title: IMCI indicators of childhood TBM at primary health care level in the Western Cape Province of South Africa.
abstract: The diagnosis of tuberculous meningitis (TBM) in children is often delayed, with disastrous consequences. The Integrated Management of Childhood Illness (IMCI) strategy aims to ensure the accurate assessment of ill children using simple yet reliable clinical signs.
  
  
  
  We conducted a retrospective observational study of 30 consecutive children aged 3 months to 5 years diagnosed with TBM at Tygerberg Hospital, Cape Town, South Africa. Clinical records were reviewed to assess diagnostic delay and identify IMCI indicators that were present at the time of initial presentation.
  
  
  
  Six patients (20%) presented with stage I, 6 (20%) with stage II and 18 (60%) with stage III TBM. Recent contact with an adult TB source case was recorded in 21 (70%) cases. The median number of health care visits before hospital admission was 4.0 (range 1-6). At the first health care visit, 21 (70%) had potential TB features and recent contact with an adult household TB source case.
  
  
  
  Adequate implementation of IMCI clinical indicators is essential to ensure earlier diagnosis and prompt treatment initiation in children with TBM, as the majority of cases present with advanced disease. Recent contact with an adult TB source case is an important consideration.
authors.affiliation: Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Solomons
authors.affiliation: Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Grantham
authors.affiliation: Marie Bashir Institute for Infectious Diseases and Biosecurity and The Children's Hospital at Westmead, University of Sydney, Westmead, New South Wales, Australia.
authors.forename: B J
authors.initials: BJ
authors.lastname: Marais
authors.affiliation: Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: van Toorn
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D002675:Child, Preschool; D057210:Delayed Diagnosis; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D059012:Lost to Follow-Up; D008297:Male; D011320:Primary Health Care; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D014390:Tuberculosis, Meningeal / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000995:Antitubercular Agents