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Burusie A, Enquesilassie F, Salazar-Austin N, Addissie A. The magnitude of unfavorable tuberculosis treatment outcomes and their relation with baseline undernutrition and sustained undernutrition among children receiving tuberculosis treatment in central Ethiopia. Heliyon 2024; 10:e28040. [PMID: 38524586 PMCID: PMC10957419 DOI: 10.1016/j.heliyon.2024.e28040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/06/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
Background One of the global key indicators for monitoring the implementation of the World Health Organization's End Tuberculosis (TB) Strategy is the treatment outcome rate. Objective This study aims to assess the magnitude of unfavorable treatment outcomes and estimate their relationship with baseline undernutrition and sustained undernutrition among children receiving TB treatment in central Ethiopia. Methods This retrospective cohort study included children treated for drug-susceptible TB between June 2014 and February 2022. The study comprised children aged 16 and younger who were treated in 32 randomly selected healthcare facilities. A log-binomial model was used to compute adjusted risk ratios (aRR) with 95% confidence intervals (CIs). Results Of 640 children, 42 (6.6%; 95% CI = 4.8-8.8%) had an unfavorable TB treatment outcomes, with 31 (73.8%; 95% CI = 58.0-86.1%) occurring during the continuation phase of TB treatment. We confirmed that baseline undernutrition (aRR = 2.68; 95% CI = 1.53-4.71), age less than 10 years (aRR = 2.69; 95% CI = 1.56-4.61), HIV infection (aRR = 2.62; 95% CI = 1.50-4.59), and relapsed TB (aRR = 3.19; 95% CI = 1.79-4.71) were independent predictors of unfavorable TB treatment outcomes. When we looked separately at children who had been on TB treatment for two months or more, we found that sustained undernutrition (aRR = 3.76; 95% CI = 1.90-7.43), age below ten years (aRR = 2.60; 95% CI = 1.31-5.15), and HIV infection (aRR = 2.26; 95% CI = 1.11-4.59) remained predictors of unfavorable outcomes, just as they had in the first two months. However, the effect of relapsed TB became insignificant (aRR = 2.81; 95% CI = 0.96-8.22) after the first two months TB treatment. Conclusions The magnitude of unfavorable TB treatment outcomes among children in central Ethiopia met the World Health Organization's 2025 milestone. Nearly three-quarters of unfavorable TB treatment outcomes occurred during the continuation phase of TB treatment. Baseline undernutrition, sustained undernutrition, younger age, HIV infection, and relapsed TB were found to be independent predictors of unfavorable TB treatment outcomes among children receiving TB treatment in central Ethiopia.
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Affiliation(s)
- Abay Burusie
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Fikre Enquesilassie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nicole Salazar-Austin
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Ksoo R, Barman H, De M, Lynser D, Duwarah SG, Lyngdoh C. Clinical Profile of Pediatric Tuberculosis in a Tertiary Hospital in Northeast India: A Retrospective Analysis. Cureus 2023; 15:e38660. [PMID: 37288235 PMCID: PMC10243406 DOI: 10.7759/cureus.38660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/09/2023] Open
Abstract
Context Tuberculosis (TB) is India's major public health problem. The profile of childhood TB in the northeast region of India is still limited. Aim To analyze the clinical, radiological, and bacteriological profiles of children with TB at a tertiary health care facility. Materials and methods A three years retrospective descriptive analysis of children admitted to a tertiary centre with TB before the introduction of cartridge-based nucleic acid amplification test (CBNAAT) for testing. Children below 18 years who were admitted from 2012 to 2014 and were diagnosed with TB were included. Relevant data were extracted in a predesigned format and entered into a Microsoft Excel sheet. Descriptive statistic was used for analysis. The results of variables are given in proportions and means and a Chi-square test was done for the test of significance using Epi-info tools. The study was done after getting ethical approval from the institute. Results A total of 150 children were included in the analysis with a Male: Female ratio of 1.1:1. A majority of the cases were under five years (n=46) and 11 to 15 years old (n=45) with a mean age of 9.3 ± 4.4 years. Fever was a common presentation (70%). Disseminated TB was seen in 31.3%, isolated central nervous system (CNS) TB was found in 30.6%, and all CNS TB with dissemination was found in 46 cases (40.7%) making extra-pulmonary TB a common finding in our study (83.3%). Isolated pulmonary TB was seen in 16.7% and total pulmonary cases along with dissemination was seen in 60 cases (40%). A bacteriological diagnosis was made in 23%. Overall mortality was 9.3%, out of which mortality in CNS TB was 13% with a p-value of 0.004 as compared to mortality other than CNS TB which was significant and mortality in under-five years was significant with a p-value of 0.001. Conclusions Pulmonary and extra-pulmonary were both causes of admission in the pediatric age group. We found that extra-pulmonary TB was the most common cause of admission in children, with CNS manifestation and disseminated TB, being the most common presentations and significant mortality was seen in under-five years and in children diagnosed with CNS TB.
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Affiliation(s)
- Rosina Ksoo
- Paediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Himesh Barman
- Paediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Manisha De
- Paediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Donboklang Lynser
- Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Sourabh G Duwarah
- Paediatrics and Neonatology, Akanksha and Ayursundra Hospital, Guwahati, IND
| | - Clarissa Lyngdoh
- Microbiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
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Penjor K, Kuenzang, Tshokey T, Wangdi K. The trend of tuberculosis case notification and predictors of unsuccessful treatment outcomes in Samdrup Jongkhar district, Bhutan: A fourteen-year retrospective study. Heliyon 2021; 7:e06573. [PMID: 33855240 PMCID: PMC8027770 DOI: 10.1016/j.heliyon.2021.e06573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/18/2021] [Accepted: 03/17/2021] [Indexed: 12/02/2022] Open
Abstract
Tuberculosis (TB) continues to be an important public health issue in Bhutan. This study aims to describe the trend of tuberculosis and investigate factors associated with a unsuccessful treatment outcome in Samdrup Jongkhar District in Bhutan. A fourteen-year (2004–2017) case records in two TB centres of Dewathang and Samdrup Jongkhar Hospitals were reviewed and analyzed to examine trends in case notification and treatment outcomes. Univariable and multivariable logistic regression analysis was undertaken to identify covariates of unsuccessful TB treatment. Of the total of 820 TB cases registered in surveillance record, 729 cases were analysed. Males made up 53.8% (397) of total cases and the median age was 29 years (range: 2–87 years). A gradual downward trend in TB case notification was noticed in the district with overall case notification rate of 139/100,000 during the study period. The annual treatment success rate was over 90% except for years 2013–2015 with overall treatment success rate for the study period at 93%. A re-treatment TB patient, sputum-positive at the second month of treatment and being of Indian nationality were significant correlates of unsuccessful treatment outcomes. The overall TB inclidence has declined and TB treatment success rate was above WHO recommended 90% in Samdrup Jongkhar District during the study period. A special attention should be paid to the poor treatment outcome predictors including re-treatment cases and failed sputum conversion at the second month of treatment.
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Affiliation(s)
- Kinley Penjor
- Dewathang Military Hospital, Samdrup Jongkhar, Department of Medical Services, Ministry of Health, Bhutan.,Vector-borne Diseases Control Program, Department of Public Health, Ministry of Health, Gelephu, Bhutan
| | - Kuenzang
- Dewathang Military Hospital, Samdrup Jongkhar, Department of Medical Services, Ministry of Health, Bhutan
| | - Tshokey Tshokey
- Department of Laboratory Services, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, Australia
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Dorji T, Tshering T, Wangdi K. Assessment of knowledge, attitude and practice on tuberculosis among teacher trainees of Samtse College of Education, Bhutan. PLoS One 2020; 15:e0241923. [PMID: 33156845 PMCID: PMC7647099 DOI: 10.1371/journal.pone.0241923] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/23/2020] [Indexed: 02/04/2023] Open
Abstract
Background Tuberculosis (TB) is a major public health problem in Bhutan despite the implementation of directly observed treatment short-course since 1997. This study aimed to assess the knowledge, attitude and practice on TB among the teacher trainees of Samtse College of Education. Methodology A cross-sectional study was conducted among the teacher trainees of Samtse College of Education. A standardized pretested questionnaire was distributed and self-administered. The participants were selected randomly using randomization. The data was entered in Epi-data 4.4.2.1 and analysed using STATA version 13. A score of 1 point for a correct answer and 0 for wrong/don’t know answer was given. The knowledge, attitude and practice score were divided into good and poor based on 50% cut off. Logistic regression was used for the analysis to identify the significant covariates. Results A total of 420 trainees responded to the survey questionnaire. The average knowledge score on TB was 10.7 (Range = 0–21). Two hundred and forty respondents (58.6%) had low knowledge (mean score 7.8±2.5) on TB. Cough, chest pain and weight loss were correctly reported as the symptoms of TB by 306 (72.9%), 187(44.5%) and 187 (44.5%) participants. Eighty-nine-point five percent (376) of participants reported coughing as the main route of TB transmission and 85% (357) of the participants said that it could be prevented by covering the mouth while coughing. In multivariable analysis; the trainees in the junior years of college had good knowledge of TB compared with the senior years (adjusted odds ratio [AOR] 2.02; 95% confidence interval [CI] 1.18–3.5; p-value 0.011). Respondents previously treated for TB were more likely to have good knowledge on TB compared to those who never had TB in the past (AOR 2.39; 95% CI 1.07–5.31; p-value 0.033). The majority (93%) of respondents had a good attitude towards TB cases. Female trainees were 2.4 (95% CI 1.02–5.62; p-value 0.045) times more likely than male trainees to have a positive attitude towards TB. Eighty-eight percent of the respondents reported that they would visit the hospital if they had TB symptoms. The mean score for the practice on TB was 1.33±0.59 (Range:0–2). Conclusion In this study, the majority of the trainees had poor knowledge on TB, especially among the trainees in senior years of college and those who had never suffered from TB. The attitude towards TB was good especially among the female trainees. However, the overall practice was poor among the participants. Therefore, the Ministry of Health should collaborate with relevant stakeholders especially the Ministry of Education to incorporate topics on TB in the syllabus of students and colleges to create awareness on it.
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Affiliation(s)
| | | | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Acton, Canberra, ACT, Australia
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Laboratory and clinico-demographic profile of patients investigated for tuberculosis in the National Referral Hospital of Bhutan. Heliyon 2020; 6:e05084. [PMID: 33015400 PMCID: PMC7522484 DOI: 10.1016/j.heliyon.2020.e05084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 12/02/2019] [Accepted: 09/24/2020] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis, is an important public health problem in Bhutan. Microscopy is the primary method of diagnosis of TB in developing countries including Bhutan. Performance of microscopy in the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), has never been assessed. A retrospective review of laboratory records for three years (2014-2016) was performed to determine the laboratory profile of patients investigated for different types of TB at the JDWNRH. A total of 10,821 sputum and 3,495 non-sputum samples were examined for pulmonary TB (PTB) and extrapulmonary TB (EPTB) respectively. The commonest EPTB samples were Fine Needle Aspiration Cytology (FNAC), urine and sterile fluids. About 6% (127/2163), 5 % (130/2390) and 5% (289/5310) were positive for PTB in 2014, 2015 and 2016 respectively and EPTB positivity was about 7% in all years. During follow-up a significant number of patients remained sputum positive. Sputum sample satisfactory rate (quality) varied between 51 % to 79% in the primary samples. Sample completeness (number) ranged between 62.3% to 94.6% but dropped sequentially in the follow-up cases. Sample completeness of urine samples for EPTB ranged between 75-90%. EPTB positivity rate was highest in FNAC, followed by urine, pleural fluid and ascitic fluid samples. Higher number of patients were investigated for TB in subsequent years from 2014 to 2016. TB positivity rates for PTB and EPTB remained consistent over three years at about 5-6% and 7% respectively. There was a significant variation in sputum sample adequateness (by quality and number). Sputum conversion in the follow-up cases was lower than other countries. Educating the patients on the importance of providing adequate samples can improve TB diagnosis, enhance early treatment, reduce transmission and contribute significantly towards TB elimination.
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Belay GM, Wubneh CA. Childhood tuberculosis treatment outcome and its association with HIV co-infection in Ethiopia: a systematic review and meta-analysis. Trop Med Health 2020; 48:7. [PMID: 32099521 PMCID: PMC7027074 DOI: 10.1186/s41182-020-00195-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background Tuberculosis is the second leading cause of death from an infectious disease worldwide, next to HIV. Hence, initiating and determining the national tuberculosis treatment program and outcome is crucial. However, the childhood tuberculosis treatment outcome in Ethiopia was not investigated. Objective This study determined the pooled estimate of childhood tuberculosis treatment outcome and its association with HIV co-infection. Methods PubMed, Google Scholar, Web of Science, reference lists of included studies, and Ethiopian institutional research repositories were used to retrieve all available studies. Searching was limited to the studies that had been conducted in Ethiopia and published in the English language. In this study, observational studies, including cohort, cross-sectional, and case-control studies, were included. The estimate of childhood tuberculosis treatment outcome was determined using a weighted inverse variance random-effects model. The overall variation between studies was checked by the heterogeneity test (I 2). The Joanna Briggs Institute (JBI) quality appraisal criteria were used for quality assessment of the studies. The summary estimates were presented with forest plots and tables. Publication bias was also checked with the funnel plot and Egger's regression test. The outcome measures were successful and unsuccessful treatment outcomes. Successful treatment outcomes are defined as patients who are cured and treatment completed, whereas, an unsuccessful treatment outcome means those patients with defaulter, failure, and death treatment outcomes. Result To estimate the overall pooled estimate of successful treatment outcome, 6 studies with 5389 participants were considered. Consequently, the overall pooled estimate of successful treatment outcome was 79.62% (95% CI 73.22, 86.02) of which 72.44% was treatment completed. On the other hand, unsuccessful treatment outcomes, including treatment failure, defaulter, and death, were 0.15%, 5.36%, and 3.54%, respectively. Moreover, this study found that HIV co-infection was significantly associated with childhood tuberculosis treatment outcomes. Poor treatment outcome was higher among children with HIV co-infection with an odds ratio of 3.15 (95% CI 1.67, 5.94) compared to that of HIV-negative children. Conclusion The summary estimate of successful childhood tuberculosis treatment outcome was low compared to the threshold suggested by the World Health Organization. HIV co-infection is significantly associated with poor treatment outcome of childhood tuberculosis. Therefore, special attention is better to be given to children infected with HIV. Moreover, adherence to anti-TB has to be strengthened. Trial registration The protocol has been registered in PROSPERO with a registration number of CRD42018110570.
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Affiliation(s)
- Getaneh Mulualem Belay
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ohene SA, Fordah S, Dela Boni P. Childhood tuberculosis and treatment outcomes in Accra: a retrospective analysis. BMC Infect Dis 2019; 19:749. [PMID: 31455234 PMCID: PMC6712824 DOI: 10.1186/s12879-019-4392-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/19/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a leading cause of death in children and adults. Unlike for adults, there is paucity of data on childhood TB in several countries in Africa. The study objective was to assess the characteristics and treatment outcomes of children with TB from multiple health facilities in Accra, Ghana. METHODS A retrospective analyses was conducted using secondary data on children less than 15 years collected from 11 facilities during a TB case finding initiative in Accra from June 2010 to December 2013. Demographic and clinical characteristics as well as treatment outcomes were assessed. Multivariable logistic regression was conducted to assess predictors of mortality. RESULTS Out of the total 3704 TB cases reported, 5.9% (219) consisted of children with a female: male ratio of 1:1.1. Children less than 5 years made up 56.2% of the patients while 44.2% were HIV positive. The distribution of TB type were as follows: smear positive pulmonary TB (SPPTB), 46.5%, clinically diagnosed pulmonary TB 36.4%.%, extra-pulmonary TB 17.4%. Among the 214 children (97.7%) for whom treatment outcome was documented, 194 (90.7%) were successfully treated consisting of 81.3% who completed treatment and 9.4% who were cured. Eighteen children (8.4%) died. Mortality was significantly higher among the 1-4 year group (p < 0.001), those with SPPTB (p < 0.001) and HIV positive children (p < 0.001). In logistic regression, SPPTB and HIV positivity were predictors of mortality. CONCLUSION The proportion of children in Accra successfully treated for TB met the target of END TB Strategy treatment success indicator. HIV positivity was a risk factor for death. Reducing mortality in TB-HIV co-infected children will further improve treatment outcomes of children with TB in Accra.
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Affiliation(s)
| | | | - Prince Dela Boni
- Ghana Institute of Management and Public Administration, Accra, Ghana
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Abstract
Multidrug-resistant tuberculosis (MDR-TB) is a well-identified raising public health concern worldwide. However, the data available on MDR-TB in children and particularly in the neonate age group are limited. Congenital tuberculosis (TB) is rare, and its diagnosis is challenging because of non-specific manifestations. The choice of anti-tubercular drugs is difficult because of the lack of international consensus as a consequence of the scarcity of evidence-based data on this age group. We hereby present a case from Bhutan of a 23-day-old male neonate with congenital MDR-TB. His mother was diagnosed with disseminated TB, and treatment was commenced 11 days post-partum. Congenital transmission of TB was suspected, as direct postnatal transmission was unlikely and thorough screening of contacts for TB was negative. In this case, the mother's MDR-TB status was revealed only after her newborn's MDR-TB diagnosis.
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Affiliation(s)
- Tenzin Lhadon
- Department of Paediatrics, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Sophie Jullien
- Department of Paediatrics, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Osman M, Lee K, Du Preez K, Dunbar R, Hesseling AC, Seddon JA. Excellent Treatment Outcomes in Children Treated for Tuberculosis Under Routine Operational Conditions in Cape Town, South Africa. Clin Infect Dis 2018; 65:1444-1452. [PMID: 29048512 DOI: 10.1093/cid/cix602] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/03/2017] [Indexed: 02/07/2023] Open
Abstract
Background Tuberculosis (TB) remains a leading cause of death in children globally. It is recognized that human immunodeficiency virus (HIV) infection increases the risk of developing TB, but our understanding of the impact of HIV on risk of mortality for children treated for TB is limited. We aimed to identify predictors of mortality in children treated for drug-susceptible TB. Methods A retrospective analysis of all children (<15 years of age) routinely treated between 2005 and 2012 for drug-susceptible TB in Cape Town was conducted using the programmatic electronic TB treatment database. Survival analysis using Cox regression was used to estimate hazard ratios for death. Logistic regression was used to estimate the odds of unfavorable outcomes. Results Of 29519 children treated for and notified with TB over the study period, <1% died during TB treatment and 89.5% were cured or completed treatment. The proportion of children with known HIV status increased from 13% in 2005 to 95% in 2012. Children aged <2 years had an increased hazard of death (adjusted hazard ratio [aHR], 3.13; 95% confidence interval [CI], 1.78-5.52) and greater odds of unfavorable outcome (adjusted odds ratio [aOR], 1.44; 95% CI, 1.24-1.66) compared with children aged 10-14 years. HIV-infected children had increased mortality compared to HIV-negative children (aHR, 6.85; 95% CI, 4.60-10.19) and increased odds of unfavorable outcome (aOR, 2.01; 95% CI, 1.81-2.23). Later year of TB treatment was a protective predictor for both mortality and unfavorable outcome. Conclusions We demonstrate a dramatic improvement in HIV testing in children with TB over time and excellent overall treatment outcomes. HIV infection and young age were associated with increased risk of death and unfavorable outcome.
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Affiliation(s)
- Muhammad Osman
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - Kevin Lee
- City of Cape Town Health Directorate, South Africa
| | - Karen Du Preez
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - Rory Dunbar
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - Anneke C Hesseling
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg
| | - James A Seddon
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg.,Centre for International Child Health, Imperial College London, United Kingdom
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Ogbudebe CL, Adepoju V, Ekerete-Udofia C, Abu E, Egesemba G, Chukwueme N, Gidado M. Childhood Tuberculosis in Nigeria: Disease Presentation and Treatment Outcomes. Health Serv Insights 2018; 11:1178632918757490. [PMID: 29511357 PMCID: PMC5826094 DOI: 10.1177/1178632918757490] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/10/2018] [Indexed: 11/15/2022] Open
Abstract
Objectives Understanding the factors that influence tuberculosis (TB) treatment outcomes in children is key to designing interventions to address them. This study aimed to determine the case category distribution of childhood TB in Nigeria and assess which clinical and demographic factors are associated with different treatment outcomes in childhood TB. Materials and methods This was a retrospective cohort study involving a review of medical records of children (0-14 years) with TB in 3 states in Nigeria in 2015. Results Of 724 childhood TB cases registered during the review period, 220 (30.4%) were aged 0-4 years. A high proportion of patients had pulmonary TB 420/724 (58.0%), new TB infection 713/724 (98.5%), and human immunodeficiency virus (HIV) coinfection 108/724 (14.7%). About 28% (n = 201) were bacteriologically diagnosed. The proportion of TB treatment success was 601/724 (83.0%). Treatment success was significantly higher in children aged 5-14 years than those 0-4 years (85.3% vs 77.7%, P = .01). Factors associated with unsuccessful outcomes in patients aged 0-4 years are male sex (adjusted odds ratio [aOR]: 1.2), HIV-positive status (aOR: 1.2), and clinical method of diagnosis (aOR: 5.6). Conclusions Efforts should be made to improve TB treatment outcomes in children by ensuring early and accurate diagnosis, focused training of health workers on childhood TB-HIV care, and effective adherence counseling of caregivers.
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Affiliation(s)
| | | | | | - Ebere Abu
- Family Health International (FHI360), Lagos, Nigeria
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Geographical and demographic profile of tuberculosis in a pediatric population in Mumbai – A retrospective cross-sectional hospital-based study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2016. [DOI: 10.1016/j.cegh.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Graham SM, Grzemska M, Brands A, Nguyen H, Amini J, Triasih R, Talukder K, Ahmed S, Amanullah F, Kumar B, Tufail P, Detjen A, Marais B, Hennig C, Islam T. Regional initiatives to address the challenges of tuberculosis in children: perspectives from the Asia-Pacific region. Int J Infect Dis 2016; 32:166-9. [PMID: 25809775 DOI: 10.1016/j.ijid.2014.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/06/2014] [Indexed: 11/28/2022] Open
Abstract
Increasing attention is being given to the challenges of management and prevention of tuberculosis in children and adolescents. There have been a number of recent important milestones achieved at the global level to address this previously neglected disease. There is now a need to increase activities and build partnerships at the regional and national levels in order to address the wide policy-practice gaps for implementation, and to take the key steps outlined in the Roadmap for Child Tuberculosis published in 2013. In this article, we provide the rationale and suggest strategies illustrated with examples to improve diagnosis, management, outcomes and prevention for children with tuberculosis in the Asia-Pacific region, with an emphasis on the need for greatly improved recording and reporting. Effective collaboration with community engagement between the child health sector, the National Tuberculosis control Programmes, community-based services and the communities themselves are essential.
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Affiliation(s)
- Stephen M Graham
- International Union Against Tuberculosis and Lung Disease, Paris, France; Centre for International Child Health, University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Australia; Centre for International Health, Burnet Institute, Melbourne, Australia.
| | - Malgorzata Grzemska
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Annemieke Brands
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Huong Nguyen
- KNCV Tuberculosis Foundation Country Office, Ha Noi, Viet Nam
| | - James Amini
- National Department for Health, Port Moresby, Papua New Guinea
| | - Rina Triasih
- Department of Pediatrics, Dr. Sardjito Hospital/Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Shakil Ahmed
- Bangladesh Paediatric Association TB CARE II Porject, Dhaka, Bangladesh
| | | | | | | | - Anne Detjen
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Ben Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity and the Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - Cornelia Hennig
- Stop TB and Leprosy Unit, Division of communicable Diseases, World Health Organization Regional Office for the Western Pacific, Manila, The Philippines
| | - Tauhid Islam
- Stop TB and Leprosy Unit, Division of communicable Diseases, World Health Organization Regional Office for the Western Pacific, Manila, The Philippines
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Tagaro M, Harries AD, Kool B, Ram S, Viney K, Marais B, Tarivonda L. Tuberculosis case burden and treatment outcomes in children, adults and older adults, Vanuatu, 2007-2011. Public Health Action 2015; 4:S14-8. [PMID: 26477280 DOI: 10.5588/pha.13.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 11/10/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING All five DOTS centres in Vanuatu. OBJECTIVES To determine across the age spectrum the tuberculosis (TB) case burden, disease pattern and treatment outcomes in patients registered between 2007 and 2011. DESIGN Retrospective cohort study involving reviews of TB registers and treatment cards. RESULTS Of 588 TB patients, 142 (24%) were children (aged 0-14 years), 327 (56%) adults (aged 15-54 years) and 119 (20%) were older adults (aged ⩾55 years; subdivided into 55-64 and ⩾65 years); 568 were new patients, 13 had been treated previously and 7 had unknown status. Compared with adults, children with new TB had a higher prevalence of extra-pulmonary TB (75% vs. 34%, OR 5.7, 95%CI 3.6-9.0) and a lower prevalence of smear-positive pulmonary TB (11% vs. 45%, OR 0.15, 95%CI 0.1-0.3), while older adults with new TB had a higher prevalence of smear-negative pulmonary TB (38% vs. 21%, OR 2.4, 95%CI 1.5-3.8). Overall TB treatment success was 83%, but in the second category of older adults (⩾65 years) treatment success was 67% and case fatality was 18%. CONCLUSION Children and older adults constitute 45% of the TB burden in Vanuatu. Differences in disease patterns and poorer treatment outcomes in older adults have implications for policy and practice.
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Affiliation(s)
- M Tagaro
- National TB Control Programme, Port Vila, Vanuatu
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - B Kool
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - S Ram
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - K Viney
- Secretariat of the Pacific Community, Nouméa, New Caledonia
| | - B Marais
- The Sydney Emerging Infections and Biosecurity Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - L Tarivonda
- Department of Public Health, Ministry of Health, Port Vila, Vanuatu
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Kumar AMV, Satyanarayana S, Berger SD, Chadha SS, Singh RJ, Lal P, Tonsing J, Harries AD. Promoting operational research through fellowships: a case study from the South-East Asia Union Office. Public Health Action 2015; 5:6-16. [PMID: 26400596 PMCID: PMC4525361 DOI: 10.5588/pha.14.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/27/2015] [Indexed: 11/10/2022] Open
Abstract
In 2009, the International Union Against Tuberculosis and Lung Disease (The Union) and Médecins Sans Frontières (MSF) jointly developed a new paradigm for operational research (OR) capacity building and started a new process of appointing and supporting OR fellows in the field. This case study describes 1) the appointment of two OR fellows in The Union South-East Asia Office (USEA), New Delhi, India; 2) how this led to the development of an OR unit in that organisation; 3) achievements over the 5-year period from June 2009 to June 2014; and 4) challenges and lessons learnt. In June 2009, the first OR fellow in India was appointed on a full-time basis and the second was appointed in February 2012-both had limited previous experience in OR. From 2009 to 2014, annual research output and capacity building initiatives rose exponentially, and included 1) facilitation at 61 OR training courses/modules; 2) publication of 96 papers, several of which had a lasting impact on national policy and practice; 3) providing technical assistance in promoting OR; 4) building the capacity of medical college professionals in data management; 5) support to programme staff for disseminating their research findings; 6) reviewing 28 scientific papers for national or international peer-reviewed journals; and 7) developing 45 scientific abstracts for presentation at national and international conferences. The reasons for this success are highlighted along with ongoing challenges. This experience from India provides good evidence for promoting similar models elsewhere.
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Affiliation(s)
- A. M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - S. Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | | | - S. S. Chadha
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - R. J. Singh
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - P. Lal
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - J. Tonsing
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - A. D. Harries
- The Union, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
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