CHILDHOOD TUBERCULOSIS - AN INDEX MEASURING THE ABILITY TO DETECT CASES EARLY

SETTING: Tuberculosis control programmes are conventionally monitored using data from sputum smear positive adult patients. Good overall res ults may mask significant and avoidable shortcomings with tuberculosis control in children. OBJECTIVE: To develop a specific surveillance to ol for child patients, using the ability to detect cases early as a pa rameter for the impact of control measures. DESIGN: A simple index of early detection was compiled with values ranging from 0 to 100. Three groups of tuberculous children diagnosed in Germany between 1985 and 1 994 (n = 303), and five other groups from the literature, were used to make a preliminary assessment of the validity of the index. RESULTS: The index values of 10, 13 and 24 for the German groups correlate well with other analysed patient data and the different functions of the i nstitutions where the patients were diagnosed. Comparable characterist ics could be found when applying the index to published data of other cases, with values of between 12 and 74. CONCLUSION: The proposed inde x seems suitable for monitoring early detection of child cases. Unexpe cted trends can be disclosed or effects of changed programme activitie s assessed. Routine use of the index would help the health services fo cus their attention on problem areas and specific patient groups with extremely low or falling index values. Conclusions can be drawn regard ing the overall impact of the control programme.