title: Does intensified case finding increase tuberculosis case notification among children in resource-poor settings? A report from Nigeria.
abstract: OBJECTIVE
  Tuberculosis (TB) is a major cause of morbidity and mortality in developing countries. Passive case detection in national TB programmes is associated with low case notification, especially in children. This study was undertaken to improve detection of childhood TB in resource-poor settings through intensified case-finding strategies.
  
  
  METHODS
  A community-based intervention was carried out in six states in Nigeria. The creation of TB awareness was undertaken, and work aids, guidelines, and diagnostic charts were produced, distributed, and used. Various cadres of health workers and ad hoc project staff were trained. Child contacts with TB patients were screened in their homes, and children presenting at various hospital units were screened for TB. Baseline and intervention data were collected for evaluation populations and control populations.
  
  
  RESULTS
  Detection of childhood TB increased in the evaluation population during the intervention, with a mean quarterly increase of 4.0% [new smear positive (NSP), although the increasing trend was not statistically significant (χ(2)=1.8; p<.179)]. Additionally, there was a mean quarterly increase of 3% for all forms of TB, although the trend was not statistically significant (χ(2)=1.48; p<.224). Conversely, there was a decrease in case notification in the control population, with a mean decline of 3% (all forms). Compared to the baseline, there was an increase of 31% (all forms) and 22% (NSP) in the evaluation population.
  
  
  CONCLUSIONS
  Intensified case finding combined with capacity building, provision of work aids/guidelines, and TB health education can improve childhood-TB notification.
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria. Electronic address: dannyoshi@yahoo.com.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Oshi
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Chukwu
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Nwafor
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Meka
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Nelson O
authors.initials: NO
authors.lastname: Madichie
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Chidubem L
authors.initials: CL
authors.lastname: Ogbudebe
authors.affiliation: Department of Community Medicine and Public Health, Federal Medical Centre, Umuahia, Abia State, Nigeria.
authors.forename: Ugochukwu U
authors.initials: UU
authors.lastname: Onyeonoro
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Joy N
authors.initials: JN
authors.lastname: Ikebudu
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Ngozi
authors.initials: N
authors.lastname: Ekeke
authors.affiliation: German Leprosy and TB Relief Association, Enugu, Nigeria.
authors.forename: Moses C
authors.initials: MC
authors.lastname: Anyim
authors.affiliation: Department of Internal Medicine, Federal Teaching Hospital (FETHA), Abakaliki, Nigeria.
authors.forename: Kingsley N
authors.initials: KN
authors.lastname: Ukwaja
authors.affiliation: Department of Community Medicine and Public Health, University of Nigeria, Enugu Campus, Enugu, Nigeria.
authors.forename: Emmanuel N
authors.initials: EN
authors.lastname: Aguwa
mesh_terms: D000293:Adolescent; D019090:Case Management; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000379:methods / Q000592:standards; D003906:Developing Countries; D018563:Disease Notification; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D011204:Poverty Areas; D011446:Prospective Studies; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*
keywords: Childhood tuberculosis; Intensified case finding; Nigeria tuberculosis