Socio demographic profile of pediatric tuberculosis patients of north Gujarat region, India: a cross sectional study

INTRODUCTION

Tuberculosis is a worldwide, chronic communicable bacterial disease. It is a very strange disease because of its varied clinical presentation, host response, chemotherapeutic response, etiology and social implications. It continues to be one of the most important public health problems worldwide. It infects one third of the world’s population at any point of time. There are approximately 9 million new cases of all forms of TB occurring annually and 3 million people dying from it each year. 95 % of cases and 98 % of the TB deaths are contributed by developing countries.¹ India is the highest TB burden country accounting for one fifth of the global incidence and it is 17^th among 22 high TB burden countries in terms of TB incidence rate.² Every year, approximately 1.8 million persons develop tuberculosis, of which about 0.8 million are new smear positive highly infectious cases. Tuberculosis kills about 0.32 million people every year. Two out of every five Indians are infected with TB bacillus. Every day about 5000 people develop the disease.^2,3 Most of new cases of TB and deaths due to TB occur in developing countries where infection is often acquired in childhood. No other chronic infection of childhood comes anywhere close to TB. It is one of the giant killers of children. Childhood deaths from TB are usually caused by disseminated disease.⁴

Tuberculosis causes poverty but also found more amongst poor. The majority of its victims are migrant, labourers, slum dwellers, residents of backward areas and rural and tribal pockets. Poor living conditions, malnutrition, shanty housing and overcrowding are the main reasons for the spread of the disease. Children are especially vulnerable to the effects of tuberculosis, which is often difficult to diagnose and therefore difficult to treat effectively. Pediatric TB results from failure of TB control in adults.⁵ This study is a humble effort to throw light on socio demographic profile of pediatric tuberculosis patients.

METHODS

This Cross sectional observational, descriptive epidemiological study was conducted at GMERS medical college and hospital Dharpur, Patan located in north Gujarat. The study was conducted among all the 151 pediatric TB patients who were currently under treatment at selected Hospital .The study period was 6 months from January to June 2015. All patients and their parents were interviewed at center. Each interview was conducted at a time when patient come into OPD and ward of TB. Parents of the patient were informed about the purpose of the study and their informed written consent was taken. By interviewing them on the basis of pre-designed and pre tested proforma, socio demographic information was collected. The collected data was analysed using statistical package for social science (SPSS 17 Trial version).

RESULTS

Out of 151 pediatric patients 87 (57.6%) were male. Age range of the children was 1 to 14 years. In our study mean age of children was 8.41±2.86 years. Mean age of male patient was 9.12±4.26 years. Mean age of female patient was 7.12±3.86 years. 68 (45.0%) patients were adolescents. 127 (84.1%) patients were from rural area. 63 (41.7%) heads of the family of patients were illiterate. 116 (76.8%) of the patients lived in joint family. 89 (58.9%) patients had kuccha house. Overcrowding was present in 86.7% of the patients. Family history of TB was present in only 23.2% of the patients. 76.8% of the patients belonged to social IV and V according to modified Prasad’s classification (Table 1).

105 (69.5%) patients had extra pulmonary TB (Table 2). These pediatric TB cases were divided into two categories as per Revised National Tuberculosis Control Programme (RNTCP). Category-1 constituted 125 (82.7%) cases. 26 (17.3%) cases were in Category-2 (Table 3). 3% patients had HIV infection. 56 % of patients preferred syrup formulation, if available.

DISCUSSION

In Thakor N et al out of 100 patients, 60 were female and 40 were male. Age range was 1-14 year. Mean age of children was 8.63±3.66 years. Mean age of male patients was 9.36±3.16 years. Mean age of female patients was 7.53±4.10 years. According to modified Prasad’s classification, 78% patients belonged to lower socioeconomic class. 94% patients were in Category-1 and 79% had extra pulmonary TB. 4% patients had HIV infection. Parents of 90% patients didn’t have knowledge of TB. 60% of patients preferred syrup formulation, if available.⁵

Figures in the parenthesis are percentages

In the study carried out by S.K. Kabra et al, mean age of the children was 7.75 years and sex distribution was almost equal. Category-1 constituted 70.4% cases. Category-2 and Category-3 cases were 2.6% and 27.0% respectively.⁶

Figures in the parenthesis are percentages

In the study of V K Arora et al, Extrapulmonary TB (EPTB) was seen in 47 percent of children. Among EPTB, lymphadenopathy was seen in 75 % of cases in their study.⁷ Whereas, in the study carried out by Saumyaswaminathan et al, lymphadenopathy was the most common (67%), among extrapulmonary manifestations.⁸

In our study Out of 151 pediatric patients 87 (57.6%) were male. Age range of the children was 1 to 14 years. In our study mean age of children was 8.41±2.86 years. 68 (45.0%) patients were adolescents. 127 (84.1%) patients were from rural area. 63 (41.7%) heads of the family of patients were illiterate. 116 (76.8%) of the patients lived in joint family. 89 (58.9%) patients had kuccha house. Overcrowding was present in 86.7% of the patients. 76.8% of the patients belonged to social IV and V according to modified Prasad’s classification. 105 (69.5%) patients had extra pulmonary TB. Category-1 constituted 125 (82.7%) cases. 3% patients had HIV infection. 56% of patients preferred syrup formulation, if available.

In our study family history of TB was present in only 23.2 % of the patients similar to the findings observed by Madhi F et al in a Paris suburb, where 22% had history of contact with TB patients.⁹ Prevalence of HIV infection in the patients was 3%. Several studies have shown prevalence between 0.8 to 2%.^10-12

CONCLUSION

Majority of the patients (69.5%) had extra pulmonary TB. Majority of the patients (82.7%) were in category-1. More than half of the cases (55%) were in age group of 1-9 years. Overcrowding was present in 86.7% of the patients. 76.8% of the patients belonged to social IV and V according to modified Prasad’s classification. This study has observed that pediatric TB still continues to be a major problem in 1-9 years of age group and belonging to low socio-economic status. Poor housing conditions which continue to haunt our population is an important risk factor for TB transmission. Thus improving the socio-economic conditions and proper treatment of adult TB who are the sources of infection to children will go a long way in preventing pediatric TB and protect children who are the future of our country.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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