Abstract

PIP: Prevention of tuberculosis (TB) in children in developing countries involves 3 interventions: detection and treatment of sources of infection, i.e., adults with pulmonary TB; BCG vaccination of newborns to prevent primary infection and its complications; and prophylactic treatment of newly infected infants. The first element of prevention is reviewed here. In less developed areas, detection and diagnosis of TB entails education of the public and of health providers so that people with chronic cough have sputum sent to regional laboratories for microscopic examination. Rarely, x-ray facilities may also be used. Quality control of laboratory work and universal coverage are essential. The proportion of actual cases of TB diagnosed by microscopy ranges from 5 to 10% in African and Latin American countries to 25% in Asian countries, depending on the prevalence of TB, the age structure of the population, and the quality of the laboratories. Calculated rates of detection are 60-90% however. There are 3 types of infectious TB cases; new cases with smear-positive pulmonary TB (80-90%), previously treated cases who are true or false failures or relapses, and chronic TB cases who probably have resistant organisms. In developing countries, the last group will probably not receive second-line drugs because of the cost, but will be treated with isoniazid alone and are considered unlikely to recover. At the end of standardized treatment, there are 6 classes of patients: cured cases, probable cures, failures or relapses, decreased, lost to follow-up, and move to another district for care. World Health Organization objectives for rate of cure will probably be modified in given countries due to financial limitations.