title: Screening for tuberculosis among orphans in a developing country.
abstract: BACKGROUND
  There has been a recent resurgence of tuberculosis (TB) as a worldwide public health concern. It is a well-documented health problem in Haiti, where the reported prevalence is 123.9 per 100,000 population. While the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) policy papers for the eradication of TB recommend screening in shelters, prisons, and other congregate-living facilities, screening in institutional orphanages is not specifically mentioned.
  
  
  METHODS
  A total of 445 orphans with no documentation of Bacillus Calmette-Guerin (BCG) vaccine at six orphanages representing urban, suburban, and rural Haiti were screened for TB using standardized purified protein derivative (PPD). An inoculum of 0.1 cc was introduced intradermally, with site checks for induration at 48-72 hours after inoculation. Induration >5 mm was recorded as positive. Active cases of TB were defined by symptoms such as fever, night sweats, cough greater than 1 month, or signs of extrapulmonary TB (like scrofula or Pott's disease).
  
  
  RESULTS
  The number of positive PPD tests was 170 of the 445 children tested, or 38,202 per 100,000; there were 10 active cases. The overall prevalence of tuberculin positivity in the three orphanages with one or more active cases was 44%, compared to 13% in the three with no identified active cases.
  
  
  CONCLUSIONS
  The data indicate that TB prevalence among the orphans screened was 1123 per 100,000. This is substantially greater than that reported for the general Haitian population. These data thus suggest children living in orphanages as a previously unidentified high-risk group for TB infection. Further investigation of TB is recommended for orphans in developing countries.
authors.affiliation: School of Medicine, University of Miami, Miami, FL 33101, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Francis
authors.forename: Alison
authors.initials: A
authors.lastname: Reed
authors.forename: Fitsum
authors.initials: F
authors.lastname: Yohannes
authors.forename: Michel
authors.initials: M
authors.lastname: Dodard
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Fournier
mesh_terms: D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D005581:Foster Home Care; D006205:Haiti / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D011315:Preventive Medicine / Q000379:methods; D012307:Risk Factors; D012424:Rural Population; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology; D014505:Urban Population