الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Childhood TB derives its pUblic health importance from the fact that each case discovered indicates recent transmission represnt .Ing failure of the responsible health services to identify an Infectious source(an adul t case). and jor to provide adequate preventive treatment to a child contanct.Furthermore.and in contrast to the publ ic view, TB has shown a resurgence in recent years.especially’so among urban children.Such a resurgence was found more related ~o ecologic factors in the family and the health services rather than to the l.ow efficacy o’f the avai lable anti - TB drugs. In the present work we have attempted to identifY the service and intra-fami lial factors affecting the occurrence and outcome of pulmonary TB in chi ldren below 5 years. The effect of such factors on the uti 1 ization of the services offered was also probed. The approaches used included assessing the medical care given to TB children from its administrative and actual implemen -tive aspects. A purposive sample(including all the children under 5 years of age having pulmonary TB encountered during the period of the field study and attending the chest dispensaries & hospi -tals of Alexandria )was taken.The mothers of these 51 children. and also of 50 controls,were questioned about their knowledge. attitudes and practices towards the disease of TB and the ser -vices offered for its prevention and treatment. The patterns of utilization of such services were determined,and eventually the family’s contribution to the problem of childhood TB was assessed. The administrative a~pects of the medical care services offered to young chi ldren wi th pulmonary TB were clari fi ed through interviewing and personally communicating with the personnel working in the field of TB control in Alexandr.ia Governorate.The results revealed lack of adequate communication between the diff -erent structural levels within the TB control services,as well e~tween these and the basic health units.There was insufficient surveillance of the TB situation, incomplete documentation and the data collected remained unanalyzed and properly formulated. ~TB control unit was offering some useful technical supervision but this lacked any authoritative backing thus limiting its use -fulness. uta the operation and flow of services,work in most of the chest dispensaries was satisfactorilY implemented.However,vaccination -~~ BCG was not given thus segregating preventive from curative .~ I H~ices,the laboratories of dispensaries lacked facilities for Lulture and sensi tivity testings.and organized health education i . activities were absent.The chest hospttals were overcrowded with long waiting lists due to the long durations of stay of cases ~d the poor understanding of indications for hospitalization of ffi~ses.There were no special pediatric wards and the pediatric forms of anti-TB drugs were maFkedly deficient.Communication with chest dispensaries was imperfect resulting in duplication of Investigations and failure of follow up of discharged cases. iOnstudyfng the fami I ial and ecologic determinants of chi Idhood TB;overcrowded premises,coupled with the presence of an index case,were the most significantly blamed.Poor sanitary conditions ~re also implicated despite that pulmonary TB has an air-borne transmission mode. The long time elapsing ti 11 the right diagnosis ofTS was attained conveyed both poor knowledge of the services offered on part of the fami ly as well as a low suspicion index among the workers in the bas i c hea 1 th un i ts. b~ledge of the mothers about the disease of TB,though I significantlY better among cases.such knowledge rC!I1ained largely . Imperfect. Of spec i al interest is the marked def i c i ency of know -ledge on the preventive aspects of the disease compared to thCJt M its treatment.Knowledge on the disease was found directly related to the mother’s educational level and social classing ~~ to other socioeconomic variables.However.the level of know -ledge did not seem to affect the pattern of utilization of the ervices offered for TB. Knowledge about such services was also ~rkedlY better among the mothers of cases than of controls,as the formers are actual users and/or directlY involved. Though a significant proportion of those studied(41.5