Mantoux Positivity Among Institutionalized Vulnerable Children

Abstract

Background: Vulnerable Children (VC) have various needs and challenges some of these are environmental, social, and health risk factors that have been associated with tuberculosis (TB). These risk factors coupled with challenges in diagnosis, treatment and the prevention of tuberculosis in the developing tropical countries like Nigeria, places VC at a higher risk of TB infection especially if they are institutionalized. This study therefore sought to describe the mantoux positivity and clinical profile of institutionalized VC living in House of Love, a Faith Based institution in Jos Plateau state North-Central Nigeria. Methodology: All residents of the orphanage were interviewed with a structured questionnaire; afterward a clinical examination was done including measurements of weight and height. A mantoux test and HIV screening were carried out. All subjects with PPD reaction of > 10mm or > 5mm if immune-deficient (HIV, malnutrition, steroid) were considered mantoux positive. Thereafter subjects adjudged to be mantoux positive had a chest radiograph done. Results: Forty people were resident in the institution, out of which 35 were VC and 5 were caregivers. Out of the 35 VC, 31 were orphans, 4 were non orphan vulnerable children, with a male female ratio of 1:0.7 and a mean, median age of 13.6 years and 15 years respectively. Clinical features of either chronic cough, night sweat or weight loss was reported by 31.4%, a BCG scar was seen on 54.3% of VC. Twenty percent of the studied population were HIV positive, 5.8% had moderate malnutrition. The range of the mantoux was between 0-20mm with a mean and mode of 8.1+6.8 and 7mm respectively. Based on gender, age group, VC type, presence of clinical features, HIV status, nutritional status and presence of BCG scar no difference was found in relationship with the mean mantoux reaction, P > 0.05. The prevalence of mantoux positivity amongst the VC was 48.6%. Comparatively the prevalence was 17.1% in males against 31.4% in females, 8.6% in HIV positive VC and 11.4% in HIV negative VC, orphan had a 40.0% prevalence against 8.6% non- orphan VC, normal nourished and malnourished VC had 37.1% and 5.8% respectively, while VC with BCG scar and VC without BCG scar had 31.4% and 17.5% respectively. None of these differences was statistically significant. Conclusion: This study showed that tuberculosis infection is a burden amongst institutionalized vulnerable children in the orphanage studied and therefore call for further in-depth research on the subject matter. Meanwhile Pre - placement and period screening of institutionalized VC and their caregivers should be emphasized.