The ability of the primary health care nurse to diagnose Tuberculosis in children

Abstract

Tuberculosis (TB) has re-emerged as a major worldwide public health challenge in the last decade with an increasing incidence amongst children. The diagnosis of TB in children is difficult as the presentation is not always classical and available diagnostic modalities are imperfect. Diagnosis is, especially complex in developing countries where resources and access to sophisticated diagnostic facilities are limited. Thus practical score charts combining a number of complementary clinical characteristics with affordable special investigations have been developed to aid diagnosis.

The new South African primary health care (PHC) nurse-driven system demands that first line nurses be equipped to suspect, diagnose, confirm the diagnosis and treat children with TB. Very little is known about the ability of PHC nurses to diagnose TB in children. In Mpumalanga province relatively low rates of notified paediatric TB prompted an investigation to determine the ability of local PHC nurses to diagnose TB in children and explore whether the PHC setting allowed this. Within method triangulation was used in this quantitative descriptive study by combining a self-completed knowledge survey with clinic visits to audit records and assess access to diagnostic aids and tests.

Important deficiencies in knowledge and limited access to certain diagnostic modalities found in this study must be addressed if appropriate management of TB in children is to be assured.