Potential effect of household contact management on childhood tuberculosis : a mathematical modelling study
Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Summary
Background Tuberculosis is recognised as a major cause of morbidity and mortality in children, with most cases in
children going undiagnosed and resulting in poor outcomes. Household contact management, which aims to identify
children with active tuberculosis and to provide preventive therapy for those with HIV or those younger than 5 years,
has long been recommended but has very poor coverage globally. New guidelines include widespread provision of
preventive therapy to children with a positive tuberculin skin test (TST) who are older than 5 years.
Methods In this mathematical modelling study, we provide the first global and national estimates of the impact of
moving from zero to full coverage of household contact management (with and without preventive therapy for
TST-positive children older than 5 years). We assembled data on tuberculosis notifications, household structure,
household contact co-prevalence of tuberculosis disease and infection, the efficacy of preventive therapy, and the
natural history of childhood tuberculosis. We used a model to estimate households visited, children screened, and
treatment courses given for active and latent tuberculosis. We calculated the numbers of tuberculosis cases, deaths,
and life-years lost because of tuberculosis for each intervention scenario and country.
Findings We estimated that full implementation of household contact management would prevent 159 500
(75% uncertainty interval [UI] 147 000–170 900) cases of tuberculosis and 108 400 (75% UI 98 800–116 700) deaths in
children younger than 15 years (representing the loss of 7 305 000 [75% UI 6 663 000–7 874 000] life-years). We
estimated that preventing one child death from tuberculosis would require visiting 48 households, screening
77 children, giving 48 preventive therapy courses, and giving two tuberculosis treatments versus no household
contact management.
Interpretation Household contact management could substantially reduce childhood disease and death caused by
tuberculosis globally. Funding and research to optimise its implementation should be prioritised.
Description
CITATION: Dodd, P. J., et al. 2018. Potential effect of household contact management on childhood tuberculosis : a mathematical modelling study. The Lancet Global Health, 6(12):e1329-e1338, doi:10.1016/S2214-109X(18)30401-7.
The original publication is available at https://www.thelancet.com
The original publication is available at https://www.thelancet.com
Keywords
Tuberculosis, Children — Tuberculosis, Multiscale modeling, Tuberculosis — Treatment, Disease management
Citation
Dodd, P. J., et al. 2018. Potential effect of household contact management on childhood tuberculosis : a mathematical modelling study. The Lancet Global Health, 6(12):e1329-e1338, doi:10.1016/S2214-109X(18)30401-7