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The prevalence of symptoms associated with pulmonary tuberculosis in randomly selected children from a high burden community
  1. B J Marais1,
  2. C C Obihara2,
  3. R P Gie1,
  4. H S Schaaf1,
  5. A C Hesseling1,
  6. C Lombard3,
  7. D Enarson4,
  8. E Bateman5,
  9. N Beyers1
  1. 1Centre for TB Research and Education (CENTRE), Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
  2. 2Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands
  3. 3Medical Research Council of South Africa, Cape Town, South Africa
  4. 4International Union against Tuberculosis and Lung Disease (IUATLD), Paris, France
  5. 5Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
  1. Correspondence to:
    Dr B J Marais
    Department of Paediatrics and Child Health, Centre for TB Research and Education (CENTRE), Faculty of Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505, South Africa;


Background: Diagnosis of childhood tuberculosis is problematic and symptom based diagnostic approaches are often promoted in high burden settings. This study aimed (i) to document the prevalence of symptoms associated with tuberculosis among randomly selected children living in a high burden community, and (ii) to compare the prevalence of these symptoms in children without tuberculosis to those in children with newly diagnosed tuberculosis.

Methods: A cross sectional, community based survey was performed on a 15% random sample of residential addresses. A symptom based questionnaire and tuberculin skin test (TST) were completed in all children. Chest radiographs were performed according to South African National Tuberculosis Control Program guidelines.

Results: Results were available in 1415 children of whom 451 (31.9%) were TST positive. Tuberculosis was diagnosed in 18 (1.3%) children. Of the 1397 children without tuberculosis, 253 (26.4%) reported a cough during the preceding 3 months. Comparison of individual symptoms (cough, dyspnoea, chest pain, haemoptysis, anorexia, weight loss, fatigue, fever, night sweats) in children with and without tuberculosis revealed that only weight loss differed significantly (OR = 4.5, 95% CI 1.5 to 12.3), while the combination of cough and weight loss was most significant (OR = 5.4, 95% CI 1.7 to 16.9). Children with newly diagnosed tuberculosis reported no symptoms in 50% of cases.

Conclusion: Children from this high burden community frequently reported symptoms associated with tuberculosis. These symptoms had limited value to differentiate children diagnosed with tuberculosis from those without tuberculosis. Improved case definitions and symptom characterisation are required when evaluating the diagnostic value of symptoms.

  • CI, confidence interval
  • CXR, chest radiograph
  • HIV, human immunodeficiency virus
  • NTCP, National Tuberculosis Control Program
  • OR, odds ratio
  • TST, tuberculin skin test
  • TU, tuberculin units
  • children
  • prevalence
  • symptoms
  • tuberculosis
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  • The study was funded by the Stellenbosch University and the University of Cape Town Lung Institute. The research was funded by a USAID research grant awarded by the IUATLD and an Astra Zeneca research fellowship awarded by the South African Thoracic Society

  • Competing interests: none declared

  • This manuscript is in partial fulfilment of a PhD thesis

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