A retrospective chart review of the prevalence and determinants of deays in the diagnosis of childhood TB

Naidoo, Romola Suriakumarie
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Background: The incidence and morbidity of childhood tuberculosis (TB) in South Africa is high. Objectives: We evaluated the incidence of childhood TB in a regional hospital, the proportion of cases with a delayed diagnosis, and the determinants and outcomes thereof. Method: We conducted a retrospective cross-sectional review of hospital records of paediatric cases that were diagnosed with probable or confirmed TB at Addington Hospital, eThekwini, KwaZulu-Natal (KZN) from July through December 2013. Caregiver delays in diagnosis were based on history taking atinitial presentation, while health care worker or systems delays were calculated fromthe time from first presentation to diagnosis.Healthcare worker and health system delays were classified asbeing of 2-4 weeks and >4 weeksduration. Delays related to health policy implementation were also determined. Results: Fifty nine (74%) of the 80 children who werediagnosed with TBhad their recordsretrieved.The overall childhood TB incidence for Addington Hospital during the study period was 2.5%. Caregiver-related factors impacting on delay in TB diagnosis were observed in 25 (42%) of the 59 cases.Nineteen (32%)childrenhad a delay from initial presentation to TB diagnosis related to healthcare worker and health systems issues.Airway reactivity occurred more frequently in the group ofchildren who had a delay in diagnosis of>4 weeks (8/11, 73%)as compared to the non-delayed group (15/40, 38%), P=0.038. Conclusion: The diagnosis of TB in childrenis delayed in a substantial proportion of children. Significant improvements in healthcare that is provided to these childrenare required to avoid missed opportunities for diagnosis and treatment.
Submitted in partial fulfillment of the requirements for the degree of Master of Science (Child Health) in the Department of Paediatrics, University of the Witwatersrand, Gauteng, South Africa, 2017