This study examined patterns of TB diagnosis among children in Ethiopia's public health facilities. The diagnostic pattern was evaluated using three groups of variables; Sociodemographic characteristics of study participants, screening for clinical symptoms, diagnostic modality, and diagnostic algorithm.. Among the socio-demographic characteristics examined, tuberculosis is more frequently diagnosed in young children between the ages of 5 and 10 than in children under 5 and over 10 years of age. This can be explained by the fact that children start school at this age, which increases their exposure to different environments, which increases the risk of infection at this age. The disease, which is also more likely to occur in rural than urban areas, can be explained by poor access to medical care, low vaccination rates and socio-cultural problems, as well as living conditions in rural areas that contribute to the spread of tuberculosis [21, 22].
Clinical signs of suspected TB in children included fever, and were more likely to be diagnosed with PTB than children without fever, and children with a contact history were more likely to be diagnosed with PTB have a higher likelihood of being diagnosed with PTB than those with no contact history. While contact history is less useful in countries with high TB endemic rates [23, 24] an important consideration is that children contract TB in the household in which they live. can be easily traced, unlike adults with many. For example, one study shows that it is not difficult to diagnose multidrug-resistant tuberculosis (MDR-TB) in children, since exposure to adults with MDR-TB is essential to establish this presumptive diagnosis [6]. This result supports the findings of another studies that clinical diagnosis is essential in the management of childhood tuberculosis [7, 25], which is why improving the competence of frontline health workers in the priority in most countries as clinical diagnosis of childhood tuberculosis commonly used in clinical practice [26–29].
Based on the duration of the cough, three different algorithms were used to detect cases of tuberculosis in children. The first algorithm is a cough for ≥ 2 weeks, followed by a chest x-ray with all findings, followed by GeneXpert/AFB swab microscopy, and with this algorithm, tuberculosis is diagnosed 63% of the time, which is less than the survey rate in all age groups in the same area, 81.2% of PTB cases [30]. The discrepancy could be due to the difference in population.The second algorithm is a cough < 2 weeks followed by a chest x-ray with findings suggestive of tuberculosis, followed by a GeneXpert/microscopic swab. Using this algorithm, we found 21% of tuberculosis cases, which is more than the study of all age groups in the same areas, accounting for 14.2% of PTB cases [30], this inequality is due to population defference.
The third algorithm was any-duration cough followed by GeneXpert/AFB swab microscopy, and with this algorithm we found 16%, more than one study in the same area across all ages, as 4.5% of PTB cases. This difference shows that GeneXpert provides more results in children with an indicative CXR score and is important in this age group. Chest X-ray was performed in 399/438 (91%), making it the most commonly used screening modality in this study. All chest radiographs were frontal (AP). Approximately 55/399 (13.78%) had evidence of tuberculosis on chest X-ray. Diagnosis was based on a cough screening algorithm followed by chest X-ray. Also, the algorithms required fewer modifications to be sentence specific. Thus, if a facility has an X-ray machine and a radiologist, this can be incorporated into the routine standard of care. As recommended by the World Health Organization, CXR screening is a good healthcare choice because it reduces costs and logistical challenges compared tocommunity-active case searches. Of 270/438 (61.6%),GeneXpert MTB/Ref gastric lavages were performed, of which 32 were positive, with a percentage positive of 11.8th %. Only 51 children had an AFB smear, of which 2 were positive with a positivity rate of 2/51 (3.9%).The use of cough screening algorithms followed by a chest x-ray followed by a GeneXpert sputum test resulted in 21% more cases of PTB than a chest x-ray alone (clinical) 13.78%. This result supports the recommendation to use GeneXpert as the first diagnostic test at the point-of-care [31, 32] over conventional tests due to its rapidity and sensitivity to diagnostic tests. resistant to TB. The use of cough screening was helpful in the COVID-19 time as TB services were compromised [33–35].
In this study, fever, weight loss, and TB contact history are highly associated with TB positivity rates in children. Differences in TB detection rates between countries such as Ethiopia may be influenced by the prevalence of the HIV epidemic, overcrowding, differences in the sensitivity of laboratory diagnostic techniques, and variability in the effectiveness of preventive measures [36–40]. In current times where technologies are rapidly evolving to advance TB care and management [], such advanced technologies are are urgently needed to improve childhood TB case ditection. (Atehortúa et al., 2015; Hajizadeh et al., 2021).