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Apis V, Landi M, Graham SM, Islam T, Amini J, Sabumi G, Mandalakas AM, Meae T, du Cros P, Shewade HD, Welch H. Outcomes in children treated for tuberculosis with the new dispersible fixed-dose combinations in Port Moresby. Public Health Action 2019; 9:S32-S37. [PMID: 31579647 DOI: 10.5588/pha.18.0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/13/2019] [Indexed: 12/30/2022] Open
Abstract
Setting The new child-friendly fixed dose combinations (FDCs) were introduced at Port Moresby General Hospital, Papua New Guinea, in 2016 for the first-line treatment of children (aged <15 years) with tuberculosis (TB) who weighed <25 kg. Objective To describe the characteristics and outcomes for children treated with the new FDCs, and to identify risk factors for unfavourable treatment outcomes. Design This was a retrospective cohort study of all children treated for TB with the FDCs from August 2016 to August 2017. Results Of 713 children included, 488 (68%) were diagnosed with pulmonary TB. Only 6 (0.8%) TB cases were bacteriologically confirmed and human immunodeficiency virus (HIV) status was known in 50%. Treatment outcomes were favourable in 425 (60%) children. Of 288 children with unfavourable outcomes, there were 242 (84%) with loss to follow-up (LTFU) and 25 (8.4%) were known to have died. Children who were severely underweight (weight-for-age Z score <-3) on presentation were at greater risk of LTFU compared to children of normal weight on multivariable analysis (aRR 1.3, 95%CI 1.0-1.6, P < 0.05). Conclusion Alternative models of care to decrease LTFU during treatment are needed, including integration with nutritional support. Improving diagnosis through microbiological confirmation of TB and HIV are major challenges to be addressed.
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Affiliation(s)
- V Apis
- Port Moresby General Hospital, Port Moresby, Papua New Guinea (PNG)
| | - M Landi
- Port Moresby General Hospital, Port Moresby, Papua New Guinea (PNG).,School of Medicine and Health Science, University of Papua New Guinea, Port Moresby, PNG
| | - S M Graham
- The Burnet Institute, Melbourne, Victoria, Australia.,Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - T Islam
- World Health Organization, Representative Office for PNG, Port Moresby, PNG
| | - J Amini
- National Department of Health, Port Moresby, PNG
| | - G Sabumi
- Health & HIV Implementation Services Provider, Abt JTA, Port Moresby, PNG
| | - A M Mandalakas
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - T Meae
- Port Moresby General Hospital, Port Moresby, Papua New Guinea (PNG)
| | - P du Cros
- The Burnet Institute, Melbourne, Victoria, Australia
| | - H D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union, South-East Asia Office, New Delhi, India
| | - H Welch
- Port Moresby General Hospital, Port Moresby, Papua New Guinea (PNG).,School of Medicine and Health Science, University of Papua New Guinea, Port Moresby, PNG.,Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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