Everyday practice - Tuberculosis in children in India – I.
Manjula Datta; Samdani, P.G.; Udani, P.M.; Bermejo, A.; Costello, A.; Crofton, J.; Cundall, D.; Cutting, W.; Hone, N.; Miller, F.; King, M.
The National Medical Journal of India; 1992; 5; 226-234.
Tuberculosis is different in children. It involves many organs, instead of being the predominantly respiratory disease that it usually is in adults. Fortunately, it readily responds to treatment - if you diagnose it early enough and treat it for long enough! This is the problem. Unfortunately, tuberculosis causes such non-specific symptoms and signs, and you are so seldom able to isolate bacilli, that you may never be sure of the diagnosis. Even experts sometimes disagree. In India particularly, it is a disease of the poorest of the poor, but even in them it causes only a small proportion of their burden of morbidity. The great problem is to reach those infected.
Of every thousand Indians, seven children and about twenty adults have active tuberculosis, and five of these adults are sputum positive. Only about half the 9 million in the community at any one time are ever diagnosed, and of these only about 13% complete their treatment, so there is a huge pool of infectious cases, half a million of whom die each year. Fortunately, the incidence of tuberculosis among children reporting to hospital is slowly decreasing, probably largely due to improved coverage with BCG.
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