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close this bookTuberculosis Control in Refugees Situations: An Interagency Field Manual (WHO - OMS, 1997, 80 p.)
View the document(introduction...)
View the documentFOREWORD
View the documentEXECUTIVE SUMMARY
View the documentGLOSSARY
View the documentABBREVIATIONS
Open this folder and view contents1. TUBERCULOSIS (TB)
Open this folder and view contents2. IMPLEMENTATION OF TB CONTROL PROGRAMMES IN REFUGE SITUATIONS
Open this folder and view contents3. MANAGEMENT OF TB IN REFUGEE SITUATIONS - ADULTS
View the document4. MANAGEMENT OF TB IN REFUGEE SITUATIONS - CHILDREN
Open this folder and view contents5. PREVENTION OF TB IN REFUGEE SITUATIONS
Open this folder and view contents6. MONITORING OF TB CONTROL PROGRAMMES IN REFUGEE SITUATIONS
Open this folder and view contents7. EVOLUTION OF TB CONTROL PROGRAMMES IN REFUGEE SITUATIONS
Open this folder and view contentsAPPENDICES
View the documentBIBLIOGRAPHY AND RESOURCES

4. MANAGEMENT OF TB IN REFUGEE SITUATIONS - CHILDREN

Cases of TB in children usually represent about 10% of all TB patients. The source of transmission of TB is usually an adult, often a family member with smear positive TB. TB in children is a general disease which may affect any part of the body. Children rarely have smear positive TB, so they are rarely infectious.

In refugee situations with a large number of children, extra-pulmonary forms of TB should be suspected, diagnosed and treated appropriately. Often, this requires referral to a hospital for x-ray and special examinations (e.g. lumbar puncture).

Children with headache, change of temperament, recent squint or ocular muscle paralysis or dyspnoea should be suspected of meningitis. TB is one, although rare, cause of meningitis (meningococcal meningitis is a more common cause in the refugee setting). Definitive diagnosis requires hospital referral.

Children with high fevers, dyspnoea, gastro-intestinal symptoms, confusion (i.e. those with suspicion of acute miliary tuberculosis) must also be referred to hospital for assessment and diagnosis.

Suspected bone and joint TB, or pleural effusions also requires referral.

Commoner forms of extra-pulmonary disease can be diagnosed and treated in a camp situation (e.g. cervical or auxiliary lymphadenitis, peritonitis with ascites).

The diagnosis of TB in children should be carefully considered in a child if there is:

· an illness lasting for more than 10 days
· a history of close contact with a TB patient
· a poor response to antibiotic therapy
· a poor response to one month of nutritional rehabilitation
· weight loss or abnormally slow growth
· loss of energy, or
· increasing irritability and drowsiness over 2 weeks.

The drug regimens used for children are the same as for adults with the exception that streptomycin should be avoided. Drug dosages must be calculated using the child's weight. Adjustments may have to be made during the course of the treatment as the child may rapidly regain lost weight.

For infants of newly diagnosed smear-positive mothers, breast-feeding should continue. The infant should not be separated from the mother. Transmission is likely to have occurred already and the infant is at greater risk of dying from other causes if breast-feeding is stopped. If the infant is well, s/he should be given isoniazid as prophylaxis for 6 months. BCG should be given one week after ceasing the isoniazid. If the infant becomes unwell, TB should be suspected.

Score Chart6

6 Adapted from, Crofton J, Home N, Miller F. Clinical Tuberculosis, MacMillan, TALC and IUATLD, 1992 (Courtesy Dr. Keith Edwards, University of Papua New Guinea).

A score sheet has been developed to improve the diagnosis of childhood TB. A score of 7 is considered suggestive of TB and treatment is recommended. If the score for the child is 6 or less, a 7 day course of antibiotics should be given and repeated if there is no clinical improvement. The response is again assessed after the second week. If there has been no improvement, anti-TB treatment is recommended.

Nutritional rehabilitation should be given to a child suspect for at least one month.

To be used after 1 month of Nutritional Rehabilitation

FEATURE

0

1

3

SCORE

LENGTH OF ILLNESS

LESS THAN 2 WEEKS

2-4 WEEKS

MORE THAN 4 WEEKS


NUTRITION (WEIGHT)

ABOVE 80% FOR AGE

BETWEEN 60% AND 80%

LESS THAN 60%


FAMILY TUBERCULOSIS PAST OR PRESENT

NONE

REPORTED BY FAMILY

PROVED SPUTUM POSITIVE


Score for other Features if Present

Positive tuberculin test (3 points)
Large painless lymph nodes, firm, soft, sinus in neck, axilla, groin (3 points)
Unexplained fever, night sweats, no response to malaria treatment (2 points)
Malnutrition, not improving after 4 weeks (3 points)
Angle deformity of spine (4 points)
Joint swelling, bone swelling or sinuses (3 points)
Unexplained abdominal mass or ascites (3 points)
Central nervous system signs (change in temperament, fits or coma) (3 points)


TOTAL SCORE


When score is 7 or more, treat for TB.