Paediatrics (RCH) - Research Publications

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Author: Graham, Stephen × Author: TRIASIH, RINA × End date: 2012 × Start date: 2012 ×

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    Preventive therapy in children exposed to Mycobacterium tuberculosis: problems and solutions
    Rutherford, ME ; Hill, PC ; Triasih, R ; Sinfield, R ; van Crevel, R ; Graham, SM (WILEY, 2012-10)
    Young children living with a tuberculosis patient are at high risk of Mycobacterium tuberculosis infection and disease. WHO guidelines promote active screening and isoniazid (INH) preventive therapy (PT) for such children under 5 years, yet this well-established intervention is seldom used in endemic countries. We review the literature regarding barriers to implementation of PT and find that they are multifactorial, including difficulties in screening, poor adherence, fear of increasing INH resistance and poor acceptability among primary caregivers and healthcare workers. These barriers are largely resolvable, and proposed solutions such as the adoption of symptom-based screening and shorter drug regimens are discussed. Integrated multicomponent and site-specific solutions need to be developed and evaluated within a public health framework to overcome the policy-practice gap and provide functional PT programmes for children in endemic settings.
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    Contact Investigation of Children Exposed to Tuberculosis in South East Asia: A Systematic Review
    Triasih, R ; Rutherford, M ; Lestari, T ; Utarini, A ; Robertson, CF ; Graham, SM (HINDAWI LTD, 2012)
    Background. Screening of children who are household contacts of tuberculosis (TB) cases is universally recommended but rarely implemented in TB endemic setting. This paper aims to summarise published data of the prevalence of TB infection and disease among child contacts in South East Asia. Methods. Search strategies were developed to identify all published studies from South East Asia of household contact investigation that included children (0-15 years). Results. Eleven studies were eligible for review. There was heterogeneity across the studies. TB infection was common among child contacts under 15 years of age (24.4-69.2%) and was higher than the prevalence of TB disease, which varied from 3.3% to 5.5%. Conclusion. TB infection is common among children that are household contacts of TB cases in South East Asia. Novel approaches to child contact screening and management that improve implementation in South East Asia need to be further evaluated.