South African study finds high risk of TB infection in kids Chris Dall, MA November 6, 2024 Tuberculosis Alissa Eckert, James Archer / CDC A prospective birth cohort study conducted in South Africa found that children who grow up in a setting where tuberculosis (TB) transmission is common have a high risk of TB infection and disease, with up to 10% developing the disease by age 10, researchers reported yesterday in The Lancet Child & Adolescent Health. Although 1.2 million children globally develop TB disease every year, and roughly 200,000 die from it, few studies have investigated the risk of developing TB during childhood, particularly in high-burden countries like South Africa. Approximately 15% to 20% of all TB cases in South Africa, which has one of the highest TB incidence rates in the world, are likely to occur in children. To assess the risk, researchers from the Boston University School of Public Health (BUSPH), the University of Cape Town, and the University of Sao Paulo followed 1,137 women and their 1,143 children who were living near Cape Town from 2012 through 2023 and were enrolled in the Drakenstein Child Health Study, a cohort study of children born in a setting with high TB and HIV burdens. A previous study of this cohort found high rates of tuberculin skin test conversion (presumptive evidence of TB infection) and TB disease in the first 5 years of life. For this study, the researchers extended their work to examine the children through the first 10 years of life. They tested the children for Mycobacterium tuberculosis infection and TB disease using tuberculin skin tests at 6 months and 12 months of age, then annually in children with a negative test.  “To the best of our knowledge, this is the first birth cohort study to prospectively investigate M tuberculosis infection and tuberculosis disease in the first decade of life in an area with a high tuberculosis burden,” the study authors wrote. An urgent health problem Over the follow-up period, the annual risk of tuberculin skin test conversion was 6.6 per 100 person-years, ranging from 4.4 to 9.3, with the greatest annual risk occurring at 1 year (9.3%) and 8 years (8.9%). The cumulative hazard of tuberculin skin test conversion was 36% at age 8 years, and the cumulative hazard of TB disease was 10% at age 10.  “These results are striking and show that children in these communities in South Africa are at extraordinarily high risk,” study co-senior author Leonardo Martinez, PhD, MPH, assistant professor of epidemiology at BUSPH, said in a university press release. “It’s clearly an urgent health problem with both short and long-term impacts on these children and their families.” Among the risk factors associated with tuberculin skin test conversion were household cigarette smoke exposure (adjusted hazard ratio , 1.7; 95% confidence interval , 1.2 to 2.5), households with more than five people (aHR, 1.3; 95% CI, 1.1 to 1.7), and known exposure to an individual with TB (aHR, 1.2; 95% CI, 1.0 to 1.6). These results are striking and show that children in these communities in South Africa are at extraordinarily high risk. Preventive treatment was associated with a reduction in TB disease among children who had tuberculin skin test conversion (aHR, 0.23; 95% CI, 0.12 to 0.47). However, most cases of TB disease (78 of 98; 79%) occurred among children who had tuberculin skin test conversion but were not administered preventive treatment. “This highlights an important challenge in tuberculosis programmes where provision of preventive treatment is of low priority,” the authors write. Martinez and his colleagues say children who develop TB disease are at risk for poor outcomes in young adulthood and later life and that follow-up on this cohort to understand their long-term health trajectories is an important next step. They also call for a multipronged approach to decrease pediatric TB in high-burden settings that combines preventive treatment for children at risk, active case finding, and reduction of community TB transmission. Read the extract below and answer the question: A prospective birth cohort study conducted in South Africa found that children who grow up in a setting where tuberculosis (TB) transmission is common have a high risk of TB infection and disease… What do you understand by birth cohort? Choose the most appropriate option below:

A close study of the use of noun phrases (highlighted) in the Extract below provides a quick summary of what the focus of the description is. What is the focus? When we think of OR what comes to mind is the most gentle soul, with the most tiger-like spirit; the kindest heart, with the fiercest determination; the most compassionate nature, with the strongest moral compass; the warmest, sweetest personality, with an unflinching dedication to honesty; the most loving, peaceful temperament, with the sharpest sense of conscience; the most beautiful smile, with a resolve to accept only absolute integrity; the most noble, patient, calm presence, with the most tenacious fervor for bold, uncompromising action; and the most brilliant intellect, with the most earnest, sincere appreciation for the simplest contribution. (Taken from the book titled Oliver Tambo remembered, edited by Z Pallo Jordan. Memoir by Nadine Hack and Jerry Dunfey, titled “Irresistable, inspirational and deeply loved”. Section with the heading: Friends and neighbours in the UK. Page 3. Johannesburg: Macmillan.)

What is missing from the sentence below?For decades the standard way to prevent people who were exposed to tuberculosis (TB) from falling ill with the disease was to offer them a medicine called isoniazid, taken daily for six or more months.

Examine the word drought-resistant in Extract below. This is a compound word containing a noun (drought) and adjective (resistant). How is this compound word functioning in this extract?Figs are very tough and drought-resistant once established, however, fruit production will decline if not provided with adequate moisture.  

Snakes, monitor or rock monitor lizards and sometimes even the odd crocodile are prevalent in the city . “Most snakes we encounter are harmless. They’re mostly brown house snakes. … The snake won’t harm you if you just leave it alone. The weather, like rain … plays a role…. They often seek shelter and might by accident go into your yard to look for a warm and dry place to stay. … We need to consider the effects of urbanization on snakes’ natural habitat.What is the best summary of the  Extract?

Carefully examine  the Extract  below. The writer has chosen to leave words out for the sake of efficiency and not repeating text, which s/he assumes the reader can fill in him/herself. What are these words?Figs are very tough and drought-resistant once established, however, fruit production will decline if not provided with adequate moisture. (Taken from magazine titled Outside and In, Summer Issue 2020, page 43, Editor Michelle Besson)

Examine the word drought-resistant in Extract below. This is a compound word containing a noun (drought) and adjective (resistant). How is this compound word functioning in this extract?Figs are very tough and drought-resistant once established, however, fruit production will decline if not provided with adequate moisture.  

The common view is that a positive attitude may strongly influence behaviour. But in Extract 23 below, we read that this is a faulty notion. What is a good paraphrase (reformulation) of the underlined text?Extract 23  MISCONCEPTION People’s attitudes are excellent predictors of their behaviour.    REALITY Decades of research have shown that attitudes are undependable predictors of behaviour. For a variety of reasons, the correlation between attitudes and behaviour is surprisingly modest. Thus, a favourable attitude about a specific product or candidate does not necessarily translate into a purchase or vote.    (Taken from Wayne Weiten’s book titled Psychology. Themes and variations. 10th edition. Chapter 12, Section 12.4, page 433. 2017. USA: Cengage Learning.)

What is the modal auxiliary will signaling in the extract below? The relevant part of the text is reproduced for you below.… fruit production will decline if not provided with adequate moisture.

What type of a sentence is the extract below presenting?