Article Category:
Research Article

Duration of Symptoms Prior to Pediatric and Adolescent Tuberculosis Diagnosis and Its Impact on Schooling in Tanzania: A Mixed Methods Study

Ghassan Ilaiwy Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia;

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Saning’o Lukumay Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania;

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Domitila Augustino Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania;

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Paulo Mejan Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania;

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Rehema Bukhay Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania;

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Museveni Justine Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania;

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Cornel Massong Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania;

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Prakruti Rao Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia;

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Kristen Petros de Guex Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia;

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Herman Pfaeffle Department of Internal Medicine, Navy Medicine and Readiness Training Command Portsmouth, Portsmouth, Virginia;

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Estomih Mduma Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania;

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Christopher Vinnard Division of Infectious Diseases, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey

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Yingda L. Xie Division of Infectious Diseases, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey

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Scott K. Heysell Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia;

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Tania A. Thomas Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia;

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DOI:
https://doi.org/10.4269/ajtmh.22-0798
Volume/Issue:
Volume 108: Issue 6
Page(s):
1235–1239
Restricted access
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ABSTRACT.

At least a third of tuberculosis (TB) cases remain undiagnosed, disproportionately so in children and adolescents, which is hampering global elimination goals. Prolonged symptom duration presents a high-risk scenario for childhood TB in endemic areas, but the prolonged period of symptoms and its impact on educational attainment are rarely documented. Using a mixed method approach, we aimed to quantify the duration of respiratory symptoms and describe their impact on education among children from a rural area of Tanzania. We used data from a prospectively enrolled cohort of children and adolescents aged 4–17 years in rural Tanzania at the start of active TB treatment. We report on the cohort’s baseline characteristics and explore the correlation between duration of symptoms and other variables. In-depth qualitative interviews were designed on the basis of a grounded theory approach to explore the impact of TB on educational attainment among school-aged children. In this cohort, children and adolescents diagnosed with TB experienced symptoms for a median of 85 days (interquartile range: 30, 231 days) prior to treatment initiation. In addition, 56 participants (65%) had a TB exposure in the household. Of the 16 families with school-aged children who were interviewed, 15 (94%) reported a significant negative impact of TB on the schooling of their children. Children in this cohort experienced a long duration of TB symptoms; the extent of illness impacted absenteeism at school. Screening initiatives for households affected by TB may lead to a shortened duration of symptoms and may minimize the impact on school attendance.

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Author Notes

Address correspondence to Ghassan Ilaiwy, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, PO Box 801340, Charlottesville, VA 22908-1340. E-mail: gilaiwy@virginia.edu

Financial support: This work was funded by NIH training grant 5T32AI007046 and NIH R01AI137080 (to S. K. H.).

Authors’ addresses: Ghassan Ilaiwy, Prakruti Rao, Scott K. Heysell, and Tania A. Thomas, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, E-mails: gilaiwy@virginia.edu, PR6ZU@uvahealth.org, SKH8R@uvahealth.org, and TAT3X@uvahealth.org. Saning’o Lukumay, Domitila Augustino, Paulo Mejan, Rehema Bukhay, Museveni Justine, Cornel Massong, and Estomih Mduma, Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Manyara, Tanzania, E-mails: sannysaruni@gmail.com, domikirway@gmail.com, paulomejan@gmail.com, bukhayrehema@gmail.com, Museveni.justine@gmail.com, cornelmassong@gmail.com, and estomduma@gmail.com. Kristen Petros de Guex, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, and Inter-American Foundation, Washington, District of Columbia, E-mail: kpetros@gmail.com. Herman Pfaeffle, Department of Internal Medicine, Navy Medicine and Readiness Training Command Portsmouth, Portsmouth, VA, E-mail: herman.pfaeffle@gmail.com. Christopher Vinnard, Division of Infectious Diseases, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, and Discovery Medicine Infectious Diseases at GlaxoSmithKline, Collegeville, PA, E-mail: cvinnard@hotmail.com. Yingda L. Xie, Division of Infectious Diseases, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, E-mail: ylx1@njms.rutgers.edu.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2023
Received:
10 Mar 2022
|
Accepted:
13 Mar 2023
|
Published Online:
24 Apr 2023
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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