Childhood Tuberculosis in a Tertiary Care Rural Hospital

Introduction: Tuberculosis (TB) remains a major public health problem, despite noteworthy socio-economic development and advances in medical science. It is a curable disease but still millions of people suffer every year and a number of them die from this infectious disease, resulting in devastating social and economic impact. TB treatment requires several months of swallowing a combination of 3 to 4 drugs every day. Patients often forget to take their medicines or stop taking them when they start to feel better. The Revised National TB Control Programme (RNTCP), based on the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy was launched. Studies of paediatric TB are scantily available both in global and national context. Reliable data on the treatment of paediatric TB and its follow up are not available. Hence, a study of paediatric TB is designed to evaluate the clinical profile of childhood tuberculosis and following up the treatment outcome upto 6 months Materials and methods: The study was carried out in the Department of Pediatrics at Dhiraj Hospital, Piparia. Recruitment took place from February 2014 to February 2015. The clinical profile of 71 patients was studied. Results: There was preponderance of males (60.56%, n=43) in study population as compared to females (39.44%, n=28). Most of the patients were belonging to age group of <6 years (32.4%, n=23) and >10 years (38.0%, n=27). Among 6 to 10 years, 21 (29.6%) patients were included in study. Most common form of TB was extra-pulmonary TB (60.56%, n=43) followed by pulmonary TB (39.43%, n=28). Non-specific symptoms like fever (82.5%, n=66) was the commonest presenting symptoms. Other symptoms included cough (33.8%, n=24), altered sensorium (19.71%, n=14), swelling (15.5%, n=11). From all, the patient with follow up (n=50), 44 (88.0%) were cured, 3 (6.0%) patients expired during the course of treatment, 3(6.0%) patient showed no improvement. Conclusion: Diagnosis of paediatric tuberculosis still continues to be a challenge. In the study TB was more common in extra-pulmonary than pulmonary forms in our setting. Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations. Presence of paediatric TB is an indication of prevalence of TB in that community. As the source of transmission of TB to children is usually an adult, control of tuberculosis in adult is necessary to decrease the prevalence of TB in children. DOTS is an effective strategy for treatment of TB.