title: Diagnosis of paediatric tuberculosis using sputum induction in Botswana: programme description and findings.
abstract: METHODS
  Four public hospitals in Botswana, a high tuberculosis (TB) burden setting.
  
  
  OBJECTIVE
  To assess the feasibility and utility of sputum induction in the diagnosis of paediatric TB.
  
  
  METHODS
  From 2008 to 2010, children aged ≤18 years referred for suspected pulmonary TB underwent sputum induction. Confirmed TB was defined as the presence of at least one of the signs and symptoms suggestive of TB and positive Mycobacterium tuberculosis culture. Information on TB-associated symptoms (cough, fatigue, night sweats, low appetite, chest pain, weight loss, haemoptysis and contact with a TB case) was collected for three risk groups: human immunodeficiency virus (HIV) positive children, HIV-negative children aged <3 years and HIV-negative children aged ≥3 years.
  
  
  RESULTS
  The median age of the 1394 subjects who underwent sputum induction was 3.8 years (IQR 1.3-8.4); 373 (27%) were HIV-positive, 419 (30%) were HIV-negative and 602 (43%) had unknown HIV status. TB was confirmed in 84 (6.0%); cases were more likely to have weight loss, chest pain or TB household contacts. There were no serious complications attributable to sputum induction during and after the procedure; only 0.8% (9/1174) of patients reported minor complications.
  
  
  CONCLUSIONS
  In Botswana, paediatric sputum induction was feasible, safe and assisted bacteriological confirmation in a subgroup of children treated for TB.
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Princess Marina Hospital, Gaborone, Botswana; Department of Paediatrics, Faculty of Health Sciences, University of Botswana School of Medicine, Gaborone, Botswana.
authors.forename: D R
authors.initials: DR
authors.lastname: Joel
authors.affiliation: Department of Paediatrics, Faculty of Health Sciences, University of Botswana School of Medicine, Gaborone, Botswana; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Botswana-UPenn Partnership, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: A P
authors.initials: AP
authors.lastname: Steenhoff
authors.affiliation: Children's National Medical Center, Washington, DC, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Mullan
authors.affiliation: Office of HIV/AIDS, US Agency for International Development, Washington, DC, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Phelps
authors.affiliation: Baylor College of Medicine, Houston, Texas, USA; Baylor Children's Foundation-Tanzania, Mwanza, Tanzania.
authors.forename: M A
authors.initials: MA
authors.lastname: Tolle
authors.affiliation: Botswana-UPenn Partnership, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ho-Foster
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Princess Marina Hospital, Gaborone, Botswana.
authors.forename: V
authors.initials: V
authors.lastname: Mabikwa
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Princess Marina Hospital, Gaborone, Botswana.
authors.forename: B G
authors.initials: BG
authors.lastname: Kgathi
authors.affiliation: Ministry of Health, Botswana National TB Programme, Gaborone, Botswana.
authors.forename: R
authors.initials: R
authors.lastname: Ncube
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Princess Marina Hospital, Gaborone, Botswana; Baylor College of Medicine, Houston, Texas, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Anabwani
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001431:Bacteriological Techniques; D001902:Botswana / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D005240:Feasibility Studies; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006779:Hospitals, Public; D006801:Humans; D015994:Incidence; D007223:Infant; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D016730:Program Development; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*