title: Prevalence of tuberculosis among children in North Sudan: Are we only seeing the tip of the iceberg?
abstract: BACKGROUND
  Tuberculosis (TB) is a significant cause of morbidity and mortality among children. The vague symptoms, the uncertain diagnostic tests and lack of adequate awareness among families all contributed in masking the actual prevalence of the disease. The objective of this study was to describe the epidemiology of childhood TB in River Nile State (RNS), North Sudan.
  
  
  METHODS
  All registered cases of TB aged 15 years and below, at the 13 management units in RNS during 3 years, 2011-2013 were included. The records included epidemiological, clinical, and microbiological data.
  
  
  RESULTS
  Out of the 1221 total TB notified cases, children were 187 (15.3%); almost equally distributed across the 3 years of the study period. Males were 56.7%. Most of the cases (89.9%) were newly diagnosed; among them, pulmonary TB (PTB) constituted 61.5%. Sputum specimen was tested in 59.4% (111/187) of cases, and only 15.3% (17/111) of specimens were sputum smear positive for new cases. The cure rate was (76.5%), and the treatment success rate was (88.2%). The death rate was 6.1% among PTB cases and 5.6% among extra-pulmonary cases. All the 20 (10.7%) children tested for HIV were negative.
  
  
  CONCLUSIONS
  TB is under-reported in RNS and treatment outcomes are sub-optimal. Strategies to identify the active case-detection among children are recommended.
authors.affiliation: Department of Pathology, Nile Valley University, Atbara, Sudan.
authors.forename: Wadie M
authors.initials: WM
authors.lastname: Elmadhooun
authors.affiliation: Department of Paediatrics and Child Health, National Ribat University, Khartoum, Sudan.
authors.forename: Elmuntasir Taha
authors.initials: ET
authors.lastname: Salah
authors.affiliation: Department of Medicine, Nile Valley University, Atbara, Sudan.
authors.forename: Sufian K
authors.initials: SK
authors.lastname: Noor
authors.affiliation: Department of Medicine, Nile Valley University, Atbara, Sudan.
authors.forename: Sarra O
authors.initials: SO
authors.lastname: Bushara
authors.affiliation: National Tuberculosis Control Program, State Ministry of Health, River Nile State, Atbara, Sudan.
authors.forename: Ekhlas O
authors.initials: EO
authors.lastname: Ahmed
authors.affiliation: National Tuberculosis Control Program, Federal Ministry of Health, Khartoum, Sudan.
authors.forename: Hamdan
authors.initials: H
authors.lastname: Mustafa
authors.affiliation: Department of Community Medicine, Nile Valley University, Atbara, Sudan.
authors.forename: Amel A
authors.initials: AA
authors.lastname: Sulaiman
authors.affiliation: Department of Medicine, Melton Keynes University Hospital NHS Foundation Trust, Melton Keynes, Buckinghamshire, UK.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Ahmed
keywords: Childhood tuberculosis; River Nile State; Sudan