Child Contact Register

I realized today that it has been almost 6 weeks since I have posted about my side project. Originally, I was interested in targeting the children on the wards with TB in order to find the adult source cases in their home. However, after exploring the wards a bit, I realized that there was a lot to fix in terms of peds TB diagnosis before that project could be feasible.

Anyway, after several weeks of reading about childhood TB, I finally came up with an idea that I am really excited about! All of our active TB cases are managed in two TB clinics in AMPATH (one for the positive sputum smears and one for the negative). The World Health Organization recommends that all active cases are asked about the child contacts in their home since children are very much at risk of getting infected in the home. In fact, >60% of childhood TB cases have or had a recent positive household contact in the home! Unfortunately, TB in kids is neglected by many TB control programs because it contributes little to transmission (children are usually sputum smear negative...meaning they are not contagious) despite the fact that TB is a major cause of mortality in HIV infected children.

I really think that many of the active TB cases who are treated in AMPATH have children at home who are also TB infected or have TB disease. My side project is to create a child contact register to record information about all of the children exposed to TB in the household. A clinical officer is responsible for filling out a child contact form for each active source case, and it has actually made them educate parents more about TB symptoms in children and encourage parents to bring their children in for HIV testing!

One of the first patients who came to clinic today was an HIV+ male who had pulmonary TB. When we started asking about his children, we found out that his 6 year old daughter has been coughing for the last 2 months and she is not getting better with any medicine. Then the dad told us that she has not been tested for HIV, even though him and his wife are both positive. The clinical officer did a great job educating him, and he promised to bring his daughter back in January for HIV testing and TB screening if necessary! When the project got started, I was just excited about finding the kids who might have TB, but I also think that this will be a useful tool for getting more children tested for HIV!

We also had a hospital employee bring his children in because they had been sleeping in the same room as their uncle who has pulmonary TB. They are completely asymptomatic but check out their chest xrays! This is a classic picture of hilar lymphadenopathy that is often seen in TB in children.
Child 1 (adenopathy on the right with some atelectasis)

















Child 2 (adenopathy on the left)

















Other kids are not fortunate enough to have a father who is a hospital employee. Many children are brought in much later once they are symptomatic for several weeks or months. My hope is that the register will help us bring these vulnerable kids to care sooner rather than later.