria

Abstract

Background: Tuberculosis (TB) is a leading cause of death in children but it is underdiagnosed and underreported in children. Objective: To determine the prevalence of pulmonary TB in children among presumptive cases of TB and to compare the diagnostic efficacy of different screening tool for TB in children.  Materials and Methods: This study was a descriptive prospective study carried out over one year in nine general health facilities that can provide diagnosis and treatment for tuberculosis in Rivers State, Nigeria. Children aged 0 – 18 years with presumptive TB were explored. They were explored by carrying out a clinical assessment with chest radiograph, sputum or gastric aspirate for AFB microscopy and XpertMTB/RIF screening. Sociodemographic data and results of the screening tests was retrieved from their case records as well as the National Tuberculosis registers. Ethical approval for the study was obtained from the Rivers state Ministry of Health. Those with confirmed pulmonary TB were commenced on anti TB medications and followed up for at least 6months. Obtained data was analysed by SPSS version 20 and expressed as percentages, proportions and frequencies. A test of significance (chi square and t-test) was conducted between proportions and means as appropriate. In all a p value of less than 0.05 was considered significant.  Results: Nine hundred and sixty three patients aged 0-18 years had presumptive diagnosis of TB,   394 (40.9%) were males while 569 (59.1%) were females. The commonest presenting symptom was chronic cough which occurred in 735 (76.5%) of the patients. The prevalence of pulmonary TB was 19.1%. Significantly more males (60.9%) than female (39.1%) had confirmed tuberculosis (X2= 37.431, p-value <0.001). Significantly more children (54.3%) from the low socioeconomic class had confirmed pulmonary. Seventy two (39.1%) and 29 (15.8%) of the patients were AFB and XpertMTB/RIF positive respectively. Children aged 0-5 years were neither AFB nor XpertMTB/RIF positive. Of the children with confirmed TB, 98 (53.3%) had suggestive clinical features while 86 (46.7%) had suggestive X-ray features. More than a third (33.2%) of the children aged 0-5 years had their TB confirmed by suggestive X-rays and Clinical features. All the patients with TB were commenced on anti TB medications, 40 (21.7%) were lost to follow up (LTFU), 21 (11.4%) were transferred to other centres while 123 (66.8%) completed the treatment.  Conclusion: The prevalence of pulmonary TB among presumptive TB cases in this study was comparable to findings from other studies and clinical diagnosis of Pulmonary TB remains very relevant in its management. Improving the clinical skills of physicians involved in TB care and treatment and the need for community/ facility collaboration to reduce cases of LTFU is advocated.