Number Needed to Screen for Tuberculosis Disease Among Children: A Systematic Review

Context Improving detection of pediatric tuberculosis (TB) is critical to reducing morbidity and mortality among children. Objective We conducted a systematic review to estimate the number of children needed to screen (NNS) to detect a single case of active TB using different active case finding (ACF) screening approaches and across different settings. Data sources We searched 4 databases (PubMed, Embase, Scopus, and the Cochrane Library) for articles published from November 2010 to February 2020. Study selection We included studies of TB ACF in children using symptom-based screening, clinical indicators, chest x-ray, and Xpert. Data extraction We indirectly estimated the weighted mean NNS for a given modality, location, and population using the inverse of the weighted prevalence. We assessed risk of bias using a modified AXIS tool. Results We screened 27 221 titles and abstracts, of which we included 31 studies of ACF in children Limitations Heterogeneity in the screening modalities and populations make it difficult to draw conclusions. Conclusions We identified a potential opportunity to increase TB detection by screening children presenting in health care settings. Pediatric TB case finding interventions should incorporate evidence-based interventions and local contextual information in an effort to detect as many children with TB as possible.