Harries A D, Hargreaves N J, Graham S M, Mwansambo C, Kazembe P, Broadhead R L, Maher D, Salaniponi F M
National Tuberculosis Control Programme, Community Health Science Unit, Lilongwe, Malawi.
Int J Tuberc Lung Dis. 2002 May;6(5):424-31.
All 43 non-private hospitals (three central, 22 [corrected] district and 18 [corrected] mission) in Malawi that register and treat adult and paediatric TB cases.
To assess the rate, pattern and treatment outcome of childhood TB case notifications in Malawi in 1998.
Retrospective data collection using TB registers, treatment cards and information from health centre registers. Information was collected on number of cases, types of TB and treatment outcomes using standardised definitions.
There were 22,982 cases of TB registered in Malawi in 1998, of whom 2,739 (11.9%) were children. Children accounted for 1.3% of all case notifications with smear-positive pulmonary TB (PTB), 21.3% with smear-negative PTB and 15.9% with extra-pulmonary TB (EPTB). Estimated rates of TB in children were 78/ 100,000 in those aged less than one year, 83/100,000 in those aged 1-4 years and 33/100,000 in those aged 5-14 years. A significantly higher proportion of TB cases was diagnosed in central hospitals. Only 45% of children completed treatment. There were high rates of death (17%), default (13%) and unknown treatment outcomes (21%). Treatment outcomes were worse in younger children and in children with smear-negative PTB. Treatment completion was best (76%) and death rates lowest (11%) for the 127 children with smear-positive PTB.
Childhood TB is common in Malawi and treatment outcomes are poor. Research should be directed towards improved diagnosis and follow-up of children with TB, and the National TB Programme should support appropriate management of childhood contacts of smear positive PTB cases.
马拉维所有43家非私立医院（3家中心医院、22家[校正后]地区医院和18家[校正后]教会医院），这些医院负责登记和治疗成人及儿童结核病病例。
评估1998年马拉维儿童结核病病例报告的发生率、模式及治疗结果。
采用结核病登记册、治疗卡及卫生中心登记信息进行回顾性数据收集。使用标准化定义收集病例数量、结核病类型及治疗结果等信息。
1998年马拉维登记的结核病病例有22982例，其中2739例（11.9%）为儿童。儿童占所有涂片阳性肺结核（PTB）病例报告的1.3%，涂片阴性PTB病例报告的21.3%，肺外结核（EPTB）病例报告的15.9%。估计小于1岁儿童的结核病发病率为78/10万，1-4岁儿童为83/10万，5-14岁儿童为33/10万。中央医院诊断出的结核病病例比例显著更高。只有45%的儿童完成了治疗。死亡（17%）、失访（13%）及治疗结果不明（21%）的比例较高。年龄较小的儿童及涂片阴性PTB儿童的治疗结果较差。127例涂片阳性PTB儿童的治疗完成率最高（76%），死亡率最低（11%）。
儿童结核病在马拉维很常见，治疗结果较差。应开展研究以改善儿童结核病的诊断和随访，国家结核病规划应支持对涂片阳性PTB病例的儿童接触者进行适当管理。
